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Objective: To evaluate the efficacy and safety of the dual toning laser of Nd:YAG 1064nm picosecond and quasi-long pulsed laser combined with D-pigment night cream in treatment of severe melasma. Subject and method: Twenty four Vietnamese females, mean age of 44.46 ± 8.04 years, Fitzpatrick skin type IV with the clinical diagnosis of dermal and mixed-type melasma were treated with 5 combination sessions of picosecond laser Nd:YAG 1064nm (Picoplus) with a spot size of 8mm, the energy of 0.65 - 0.8J/cm2 and quasi-long pulsed mode laser (Clarity) with the duration of 0.35ms, the spot size of 15mm, the energy of 2.6J/cm2, ICD (Intelligent Cool Device) off. Mild and transient erythema was the endpoint. Laser treatments were given every 4 weeks. All patients were applied with UVA/B sunscreen, SPF of at least 30 in daytime and D-pigment cream at night. Improvement was rated by mMASI at the baseline (first -T1) and after 5 sessions (sixth -T6). Result: The mean mMASI score of 24 patients at T1 was 11.10 ± 3.59 (min 6.0; max 22.4); after one month of 5th session, the mean mMASI score at T6 was reduced to 5.43 ± 2.18 (min 1.8 - max 11.0) (mMASI score reduced by a mean of 5.68 ± 2.36), achieving 51.06 ± 13.17% reduction. There were no unexpected side effects in any patients. Conclusion: Dual toning technique using 1064nm Nd:YAG picosecond and quasi-long pulsed laser combined with D-pigment cream at night was safe, effective and well-tolerated in treatment of patients with melasma. Further larger studies should be carried out with control to confirm the advantage of the method.

Background: Melasma is a common acquired, chronic hypermelanosis, more common in women and dark skin types, less dangerous but greatly affects aesthetics. The picosecond laser have been used with good effectiveness on melasma. Objective: To evaluate the efficacy and safety of a picosecond laser (Picoplus, Lutronic, Korea) on patients with melasma. Subject and method: We conducted a comparative longitudinal descriptive study in 58 dermal and mixed melasma patients (100% females), middle-aged, with initial severe MASI underwent treatments in 108 Military Central Hospital from 7/2017 to 12/2018 with picosecond laser. Result: Good/excellent improvement 28.9%, fair 42.2% after 8 treatment sessions. All most patient was no side effect, only 3.4% patients had temporary burning sensation. Conclusion: Treatment of melasma using a picosecond laser is an effective and safe method. However, the disadvantage of the method is the multistage procedure.

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