Evaluation of the of the efficacy of Fractional Erbium-Doped Yttrium Aluminum Garnet Laser-Assisted Drug Delivery of Kojic Acid in the Treatment of Melasma; A split face, comparative clinical study.

Melasma is a common, difficult to treat hyperpigmentary disorder. Recently, ablative fractional lasers were utilized to enhance topical agents delivery to treat different skin conditions. This work was designed to evaluate the efficacy of fractional Er:YAG laser in enhancing the effect of topical kojic acid in patients with facial melasma. The patients were randomly treated in a split-face mode, by simple randomization, either with kojic acid alone on one side or combined with fractional Er:YAG laser on the other side. Twenty five patients completed six laser sessions at 2 week interval. The severity of melasma was assessed before and after treatment in addition to 3 months follow up after the last treatment session. The response to the treatment was evaluated by Melasma Area and Severity Index Score, physician global assessment of photographs and patient satisfaction. The side treated with fractional Er:YAG laser and kojic acid cream was found to have a statistically significant better improvement than the side treated with kojic acid alone. The patients were reported mild tingling sensation and mild erythema on both sides. Using combination of fractional Er:YAG laser and topical kojic acid was effective in the treatment of melasma.