الفهرس 
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Abstract
Melasma is a common disorder of macular facial hyperpigmentation, which can also affect the neck, namely sun-exposed areas. It usually affects females during childbearing age, but can also be seen in men occasionally. Melasma was been reported during pregnancy however many other factors have been implicated in the etiology of melasma including sun exposure, hormonal changes and use of oral contraceptive pills. Treatment of melasma is challenging due to resistance to respond and high incidence of recurrence after discontinuation of therapy. Thus, application of combined treatment modalities and use of maintenance therapy after resolution has always been mandatory.
On reviewing the literature, we found that there are different modalities in the treatment of melasma. The 3 modalities used in this study showed good results in treatment of melasma, especially with the proper selection of the patient, proper priming and post-peel care. However no previous clinical trials were done to compare the effects of fractional laser versus TCA versus cryopeel.
In this study, we compared clinical efficacy of fractional laser versus chemical peeling using TCA 20-25% versus cryopeel (liquid nitrogen). 30 patients were randomly selected and divided into three groups 10 patients each they were all females.
Group A was subjected to fractional laser, group B was subjected to chemical peeling using TCA 20-25% and group C was subjected to cryopeel.
All groups were primed with Hydroquinone 2% for 2 weeks before beginning any of the sessions.
We compared the results by MASI score, photography and patients evaluation before treatment and after treatment.
At the end of the treatment period group C showed best results, its MASI score was 1.38, while MASI score of group A was 4.48 and of group B was 5.43, a difference which was statistically significant.
In conclusion, cryopeel proved to give excellent results in treating melasma. However, laser as well as TCA 20-25% also showed good results in treatment of melasma.