Melasma and laser treatment: an evidenced-based analysis

The use of lasers in the treatment of melasma has been addressed in case reports, but there is no consensus in the literature regarding the safety, efficacy, or durability of laser-based treatments. Furthermore, given the potential risks of laser intervention in hyperpigmented skin, the relative risks and benefit of laser must be compared to more conservative and traditional treatment approaches. English language literature in which the main intervention was a light-based therapy and the target was melasma was analyzed. The study included only prospective, controlled studies which included at least 10 participants, and which presented the data with accepted objective and quantitative study metrics. Seven studies met the inclusion criteria. Two studies reported the response to melanin-targeting lasers and five reported the response to fractional photothermolysis. The response to lasers was not consistent among the reports. Adverse events including hyperpigmentation were reported in several studies. The durability of melasma improvement was limited in all cases where laser was used as monotherapy. In studies that compared laser to topical treatments, laser-based monotherapy failed to show benefit over topical treatments. This analysis suggests that the use of lasers for the treatment of melasma cannot be recommended, due to unpredictable safety and efficacy, time-limited clinical improvement, and no clear benefit over conventional treatments.