Combination of a 755‐nm picosecond laser and hydroquinone 2% cream versus hydroquinone 2% cream alone for the treatment of melasma: A randomized, split‐face, and controlled trial

Abstract

Background While combined laser and topical treatments are currently a common approach to melasma treatment, data on the efficacy and safety of this combined therapy remain scarce, with studies showing varied results. Objective To compare the efficacy and safety of hydroquinone (HQ) cream alone versus HQ cream combined with 755‐nm picosecond (PS) laser in the treatment of melasma. Method Twenty subjects presenting with mixed‐type melasma were enrolled in the study. All patients were instructed to apply 2% HQ cream to both sides of the face for 4 weeks. Randomly assigned hemifaces of all patients thereafter received 5 biweekly PS laser treatments. Objective (measurement of average melanin content and melanin index) and subjective (grading of modified melasma area and severity index [mMASI] score and global percentage of pigment clearance) assessments of melasma clearance, and occurrence of adverse effects were evaluated at 1‐, 3‐, and 6‐months after the final laser treatment. Results mMASI scores were significantly improved from baseline for both sides (p = 0.006 HQ alone, p < 0.001 HQ + PS laser), with no statistically significant difference when comparing HQ alone versus HQ + PS laser. Objective assessments (measurements of average melanin content and melanin index) of melasma clearance corresponded to the clinical evaluation using mMASI score. Mild postinflammatory hyperpigmentation was observed in 15% of the patients on the laser‐treated side, while no adverse effects were reported on the HQ monotherapy side. Conclusions Adjunctive treatment with a 755‐nm PS laser does not provide additional benefit to topical HQ in the treatment of melasma. http://ClinicalTrail.gov PRS. number: NCT04597203.

Comparison of the efficacy and safety of picosecond Nd:YAG laser (1,064 nm), picosecond alexandrite laser (755 nm) and 2% hydroquinone cream in the treatment of melasma: A randomized, controlled, assessor-blinded trial

“…Our results were consistent with those described in other studies which also confirmed the efficacy of PSNYL ( 11 , 14 – 17 ) and PSAL ( 5 , 8 – 10 , 18 – 20 ) for melasma. However, only two ( 14 , 21 ) and three ( 5 , 9 , 22 ) of the studies were RCTs regarding non-fractional PSNYL and PSAL, respectively. This randomized controlled study aimed to provide reliable evidence-based interventions for the clinical treatment of melasma using Picos.…”

“…However, mMASI or hemi-MASI displayed an increasing trend in the later stages of follow-up in the two studies mentioned above ( 21 , 31 ), suggesting a likelihood of melasma recurrence after a period of cessation of treatment. Moreover, a recent split-face study suggested that there was not a substantial advantage in the PSAL and 2% HQ combination therapy versus the 2% HQ monotherapy ( 22 ). Thus, whether combination therapy has benefits and in what specific domains, such as enhancing the therapeutic effect or extending the duration of the therapeutic outcome, are problems that still require scrutiny.…”

Melasma treatment with a 1064 nm, picosecond‐domain laser with a fractionated multibeam lens array

“…Since melanin has a very broad absorption spectrum, extending from ultraviolet wavelengths well into the infrared spectrum, a variety of lasers and light sources have been used to treat melasma. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Q-switched lasers and fractionated thulium lasers are commonly used to treat melasma, due to their ability to target pigmentation while minimizing subsequent inflammation. [7][8][9][11][12][13][15][16][17][18] The relatively recent development of picosecond-domain lasers enables the delivery of high peak powers with relatively low fluences, minimizing inflammation while still targeting melanin pigment.…”

“…Since melasma is often exacerbated by inflammation, picosecond-domain laser treatments that limit inflammation while targeting melanin pigment may be ideal for treating melasma. 10,14,[19][20][21] In the current study, we investigate the effect of treatment with a 1064-nm picosecond-domain laser, delivering highly focused, fractionated laser energy in an array of 101, 10 × 10 beamlets via a holographic optic, on improving the appearance of melasma. Since melasma is highly affected by sun-exposure and waxes and wanes throughout the course of a year, the pretreatment and final post-treatment digital images were taken exactly 1-year apart.…”

“…For this reason, lasers have been used as an adjunct to topical and oral melasma treatments. Since melanin has a very broad absorption spectrum, extending from ultraviolet wavelengths well into the infrared spectrum, a variety of lasers and light sources have been used to treat melasma 7–21 . Q‐switched lasers and fractionated thulium lasers are commonly used to treat melasma, due to their ability to target pigmentation while minimizing subsequent inflammation 7–9,11–13,15–18 .…”