Non‐ablative 1,550 nm fractional laser therapy versus triple topical therapy for the treatment of melasma: A randomized controlled split‐face study

Abstract

Given the high rate of postinflammatory hyperpigmentation, non-ablative 1,550 nm fractional laser at 15 mJ/microbeam is not recommendable in the treatment of melasma. TTT remains the gold standard treatment.

Combination of Q-Switched Nd:YAG and Fractional Erbium:YAG Lasers in Treatment of Melasma: A Randomized Controlled Clinical Trial

“…12 Wind et al compared fractionated nonablative 1550-nm erbium laser with TTC and reported significantly lower GPA and satisfaction as well as high rate of hyperpigmentation (31%) in the laser-treated sides and hence, did not recommend such a therapy for melasma. 13 While laser therapies are associated with adverse effects such as burn and erythema and might induce post inflammatory hyperpigmentation, their usage in dermatology and cosmetic procedures is increasing. We did not employ MASI, GPA, or other subjective tools to assess the improvement; instead, we tried objective measures, which would provide less biased and more precise determination of changes in skin.…”

Use of Fractional Laser in Mixed-Race Patients

“…On the other hand, there are publications that had similar results as ours. 4 In a randomized controlled split-face study, Wind et al compared results on melasma, treating one side of the face with the fractional erbium 1,550 nm and the other side of the face with topical triple therapy (hydroquinone 5%, tretinoin 0.05%, and triamcinolone acetonide 0.1%); they found that the erbium fractional laser-treated side showed a significant worsening of hyperpigmentation, and the topical therapy-treated side showed no significant change. In addition, 31% of their patients developed PIH, and the authors concluded that the nonablative 1,550-nm fractional laser was not recommended in the treatment of melasma.…”

“…It even got Food and Drug Administration clearance for this purpose but its effectiveness is still controversial. [2][3][4] Fractional ablative CO 2 has become the gold standard in facial rejuvenation and skin resurfacing. 5,6 In this article, we review the use of two fractional lasers (Fraxel erbium 1,550 nm [Reliant/Solta Medical] and CO 2 Lumenis Acupulse [Lumenis, Yokneam, Israel]) in patients with Fitzpatrick skin types IV to VI, we discuss the main clinical concerns of this type of skin, and we share our own experience.…”

Melasma, Novel Treatment Modalities

“…Fractional Non-Ablative Laser: Controversy about the use of fractional erbium glass laser (1550 nm) in melasma has emerged from vast publications [80][81][82][83][84][85]. FP is a safe and effective treatment for refractory melasma, with long-term remission especially in fairskinned patients.…”

“…Treatment of patients with skin types III+ should be with extreme caution, since darker skin types are more prone to develop PIH [80,81]. Given the high rate of PIH, FP should not be used at higher fluencies (15 mJ/micro beam) in the treatment of melasma [82]. The combination of FP with TCC is useful for patients with melasma resistant to topical therapy alone, but its long-term efficacy is limited [83].…”