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Low-fluence QS Nd:YAG laser effective in melasma, but with high recurrence rate

Low-fluence Q-switched neodymium-doped yttrium aluminum garnet laser was effective and safe in treating melasma; however, there was a high recurrence rate following treatment, according to recently published study results.

Researchers studied 20 healthy Brazilian women aged 18 to 17 years who had Fitzpatrick skin types III to V and mild-to-severe facial melasma.

The patients were treated during 10 weekly sessions with low-fluence 1064-nm Q-switched neodymium-doped yttrium aluminum garnet (QS Nd:YAG) laser (Spectra; Lutronic Corp.). The parameters were 8-mm spot size, 0.8 to 1.6 J/cm² of fluence, and a 10 Hz pulse repetition rate.

At baseline, 1 week, and 1, 3 and 6 months after treatment, the researchers measured the modified Melasma Area and Severity Index (mMASI) score. Ten biopsy samples were used for epidermal melanin quantification, which were compared before and after treatment.

Sixteen patients (80%) completed the study; the other four patients did not complete the study due to noncompliance of treatments sessions. There was an improvement in mMASI scores (range, 21%-75%) for all patients, when compared with baseline. Minimal side effects, including mild erythema and local warmth up to 2 hours after the laser session, were reported, and there were no permanent side effects.

Seventy-five percent of patients who completed the study had a fair mMASI score reduction and 25% had a good mMASI score reduction 1 week after the final laser session. There was a nonsignificant decrease in melanin deposition in all epidermal layers 1 week after treatment.

By 1 month, there were no improvements rated good or excellent and by 3 months, 81% of patients had melisma recurrence or mMASI scores worse than their baseline scores.

“Our results revealed that low-fluence QS Nd:YAG laser is a safe and effective method of treating melasma; however, a high recurrence rate was seen at long-term follow-up (6 months) in the patients,” the researchers concluded. “Therefore, the authors believe that low-fluence QS Nd:YAG laser may be considered an option for treating recalcitrant melasma; however, the poor long-term results of monotherapy must be considered when making therapeutic choices.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.