Efficacy of low‐fluence 1064 nm Q‐switched Nd: YAG laser for the treatment of melasma: A meta‐analysis and systematic review

Abstract

Background: Melasma is considered as a type of acquired facial pigmentary disorder that is challenging to treat. Low-fluence 1064 nm Q-switched Nd: YAG laser (LQSNY) has clinical benefits against melasma; however, there are some disputes.Objective: To explore these contentious views, we conducted a meta-analysis and systematic review to evaluate the efficacy and safety of LQSNY monotherapy and combined therapy for the treatment of melasma. Methods:The PubMed, Embase, Cochrane Library, and Web of Science databases were searched for relevant articles from inception to July 2021. The resulting data were analyzed using the Review Manager 5.3 software. Results:Twelve eligible studies comprising 358 patients were included. No significant differences in melasma area and severity index (MASI) were observed between the LQSNY and drug groups (mean difference (MD):−0.26, 95% confidence interval (CI):−1.16-0.64, p = 0.57). We found that combination therapy with LQSNY and drugs had a greater MASI improvement compared with LQSNY therapy alone (MD: 1.78, 95% CI 0.93-2.63, p < 0.0001); nevertheless, no statistically significant results were found in melanin index (MI) and self-assessment. The melasma improvement was similar when using LQSNY alone and LQSNY combined with other lasers in terms of RMASI (MD 0.05, 95% CI:−0.61, 0.70, p = 0.56). Compared with intense pulsed light (IPL) alone, LQSNY with IPL provided an added benefit for melasma severity (MD:3.23, 95% CI:0.65-5.81, p = 0.01). Conclusion:Low-fluence 1064 nm Q-switched Nd: YAG laser can be applied as an alternative treatment for drug intolerance. Combination therapy with LQSNY and drugs or other lasers may have pleasantly surprising efficacy, but numerous studies are still needed to verify this.

Comparison of 755‐nm picosecond alexandrite laser versus 1064‐nm Q‐switched Nd:YAG laser for melasma: A randomized, split‐face controlled, 2‐year follow‐up study

“…Several clinical trials have been conducted to examine the use of various lasers in the management of melasma. 11,[13][14][15] However, it is difficult to reach any conclusions because of varying study designs, including different skin types, melasma types, and a range of devices and parameters. 5 The use of low-fluence QSNYL for melasma has been referred to as "laser toning" in recent years.…”

“…[8][9][10] Some studies have evaluated the performance of QSNYL compared to other lasers for melasma treatment, but most studies have assessed the adjuvant role of laser treatment and the follow-up period was rather limited. 11 To directly compare the treatment outcomes using different lasers, we conducted this study to compare the effects of QSNYL alone versus PSAL with DLA alone for melasma with a longer-term follow-up period.…”

Research Advances in the Treatment of Riehl’s Melanosis

“…It is reported that the using the laser to treat chronic hyperpigmentation diseases like chloasma and post-inflammatory hyperpigmentation (PIH) shows significant benefits. 25 1064 nm QSNY can precisely target melanin phages of lesion and destroy the melanin particles within lesional melanin phages. 26 Compared to short wavelength laser (523 nm), the selected long wavelength laser (1064 nm) can be easier to pass through the epidermis to the dermis.…”

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

“…The number of laser‐related treatment modalities and combinations is increasing, but determining which combination will yield the best clinical results remains a problem. Several meta‐analyses of different laser treatments have been performed, but no multiple treatment comparison or network meta‐analysis has been conducted 14,15 . Thus, to confirm the most proper laser‐related treatment for melasma, we conducted a systematic review and NMA based on the most recently published studies.…”

“…Several meta-analyses of different laser treatments have been performed, but no multiple treatment comparison or network meta-analysis has been conducted. 14,15 Thus, to confirm the most proper laser-related treatment for melasma, we conducted a systematic review and NMA based on the most recently published studies.…”