title: Combination treatment of melasma with pulsed CO2 laser followed by Q-switched alexandrite laser: a pilot study.
abstract: BACKGROUND
  Melasma is very difficult to treat and often refractory to treatment with topical creams and pigmented-lesion lasers.
  
  
  OBJECTIVE
  Pulsed CO2 laser alone is compared with the combination of pulsed CO2 laser followed by Q-switched alexandrite laser in the treatment of dermal-type melasma. This combination is proposed to be effective by first destroying the abnormal melanocytes with the pulsed CO2 laser and then selectively eliminating the dermal melanin with the alexandrite laser.
  
  
  METHODS
  Four patients were randomly chosen for each treatment arm. There were multiple follow-up visits for examination by an objective blinded investigator.
  
  
  RESULTS
  All patients in the combination laser group showed complete resolution, and two patients in the CO2 laser only group had peripheral hyperpigmentation in the long-term follow-up evaluation.
  
  
  CONCLUSIONS
  These laser therapies are safe, as there was no scarring and no infection. The combination laser therapy was highly effective in removing the hyperpigmentation and all patients in this group showed complete resolution without any peripheral hyperpigmentation.
authors.affiliation: Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Florida, USA.
authors.forename: K
authors.initials: K
authors.lastname: Nouri
authors.forename: L
authors.initials: L
authors.lastname: Bowes
authors.forename: T
authors.initials: T
authors.lastname: Chartier
authors.forename: R
authors.initials: R
authors.lastname: Romagosa
authors.forename: J
authors.initials: J
authors.lastname: Spencer
mesh_terms: D001608:Beryllium; D002245:Carbon Dioxide; D006801:Humans; D053685:Laser Therapy; D008548:Melanosis / Q000532:radiotherapy*; D010865:Pilot Projects; D016037:Single-Blind Method
chemical_list: C112654:alexandrite; D002245:Carbon Dioxide; D001608:Beryllium