Comparative Effectiveness of 20% Azelaic Acid with 1064-nm Nd:YAG Picosecond Laser vs Azelaic Acid Alone for Melasma Treatment in Thai Female Patients: A Split-Face Study

Melasma is one of the most concerning pigmented skin conditions, especially in females. It can be influenced by sunlight, occupation, gender, and drug use, which can aggravate the disease. This split-face clinical trial assesses the effectiveness of picosecond laser in melasma treatment combined with topical azelaic acid compared with azelaic alone. The primary outcome of this study is the Hemi-MASI score, while the secondary outcome is demographic data, physicians' global assessment, patient satisfaction score, and adverse events. The study recruited twenty Thai females aged between 18 and 65 diagnosed with bilateral symmetrical malar-type melasma. The patients were treated with low fluence 1064-nm Nd:YAG picosecond laser three sessions every two weeks combined with topical azelaic acid twice daily on the right side of the face, whereas the left side was treated with topical azelaic acid twice daily alone for 16 weeks. The mean Hemi-MASI decrease is 3.52%, 9.38%, and 19.94% on the combination side, while there are 1.93%, 7.89%, and 16.73% at the 8th, 12th, and 16th, respectively in the topical azelaic alone side. There were no severe side effects from both picosecond laser and azelaic acid, and they can be relieved without treatment. Thus, the overall clinical result demonstrates the improvement as the patient satisfaction score is satisfied. Still, the mean Hemi-MASI score between the two sides is not statistically significantly different (p>0.05). In conclusion, combining the picosecond laser with azelaic acid alone in melasma treatment results in a better overall general outcome than the azelaic alone.