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BACKGROUND Melasma is a common hyperpigmentation disorder that can cause refractory cosmetic disfigurement, especially in Asians. Fractional photothermolysis (FP) has been reported to be effective for the treatment of melasma, despite small study populations and short follow-up periods.

OBJECTIVE To evaluate the efficacy and safety of FP for the treatment of melasma in Asians.

PATIENTS AND METHODS Twenty-five patients with melasma received four monthly FP sessions and were followed up to 24 weeks after treatment completion. Efficacy was evaluated using objective and subjective ratings, Melasma Area and Severity Index (MASI), melanin index tracking, and skin elasticity measurements.

RESULTS Investigators observed clinical improvements in 60% and patients in 44% at 4 weeks after treatment, but the figures decreased to 52% and 35%, respectively, at 24 weeks after treatment. Mean MASI scores decreased significantly from 7.6 to 6.2. Mean melanin index decreased significantly after the first two sessions, but it relapsed slightly in subsequent follow-ups. The treatment did not alter skin elasticity. Hyperpigmentation was observed in three of 23 subjects (13%).

CONCLUSION Treatment of melasma with FP led to some clinical improvements, but it was not as efficacious as previously reported at 6-month follow-up. We recommend judicious use of FP for the treatment of melasma in Asian skin because of its limited efficacy.