Vol. 6, Issue 1, Part A (2024)

Background: Melasma, formerly known as chloasma, is an acquired pigmentary disorder that mostly affects the face. This disease, which is more common in females and darker skin types, is primarily caused by ultraviolet (UV) exposure and hormonal effects.

Aim of the study: The aim of this study was to evaluate the safety and outcomes of ablative fractional CO₂ lasers on melasma in patients with skin of color.

Patients and Methods: This prospective study, conducted from December 1, 2023, to May 2024 at the private clinics in Karbala City, involved 80 female patients aged 22-60 years with melasma. Participants provided written informed consent and were randomly assigned to two groups. Group A (n=40) received fractional CO₂ laser treatment (4 sessions, 3 weeks apart), while Group B (n=40) applied a topical 5% TXA cream nightly for 12 weeks. Exclusion criteria included autoimmune diseases, hepatitis, coagulopathies, thyroid disorders, recent use of certain medications, pregnancy, breastfeeding, and dissatisfaction with treatment techniques. Patients were diagnosed using standard criteria and Wood's light examination. All were advised to avoid sun exposure and use daily sunscreen. Efficacy was assessed through digital photographs, modified melasma area and severity index (mMASI) scores, patient satisfaction, side effects, and dermoscopic evaluations before and after treatment.

Results: Both groups had similar baseline characteristics, with no significant differences in age, disease duration, skin type, or clinical types of melasma. At 8 weeks, the CO₂ laser group showed a significantly greater reduction in mMASI scores compared to the TXA group (P=0.001). This trend continued at 12 and 16 weeks, indicating the superior efficacy of CO₂ laser treatment. Patient satisfaction was higher in the CO₂ laser group, with 45% reporting being very satisfied compared to 20% in the TXA group. The recurrence rate was lower in the CO₂ laser group (18%) than in the TXA group (30%). Side effects were fewer in the CO₂ laser group, with no cases of post-inflammatory hyperpigmentation, compared to 30% in the TXA group (P=0.003).

Conclusion: Fractional CO₂ laser treatment is more effective than topical TXA in reducing melasma severity, improving patient satisfaction, and preventing recurrence, with fewer side effects. Dermoscopic evaluations confirmed significant improvement in pigmentation and skin texture post-treatment in both groups.