Nonablative 1550-nm fractional laser therapy versus triple topical therapy for the treatment of melasma: a randomized controlled pilot study.
BACKGROUND
Various treatments are currently available for melasma. However, results are often disappointing.


OBJECTIVE
We sought to assess the efficacy and safety of nonablative 1550-nm fractional laser therapy and compare results with those obtained with triple topical therapy (the gold standard).


METHODS
Twenty female patients with moderate to severe melasma and Fitzpatrick skin types II to V were treated either with nonablative fractional laser therapy or triple topical therapy (hydroquinone 5%, tretinoin 0.05%, and triamcinolone acetonide 0.1% cream) once daily for 8 weeks in a randomized controlled observer-blinded study. Laser treatment was performed every 2 weeks for a total of 4 times. Physician Global Assessment was assessed at 3 weeks, 3 months, and 6 months after the last treatment.


RESULTS
Physician Global Assessment improved (P < .001) in both groups at 3 weeks. There was no difference in Physician Global Assessment between the two groups. Mean treatment satisfaction and recommendation were significantly higher in the laser group at 3 weeks (P < .05). However, melasma recurred in 5 patients in both groups after 6 months. Side effects in the laser group were erythema, burning sensation, facial edema, and pain; in the triple group side effects were erythema, burning, and scaling.


CONCLUSIONS
Limitations were: small number of patients; only one set of laser parameters; and a possible difference in motivation between groups.


CONCLUSIONS
Nonablative fractional laser therapy is safe and comparable in efficacy and recurrence rate with triple topical therapy. It may be a useful alternative treatment option for melasma when topical bleaching is ineffective or not tolerated. Different laser settings and long-term maintenance treatment should be tested in future studies.
The Netherlands Institute for Pigment Disorders, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. m.w.kroon@amc.uva.nl
Marije W
MW
Kroon
Bas S
BS
Wind
Johan F
JF
Beek
J P Wietze
JP
van der Veen
Ludmila
L
Nieuweboer-Krobotová
Jan D
JD
Bos
Albert
A
Wolkerstorfer
D000287:Administration, Topical; D000328:Adult; D005260:Female; D006801:Humans; D006873:Hydroquinones / Q000627:therapeutic use; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D008548:Melanosis / Q000188:drug therapy / Q000628:therapy*; D008875:Middle Aged; D010865:Pilot Projects; D012008:Recurrence; D016896:Treatment Outcome; D014212:Tretinoin / Q000627:therapeutic use; D014222:Triamcinolone Acetonide / Q000627:therapeutic use
D006873:Hydroquinones; D014212:Tretinoin; D014222:Triamcinolone Acetonide; C031927:hydroquinone