combination of q-switched nd:yag and fractional erbium:yag lasers in treatment of melasma: a randomized controlled clinical trial

introduction: ablative and nonablative lasers have been used to treat melasma. we aimed to assess and compare the combining q-switched nd:yag laser (qsnyl) and fractional erbium:yag laser (feyl) with qsnyl alone in treatment of melasma. methods: this randomized controlled clinical trial was performed in our research center during 2013-2014. women with melasma and without a history of keloid formation, hypersensitivity to hydroquinone, or pigmentary changes due to laser therapy were randomly allocated to receive four sessions of either qsnyl-feyl combination or qsnyl alone. all patients received topical treatment with kligman’s formula. before laser therapy and 4 weeks after the last treatment session, patients’ skin was assessed for changes in skin color, melanin content, and erythema intensity of melasma lesions quantitatively. results: finally, 21 patients in qsnyl-feyl and 20 in qsnyl group (mean age, 38.57 [5.60] and 42.60 [8.44] years, respectively) completed study. the skin color had become lighter in both groups (mean [sd] percentage change of 56.95 [40.29] and 29.25 [13.20] in qsnyl-feyl and qsnyl groups, respectively) with significantly better results in qsnyl-feyl group ( p = 0.006). percentage of decrease of melanin content was significantly higher in qsnyl-feyl group (22.01 [10.67] vs. 7.69 [4.75]; p < 0.001). after adjustment for baseline values, the post treatment intensity of erythema was significantly lower in qsnyl-feyl group ( p < 0.001). the patients reported no adverse events. conclusion: qsnyl-feyl was significantly more effective in decreasing melanin content of lesions than qsnyl and led to a lighter skin.