title: Treatment of melasma using variable square pulse Er:YAG laser resurfacing.
abstract: BACKGROUND
  Treatment of melasma remains a challenge. Laser treatments show limited efficacy, with a high rate of recurrence and side effects. Recently, variable-pulsed erbium:yttrium aluminum garnet (Er:YAG) lasers have shown favorable results in skin resurfacing, with minimal downtime and adverse effects.
  
  
  OBJECTIVE
  To determine the efficacy and side effects of variable square pulsed (VSP) Er:YAG laser resurfacing for treatment of epidermal type melasma.
  
  
  METHODS
  Twenty Thai women with epidermal-type melasma were treated with two passes of VSP Er:YAG laser resurfacing using a 7-mm spot size, pulse duration of 300 micros, and a fluence of 0.4 J/cm(2). Two treatments were given 1 month apart. Visual analog scale (VAS), Melasma Area and Severity Index (MASI) score and melanin index (MI) were measured at baseline and 1, 2, and 4 months after treatment.
  
  
  RESULTS
  There was a significant improvement in VAS from baseline at 1-, 2-, and 4-month follow-up visits (p<.001). Significant improvement in MASI score at the 2-month visit from baseline (p=.004) was also observed. The average MI measured using melanin reflectance spectrometry measurements corresponded to MASI score rating.
  
  
  CONCLUSIONS
  VSP Er:YAG laser resurfacing effectively but temporarily improved epidermal-type melasma. Recurrence was observed after the treatment was discontinued.
authors.affiliation: Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. sirwn@mahidol.ac.th
authors.forename: Rungsima
authors.initials: R
authors.lastname: Wanitphakdeedecha
authors.forename: Woraphong
authors.initials: W
authors.lastname: Manuskiatti
authors.forename: Sujittra
authors.initials: S
authors.lastname: Siriphukpong
authors.forename: T Minsue
authors.initials: TM
authors.lastname: Chen
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008548:Melanosis / Q000601:surgery*; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology; D014945:Wound Healing