Efficacy and safety of laser‐related therapy for melasma: A systematic review and network meta‐analysis

Abstract

BackgroundMelasma is a prevalent, persistent hyperpigmentation disorder that negatively affects the psychological health of patients. However, the treatment outcome remains unsatisfactory due to the complexity of pathogenesis, recurrence characteristics, and relatively high morbidity.ObjectivesTo compare the performance of laser‐related therapies in improving the melasma area severity index (MASI) score of melasma and the occurrence of adverse effects by network meta‐analysis (NMA).MethodsFrom the inception to November 2022, eligible randomized controlled trials were identified. Two investigators independently searched relevant studies from PUBMED, EMBASE, and the Cochrane Library database.ResultsA total of 39 clinical studies with 1394 participants were eligible for enrollment. For efficacy, the NMA demonstrated that Q‐switched Nd: YAG laser + topical medications (QSND+TM) was superior to Q‐switched Nd:YAG laser (QSND) [MD = −4.21 (−6.80, −1.63)], Er: YAG laser + topical medications (ERYL+TM) [MD = ‐3.52 (−6.84, −0.19)], and picosecond laser + topical medications (PICO+TM) [MD = −4.80 (−9.33, −0.27)]. The microneedling + topical medications (MN+TM) was superior to picosecond laser (PICO) [MD = −5.26 (−10.44, −0.08)] and topical medications (TM) [MD = −5.22 (−9.20, −1.23)]. The top five of the surface under the cumulative ranking curve value (SUCRA) are Q‐switched Nd:YAG laser + topical medications (QSND+TM 85.9%), oral tranexamic acid (oTA 80.1%), microneedling + topical medications (MN+TM 79.7%), Q‐switched Nd:YAG laser + intense pulse light (QSND+IPL 78.9%), and fractional carbon dioxide laser + topical medications (FCDL+TM 70.5%).ConclusionsIn conclusion, the Qs‐Nd:YAG laser with topical medications is the first choice for treating melasma according to the SUCRA value. Among the three treatment modalities, namely MN + TM, PICO, and TM, our recommendation favors MN+TM as the superior choice for enhancing the curative efficacy in melasma. However, the actual clinical choice should also take into account the adverse effects, the skin type of the patient, the duration of the disease, and other relevant factors.

Efficacy and Tolerability of a Microneedling Device plus Exosomes for Treating melasma

“…Current therapeutic approaches focus on reducing melanin production and inhibiting melanin synthesis pathways. However, the efficacy of most treatments is limited, and adverse effects are not uncommon [35] Notably, the epidermal changes associated with melasma go beyond hypermelanosis. Recent histopathological studies have unveiled additional dimensions, exposing solar elastosis, a thinner SC, atrophic granular layer, and modifications in basal keratinocytes [5].…”

Melasma: A Step-by-Step Approach Towards a Multimodal Combination Therapy

“…The use of picosecond lasers with diffractive lens arrays may, in addition, alleviate related photoaging characteristics, and the effects may be maintained for a longer time. 145–149 …”

“…The use of picosecond lasers with diffractive lens arrays may, in addition, alleviate related photoaging characteristics, and the effects may be maintained for a longer time. [145][146][147][148][149] Microneedle radiofrequency (RF) creates microscopic channels to the required depths of the dermis, so that thermal energy can stimulate the production of collagen and elastin. As a result of this controlled skin injury, keratinocyte turnover is accelerated, which leads to increased melanin removal as well as to decreased blood vessel proliferation and restoration of the basement membrane.…”

Combining large‐spot low‐fluence 1064‐nm and fractional 1064‐nm picosecond lasers for promoting protective melanosome autophagy via the PI3K/Akt/mTOR signalling pathway for the treatment of melasma

“…Recently, various phototherapeutic devices have been developed to treat melasma. However, challenges persist, including pigmentation changes and rebound after laser therapy 2,3 . The Q‐switched 1064‐nm Nd:YAG laser with large‐spot low‐fluence (<3 J/cm 2 ), administered over multiple sessions at 1–2‐week intervals, has gained widespread use and demonstrated efficacy in treating melasma 4,5 .…”

“…However, challenges persist, including pigmentation changes and rebound after laser therapy. 2,3 The Q-switched 1064-nm Nd:YAG laser with large-spot low-fluence (<3 J/cm 2 ), administered over multiple sessions at 1-2-week intervals, has gained widespread use and demonstrated efficacy in treating melasma. 4,5 This technique employs the principle of 'subcellular selective photothermal effect', targeting melanocyte dendrites to disrupt melanin in both melanocytes and keratinocytes while preserving cell membranes and nuclei, thus minimizing damage to cells.…”