title: Combination of fractional erbium-glass laser and topical therapy in melasma resistant to triple-combination cream.
abstract: BACKGROUND
  Melasma is a common melanosis often difficult to treat.
  
  
  OBJECTIVE
  The aim of this paper was to report on the safety and efficacy of non-ablative fractional photothermolysis combined with the use of triple-combination cream (TCC) on a large population with melasma resistant (i.e., with no complete/near-complete clearing) to TCC alone.
  
  
  METHODS
  Seventy-six patients with resistant melasma underwent a combined treatment protocol. The protocol consisted of a TCC (hydroquinone 4%, retinoic acid 0.03%, hydrocortisone butyrate 0.1%) applied daily for 10 days followed by four laser treatments performed in 3-week intervals with a fractional 1540-nm erbium-glass laser. During these intervals, and for 3 months after the last laser session, TCC was also applied daily following a "pulse-therapy" scheme. Improvement was assessed by the melasma-area-and-severity-index (MASI) score.
  
  
  RESULTS
  At 1 month, marked (>75%) and moderate (51-75%) clearing of melasma were observed in 46 of 76 (67.1%) and 12 of 76 (21%) cases, respectively. At 6 months, we noticed a marked improvement in 16 of 76 (21.1%) and no improvement in 33 of 76 (43.4%) patients.
  
  
  CONCLUSIONS
  Our study proposes the combination of NFP/TCC as a useful therapy for patients with melasma resistant to TCC alone, but it shows that its long-term efficacy is limited.
authors.affiliation: Istituto di Chirurgia e Laserchirurgia in Dermatologia (I.C.L.I.D.) , Milano , Italy.
authors.forename: Athanasia
authors.initials: A
authors.lastname: Tourlaki
authors.forename: Michela Gianna
authors.initials: MG
authors.lastname: Galimberti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pellacani
authors.forename: Pier Luca
authors.initials: PL
authors.lastname: Bencini
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D003879:Dermatologic Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D006873:Hydroquinones / Q000008:administration & dosage; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D028022:Low-Level Light Therapy; D008548:Melanosis / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D008875:Middle Aged; D017211:Treatment Failure; D016896:Treatment Outcome; D014212:Tretinoin / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D003879:Dermatologic Agents; D006873:Hydroquinones; D014212:Tretinoin; D006854:Hydrocortisone; C031927:hydroquinone