الفهرس 
Efficacy and safety of different fluencesof Q-switched Nd:YAG laser in treatment of melasma
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Abstract
Background:Melasma continues to be a difficult to treat disease with no fully satisfactory results. Low-fluence 1064 nm Q-switched Nd:YAG laser has recently been shown to be effective for the melasma treatment and used successfully in combination with tranexamic acid. Objective:To assess the efficacy ofdifferennt fluencies of Qs Nd:YAG laser in treatment of melasma, role of tranexamic acid in treatment of melasma and to correlate clinical, colorimetric and dermoscopic features before and after treatment.Methods: Thirty eight patients with bilateral melasma were enrolled in the study. Each patient was treated by Q-Switched Nd-Yag laser at both sides of face with different fluencies. One side treated by 3J 2 passes and the other side treated by 1.5 J 4 passes followed by intradermal injection of tranexamic acid of 500mg/5ml concentration by insulin syringe 30 gauge as 100 ml in dilution of 40ml tranexamic acid and the rest saline. All patients underwent six sessions every two weeks then follow up one month after the last session.The outcome was assessed clinically by using two types of evaluation: subjective techniques as melasma severity index (MSI) score and patient satisfaction score, and objective techniques as dermoscopy, colorimetry and digital photography.Results: After treatment, significant reduction in MSI score was noted on both sides of the face; the side treated by Q-switched Nd:YAG laser 3J 2 passes and the side treated by Q-switched Nd:YAG laser 1.5J 4 passes (p value {u02C2}0.001 for both sides). Melanin and erythema index were also significantly reduced on both sides of face treated by 3J 2 passes or 1.5J 4 passes (p value {u02C2}0.001 for both sides) melasma.