COMPARISON OF EFFICACY OF GLYCOLIC ACID 60% PEEL VERSUS Q-SWITCHED Nd: YAG LASER IN THE TREATMENT OF MELASMA AT TERTIARY CARE HOSPITAL OF BAHAWALPUR

Background: Melasma is a common acquired pigmentary disorder, especially among individuals with darker skin types. Various therapeutic modalities, including chemical peels and lasers, are used to manage melasma; however, their comparative effectiveness remains a subject of ongoing clinical investigation. Objective: To compare the therapeutic efficacy and safety profile of low-fluence Q-switched Nd: YAG laser with topical 60% glycolic acid peel in the treatment of melasma. Study Design: Quasi-experimental, non-randomized controlled study. Setting: Department of Dermatology, Combined Military Hospital (CMH), Bahawalpur, Pakistan. Duration of Study: From 15 April to 14 September 2024. Methods: Eighty patients clinically diagnosed with melasma were enrolled and divided into two groups: Group A (n=40) received 60% glycolic acid peels and Group B (n=40) received low-fluence Q-switched Nd: YAG laser therapy. Each patient received treatment for a period of three months. Treatment efficacy was assessed using the Melasma Area and Severity Index (MASI) at baseline and 8 weeks. Statistical analysis included a median score comparison and a chi-square test for categorical data, with p < 0.05 considered statistically significant. Results: The peak incidence of melasma was observed in the 29–32-year age group, with a female-to-male ratio of 4:1. Sunlight exposure was the most common aggravating factor. Epidermal melasma was predominant in both groups (33.7% in Group A vs. 23.8% in Group B; p < 0.05). MASI scores showed a significant reduction in both groups: from 7.20 to 4.20 in Group A and from 5.40 to 4.10 in Group B by week 8 (p < 0.005 for both). Erythema was more frequent in Group A (18.7%) compared to Group B (2.5%, p < 0.05). However, post-inflammatory hyperpigmentation (PIH) was more common in Group B (10%) than in Group A (1.3%, p < 0.05). Conclusion: Topical 60% glycolic acid peel demonstrated greater therapeutic efficacy and a better safety profile than low-fluence Q-switched Nd: YAG laser in the treatment of melasma. PIH was notably more frequent in patients treated with laser, particularly those with darker skin types. Glycolic acid peel remains a favorable first-line treatment in such populations.