الفهرس 
Title : Pigmentary and Vascular Changes Induced by 1064-nm Qswitched Nd: YAG Laser in Melasma: A Dermoscopic Evaluation
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Abstract
Background: Melasma continues to be a difficult to treat disease with no fully satisfactory results. Low-fluence 1064 nm Q-switched Nd:YAG laser has recently been shown to be effective for the melasma treatment.Objective: To assess the efficacy of low fluence Qs Nd: YAG laser for the treatment of melasma, to identify any side effects and to introduce a new scoring system for treatment of melasma using dermoscopy. Methods: Thirty one patients with melasma underwent five sessions on all areas affected by melasma every other week using a Q-switched Nd:YAG laser at 1064 nm with an 8-mm spot size, and a fluence of 2 J/cm2. The outcome was assessed clinically by using two types of evaluation: subjective techniques as modified melasma area and severity index (mMASI) score and patient satisfaction score, and objective techniques as dermoscopy, colorimetry and digital photography. Results: mMASI score showed significant reduction after Qs Nd: YAG laser sessions as the difference between pre and post mMASI scores ranged from 0 and 7.80 with a mean of 2.73± SD 1.981 (P value <0.001). Total dermoscopic score also showed significant reduction as the difference between pre and post total scores ranged from -2 and 6 with a mean of 1.84± SD 1.675(P value <0.001). Melanin index showed significant reduction (P value <0.001) after Qs Nd: YAG laser sessions. Before treatment; their melanin index ranged between 565 and 761 with a mean of 647.19 ± SD 43.422, while after treatment; their melanin index ranged between 558 and 675 with a mean of 616.94 ± SD 30.102. Erythema index also showed significant reduction (P value =0.009). Before treatment; their erythema index ranged between 428 and 471 with a mean of 447.84 ± SD 8.572, while after treatment; their erythema index ranged between 415 and 459 with a mean of 443.68 ± SD 8.215. None of the 31 patients showed any signs of severe side effects during the course of the treatment