A comparative study of low-fluence 1064-nm Q-switched Nd:YAG laser with or without chemical peeling using Jessner's solution in melasma patients.

Although low-fluence 1064-nm Q-switched Nd:YAG laser (QSNYL) is widely used for the treatment of melasma, multiple treatments are necessary for clinical improvement. Superficial chemical peeling using Jessner's solution has been used for treatment of melasma conventionally. To evaluate the additional therapeutic effect and adverse effects of Jessner's peel when combined with 1064-nm QSNYL for melasma patients in a double-blind, placebo-controlled design. Total of 52 patients were included. Patients who received 10 sessions of 1064-nm QSNYL plus chemical peeling with placebo (group A) in a two-week interval and those who received 10 sessions of 1064-nm QSNYL plus chemical peeling with Jessner's solution (group B) in a two-week interval were analyzed. Responses were evaluated using the Melasma Area and Severity Index (MASI) score, physician's global assessment (PGA) and subjective self-assessment. At 8 weeks, the mean MASI score decreased from 8.68 ± 4.06 to 8.60 ± 3.88 in group A and from 8.98 ± 3.72 to 7.13 ± 2.57 in group B, showing a significant difference (p < 0.001). But at 20 weeks, there was no significant difference on reduction of MASI, self-assessment and PGA between the two groups. No serious adverse effects were reported with the additional Jessner's peeling. This study suggests Jessner's peel is a safe and effective method in the early course of treatment for melasma when combined with low-fluence 1064-nm Q-switched Nd:YAG laser.