Therapeutic approaches for refractory melasma: Fractional CO2 Laser and Q-Switched Nd:YAG Laser with tranexamic acid injections

Background  Melasma is characterized by dyspigmentation that is difficult to treat. This is due to the complex underlying factors and high risk to recurrence.   Objective Investigating the clinical outcomes from utilizing fractional CO2 laser and Q-Switched Nd:YAG laser (QSNY) in combination with tranexamic acid (TA) in treating refractory melasma.   Methods The cross sectional study included sixty women with refractory melasma. Patients were randomly assigned into two groups (30 patients per group) to receive either the fractional CO2 laser or the QSNY laser treatment. Patients from both groups were supplemented with intradermal microinjections of TA (4 mg/ml), and laser sessions were conducted every month for a total of four successive sessions per patient. Treatment outcomes were assessed via calculating modified melasma area and severity index (mMASI) at baseline and after 30, 60, 90, and 120 days of post-treatment.   Results There was a significant reduction in mMASI score (p<.001) after each therapy session. The fractional CO2 laser with TA demonstrated higher efficacy in reducing mean mMASI score (1.98±1.0) relative to the Nd-YAG laser with TA (3.1±1.5), (p<.001). Although the clinical effectiveness of fractional CO2 laser with TA was higher, patient satisfaction among study groups were found with no significant difference (p>.05).   Conclusion Fractional CO2 laser and QSNY laser treatments in combination with intradermal TA injections are effective approaches in decreasing the overall mMASI scores in women with refractory melasma. Further studies are necessary to enhance our understanding and to guide optimal clinical practice regarding refractory melasma.