Melasma: Which Laser and Light Therapies Achieve Long Lasting Results? A Review of the Literature Over the Last 30 Years

Abstract

Background: Melasma often presents as a therapeutic challenge to dermatologists. Due to its relapsing nature, long-term topical maintenance therapies are often required which may be time consuming and costly for patients. As a result, light and laser therapies have become increasingly popular in the treatment of melasma. Yet, clinical studies on melasma tend to focus more on the efficacy of these treatments rather than their ability to achieve long-term results. Objective: To assess the ability of light and laser treatments to achieve long lasting results in melasma. Methods: A literature review was conducted to assess the long-term efficacy of laser and light treatments in epidermal, mixed and dermal melasma. Results: Out of 128 articles reviewed, 17 studies of laser and light therapies included patient follow-up without maintenance therapies in their study designs. According to these studies, IPL and Nd:YAG achieved long lasting results for up to 6-months. Studies also suggest that combining these therapies together as well as combining them with other topical or procedural therapies, may result in enhanced long-term efficacy. Despite this, these treatments are less commonly used than topical therapies in clinical practice due to their cost and potential side effects, such as scarring, post inflammatory hyperpigmentation and prolonged erythema. Studies also indicate that these therapies vary in efficacy depending on the melasma subtype. Limitations: There was a lack of standardized outcome assessments. Conclusions: In conclusion, light and laser treatments have a role in treating melasma. To study their efficacy in treating melasma long-term, more studies with extended duration of follow-ups and standardized outcome measures are needed.