American Journal of Clinical Dermatology

, Volume 15, Issue 4, pp 357–363 | Cite as

Low-Power Fractional CO2 Laser Versus Low-Fluence Q-Switch 1,064 nm Nd:YAG Laser for Treatment of Melasma: A Randomized, Controlled, Split-Face Study

  • Niloofar Y. Jalaly
  • Neda Valizadeh
  • Behrooz Barikbin
  • Maryam Yousefi
Original Research Article



Various laser treatments are currently available for melasma but their use remains challenging because of potential side effects.


The aim of this randomized controlled study was to compare the efficacy and safety of low-fluence Q-switch 1,064 nm Nd:YAG and low-power fractional CO2 laser using a split-face design.

Materials and Methods

A total of 40 female patients with symmetric melasma were enrolled to the study and each side of their face was randomly allocated to either low-fluence Q-switch 1,064 nm Nd:YAG or low-power fractional CO2 laser. They were treated every 3 weeks for five consecutive sessions and followed for 2 months after the last treatment session. Response to treatment was assessed using the Melanin Index (MI) score, modified Melasma Area and Severity Index (mMASI) score, and a subjective self-assessment method.


At the 2-month follow-up visit, both sides of the face had statistically significant reductions in the MI and mMASI scores compared with the first visit (p < 0.001). The differences between the mean MI and mMASI scores at baseline and at 2-month follow-up were compared between the two treatments and results showed that the reduction of MI and mMASI score in the fractional CO2 laser-treated side was significantly more than on the Q-switch 1,064 nm Nd:YAG laser-treated side (p < 0.001). There were no significant adverse effects with either of the laser treatments.


The present study shows that low-power fractional CO2 laser is safe and effective and can be considered as a valuable approach in the treatment of melasma.


Laser Treatment Intense Pulse Light Melanin Index Pigmentation Grade Khazaka Electronic GmbH 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No sources of funding were used to conduct this study or prepare this manuscript. N.Y. Jalaly, N. Valizadeh, B. Barikbin, and M. Yousefi have no conflicts of interest that are directly relevant to the content of this study.


  1. 1.
    Grimes PE. Melasma: etiologic and therapeutic considerations. Arch Dermatol. 1995;131(12):1453–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Gupta AK, Gover MD, Nouri K, Taylor S. The treatment of melasma: a review of clinical trials. J Am Acad Dermatol. 2006;55(6):1048–65. doi: 10.1016/j.jaad.2006.02.009.PubMedCrossRefGoogle Scholar
  3. 3.
    Rendon M, Berneburg M, Arellano I, Picardo M. Treatment of melasma. J Am Acad Dermatol. 2006;54(5 Suppl 2):S272–81. doi: 10.1016/j.jaad.2005.12.039.PubMedCrossRefGoogle Scholar
  4. 4.
    Nouri K, Bowes L, Chartier T, Romagosa R, Spencer J. Combination treatment of melasma with pulsed CO2 laser followed by Q-switched alexandrite laser: a pilot study. Dermatol Surgery. 1999;25(6):494–7.CrossRefGoogle Scholar
  5. 5.
    Neeley MR, Pearce FB, Collawn SS. Successful treatment of malar dermal melasma with a fractional ablative CO(2) laser in a patient with type V skin. J Cosmet Laser Ther. 2010;12(6):258–60. doi: 10.3109/14764172.2010.538412.PubMedCrossRefGoogle Scholar
  6. 6.
    Barysch MJ, Rummelein B, Kolm I, Karpova MB, Schonewolf N, Bogdan Allemann I, et al. Split-face study of melasma patients treated with non-ablative fractionated photothermolysis (1540 nm). J Eur Acad Dermatol Venereol. 2012;26(4):423–30. doi: 10.1111/j.1468-3083.2011.04086.x.PubMedCrossRefGoogle Scholar
  7. 7.
    Jeong SYCS, Bak H, Choi JH, Kim IH. New melasma treatment by collimated low fluence Q-switched Nd:YAG laser. Korean J Dermatol. 2008;46(9):1163–70.Google Scholar
  8. 8.
    Kim MJ, Kim JS, Cho SB. Punctate leucoderma after melasma treatment using 1064-nm Q-switched Nd:YAG laser with low pulse energy. J Eur Acad Dermatol Venereol. 2009;23(8):960–2. doi: 10.1111/j.1468-3083.2008.03070.x.PubMedCrossRefGoogle Scholar
  9. 9.
    Chan NP, Ho SG, Shek SY, Yeung CK, Chan HH. A case series of facial depigmentation associated with low fluence Q-switched 1,064 nm Nd:YAG laser for skin rejuvenation and melasma. Lasers Surg Med. 2010;42(8):712–9. doi: 10.1002/lsm.20956.PubMedCrossRefGoogle Scholar
  10. 10.
    Gilchrest BA, Fitzpatrick TB, Anderson RR, Parrish JA. Localization of malanin pigmentation in the skin with Wood’s lamp. Br J Dermatol. 1977;96(3):245–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Angsuwarangsee S, Polnikorn N. Combined ultrapulse CO2 laser and Q-switched alexandrite laser compared with Q-switched alexandrite laser alone for refractory melasma: split-face design. Dermatol Surg. 2003;29(1):59–64.PubMedGoogle Scholar
  12. 12.
    Kimbrough-Green CK, Griffiths CE, Finkel LJ, Hamilton TA, Bulengo-Ransby SM, Ellis CN, et al. Topical retinoic acid (tretinoin) for melasma in black patients: a vehicle-controlled clinical trial. Arch Dermatol. 1994;130(6):727–33.PubMedCrossRefGoogle Scholar
  13. 13.
    Kang WH, Chun SC, Lee S. Intermittent therapy for melasma in Asian patients with combined topical agents (retinoic acid, hydroquinone and hydrocortisone): clinical and histological studies. J Dermatol. 1998;25(9):587–96.PubMedGoogle Scholar
  14. 14.
    Torok HM. A comprehensive review of the long-term and short-term treatment of melasma with a triple combination cream. Am J Clin Dermatol. 2006;7(4):223–30.PubMedCrossRefGoogle Scholar
  15. 15.
    Erbil H, Sezer E, Tastan B, Arca E, Kurumlu Z. Efficacy and safety of serial glycolic acid peels and a topical regimen in the treatment of recalcitrant melasma. J Dermatol. 2007;34(1):25–30. doi: 10.1111/j.1346-8138.2007.00211.x.PubMedCrossRefGoogle Scholar
  16. 16.
    Taylor CR, Anderson RR. Ineffective treatment of refractory melasma and postinflammatory hyperpigmentation by Q-switched ruby laser. J Dermatol Surg Oncol. 1994;20(9):592–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Kopera D, Hohenleutner U. Ruby laser treatment of melasma and postinflammatory hyperpigmentation. Dermatol Surg. 1995;21(11):994.PubMedCrossRefGoogle Scholar
  18. 18.
    Moreno Arias GA, Ferrando J. Intense pulsed light for melanocytic lesions. Dermatol Surg. 2001;27(4):397–400.PubMedCrossRefGoogle Scholar
  19. 19.
    Wang CC, Hui CY, Sue YM, Wong WR, Hong HS. Intense pulsed light for the treatment of refractory melasma in Asian persons. Dermatol Surg. 2004;30(9):1196–200. doi: 10.1111/j.1524-4725.2004.30371.x.PubMedGoogle Scholar
  20. 20.
    Rokhsar CK, Ciocon DH. Fractional photothermolysis for the treatment of postinflammatory hyperpigmentation after carbon dioxide laser resurfacing. Dermatol Surg. 2009;35(3):535–7. doi: 10.1111/j.1524-4725.2009.01090.x.PubMedCrossRefGoogle Scholar
  21. 21.
    Rokhsar CK, Fitzpatrick RE. The treatment of melasma with fractional photothermolysis: a pilot study. Dermatol Surg. 2005;31(12):1645–50.PubMedGoogle Scholar
  22. 22.
    Geronemus RG. Fractional photothermolysis: current and future applications. Lasers Surg Med. 2006;38(3):169–76. doi: 10.1002/lsm.20310.PubMedCrossRefGoogle Scholar
  23. 23.
    Goldberg DJ, Berlin AL, Phelps R. Histologic and ultrastructural analysis of melasma after fractional resurfacing. Lasers Surg Med. 2008;40(2):134–8. doi: 10.1002/lsm.20591.PubMedCrossRefGoogle Scholar
  24. 24.
    Trelles MA, Velez M, Gold MH. The treatment of melasma with topical creams alone, CO2 fractional ablative resurfacing alone, or a combination of the two: a comparative study. J Drugs Dermatol. 2010;9(4):315–22.PubMedGoogle Scholar
  25. 25.
    Fife DJ, Fitzpatrick RE, Zachary CB. Complications of fractional CO2 laser resurfacing: four cases. Lasers Surg Med. 2009;41(3):179–84. doi: 10.1002/lsm.20753.PubMedCrossRefGoogle Scholar
  26. 26.
    Lipper GM, Anderson RR. Lasers in dermatology. In: Wolff K, Goldsmith LA, Katz SI, et al. Fitzpatrik’s dermatology in general medicine. 7th ed. New York: McGraw Hill; 2007.Google Scholar
  27. 27.
    Cho SB, Kim JS, Kim MJ. Melasma treatment in Korean women using a 1064-nm Q-switched Nd:YAG laser with low pulse energy. Clin Exp Dermatol. 2009;34(8):e847–50. doi: 10.1111/j.1365-2230.2009.03599.x.PubMedCrossRefGoogle Scholar
  28. 28.
    Suh KS, Sung JY, Roh HJ, Jeon YS, Kim YC, Kim ST. Efficacy of the 1064-nm Q-switched Nd:YAG laser in melasma. J Dermatol Treat. 2011;22(4):233–8. doi: 10.3109/09546631003686051.CrossRefGoogle Scholar
  29. 29.
    Wattanakrai P, Mornchan R, Eimpunth S. Low-fluence Q-switched neodymium-doped yttrium aluminum garnet (1,064 nm) laser for the treatment of facial melasma in Asians. Dermatol Surg. 2010;36(1):76–87. doi: 10.1111/j.1524-4725.2009.01383.x.PubMedCrossRefGoogle Scholar
  30. 30.
    Negishi K, Kushikata N, Tezuka Y, Takeuchi K, Miyamoto E, Wakamatsu S. Study of the incidence and nature of “very subtle epidermal melasma” in relation to intense pulsed light treatment. Dermatol Surg. 2004;30(6):881–6; discussion 886. doi: 10.1111/j.1524-4725.2004.30257.x.
  31. 31.
    Li YH, Chen JZ, Wei HC, Wu Y, Liu M, Xu YY et al. Efficacy and safety of intense pulsed light in treatment of melasma in Chinese patients. Dermatol Surg. 2008;34(5):693–700; discussion 700-1. doi: 10.1111/j.1524-4725.2008.34130.x.
  32. 32.
    Lee HS, Won CH, Lee DH, An JS, Chang HW, Lee JH, et al. Treatment of melasma in Asian skin using a fractional 1,550-nm laser: an open clinical study. Dermatol Surg. 2009;35(10):1499–504. doi: 10.1111/j.1524-4725.2009.01264.x.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Niloofar Y. Jalaly
    • 1
  • Neda Valizadeh
    • 1
  • Behrooz Barikbin
    • 1
  • Maryam Yousefi
    • 2
  1. 1.Laser Application in Medical Sciences Research CenterShahid Beheshti University of Medical SciencesTehranIran
  2. 2.Skin Cancer Research CenterShahid Beheshti University of Medical SciencesTehranIran

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