Photobiomodulation for melasma treatment: Integrative review and state of the art

Abstract

PurposePhotobiomodulation therapy (PBM) is a versatile technique for treating skin diseases. Melasma, a chronic hyperpigmentation condition, has recently been associated with vascular features and dermal photoaging and poses significant management challenges. We review the recent literature on melasma etiology and the evidence supporting PBM as a therapeutic modality for melasma treatment.MethodsWe conducted a comprehensive literature search in three different databases from May to August 2023, focusing on studies published in the past 10 years. The inclusion criteria comprised full‐text studies investigating low‐power lasers and/or light‐emitting diodes (LEDs) in in vitro or in vivo models, as well as clinical trials. We excluded studies discussing alternative melasma therapies or lacking experimental data. We identified additional studies by searching the reference lists of the selected articles.ResultsWe identified nine relevant studies. Clinical studies, in agreement with in vitro experiments and animal models, suggest that PBM effectively reduces melasma‐associated hyperpigmentation. Specific wavelengths (red: 630 nm; amber: 585 and 590 nm; infrared: 830 and 850 nm) at radiant exposures between 1 and 20 J/cm2 exert modulatory effects on tyrosinase activity, gene expression, and protein synthesis of melanocytic pathway components, and thus significantly reduce the melanin content. Additionally, PBM is effective in improving the dermal structure and reducing erythema and neovascularization, features recently identified as pathological components of melasma.ConclusionPBM emerges as a promising, contemporary, and non‐invasive procedure for treating melasma. Beyond its role in inhibiting melanogenesis, PBM shows potential in reducing erythema and vascularization and improving dermal conditions. However, robust and well‐designed clinical trials are needed to determine optimal light parameters and to evaluate the effects of PBM on melasma thoroughly.

Characteristics of dermal vascularity in melasma and solar lentigo

“…These findings suggest that a specific subtype of melasma is suitable for vascular‐targeted therapy. Recently, photobiomodulation (PBM) therapy (i.e., low‐level laser therapy) has attracted interest for potential use in the treatment of melasma 55 . The achievement of a good therapeutic effect with PBM requires careful control of treatment doses and protocols 56 .…”