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Nonablative 1550-nm fractional laser therapy versus triple topical therapy for the treatment of melasma: A randomized controlled pilot study - 10/08/11

Doi : 10.1016/j.jaad.2010.01.048 
Marije W. Kroon, MD a, b, , Bas S. Wind, MD a, b, Johan F. Beek, MD, PhD a, b, c, J.P. Wietze van der Veen, MD, PhD a, b, d, Ludmila Nieuweboer-Krobotová, MD a, b, d, Jan D. Bos, MD, PhD, FRCP b, Albert Wolkerstorfer, MD, PhD a, b
a The Netherlands Institute for Pigment Disorders, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands 
b Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands 
c Laser Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands 
d The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands 

Reprint requests: Marije W. Kroon, MD, Netherlands Institute for Pigment Disorders, Meibergdreef 35, 1105 AZ Amsterdam, The Netherlands.

Abstract

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.

Limitations

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.

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Key words : bleaching, melasma, nonablative fractional laser therapy, randomized, triple topical therapy

Abbreviations used : MASI, PGA, PhGA


Esquema


 The first two authors contributed equally to this article.
 Funding sources: None.
 Conflicts of interest: None declared.


© 2010  American Academy of Dermatology, Inc.. Publicado por Elsevier Masson SAS. Todos los derechos reservados.
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Vol 64 - N° 3

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