A study published in Dermatologic Surgery has indicated that long-pulsed alexandrite laser with a fractional handpiece can produce moderately effective results in treating women with melasma.
Researchers studied 48 Korean women with melasma, with a mean age 44.1 years, who were treated with two to four sessions of fractional, 755 nm long-pulsed alexandrite laser with two to three week intervals. Of the women, 27 had Fitzpatrick skin type 3, and 21 women had Fitzpatrick skin type 4.
To treat the lesions, a 15 mm spot size of the fractional handpiece was used with settings of 60-80 J/cm2, without a dynamic cooling device, and a 0.5-1 millisecond pulse width.
Researchers noted that compared with baseline, there was a ‘significant decrease’ in the mean modified melasma area and severity index score, two months after final treatment. A reduction of 30.5% in the mean score was indicated.
Patients with an epidermal type of melasma displayed significant improvement compared to those with the dermal type of melasma, in mean modified melasma and severity index scores. A 51% to 75% improvement was noted in 20 patients (41.7%), while 15 patients (31.3%) were suggested to show a 26% to 50% improvement using the quartile grading scale. Improvements were rated excellent by 10.4% of patients, while good-or-fair improvement was reported by 70.8% of patients.
Mild erythema and a heating sensation were minor adverse effects developed by patients within one day of treatment. Postinflammatory hyperpigmentation was reported by one patient, with improvement at a two-month follow-up.
“A fractional, long-pulsed 755 nm alexandrite laser was adapted for the treatment of melasma in patients with a Fitzpatrick skin type 3 or 4,” Lee et al said. “It is believed that long-pulsed alexandrite laser is effective and has few side effects in the treatment of melasma. However, as the outcome of monotherapy with the long-pulsed alexandrite laser was not completely satisfactory for patients, and because the melasma subtype affected the efficacy of long-pulsed alexandrite laser, a combination with other modalities, such as topical agents and chemical peels, may be needed to optimise the management in unsatisfactory cases.”