Treatment of melasma using variable square pulse Er: Yag laser resurfacing

Abstract

BACKGROUND Treatment of melasma remains a challenge. Laser treatments show limited efficacy, with a high rate of recurrence and side effects. Recently, variable-pulsed erbium:yttrium aluminum garnet (Er:YAG) lasers have shown favorable results in skin resurfacing, with minimal downtime and adverse effects. OBJECTIVE To determine the efficacy and side effects of variable square pulsed (VSP) Er:YAG laser resurfacing for treatment of epidermal type melasma. METHODS Twenty Thai women with epidermal-type melasma were treated with two passes of VSP Er:YAG laser resurfacing using a 7-mm spot size, pulse duration of 300 μs, and a fluence of 0.4 J/cm 2. Two treatments were given 1 month apart. Visual analog scale (VAS), Melasma Area and Severity Index (MASI) score and melanin index (MI) were measured at baseline and 1, 2, and 4 months after treatment. RESULTS There was a significant improvement in VAS from baseline at 1-, 2-, and 4-month follow-up visits (p<.001). Significant improvement in MASI score at the 2-month visit from baseline (p=.004) was also observed. The average MI measured using melanin reflectance spectrometry measurements corresponded to MASI score rating. CONCLUSIONS VSP Er:YAG laser resurfacing effectively but temporarily improved epidermal-type melasma. Recurrence was observed after the treatment was discontinued. The authors have indicated no significant interest with commercial supporters. © 2009 by the American Society for Dermatologic Surgery, Inc.