Fractional CO2 laser and adjunctive therapies in skin of color melasma patients

Abstract

BackgroundAblative lasers have long been considered an unfavorable option for melasma in patients with skin of color and continue to be underutilized.ObjectiveTo evaluate the safety and outcomes of ablative fractional CO2 lasers on refractory melasma in patients with skin of color.MethodsA retrospective chart review of 12 patients from a single-center dermatology clinic. The study included refractory melasma patients receiving ablative fractional CO₂ laser therapy alone or with laser toning and/or tranexamic acid (TXA). A validated modified Melasma Area and Severity Index (mMASI) scoring scale was used to assess disease severity at baseline and approximately 1 month after each treatment session.ResultsAmong the 12 patients, 41.7% patients showed >50% reduction in mMASI scores with 33.3% of patients showing statistical significance (P < .05). The CO₂ laser therapy with the TXA cohort showed the largest decrease in the mean mMASI scores and the CO₂ laser with laser toning showed the lowest decrease in scores. Patients who started on oral TXA earlier, after their initial ablative laser session, showed better clinical improvement.LimitationsRetrospective study design with short follow-up period and a small sample size.ConclusionAblative CO2 laser treatment may be a reasonable option for refractory melasma in patients with skin of color, though future research is needed.