The efficacy of energy‐based devices combination therapy for melasma

Abstract

Melasma is a recalcitrant pigmentary disease with a complex pathogenesis. Monotherapy often results in unsatisfactory results with high recurrence rate. In this review article, we evaluate efficacy of energy‐based devices combination therapy for melasma. We reviewed published literature since 2010 up to November 2020 regarding adjuvant therapy of energy‐based devices with other treatment modalities in the treatment of melasma. After final selection, we assessed 49 articles. Energy‐based devices include lasers, non‐coherent lights, radiofrequency, iontophoresis, sonophoresis, microneedling, and microdermabrasion. Adjuvant therapies other than energy‐based devices were lightening agents, chemical peels, platelet rich plasma (PRP) and mesotherapy. Combination of Q‐switched neodymium‐doped: yttrium, aluminum, and garnet (QSNY) with either intense pulsed light therapy (IPL) or pulsed‐dye laser (PDL) are recommended in recalcitrant melasma in patients with light skin photo types and with dilated skin vessels (especially with PDL). Combination of fractional microneedling radiofrequency or microneedling with QSNY leads to promising results and is a safe treatment modality, especially in darker skin types. Application of topical lightening agents in combination with laser therapy leads to higher efficacy with less adverse effects (post‐inflammatory hyperpigmentation) and rebound of melasma. Combination of ablative techniques with QSNY is not recommended, due to the high risk of permanent adverse effects such as guttate hypopigmentation and exacerbation of melasma.

Efficacy and Safety of Using Noninsulated Microneedle Radiofrequency Alone Versus in Combination with Polynucleotides for the Treatment of Melasma: A Pilot Study

“…Its histopathological characteristics include increased melanin in keratinocytes and macrophages, increased mast cells, dilated vessels in the dermis, solar elastosis, and a disrupted basement membrane [ 1 ]. Such findings have recently led to the proposal that melasma is not only a disease of melanocytes but also a photoaging skin disorder, with treatment modalities such as laser and light systems, and energy-based devices aiming to address this aspect being proposed as possible options [ 2 , 3 ].…”

Dependence of laser‐induced optical breakdown on skin type during 1064 nm picosecond laser treatment

“…Melasma, also known as chloasma (when occurs in pregnancy), is a common pigmentary disease that occurs to hyperpigmentation in the epidermis and dermis of the skin [1]. The disease happens in protruding face areas, such as cheeks, upper lip, and forehead, which can be easily exposed to the sunlight [1][2][3][4][5]. Melasma is typically accompanied by dark discoloration (brown, gray, and black) patches on the skin and happens in all the races and regions [6].…”

Safety and efficacy of mesotherapy in the treatment of melasma: A review article

“…ID microinjection of lightening drugs crosses skin barrier and results in better effectiveness on dermal pigmentation. Furthermore, higher concentration of drug in target area can be achieved with lower volumes, while having lower local side effects and prolonged efficacy 3–6 . In this review, we evaluated efficacy and safety of various types of mesotherapy for treating melasma.…”

“…Furthermore, higher concentration of drug in target area can be achieved with lower volumes, while having lower local side effects and prolonged efficacy. [3][4][5][6] In this review, we evaluated efficacy and safety of various types of mesotherapy for treating melasma.…”