BackgroundIncreasing numbers of studies demonstrated that picosecond lasers (Picos) were effective and safe for melasma. However, A limited number of randomized controlled trials (RCTs) regarding Picos contribute to a modest level of evidence. Topical hydroquinone (HQ) remains to be the first-line therapy.ObjectiveTo compare the efficacy and safety of non-fractional picosecond Nd:YAG laser (PSNYL), non-fractional picosecond alexandrite laser (PSAL), and 2% HQ cream in the treatment of melasma.MethodSixty melasma patients with Fitzpatrick skin types (FST) III-IV were randomly assigned to the PSNY, PSAL, and HQ groups at a 1:1:1 ratio. Patients in PSNYL and PSAL groups received 3 laser sessions at 4-week intervals. The 2% HQ cream was applied twice daily for 12 weeks in patients of the HQ group. The primary outcome, the melasma area and severity index (MASI) score, was evaluated at weeks 0, 4, 8, 12, 16, 20, and 24. The patient assessment score by quartile rating scale was rated at weeks 12, 16, 20, and 24.ResultsFifty-nine (98.3%) subjects were included in the analysis. Each group showed significant change from baseline in MASI scores from week 4 to week 24. The MASI score in the PSNYL group showed the greatest reduction compared to the PSAL group (p = 0.016) and HQ group (p = 0.018). The PSAL group demonstrated comparable MASI improvement as the HQ group (p = 0.998). The PSNYL group had the highest patient assessment score, followed by the PSAL group and then the HQ group, although only the differences between PSNYL and HQ groups at weeks 12 and 16 were significant. Four patients (6.8%) experienced recurrence. Other unanticipated events were transient and subsided after 1 week to 6 months.ConclusionThe efficacy of non-fractional PSNYL was superior to that of non-fractional PSAL, which was not inferior to 2% HQ, thus non-fractional Picos providing an alternative for melasma patients with FSTs III-IV. The safety profiles of PSNYL, PSAL, and 2% HQ cream were similar.Clinical Trial Registrationhttps://www.chictr.org.cn/showprojen.aspx?proj=130994, ChiCTR2100050089.

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To the Editor, The type 2 immune response is mediated by Th2 and ILC2s cells, through the production of type 2 cytokines such as IL-4, IL-13, and IL-5. Multiple cells, including eosinophils, are active by these cytokines. In healthy individuals, eosinophils account for 1%-5% of peripheral blood leukocytes. The type 2 inflammatory diseases include a series of allergic, immune diseases, such as atopic dermatitis, asthma, allergic rhinitis and eosinophilic esophagitis. 1,2 Dupilumab is a fully human monoclonal antibody, which blocks IL-4/13. Clinical studies have shown optimistic efficacy of Dupilumab, while some studies found that Dupilumab could induce an increase in blood eosinophils. 3 Clinicians may be concerned about whether changes in eosinophils may limit the continued use of Dupilumab. 4 In this study, we evaluated the changes in eosinophil counts after Dupilumab treatment through meta-analysis. Data from different studies were merged, and at different weeks, comprehensive results were obtained.We searched five databases up to December 31, 2021, to select eligible publications. For included studies, quality was assessed.For randomized studies, the risk of bias tool was applied. For observational studies, Newcastle-Ottawa Scale was applied. The standardized mean difference (SMD) was used to evaluate the change.According to the between-study heterogeneity, fixed or random effect model was selected. The detail of selection and study quality were in Figure S1.Ten studies were included. Three diseases were included and analyzed through meta-analysis. The detail was in Table 1. At weeks 8, 16, 48, 100, and 148, eosinophil counts showed significant decrease (P < .05), which were SMD = −0.18 (95%CI: −0.31, −0.05); −0.17