Lasers for melasma: not the sharpest knives in the drawer

• The study compares

• trichloroacetic acid (TCA): treatment applied every 2 weeks up to 8sessions

vs

• double frequency Q-switched Nd;YAG laser (1064nm and 532nm): treatment done once a month up to 6 sessions

Methods (and comments)

• 65 adult female patients were included
• Wood’s light to determine depth (sometimes unreliable)
• Evaluation through MASI: not reliable (Link)
• Follow up three months after the last treatment for recurrence

• Group 1
  • epidermal location of the pigmentation
  • n (number of patients) = 15,  TCA 20%
• Group 2
  • dermal and mixed (epidermal and dermal)
  • n=20, TCA 25%
• Group 3
  • dermal and mixed
  • n=15, TCA 30%
• Group 4
  • n=15:
    • 7 with epidermal with wavelength at 532nm
    • 8 dermal mixed location with wavelength at 1064nm

• Results show that the biggest improvement (64.7% +/- 21.9%) was seem in group 2 (TCA25%).
  • The condition actaully worsened in group 4 (laser): (-49.2% +/- 66.3&)
  • Recurrence rate was 32% siimilar in all 4 groups

• Conclusion and comment. Lasers actually worsened the melasma and this could be through the induction of post-inflammatory hyperpigmentation.

No conflicts of interest disclosed

Source of information: Alaa E. et al. P1422. Q-switched Nd:YAG laser versus trichloroacetic acid peeling in the treatment of melasma among Egyptian patients. European Academy of Dermatology and Venereology (EADV) Annual Meeting – Istanbul, Turkey, 2-6 October 2013