title: Comparison of Q-switched Nd:YAG laser alone versus its combination with ultrapulse CO2laser for the treatment of black tattoo.
abstract: BACKGROUND
  Q-switched lasers are conventionally used for the treatment of black tattoo. However, they require multiple sittings, and the response may be slow due to competing epidermal pigment in dark skin.
  
  
  OBJECTIVE
  To compare the efficacy of Q-switched Nd:YAG laser alone with its combination with ultrapulse CO2for the removal of black tattoo.
  
  
  METHODS
  Sixty patients with black tattoo were randomized into two groups viz., group A and group B. Group A was treated with QS Nd:YAG laser (1064 nm) alone, and group B received combination of ablative ultrapulse CO2followed by fixed-dose QS Nd:YAG laser (1064 nm), at 6-week interval for a maximum of 6 sittings. After each sitting, 3 independent physicians noted percentage of improvement that was evaluated using visual analogue scale (VAS) and grading system for tattoo ink lightening (TIL).
  
  
  RESULTS
  Combination laser (group B) showed statistically significant improvement in mean VAS score in the last 2 noted visits as compared to 1st session (p < 0.007, p < 0.001) and TIL mean score in last three noted visits as compared to 1st session (p < 0.008, p < 0.020, and p < 0.004). There was no statistically significant difference in the side effect profile of both the groups.
  
  
  CONCLUSIONS
  For refractory professional tattoos, combination of ultrapulse CO2laser and QS Nd:YAG laser is superior to QS Nd:YAG laser alone.
authors.affiliation: a Department of Dermatology , Venereology and Leprosy, Dr Ram Manohar Lohia Hospital , New Delhi , India.
authors.forename: Mithila
authors.initials: M
authors.lastname: Vanarase
authors.affiliation: a Department of Dermatology , Venereology and Leprosy, Dr Ram Manohar Lohia Hospital , New Delhi , India.
authors.forename: Ram Krishan
authors.initials: RK
authors.lastname: Gautam
authors.affiliation: a Department of Dermatology , Venereology and Leprosy, Dr Ram Manohar Lohia Hospital , New Delhi , India.
authors.forename: Pooja
authors.initials: P
authors.lastname: Arora
authors.affiliation: a Department of Dermatology , Venereology and Leprosy, Dr Ram Manohar Lohia Hospital , New Delhi , India.
authors.forename: Sonali
authors.initials: S
authors.lastname: Bajaj
authors.affiliation: a Department of Dermatology , Venereology and Leprosy, Dr Ram Manohar Lohia Hospital , New Delhi , India.
authors.forename: Neha
authors.initials: N
authors.lastname: Meena
authors.affiliation: a Department of Dermatology , Venereology and Leprosy, Dr Ram Manohar Lohia Hospital , New Delhi , India.
authors.forename: Ananta
authors.initials: A
authors.lastname: Khurana
mesh_terms: D000328:Adult; D002921:Cicatrix / Q000209:etiology; D003116:Color; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D017495:Hyperpigmentation / Q000209:etiology; D017496:Hypopigmentation / Q000209:etiology; D007281:Ink; D054020:Lasers, Gas / Q000009:adverse effects / Q000627:therapeutic use*; D053844:Lasers, Solid-State / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D010781:Photography; D011446:Prospective Studies; D013653:Tattooing; D016896:Treatment Outcome; D064232:Visual Analog Scale; D055815:Young Adult
keywords: CO2 laser; Nd: YAG laser; tattoo