The use of ablative lasers in the treatment of facial melasma

Abstract

Melasma represents a pigmentary disorder that is difficult to treat. This study aims to broadly review the use of ablative lasers (Er:YAG and CO2) in the treatment of melasma, presenting the level of evidence of studies published to date. A total of 75 patients were enrolled in four case series studies (n=39), one controlled clinical trial (n=6) and one randomized controlled clinical trial (n=30). Studies on the Er:YAG laser showed better results with the use of short square-shaped pulses, which determined low rates of post-inflammatory hyperpigmentation and long-lasting maintenance of results. Likewise, studies on the CO2 laser proved the benefits of short pulse duration along with low-density energy. Post-treatment maintenance with the use of antipigmenting creams was necessary and effective to sustain long-term results. Ablative lasers may represent another useful and effective tool against melasma. Postinflammatory hyperpigmentation and difficulty in sustaining long-term results still represent the main limitations to a broader use of ablative lasers. Based on actual evidence, the use of this technology should be restricted to patients with recalcitrant disease. Further studies will help establish optimal laser parameters and treatment regimens.

A review of laser and light therapy in melasma

“…Ablative fractionated resurfacing lasers (AFL) such as CO2 lasers and erbium:YAG lasers have been reported for the treatment of patients with melasma ( Morais et al, 2013 ). The CO2 laser emits a 10,600-nm wavelength, which is strongly absorbed by water in the skin cells.…”

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

“…Nonablative lasers such as Q-switched Nd:YAG laser (QSNYL) that selectively target melanosomes [2][3][4] and ablative lasers such as fractional erbium:YAG laser (FEYL) or fractional CO 2 laser (FCOL) have been used frequently for this purpose. 5 Nonetheless, we could not find any study that had employed both laser systems in treatment of melasma. Moreover, most of the studies have used melasma area and severity index (MASI) or physician's global assessment (GPA) to evaluate the improvement of therapy; however, objective assessment of the melanin content and changes in lesions' color would provide more reliable result in terms of treatment efficacy.…”

The Split-Face Comparison of the Combined Er-YAG Laser and Hydroquinone 4% With Hydroquinone 4% Alone in the Treatment of Melasma in Iranian Patients: A Prospective, Interventional Case Study

“…Melasma is a dysfunction of the melanogenesis system, which results in localized, chronic hypermelanosis. 1,2 It mostly affects women aged between 30 and 55 and appears symmetrically on areas that are exposed to the sun, such as the cheeks, forehead, temples, upper lip and chin. 2 The exact cause is not clear but genetics, sex hormones, and ultraviolet exposure are proposed to be involved in the pathogenesis of the disease.…”

“…1,2 It mostly affects women aged between 30 and 55 and appears symmetrically on areas that are exposed to the sun, such as the cheeks, forehead, temples, upper lip and chin. 2 The exact cause is not clear but genetics, sex hormones, and ultraviolet exposure are proposed to be involved in the pathogenesis of the disease. 3 Lesions are mostly light brown to blackish patches with irregular borders.…”

“…3 Lesions are mostly light brown to blackish patches with irregular borders. 2 Four types of diseases including epidermal, dermal, mixed epidermal-dermal, and indeterminate have been defined. 4 Current treatments for melasma are unsatisfactory.…”