The Treatment of Melasma with Topical Creams Alone, CO2 Fractional Ablative Resurfacing Alone, or a Combination of the Two: a Comparative Study

Background: Melasma is a difficult entity to treat. Topical creams or chemical peels offer some success, and the newer fractional lasers have also been proposed to be useful. This three-armed study compares topical creams, CO2 ablative fractional resurfacing and the combination of both modalities.

Patients And Methods: Thirty females with melasma, mean age of 38 years, skin types II-IV, were allocated to three groups: group A received treatment with Kligman's formula maintenance topical cream program; group B, CO2 fractional resurfacing using high power, fixed pulse width and low frequency; and group C, both laser and maintenance topical cream treatment. Subjective patient and clinician assessments based on melasma area severity index (MASI) scores were made at baseline, one, two, six and 12 months, and the satisfaction index (SI) and overall efficacy calculated.

Results: All patients completed the study. The SI and overall efficacy in groups A, B and C were 100% at one month in all groups but progressively decreased in further assessments except for group C in which better scores were maintained throughout. MASI scores for group C were statistically significantly improved compared to A and B at six and 12 months (P < 0.001 for both).

Conclusion: The fractional CO2 laser and topical cream regimen produced good, well-maintained results in melasma treatment compared with the monotherapy groups.