Fractional non ablative 675 nm diode laser versus low fluence high frequency Q- switched 1064 nm nd: YAG laser in the treatment of melasma: a comparative split face trial

Melasma is a chronic, relapsing pigmentary disorder that poses a significant therapeutic challenge, particularly in individuals with darker skin types. Laser therapies have shown promise in targeting both epidermal and dermal melanin deposits. The study aimed to compare the efficacy and safety of fractional non-ablative 675 nm diode laser and Q-switched 1064 nm Nd:YAG laser in the treatment of facial melasma using a split-face design. Thirty female patients with bilateral facial melasma were enrolled in a prospective, split-face trial. Each received five treatment sessions at two-week intervals: the right side with 675 nm diode laser and the left with 1064 nm Q-switched Nd:YAG laser. Clinical efficacy was assessed using the Melasma Area and Severity Index (MASI), dermoscopic scoring, and post-therapy lightening grade at baseline and 12 weeks post-treatment. Both modalities resulted in significant reductions in MASI and dermoscopic scores (p < 0.05). The 675 nm laser showed superior improvement, with a greater proportion of patients achieving excellent lightening. Adverse events were mild and transient. Fractional non-ablative 675 nm diode laser is more effective and equally safe compared to Q-switched 1064 nm Nd:YAG laser in treating facial melasma, offering a promising modality for patients with recalcitrant hyperpigmentation.