A pilot randomized split-face trial comparing fractional Q-Switched ruby laser and 1064-nm Q-Switched nd: YAG laser in Chinese women with melasma running titile: fQSRL vs. QSNY in melasma.

Laser therapy plays an essential role in the management of melasma. However, direct comparisons between the fractional Q-switched ruby laser (fQSRL) and the Q-switched 1064-nm Nd: YAG laser (QSNY) are limited, particularly in Asian populations. Therefore, we conducted this study to compare the clinical efficacy, safety, and patient-reported outcomes of fQSRL versus QSNY in the treatment of melasma. In this randomized, assessor-blinded, split-face study, 21 Chinese women (Fitzpatrick skin types III-IV) with bilateral melasma received 3 to 6 treatment sessions with fQSRL and QSNY, administered at three-week intervals. Efficacy, safety, and patient satisfaction were assessed. Both lasers achieved a 62.0% response rate, with no significant difference in hemi-mMASI score reduction (P > 0.05). Patient satisfaction scores were similar between treatments. However, pain scores were significantly higher with fQSRL than with QSNY (P < 0.0001). Post-inflammatory hyperpigmentation occurred bilaterally in one patient (4.8%), with no serious adverse events reported. QSNY and fQSRL demonstrated comparable efficacy in treating melasma in Chinese women. However, the higher pain associated with fQSRL may limit its patient acceptability. Further large-scale, multicenter studies are needed to confirm long-term efficacy and safety.