GRAPEVINE, TEX. A fractional, 1540-nm laser produced good responses in patients with treatment-resistant melasma of the face or neck in a pilot study with 12 patients.
These early findings suggest that this approach "is a useful, additional treatment modality," Dr. David B. Vasily said at the annual meeting of the American Society for Laser Medicine and Surgery.
"I wouldn't suggest that it produces a cure, but it was effective for resistant melasma, and we have not seen any recurrences during up to 6 months of follow-up in a small group of patients," said Dr. Vasily, a dermatologist in private practice in Bethlehem, Pa.
The study included patients with skin types I-III whose melasma of the face or neck had not responded well to conventional treatments. All patients received four treatments, at 3-week intervals, with the Lux1540 fractional laser handpiece made by Palomar.
Dr. Vasily has received research grants, equipment, and discounts from Palomar, and has stock in the company. The laser is approved by the Food and Drug Administration for soft-tissue coagulation and nonablative resurfacing; treatment of melasma is an off-label use.
Treatment was with a handpiece measuring 15 mm in diameter that produces at least 320 microbeams per pass. Each patient received four passes at a fluence of 1015 mJ per microbeam and a 10-ms pulse duration. Topical anesthesia was not used; the average pain score was 4.4 on a scale of 010.
Erythema and edema did not appear after every treatment, and when it did occur it resolved within 72 hours.
Blinded assessments of before and after photographs showed an average 51% reduction in melasma at 3 months after the final treatment, with two patients having virtually complete clearance, said Dr. Vasily. The response was judged to be excellent (75%-100% resolution) in four patients, and good (50%-75% resolution) in another four patients.
All patients had some degree of pigmentation lightening that was maintained during follow-up, with no episodes of repigmentation or hyperpigmentation. Overall, these responses compare favorably with what is usually achieved with conventional treatments in patients who respond to those treatments, Dr. Vasily said.
He suggested that a better level of response might be seen in a study that enrolled all comers rather than one that focused entirely on the patients who had not responded to other treatments.
Before and after images of a patient in the pilot study showing the effect of four treatments of a 1,540-nm fractional laser for melasma at 3-week intervals. Photos courtesy Dr. David B. Vasily