Melasma treatment with a 1064 nm, picosecond‐domain laser with a fractionated multibeam lens array

• Published in: Lasers in surgery and medicine Vol. 55; no. 9; pp. 801 - 808
• Main Authors: Bernstein, Eric F., Basilavecchio, Lisa D., Wang, Jenny
• Format: Journal Article
• Language: English
• Published: United States 01.11.2023
• Subjects: Administration, Topical; Adult; Humans; Lasers, Solid-State - therapeutic use; Low-Level Light Therapy - methods; Melanosis - radiotherapy; Treatment Outcome; hyperpigmentation; fractionated; melasma; laser; picosecond
• ISSN: 0196-8092; 1096-9101; 1096-9101
• DOI: 10.1002/lsm.23723

Picosecond-domain lasers have been fitted with fractionated optics for dermal remodeling. This study evaluates the safety and efficacy of a multiwavelength picosecond-domain laser, using a 1064 nm multibeam lens array, for improving the appearance of melasma. Twenty adults with a clinical diagnosis of melasma were enrolled and received 4 monthly 1064-nm, 450 ps laser treatments delivered with a 10 × 10 fractional array of 150 µm microbeams. Cosmetic units with melasma were treated with fluences ranging from 1.7 to 2.9 mJ/microbeam with a repetition rate of 6 Hz. Treatment effect was evaluation of digital images by dermatologists blinded as to the treatment conditions, comparing baseline and 3- and 8-month post-treatment images. Modified melasma area and severity index (mMASI) scores were determined by the study investigator based on clinical photography. Subject self-assessment of treatment effects was also recorded. Blinded reviewers correctly identified the post-treatment image in 16 of the 20 image sets (80%). Ratings demonstrated statistically significant (p < 0.001) improvement on an 11-point scale at both the 3- and 8-month timepoints for a mean improvement of 3.7 point (range -8 to 10) or 37% improvement at the 3-month follow-up, and 2.7 (range -8 to 9) or 27% at the 8-month follow-up for all subjects. The average mMASI score showed highly significant reduction at both the 3- and 8-month follow-ups compared to baseline (p < 0.01). Most subjects (90%) were satisfied with the treatment outcome in melasma at both follow-ups, which is consistent with the treatment outcome and mMASI scores. The fractionated, picosecond-domain, 1064 nm laser is safe and effective for improving melasma and should be considered as an adjunct to topical treatment regimens and sun-protection for management of melasma.