Comparative study of fractional Erbium: YAG laser vs combined therapy with topical steroid as an adjuvant treatment in melasma

Summary Background Melasma is an acquired disorder of symmetrical hyperpigmentation. Several treatment methods are available for patients with melasma, including topical compounds, broad‐spectrum photoprotection, camouflage, chemical peels, and laser and light therapies which represent potentially promising options for patients who are refractory to other modalities. Objective To evaluate and compare the clinical, histopathological, and immunohistochemical changes in melasma after fractional Er:YAG laser versus fractional Er:YAG laser and topical steroids. Methods Twenty‐two patients were treated with fractional Er:YAG laser on both sides of the face with the use of topical steroid only on the left side to make left‐to‐right‐side comparison. Clinical evaluation, histopathological, and immunohistochemical assessment for skin specimens were performed before treatment and 3 months after the end of sessions. Results Treatment by fractional Er:YAG laser on the right side showed significant decrease in MASI score with clinical outcome which considered as excellent in three patients (13.6%), very good in six (27.2%), good in eight (36.3%), and fair in five (22.7%) with significant decrease in basal pigmentation and reorganization of dermal collagen and decreased number of MART1‐positive cells. After combined therapy, the decrease in MASI score was highly significant with the clinical outcome which considered as excellent in six patients (27.2%), very good in 10 (45.4%), good in three (13.6%), and fair in three (13.6%). The histological changes were highly evident and more significant. Conclusion Clinical, histopathological, and immunohistochemical improvement was evident on both sides, with more significant better outcome with the use of combined therapy on the left side. However, combined therapy was more beneficial for Fitzpatrick skin type III rather than type IV.