P057 Evaluation of fractional ablative CO2 laser and triple combination cream in the treatment of melasma: a randomized controlled study

Abstract

Melasma is a common pigmentary disorder causing considerable disfigurement and distress. The treatment of melasma remains a challenge, due to its refractory and recurrent nature. Triple combination cream (TCC), which includes hydroquinone (4%), tretinoin (0.05%) and fluocinolone acetonide (0.01%), is considered first-line therapy for melasma. Ablative fractional lasers have been reported to be effective. We aimed to evaluate the effectiveness and safety of fractional ablative CO2 and TCC in melasma in a split-face randomized control study. Clinically diagnosed adult patients with symmetrical melasma were included in the study and randomized to either fractional CO2 laser, once every 4 weeks plus TCC (group A) or TCC alone (group B) to either side of face once daily for 12 weeks. The patients were evaluated every 4 weeks to determine treatment response and adverse effects. There were 54 patients included (19 male and 35 female; mean age 33.0 years, SD 7.7 years, range 21–57), who had melasma for 0.5–15 years (mean duration 5.7 years, SD 3.5). Melanin Index and modified Melasma Area Severity Index (mMASI) were recorded. Following treatment, mean Melanin Index and mMASI scores decreased in both groups. The mean Melanin Index decreased from 46.5 (SD 5.2) to 43.7 ± 5.6 (P < 0.001) in group A, and from 47.0 (SD 5.5) to 44.3 (SD 5.5) (P < 0.001) in group B. The mean mMASI decreased from 4.38 (SD 1.82) to 2.78 (SD 1.60) (P < 0.001) in group A and from 4.35 (SD 1.85) to 3.19 (SD 1.69) (P < 0.001) in group B. These results were statistically significant, but comparable between the two groups (Melanin Index P = 0.47, mMASI P = 0.20). Physician’s Global Assessment improvement was superior in group A compared with group B (60.8% vs. 39.1%, P < 0.001). Mean patient self-assessment scores were 5.88 (SD 2.01) in group A and 4.57 (SD 1.98) in group B (P < 0.001). There were no significant adverse effects. The study has shown that fractional CO2 laser offers modest additional benefit and is safe in the treatment of melasma. Hence, further studies are required.