title: Treatment of refractory melasma with combination of topical 5% magnesium ascorbyl phosphate and fluorescent pulsed light in Asian patients.
abstract: BACKGROUND
  Melasma is an acquired disorder of hypermelanosis of great psychosocial concern. The treatments with various conventional therapies are often unsatisfactory. Lasers and light sources have been used to treat pigmented lesions, but in Asian skin with higher melanin content, such treatments may be challenging.
  
  
  OBJECTIVE
  To determine the effectiveness of treating melasma with a combination of topical 5% magnesium ascorbyl phosphate (MAP) and fluorescent pulsed light (FPL).
  
  
  METHODS
  Patients of skin types III-V with refractory melasma were treated for 12 weeks with topical application of 5% MAP and three sessions of FPL (570-950 nm) at 3, 6, and 9 weeks (fluence 12-14 J/cm(2) , pulse width 15 ms, and spot size 3 cm(2) ). They were followed up for another 12 weeks to assess the persistence of treatment benefit. Digital photographs of the patients were taken at each visit. Treatment efficacy was determined by calculating mean melasma area and severity index (MASI) at the beginning and then at weeks 6, 12, and 24. The subjective assessment was done by comparing pre-treatment and post-treatment photographs by an independent observer and self-assessment by patients using four-point scoring scale (1, poor, 2, fair, 3, good, and 4, excellent).
  
  
  RESULTS
  Sixty-five patients completed the study. The baseline mean MASI score of 14.80 decreased to 4.53 at the 12th week (end of treatment) and 6.35 at the 24th week (end of follow-up). The overall regression of mean MASI at these end-points was 69.3% and 57% (P < 0.01). The pre- and post-treatment photographic evaluation by independent observer and patients' self-assessment at the 12th week showed good to excellent response (scores 3 and 4) in 52.3% and 44.6% cases, respectively. No significant adverse effects of treatment were noted.
  
  
  CONCLUSIONS
  Combination of 5% MAP with FPL is effective, well tolerated, and safe in treating refractory melasma in Asian patients but for persistent improvement, maintenance treatments would be required.
authors.affiliation: Department of Dermatology, Army Medical College, Rawalpindi, Pakistan; Department of Dermatology, Military Hospital, Rawalpindi, Pakistan.
authors.forename: Zafar I
authors.initials: ZI
authors.lastname: Shaikh
authors.forename: Ashar A
authors.initials: AA
authors.lastname: Mashood
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001205:Ascorbic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D044466:Asian People; D003131:Combined Modality Therapy; D005260:Female; D005453:Fluorescence; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008548:Melanosis / Q000188:drug therapy*; D010789:Phototherapy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; C011669:ascorbate-2-phosphate; D001205:Ascorbic Acid