A Review of Laser and Light Therapy in Melasma [25E

Abstract

INTRODUCTION: Melasma is a condition of facial hyperpigmentation and is commonly associated with pregnancy. Current treatments are unsatisfactory due to high rates of recurrence and adverse events. Laser and light therapy are often times the treatment of choice for refractory melasma. Our objective is to comment on both the efficacy and safety of the most commonly used laser and light therapies for melasma as published in the current literature. METHODS: A systematic literature search was done using the PubMed database. Key words included, “melasma” and “laser” in the title. A total of 442 results were obtained. Exclusion criteria were applied to the 442 search results. This systematic approach yielded 55 relevant prospective studies which were selected for review. RESULTS: Several types of laser and light therapy have been studied in the treatment of melasma. Of the Q-switched lasers, Qs Nd:YAG lasers have been the most effective especially with the use of sub-photothermolytic fluencies to reduce side effects. Intense pulsed light in combination with Qs Nd:YAG lasers and topical creams have shown to be effective in darker-skinned patients. Non-ablative lasers are often superior in safety to ablative lasers. However, non-ablative lasers are shown to be generally inferior to Qs Nd:YAG and should be used with caution in darker-skinned patients. CONCLUSION: Laser and light therapy, especially in combination with traditional therapies for melasma seem to be promising therapeutic modalities. More studies with longer term follow-up and varied patient populations are needed to further guide clinical practice.