Assessing the Safety and Efficacy of Picosecond Alexandrite Lasers in the Management of Melasma: A Systematic Review and Meta-Analysis of Randomised Control Trials.

BackgroundIncreasing numbers of studies demonstrated that picosecond lasers (Picos) were effective and safe for melasma. However, A limited number of randomized controlled trials (RCTs) regarding Picos contribute to a modest level of evidence. Topical hydroquinone (HQ) remains to be the first-line therapy.ObjectiveTo compare the efficacy and safety of non-fractional picosecond Nd:YAG laser (PSNYL), non-fractional picosecond alexandrite laser (PSAL), and 2% HQ cream in the treatment of melasma.MethodSixty melasma patients with Fitzpatrick skin types (FST) III-IV were randomly assigned to the PSNY, PSAL, and HQ groups at a 1:1:1 ratio. Patients in PSNYL and PSAL groups received 3 laser sessions at 4-week intervals. The 2% HQ cream was applied twice daily for 12 weeks in patients of the HQ group. The primary outcome, the melasma area and severity index (MASI) score, was evaluated at weeks 0, 4, 8, 12, 16, 20, and 24. The patient assessment score by quartile rating scale was rated at weeks 12, 16, 20, and 24.ResultsFifty-nine (98.3%) subjects were included in the analysis. Each group showed significant change from baseline in MASI scores from week 4 to week 24. The MASI score in the PSNYL group showed the greatest reduction compared to the PSAL group (p = 0.016) and HQ group (p = 0.018). The PSAL group demonstrated comparable MASI improvement as the HQ group (p = 0.998). The PSNYL group had the highest patient assessment score, followed by the PSAL group and then the HQ group, although only the differences between PSNYL and HQ groups at weeks 12 and 16 were significant. Four patients (6.8%) experienced recurrence. Other unanticipated events were transient and subsided after 1 week to 6 months.ConclusionThe efficacy of non-fractional PSNYL was superior to that of non-fractional PSAL, which was not inferior to 2% HQ, thus non-fractional Picos providing an alternative for melasma patients with FSTs III-IV. The safety profiles of PSNYL, PSAL, and 2% HQ cream were similar.Clinical Trial Registrationhttps://www.chictr.org.cn/showprojen.aspx?proj=130994, ChiCTR2100050089.

Melasma significantly impacts life quality, and while various laser therapies show promise, rigorous comparative studies, especially between the novel Picosecond Alexandrite Laser (PSAL) and the traditional combined modality of Q-switched and Long-pulse Nd: YAG Lasers (QLNYL), are notably lacking. This study aims to fill this gap by evaluating the efficacy and safety of these modalities, providing insights into their comparative advantages for clinical practice. In a prospective, evaluator-blinded study, 40 participants with Fitzpatrick Skin Types (FST) III and IV underwent three treatment sessions at four-week intervals with either PSAL or QLNYL. Efficacy was primarily assessed by changes in Melasma Area and Severity Index (MASI) scores at baseline, 4, 8, 12, and 24 weeks, along with patient satisfaction evaluations at the 12- and 24-week marks, and safety assessments conducted throughout the study. Both groups experienced significant reductions in MASI scores post-treatment. Overall, the improvement in MASI scores in the QLNYL group significantly surpassed that in the PSAL group (P = 0.010). Patient satisfaction was comparably high between groups, and no significant differences were noted in safety profiles. The PSAL group showed a slightly higher incidence of adverse reactions (not significant) and significantly higher pain scores (P = 0.018). Recurrence rates at the 24-week follow-up were 10.5% for PSAL and 0% for QLNYL, with no significant difference. Both PSAL and QLNYL proved effective in treating melasma, with the traditional combined modality of QLNYL demonstrating superior efficacy in FST III-IV. Safety profiles were similar comparable.

Melasma is a common hyperpigmentary disorder that can be disfiguring and negatively impact patients’ quality of life. While the primary treatment is triple combination cream, there is growing evidence supporting the use of combination therapies. This review evaluates the efficacy of combining oral tranexamic acid (TXA) with laser therapy for managing melasma. A comprehensive literature search was conducted across multiple databases, and articles were assessed based on inclusion and exclusion criteria. The primary outcome was clinical improvement measured by the Melasma Area and Severity Index (MASI) or its modified version (mMASI). Secondary outcomes included patient-reported satisfaction, recurrence rates, safety and tolerability. Eight studies met the inclusion criteria, comprising five randomized controlled trials and three retrospective cohort studies, with a total of 885 patients. All intervention groups received oral TXA combined with laser therapy. Most studies utilized low-fluence Q-switched Nd:YAG lasers, while others used intense pulsed light, Er:YAG, or 1927-nm fractional diode lasers. Oral TXA doses were 250 mg ranging from once daily to three times daily, with a median treatment duration of 12 weeks. Combination therapy with oral TXA and laser demonstrated an additional 12–15% reduction in mMASI scores compared with laser alone, with most studies reporting moderate-to-excellent clinical improvement. Patient satisfaction was higher in the combination therapy group. Treatment was well tolerated, with minimal side-effects reported, and recurrence rates averaged < 20%, 6 months after treatment cessation. This review demonstrates the enhanced efficacy of combining oral TXA with laser therapy in melasma management. The combination offers significant clinical improvement, higher patient satisfaction and lower recurrence rates. It may also reduce the risk of adverse effects, such as postinflammatory hyperpigmentation, which aligns with our clinical experience. Oral TXA is well tolerated and safe when used at low doses; however, patients should be screened for contraindications and thromboembolic risk factors. This comprehensive review highlights the benefits of adjunctive oral TXA in laser therapy for melasma, supporting its role as a valuable addition to current treatment regimens. More studies are warranted to further assess the effectiveness of combination treatments and explore long-term outcomes.

Melasma is a common hyperpigmentary disorder that can be disfiguring and negatively impact patients’ quality of life. While the primary treatment is triple combination cream, there is growing evidence supporting the use of combination therapies. This review evaluates the efficacy of combining oral tranexamic acid (TXA) with laser therapy for managing melasma. A comprehensive literature search was conducted across multiple databases, and articles were assessed based on inclusion and exclusion criteria. The primary outcome was clinical improvement measured by the Melasma Area and Severity Index (MASI) or its modified version (mMASI). Secondary outcomes included patient-reported satisfaction, recurrence rates, safety and tolerability. Eight studies met the inclusion criteria, comprising five randomized controlled trials and three retrospective cohort studies, with a total of 885 patients. All intervention groups received oral TXA combined with laser therapy. Most studies utilized low-fluence Q-switched Nd:YAG lasers, while others used intense pulsed light, Er:YAG, or 1927-nm fractional diode lasers. Oral TXA doses were 250 mg ranging from once daily to three times daily, with a median treatment duration of 12 weeks. Combination therapy with oral TXA and laser demonstrated an additional 12–15% reduction in mMASI scores compared with laser alone, with most studies reporting moderate-to-excellent clinical improvement. Patient satisfaction was higher in the combination therapy group. Treatment was well tolerated, with minimal side-effects reported, and recurrence rates averaged < 20%, 6 months after treatment cessation. This review demonstrates the enhanced efficacy of combining oral TXA with laser therapy in melasma management. The combination offers significant clinical improvement, higher patient satisfaction and lower recurrence rates. It may also reduce the risk of adverse effects, such as postinflammatory hyperpigmentation, which aligns with our clinical experience. Oral TXA is well tolerated and safe when used at low doses; however, patients should be screened for contraindications and thromboembolic risk factors. This comprehensive review highlights the benefits of adjunctive oral TXA in laser therapy for melasma, supporting its role as a valuable addition to current treatment regimens. More studies are warranted to further assess the effectiveness of combination treatments and explore long-term outcomes.

Objective: To evaluate the efficacy and safety of picosecond (ps) 755-nm alexandrite laser with a diffractive lens array (DLA) generating laser-induced optical breakdown, which may be beneficial for melasma treatment. Background: Melasma is notorious for difficult to treat with any modality setting. Recently, picosecond alexandrite laser with DLA seems promising for dealing with it without intolerable complications. Methods: Twenty (N = 20) Asian female melasma patients with Fitzpatrick skin type IV were recruited for 3 treatment sessions of picosecond 755-nm alexandrite laser with DLA at a 4- to 6-week interval. The pulse duration was 750 ps. An 8-mm spot size and the fluence of 0.4 J/cm2 was used over the target area with 2 passes per treatment area and around 2000-2500 passes in total. The repetition rate was 10 Hz. Melasma Area and Severity Index (MASI) score and VISIA® imaging system analysis were utilized for evaluation before treatment and 4 weeks after the completion of the third treatment session. The clinical improvement and adverse events were assessed by the physicians and patients, respectively. Results: The median age of the patients was 45 years (from 27 to 55 years). In the physicians' evaluation, 40% (n = 8) of patients showed good improvement and 40% (n = 8) of patients showed moderate improvement. The mean MASI score before and after laser therapy showed significant improvement from 9.0 ± 4.8 to 6.5 ± 3.7 (p < 0.001). VISIA analysis of the forehead presented significant improvement in spots (p = 0.007) and porphyrins (p = 0.032). Some patients experienced erythema (25%), pruritus (20%), and scaling (20%) but subsided within few days of using emollients and sunscreen. Only 5% (n = 1) of patients developed mild postinflammatory hyperpigmentation, which also subsided in 3 weeks. Conclusions: Three sessions of picosecond 755-nm alexandrite laser with a DLA were effective for melasma treatment in Asian patients with minimal side effects.

Introduction: Various studies explored the use of intense pulse light (IPL) therapy in treating melasma, but only a few randomized clinical trials have evaluated the combination of triple combination cream (TCC) with IPL so far. Objective: This study compared the efficacy and safety of the combination of IPL and triple combination cream with triple combination cream alone in treating melasma. Material and Methods: Sixty patients with melasma were enrolled in this assessor-blinded, parallel-group randomized controlled study. Thirty patients were treated with IPL (15J/cm2, two sessions at 2-week intervals) and TCC (Hydroquinone 2%, tretinoin 0.025%, fluocinolone acetonide 0.01%) at night and broad-spectrum sunscreen during day time whereas other groups received only TCC and broad-spectrum sunscreen. The median percentage reduction in melasma area and severity index (MASI) and physician’s global assessment scale was assessed at 12-week to determine the efficacy of the treatment. The incidence of adverse effects at each follow-up and relapse at 16-week were also noted during the study period as the secondary outcome measure. Results: The median reduction in MASI achieved at 12 weeks was 48% in the IPL+TCC group and 13.1% in the TCC group from the baseline. The incidence of relapse was seen in 7.14% and 13.04% patients in the IPL+TCC group and TCC alone group respectively at 16 weeks however, this difference was not statistically significant (p&lt;0.05). Conclusion: Our study supports that IPL and TCC are more effective than TCC therapy alone in treating melasma.

Background:Numerous therapeutic options have been tried in the management of melasma.Aims and Objectives:This prospective randomized study was planned to assess the efficacy of low potency triple combination (TC) cream (TC-hydroquinone 2%/tretinoin 0.05%/fluocinolone 0.01%) versus glycolic acid (GA) peels/azelaic acid (AA) 20% cream (GA/AA) combination in melasma.Materials and Methods:Forty patients with melasma were recruited into this study and randomized into two groups. Group A consisting 20 patients received TC cream once a day for night time application for 3 months. Group B comprising of 20 patients received GA/AA 20% cream combination for 3 months. The disease severity was monitored with digital photography, melasma area and severity index (MASI) score, which was calculated at baseline, 6 weeks and 12 weeks, and visual analog scale (VAS) score, which was calculated at baseline and 12 weeks.Results:Of 40 patients, 38 were completed the study. A significant reduction in MASI and VAS was recorded after 6 weeks and 12 weeks of treatment in both groups A and B (P = 0.001). However, there was no significant difference in the mean MASI scores between the two groups at baseline, 6 weeks and 12 weeks. Similarly, there was no difference in the mean VAS scores between the two groups at baseline and 12 weeks. Four patients in group A and 3 in group B experienced adverse effects such as irritation, dryness, and photosensitivity.Conclusion:Both low potency TC cream and GA/AA 20% cream combination are effective in treating melasma among Indian patients.

Activated melanocytes and senescent collagen fibers predict laser-treated melasma outcomes: An optical biopsy-based prospective cohort study.

Background: Melasma is a common, acquired hyperpigmentation disorder characterized by brown or gray-brown macules primarily on the face. Current treatment options for melasma include topical agents and intradermal therapies. This study compares the efficacy and safety of intradermal tranexamic acid (TA) and fluocinolone-based triple combination therapy (hydroquinone 4%, tretinoin 0.05%, fluocinolone acetonide 0.01%) in 215 patients diagnosed with melasma. Objective: To evaluate and compare the efficacy and safety of intradermal TA versus fluocinolone-based triple combination therapy in the management of melasma. Methods: A randomized controlled trial was conducted with 215 patients, who were randomly assigned to receive either intradermal TA injections (100 mg) every 2 weeks for 12 weeks or topical fluocinolone-based triple combination therapy. The primary outcome was the change in the Melasma Area and Severity Index (MASI) score from baseline to week 12. Secondary outcomes included patient satisfaction and adverse effects. Results: Both treatments led to significant improvement in MASI scores. However, intradermal TA demonstrated a statistically greater reduction in MASI scores compared to the triple combination therapy (mean MASI reduction: TA = 8.5 vs. triple combination = 6.3, p &lt; 0.05). Patient satisfaction was higher in the intradermal TA group, with fewer reported side effects such as skin irritation. Conclusion: Intradermal tranexamic acid is more effective and safer than the fluocinolone-based triple combination therapy in the treatment of melasma, offering a promising alternative with a superior safety profile. Keywords: Melasma, Intradermal Tranexamic Acid, Fluocinolone-Based Triple Combination Therapy, Hydroquinone, Tretinoin, Clinical Trial, MASI, Pigmentation Disorder

To compare the efficacy of intradermal platelet-rich-plasma vs. intradermal tranexamic acid in treatment of melasma. Non-randomised controlled trial. Sheikh Zayed Hospital, Rahim Yar Khan from 1st October 2019 to 30th April 2020. Cases of melasma from either gender with age 20-40 years, were included. Diagnosis of melasma was made clinically on the basis of hyperpigmentation at sun-exposed areas and by Wood's lamp. Severity was labelled on the basis of melasma area and severity index (MASI) score. Cases in group A were managed with 1 ml of intradermal platelet-rich plasma (PRP) and those in group B were offered intradermal tranexamic acid in a dose of 4 mg. The treatment was offered every 4th week and for a total period of 12 weeks; and final outcome was seen at 24th week. At every visit, the cases were noted for their mean MASI score. In this study, there were a total of 64 cases, 32 in each group. There were 19 (59.38%) males in group A and 16 (50%) in group B (p=0.61). Mean age in group A and B was 24.63 ± 9.87 vs. 23.94 ± 8.93 years (p= 0.76). Mean MASI score at baseline was 29.84 ± 5.14 vs. 29.56 ± 4.39, p=0.21. MASI was significantly better in group A at 4 weeks where score was 29.44 ± 5.35 vs. 28.69 ± 4.10, p=0.01. Mean MASI was 12.81 ± 1.78 vs. 18.38 ± 3.50, p=00001 at 12 weeks and 8.72 ± 3.40 vs. 14.97±4.33, p=0.02 at 24 weeks in group A and B, respectively. Intradermal PRP is significantly better than intradermal tranexamic acid in management of melasma. Key Words: Melasma, Tranexamic acid, PRP, MASI.

Comparison of a picosecond alexandrite laser versus a Q-switched alexandrite laser for the treatment of nevus of Ota: A randomized, split-lesion, controlled trial

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Melasma management is often difficult and unsatisfactory, and there is need to explore newer modalities for melasma treatment. Disruption in antioxidant balance occurs in melasma. Superoxide dismutase (SOD) is a cellular antioxidant and restores this balance. Our hypothesis is that the oral SOD-Gliadin can replenish the SOD stores in body and quench the ‘reactive oxygen species’-induced damage in melasma.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A randomized, open label, single centre, comparative, five arm study was conducted in 90 patients with facial mixed melasma, for 12 weeks to evaluate the efficacy, safety and tolerability of two regimens (BD &amp;amp; OD) of oral SOD as add-on treatment with triple combination cream in melasma patients compared with two regimens (BD &amp;amp; OD) of beta-carotene (BC) and placebo. Primary outcome measure was improvement in Melasma Area and Severity Index (MASI) score, and secondary outcome measures were quality of life score, patient satisfaction score, global assessment by investigator and patients. Pair-wise comparisons were performed on adjusted mean using SAS v9.1.3.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There was significant reduction in MASI score with add-on treatment with SOD BD (67.97%) as compared to BC BD (43.04%), BC OD (33.68%) and placebo (22.60%). There was significant reduction in MASI score with SOD OD (51.93%) as compared to placebo (22.60%). The subjective assessments reported by patient and evaluator also ranked SOD BD as a superior regimen.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; By inhibiting oxidative stress, nutraceutical SOD-Gliadin Combination offers significantly better efficacy and higher treatment satisfaction as add-on treatment compared to beta-carotene in Indian patients.&lt;/p&gt;

Melasma is a common chronic, relapsing pigmentary disorder that causes psychological impact. Chemical peels are a well-known therapeutic modality used for accelerating the treatment of melasma. To review the published evidence on the efficacy and safety of chemical peels in the treatment of melasma. A systematic review was done. A meta-analysis could not be done due to the heterogeneity of data. The authors conducted a PubMed search and included prospective case series of more than 10 cases and randomized controlled trials (RCTs) that have studied the safety and/or efficacy of chemical peel in melasma. Out of 24 studies, 9 were clinical/comparative trials and 15 were RCTs. The total sample size was 1,075. The duration of the study varied from 8 to 36 weeks. Only 8 studies were split face. All studies used self-assessment, physician global assessment, and Melasma Area and Severity Index (MASI) for quantifying the results. Glycolic acid was found to be the most safe and effective in melasma. Chemical peels were found to be safe and effective in the management of melasma.

Melasma is a prevalent dermatological challenge with limited therapeutic interventions. Platelet-rich plasma (PRP) has been increasingly explored for its potential benefits in various dermatological conditions. This study aimed to systematically review the efficacy and safety of PRP in the treatment of melasma. A comprehensive search in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was executed in January 2024 using PubMed, focusing on studies investigating the efficacy and safety of PRP in melasma. Criteria for inclusion were clinical trials and controlled studies examining PRP's role in melasma treatment, while exclusions covered reviews, non-English articles, and studies older than 10 years, among others. Eight studies were included, with the majority targeting female participants. The research displayed consistent positive outcomes, whether PRP was used alone or synergistically with treatments like hydroquinone and tranexamic acid. However, positive studies with the combination of PRP and other drugs will not provide the actual safety and efficacy data of PRP. The combined treatment approaches often showed enhanced results. Satisfaction rates among patients and reductions in the melasma area and severity index (MASI) scores were common findings across the studies, emphasizing the potential of PRP in melasma management. In conclusion, PRP emerges as a promising therapeutic intervention for melasma. Whether as a standalone treatment or combined with established methods, PRP presents significant potential in melasma's clinical management, warranting further expansive trials to substantiate its long-term efficacy and safety.

Objective To evaluate the efficacy and safety of low-fluence and large spot-size 1064-nm Q-switched Nd∶YAG laser combined with glutathione hormone (GSH) and vitamin C for the treatment of melasma.Methods This study recruited 12 female melasma patients,with the age averaging (42.3 ± 6.56) years and varying from 32 to 56 years.The whole face with melasma lesions of all the patients were irradiated with 1064-nm Q-switched Nd∶YAG laser (Medlite C6) at fluences of 2.5-3.0 J/cm2 and a spot size of 6 mm for 8 sessions with an interval of 1 week followed by 6 sessions with an interval of 1 month.The patients also received 3 courses of 14-consecutive-day treatment with intravenous GSH 0.9 g and vitamin C 2 g once a day at a 3-month interval.Photographs were taken and melasma area and severity index (MASI) was calculated for the patients before and after the treatment.Results Of the 12 patients,1 was cured,5 markedly improved,6 improved,and all showed clinical response.The average MASI decreased from 13.8 ± 4.3 before treatment to 7.1 ± 2.4 after treatment (P＜ 0.05).Follicular orifices constricted and skin became smoother with no hypopigmentation or hyperpigmentation observed in the patients after the treatment.Conclusion The lowfluence,large spot-size,1064-nm Q-switched Nd ∶ YAG laser combined with GSH and vitamin C is a safe and effective treatment modality for melasma with no requirement for downtime.