A comparative study of efficacy of 1064-nm Q-switched Neodymium: YAG laser at sub photothermolytic fluence alone and in combination therapy with epicutaneous 20% azelaic acid and in sequential therapy with microdermabrasion in melasma in South India

Introduction: Melasma is a symmetric hyperpigmentary disorder defined by irregular light to brown macules over the face. Treating melasma is demanding and there is curiosity in anticipation of recent various therapeutic options like sub photothermolytic fluence – 1064-nm Q switched Nd:YAG laser (SPF-1064-nm-QSNdYL) with combinational and sequential therapies. Aim: To study and compare the therapeutic effect of SPF-1064-nm-QSNdYL alone and in combinational therapy with epicutaneous 20% Azelaic Acid and in sequential therapy with microdermabrasion in melasma in three study groups of 20 cases each. Materials and Methods: Sixty female cases identified as melasma were randomly segregated into three factions [group L(laser only) = 20 cases of melasma treated with SPF-1064-nm-QSNdYL at weekly intervals, group C (combinational) = 20 cases of melasma treated with twice daily epicutaneous application of 20% azelaic acid and SPF-1064-nm-QSNdYL at weekly intervals and group S (sequential) = 20 cases of melasma treated with Sequential therapy with microdermabrasion followed by SPF-1064-nm-QSNdYL once weekly as given in group L]. The study duration was of 12 weeks for each. The outcome to therapy was analyzed using melasma area and severity index scoring. Results: Convincing therapeutic response was noted in all the three factions. It was statistically highly significant in Group C as compared to Group L (P<0> 0.05). Conclusions: This study highlights the superior therapeutic effect of combinational therapy using SPF-1064-nm- QSNdYL with azelaic acid in epidermal, dermal and mixed types of melasma with minimal adverse effects followed by sequential therapy of microdermabrasion with SPF-1064-nm- QSNdYL and SPF-1064-nm- QSNdYL alone therapy.