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

Background and Objectives The management of melasma is challenging and requires multiple uses of available therapeutic options. To compare 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. Study Design/Materials and Methods Fifty female patients with melasma were included in this study. They were randomly divided into two groups. Group A: 25 patients were treated with six sessions of low fluence Q switched ND:YAG 1064‐nm laser, and group B: 25 patients were treated with topical silymarin cream 1.4% with a 3‐month treatment duration. Patients were evaluated clinically by the modified melasma area and severity index (mMASI) score. Dermoscopic examinations were performed before and after the treatment sessions. Results The severity of melasma, as evaluated dermoscopically and clinically by mMASI score, was significantly reduced after treatment in all patients with no recorded side effects. There was no statistically significant difference between both studied groups regarding the change in mMASI score and dermoscopic assessment of the patients after the treatment sessions. Conclusion Both low fluence Q switched ND:YAG 1064‐nm laser and topical silymarin cream appear to be safe and effective modalities in the treatment of melasma. © 2021 Wiley Periodicals LLC.