BACKGROUND Topical triple combination (TC) treatment is considered the primary approach to melasma. Recently, collimated low-fluence 1,064-nm Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser treatment has attracted attention as an alternative approach.

OBJECTIVES To compare the clinical efficacy and adverse effects of low-fluence Q-switched Nd:YAG laser when performed before and after treatment with topical TC using a split-face crossover design.

METHODS Thirteen patients with melasma received topical treatment with TC cream or 1,064-nm Q-switched Nd:YAG laser treatment on opposite sides of the face for 8 weeks, and then treatments were reversed for 8 weeks. Responses were evaluated using the Melasma Area and Severity Index scoring system, spectrophotometry measurements, and a subjective self-assessment method.

RESULTS After 16 weeks, better results were seen in subjective assessments when laser treatment was used after 8 weeks of topical TC treatment than before usage of TC. There were no significant adverse effects with the laser treatments.

CONCLUSIONS Laser treatment after topical TC cream was found to be safer and more effective than the post-treatment use of topical agents.

The authors have indicated no significant interest with commercial supporters.