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Non-ablative 1,550 nm fractional laser therapy versus triple topical therapy for the treatment of melasma: A randomized controlled split-face study

Authors

  • Bas S. Wind MD,

    Corresponding author
    1. Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Center, University of Amsterdam, NL-1105AZ Amsterdam, The Netherlands
    2. Department of Dermatology, Academic Medical Center, University of Amsterdam, NL-1100DD Amsterdam, The Netherlands
    • Netherlands Institute for Pigment Disorders (SNIP), Meibergdreef 35, 1105 AZ Amsterdam, The Netherlands.
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  • Marije W. Kroon MD,

    1. Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Center, University of Amsterdam, NL-1105AZ Amsterdam, The Netherlands
    2. Department of Dermatology, Academic Medical Center, University of Amsterdam, NL-1100DD Amsterdam, The Netherlands
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  • Arne A. Meesters MSc,

    1. Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Center, University of Amsterdam, NL-1105AZ Amsterdam, The Netherlands
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  • Johan F. Beek MD, PhD,

    1. Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, NL-1105AZ Amsterdam, The Netherlands
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  • J.P. Wietze van der Veen MD, PhD,

    1. Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Center, University of Amsterdam, NL-1105AZ Amsterdam, The Netherlands
    2. Department of Dermatology, Academic Medical Center, University of Amsterdam, NL-1100DD Amsterdam, The Netherlands
    3. The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), NL-1006BE Amsterdam, The Netherlands
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  • Ludmila Nieuweboer-Krobotová MD,

    1. Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Center, University of Amsterdam, NL-1105AZ Amsterdam, The Netherlands
    2. Department of Dermatology, Academic Medical Center, University of Amsterdam, NL-1100DD Amsterdam, The Netherlands
    3. The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), NL-1006BE Amsterdam, The Netherlands
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  • Jan D. Bos MD, PhD, FRCP,

    1. Department of Dermatology, Academic Medical Center, University of Amsterdam, NL-1100DD Amsterdam, The Netherlands
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  • Albert Wolkerstorfer MD, PhD

    1. Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Center, University of Amsterdam, NL-1105AZ Amsterdam, The Netherlands
    2. Department of Dermatology, Academic Medical Center, University of Amsterdam, NL-1100DD Amsterdam, The Netherlands
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  • Bas S. Wind and Marije W. Kroon contributed equally to this work.

  • The authors certify that they have no affiliation with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the manuscript (e.g., employment, consultancies, stock ownership, honoraria).

Abstract

Background

Melasma is a uichronic, often relapsing skin disorder, with poor long-term results from all current therapies.

Objective

To assess efficacy and safety of non-ablative 1,550 nm fractional laser therapy (FLT) as compared to the gold standard, triple topical therapy (TTT).

Study design

Twenty-nine patients with melasma were included in a randomized controlled observer-blinded study with split-face design. Each side of the face was randomly allocated to either 4–5 non-ablative FLT sessions (15 mJ/microbeam, 14–20% coverage) or TTT (hydroquinone 5%, tretinoin 0.05%, triamcinolone acetonide 0.1% cream). TTT was applied once daily for 15 weeks until the last FLT session. After this last treatment, patients were asked to apply TTT twice weekly on both sides of the face during follow-up. Improvement of melasma was assessed by patient's global assessment (PGA), patient's satisfaction, physician's global assessment (PhGA), melanin index, and lightness (L-value) at 3 weeks, and at 3 and 6 months after the last treatment.

Results

Mean PGA and satisfaction were significantly lower at the FLT side (P<0.001). PhGA, melanin index, and L-value showed a significant worsening of hyperpigmentation at the FLT side. At the TTT side, no significant change was observed. At 6 months follow-up, most patients preferred TTT. Side effects of FLT were erythema, burning sensation, edema, and pain. Nine patients (31%) developed PIH after two or more laser sessions. Side effects of TTT were erythema, burning sensation, and scaling.

Conclusions

Given the high rate of postinflammatory hyperpigmentation, non-ablative 1,550 nm fractional laser at 15 mJ/microbeam is not recommendable in the treatment of melasma. TTT remains the gold standard treatment. Lasers Surg. Med. 42:607–612, 2010. © 2010 Wiley-Liss, Inc.

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