Q-switched Nd: YAG laser versus trichloroacetic acid peeling in the treatment of melasma among Egyptian patients

Dermatol Surg. 2014 Aug;40(8):874-82. doi: 10.1097/DSS.0000000000000065.


Background: Melasma is a common disorder of facial hyperpigmentation that is often resistant to treatment.

Objective: To evaluate the efficacy of trichloroacetic acid (TCA) peeling in comparison with double frequency Q-switched neodymium-doped:yttrium aluminum garnet (QS-Nd:YAG) laser in the treatment of melasma.

Patients and methods: Sixty-five adult Egyptian female patients with melasma were enrolled in this study. Wood light was used for determination of the histological type of melasma. The patients were divided into 4 groups according to treatment modalities: peeling with different concentrations of TCA and double frequency QS-Nd:YAG laser. Trichloroacetic acid peeling was performed every 2 weeks up to 8 sessions, whereas laser treatment was performed every month up to 6 sessions. Melasma area and severity index (MASI) score was used before and after treatment for evaluation.

Results: Improvement percentage of MASI score was significantly higher among patients treated with TCA 25% (p < .001). Epidermal type of melasma was significantly improved compared with the dermal type (p = .0029). Q-switched neodymium-doped:yttrium aluminum garnet laser showed the highest incidence of postinflammatory hyperpigmentation (53.3%).

Conclusion: Trichloroacetic acid peeling is effective in the treatment of melasma, TCA 25% was the most effective concentration. Q-switched neodymium-doped:yttrium aluminum garnet laser is not recommended in the treatment of melasma because it was associated with the highest incidence of complications.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Chemexfoliation* / adverse effects
  • Dermatitis, Contact / etiology
  • Egypt
  • Face
  • Female
  • Humans
  • Keratolytic Agents / administration & dosage*
  • Lasers, Solid-State / adverse effects
  • Lasers, Solid-State / therapeutic use*
  • Melanosis / pathology
  • Melanosis / therapy*
  • Middle Aged
  • Patient Satisfaction*
  • Severity of Illness Index
  • Trichloroacetic Acid / administration & dosage*
  • Trichloroacetic Acid / adverse effects
  • Young Adult


  • Keratolytic Agents
  • Trichloroacetic Acid