Non-ablative 1,550 nm fractional laser therapy versus triple topical therapy for the treatment of melasma: a randomized controlled split-face study.
BACKGROUND
Melasma is a uichronic, often relapsing skin disorder, with poor long-term results from all current therapies.


OBJECTIVE
To assess efficacy and safety of non-ablative 1,550 nm fractional laser therapy (FLT) as compared to the gold standard, triple topical therapy (TTT).


METHODS
Twenty-nine patients with melasma were included in a randomized controlled observer-blinded study with split-face design. Each side of the face was randomly allocated to either 4-5 non-ablative FLT sessions (15 mJ/microbeam, 14-20% coverage) or TTT (hydroquinone 5%, tretinoin 0.05%, triamcinolone acetonide 0.1% cream). TTT was applied once daily for 15 weeks until the last FLT session. After this last treatment, patients were asked to apply TTT twice weekly on both sides of the face during follow-up. Improvement of melasma was assessed by patient's global assessment (PGA), patient's satisfaction, physician's global assessment (PhGA), melanin index, and lightness (L-value) at 3 weeks, and at 3 and 6 months after the last treatment.


RESULTS
Mean PGA and satisfaction were significantly lower at the FLT side (P<0.001). PhGA, melanin index, and L-value showed a significant worsening of hyperpigmentation at the FLT side. At the TTT side, no significant change was observed. At 6 months follow-up, most patients preferred TTT. Side effects of FLT were erythema, burning sensation, edema, and pain. Nine patients (31%) developed PIH after two or more laser sessions. Side effects of TTT were erythema, burning sensation, and scaling.


CONCLUSIONS
Given the high rate of postinflammatory hyperpigmentation, non-ablative 1,550 nm fractional laser at 15 mJ/microbeam is not recommendable in the treatment of melasma. TTT remains the gold standard treatment.
Wind
Bas S
BS
Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Center, University of Amsterdam, NL-1105AZ Amsterdam, The Netherlands. b.s.wind@amc.uva.nl
Kroon
Marije W
MW
Meesters
Arne A
AA
Beek
Johan F
JF
van der Veen
J P Wietze
JP
Nieuweboer-Krobotová
Ludmila
L
Bos
Jan D
JD
Wolkerstorfer
Albert
A
D000287:Administration, Topical; D000328:Adult; D004359:Drug Therapy, Combination; D005145:Face; D005260:Female; D006801:Humans; D028022:Low-Level Light Therapy / Q000379:methods*; D008297:Male; D008548:Melanosis / Q000188:drug therapy* / Q000532:radiotherapy*; D008875:Middle Aged; D017060:Patient Satisfaction; D016896:Treatment Outcome; D014212:Tretinoin / Q000008:administration & dosage*; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*
D014212:Tretinoin; D014222:Triamcinolone Acetonide