It is challenging to manage melasma as it requires multiple uses of available therapeutic options. A study compared the short-term efficacy and safety of topical silymarin and low fluence 1064-nm Q-switched ND: YAG laser for treatment of melasma with dermoscopic follow-up.

The study included fifty female patients with melasma who were randomly divided into two groups. Group A- comprised 25 patients who were treated with six sessions of low fluence Q switched ND: YAG 1064-nm laser, and group B- comprised 25 patients who were treated with topical silymarin cream 1.4% with a 3-month treatment duration. Patients were further evaluated clinically by the modified melasma area and severity index (mMASI) score. Additionally, Dermoscopic examinations were undertaken before and after the treatment sessions.

The results revealed-

• Significant reduction in the severity of melasma, as evaluated dermoscopically and clinically by mMASI score, after treatment in all patients with no recorded side effects.
• No statistically significant difference was observed between both studied groups regarding the change in mMASI score and dermoscopic assessment of the patients after the treatment sessions.

Thus it was concluded that both low fluence Q switched ND:YAG 1064-nm laser and topical silymarin cream are safe and effective modalities in the treatment of melasma. 

Ibrahim SMA, Farag AS, Ali MS, El-Gendy WMAF. Efficacy and Safety of Topical Silymarin Versus Low Fluence 1064-nm Q Switched Nd: YAG laser in the Treatment of Melasma: A Comparative Randomized Trial. Lasers Surg Med. 2021 Jun 8. doi: 10.1002/lsm.23440. Epub ahead of print. PMID: 34101206.