Comparing the Efficacy of Combination of Q-Switched Nd:YAG and Fractional CO2 Lasers versus Q-Switched Nd:YAG Laser alone in Melasma: A Split-face Randomised Controlled Trial

Patients with clinically diagnosed melasma visiting the Dermatology OPD at AIIMS Jodhpur during the study period will be recruited based on inclusion and exclusion criteria after a written informed consent. Through our study we want to find whether the combination of Q-switched Nd:YAG and Fractional CO2 lasers provide better clinical improvement than Q-switched Nd:YAG laser alone in Melasma. This split-face randomized controlled trial will last approximately 18 months. Using block randomization method we will randomly assign one half of the face to receive both lasers, while the other half will receive only the Q-switched Nd:YAG laser. After the patient is recruited, he/she will be started on topical sunscreen with spf>30. The first laser session will be held after 4 weeks, followed by sessions every 2-4 weekly. Q-switched Nd:YAG laser will be done every 2 weekly while Fractional Co2 laser will be done monthly. A total of 6 sittings of Q-switched Nd:YAG and 3 sittings of Fractional Co2 will be done in combination group while only 6 sittings of Q-switched Nd:YAG laser will be done in another group. We will compare efficacy using Photography, Modified MASI scoring, Physician Global Assessment (PGA) scoring, and dermoscopic evaluation, and monitor side effects. All information will be recorded on a pre-designed proforma, and photographic records will be maintained. Patient satisfaction will be measured using a percentage-graded score. Final assessment will be done 2 weeks after the last laser session. Our study can help us understand the effect of combination of Q-Switched Nd:YAG and Fractional CO2 lasers in Melasma better. Also it will guide us in formulating standardized laser protocol for Indian Melasma patients.