Comparison of Picosecond and Nanosecond Nd:YAG 1064-nm Lasers in the Treatment of Melasma: A Split-Face Randomized Clinical Trial

Abstract

Background: Melasma is a refractory pigmentary disorder. The picosecond Nd:YAG 1064-nm laser (PSNY) has promise as a better treatment for melasma with few side effects and favorable therapeutic efficacy. The authors evaluated the efficacy and safety of PSNY and the nanosecond Q-switched Nd:YAG 1064-nm laser (QSNY) in patients with melasma. Methods: Eighteen patients were recruited to receive the two types of laser treatment on split faces. The modified Melasma Area Severity Index was assessed at baseline and the 3-month follow-up visit. The recurrence rate and the patients’ self-satisfaction assessment were also evaluated. Results: The two treated sides showed statistically significant decreases in modified Melasma Area Severity Index score after treatment at follow-up compared with baseline (P < 0.001). There was no statistically significant difference between the modalities (P = 0.873) or the patients’ satisfaction assessment (P = 0.287). The visual analogue scale pain assessment score showed that the QSNY was more painful than the PSNY counterpart (P = 0.007). The recurrence rate was the same for the two treated sides (12.5%). Conclusion: PSNY is a better choice compared with QSNY with less treatment pain and postprocedure erythema as well as lower potential risk of exacerbation of melasma. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.