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Lasers in Medical Science

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01.12.2024 | Review Article

Efficacy and Safety of Ablative Fractional Laser in Melasma: A Meta-analysis and Systematic Review

verfasst von: Shasha Zhao, Meng Wang, Xiaodong Lai, Yan Yan

Erschienen in: Lasers in Medical Science | Ausgabe 1/2024

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Abstract

Melasma is a common acquired skin pigmentation disorder. The treatment is urgent but challenging. Ablative fractional laser (AFL) can improve pigmentation, but the efficacy and potential side effects are still debatable. This study aimed to evaluate the efficacy and safety of ablative fractional lasers in the treatment of melasma. A comprehensive systematic search of literature published before June 20, 2023, was conducted on online databases, including PubMed, Embase, Cochrane Library, and Web of Science. The data obtained were analyzed using Review Manager 5.4 software. Fourteen randomized controlled trials, comprising 527 patients, were included. Compared to the drug alone, the combination of AFL and the drug showed improved therapeutic efficacy in the melasma area and severity index (MASI) (MD = 1.54, 95% CI [0.16, 2.92], P = 0.03) and physician global assessment (RR = 1.61, 95% CI [1.08, 2.41], P = 0.02). However, no statistically significant results were found in patient self-assessment (RR = 1.56, 95% CI [0.88, 2.76], P = 0.12). As an individual therapy, AFL is not superior to any other lasers in terms of MASI (MD = 2.66, 95% CI [-1.32, 6.64], P = 0.19) or melanin index (MD = -7.06, 95% CI [-45.09, 30.97], P = 0.72). Common adverse events included transient erythema, burning, edema, and superficial crusting. Only a few patients experienced reversible post-inflammatory hyperpigmentation, herpes labialis, and acne breakouts. These results support the application of AFL as a viable treatment option for melasma, particularly in refractory and severe cases. Rational parameterization or combination therapy may lead to significant clinical improvement with fewer complications.

Kwon SH, Na JI, Choi JY et al (2019) Melasma: Updates and perspectives. Experimental Dermatol 28(6):704–8. https://doi.org/10.1111/exd.13844CrossRef

Passeron T (2013) Melasma pathogenesis and influencing factors - an overview of the latest research. J Eur Acad Dermatol Venereol 27(Suppl 1):5–6. https://doi.org/10.1111/jdv.12049CrossRefPubMed

Artzi O, Horovitz T, Bar-Ilan E et al (2021) The pathogenesis of melasma and implications for treatment. J Cosmet Dermatol 20(11):3432–45. https://doi.org/10.1111/jocd.14382CrossRefPubMed

Piętowska Z, Nowicka D, Szepietowski JC (2022) Understanding melasma-how can pharmacology and cosmetology procedures and prevention help to achieve optimal treatment results? A narrative review. Int J Environ Res Public Health 19(19):12084. https://doi.org/10.3390/ijerph191912084

Espósito ACC, Cassiano DP, da Silva CN et al (2022) Update on Melasma-Part I: Pathogenesis. Dermatol Ther (Heidelb). 12(9):1967–88. https://doi.org/10.1007/s13555-022-00779-xCrossRefPubMedPubMedCentral

Cassiano DP, Espósito ACC, da Silva CN et al (2022) Update on Melasma-Part II: Treatment. Dermatol Ther (Heidelb). 12(9):1989–2012. https://doi.org/10.1007/s13555-022-00780-4CrossRefPubMedPubMedCentral

Lai D, Zhou S, Cheng S et al (2022) Laser therapy in the treatment of melasma: a systematic review and meta-analysis. Lasers Med Sci. 37(4):2099–110. https://doi.org/10.1007/s10103-022-03514-2CrossRefPubMed

Morais OO, Lemos ÉF, Sousa MC et al (2013) The use of ablative lasers in the treatment of facial melasma. An Bras Dermatol. 88(2):238–42. https://doi.org/10.1590/s0365-05962013000200009CrossRefPubMedPubMedCentral

Ng WHS, Smith SD (2022) Laser-assisted drug delivery: a systematic review of safety and adverse events. Pharmaceutics 14(12):2738. https://doi.org/10.3390/pharmaceutics14122738CrossRefPubMedPubMedCentral

10.

Higgins JP, Altman DG, Gøtzsche PC et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Bmj. 343:d5928. https://doi.org/10.1136/bmj.d5928CrossRefPubMedPubMedCentral

11.

Jalaly NY, Valizadeh N, Barikbin B et al (2014) Low-power fractional CO₂ laser versus low-fluence Q-switch 1,064 nm Nd:YAG laser for treatment of melasma: a randomized, controlled, split-face study. Am J Clin Dermatol 15(4):357–63. https://doi.org/10.1007/s40257-014-0080-xCrossRefPubMed

12.

Tawfic SO, Abdel Halim DM, Albarbary A et al (2019) Assessment of combined fractional CO(2) and tranexamic acid in melasma treatment. Lasers Surg Med 51(1):27–33. https://doi.org/10.1002/lsm.23032CrossRefPubMed

13.

Nourmohammadi Abadchi S, Fatemi Naeini F, Beheshtian E (2019) Combination of Hydroquinone and Fractional CO(2) Laser versus Hydroquinone Monotherapy in Melasma Treatment: A Randomized, Single-blinded. Split-face Clinical Trial Indian J Dermatol 64(2):129–35. https://doi.org/10.4103/ijd.IJD_240_17CrossRefPubMed

14.

Qu Y, Wang F, Liu J et al (2021) Clinical observation and dermoscopy evaluation of fractional CO(2) laser combined with topical tranexamic acid in melasma treatments. J Cosmet Dermatol 20(4):1110–6. https://doi.org/10.1111/jocd.13992CrossRefPubMed

15.

Elmorsy E, Aboukhadr N, Tayyeb M et al (2021) Low-power Fractional Carbon Dioxide Laser Followed by Jessner’s Peel versus Jessner’s Peel Alone for the Treatment of Melasma. J Clin Aesthet Dermatol 14(2):61–7PubMedPubMedCentral

16.

Mekawy KMM, Sadek A, Seddeik Abdel-Hameed AK (2021) Micro-needling versus fractional carbon dioxide laser for delivery of tranexamic acid in the treatment of melasma: A split-face study. J Cosmet Dermatol 20(2):460–5. https://doi.org/10.1111/jocd.13537CrossRefPubMed

17.

Esmat S, Elramly AZ, Shahin D, Hilal RF et al (2021) Combining Low Power Fractional CO(2) With QS-NdYAG Toning in the Treatment of Melasma Reduces the Incidence of Punctate Leukoderma. Lasers Surg Med 53(10):1325–40. https://doi.org/10.1002/lsm.23441CrossRefPubMed

18.

Tawfic SO, Abdel Hay RM, Abouelazm DI et al (2022) Tranexamic Acid Microinjection Alone Versus Its Combination With Fractional Carbon Dioxide Laser in Melasma Treatment: A Dermoscopic Evaluation. Dermatol Surg. 48(5):556–61. https://doi.org/10.1097/dss.0000000000003423CrossRefPubMed

19.

Alavi S, Abolhasani E, Asadi S et al (2017) Combination of Q-Switched Nd:YAG and Fractional Erbium:YAG Lasers in Treatment of Melasma: A Randomized Controlled Clinical Trial. J Lasers Med Sci 8(1):1–6. https://doi.org/10.15171/jlms.2017.01CrossRefPubMedPubMedCentral

20.

Badawi AM, Osman MA (2018) Fractional erbium-doped yttrium aluminum garnet laser-assisted drug delivery of hydroquinone in the treatment of melasma. Clin Cosmet Investig Dermatol 11:13–20. https://doi.org/10.2147/ccid.s147413CrossRefPubMedPubMedCentral

21.

Garg S, Vashisht KR, Makadia S (2019) A prospective randomized comparative study on 60 Indian patients of melasma, comparing pixel Q-switched NdYAG (1064 nm), super skin rejuvenation (540 nm) and ablative pixel erbium YAG (2940 nm) lasers, with a review of the literature. J Cosmet Laser Ther 21(5):297–307. https://doi.org/10.1080/14764172.2019.1605447CrossRefPubMed

22.

Al-Dhalimi MA, Yasser RH (2021) Evaluation of the of the efficacy of Fractional Erbium-Doped Yttrium Aluminum Garnet Laser-Assisted Drug Delivery of Kojic Acid in the Treatment of Melasma; A split face, comparative clinical study. J Cosmet Laser Ther 23(3–4):65–71. https://doi.org/10.1080/14764172.2021.1964536CrossRefPubMed

23.

Nasimi M, Ghiasi M, Lajevardi V et al (2022) A split-face comparison of fractional erbium: YAG laser plus Kligman’s formula vs Kligman’s formula monotherapy for facial melasma. Arch Dermatol Res 314(8):791–7CrossRefPubMed

24.

Mokhtari F, Bahrami B, Faghihi G et al (2022) Fractional erbium:YAG laser (2940 nm) plus topical hydroquinone compared to intradermal tranexamic acid plus topical hydroquinone for the treatment of refractory melasma: a randomized controlled trial. J Dermatolog Treat 33(5):2475–81. https://doi.org/10.1080/09546634.2021.1968996CrossRefPubMed

25.

Neagu N, Conforti C, Agozzino M et al (2022) Melasma treatment: a systematic review. J Dermatolog Treat 33(4):1816–37. https://doi.org/10.1080/09546634.2021.1914313CrossRefPubMed

26.

Abdel-Raouf Mohamed H, Ali Nasif G, Saad Abdel-Azim E et al (2019) Comparative study of fractional Erbium: YAG laser vs combined therapy with topical steroid as an adjuvant treatment in melasma. J Cosmet Dermatol 18(2):517–23. https://doi.org/10.1111/jocd.12751CrossRefPubMed

27.

El-Sinbawy ZG, Abdelnabi NM, Sarhan NE et al (2019) Clinical & ultrastructural evaluation of the effect of fractional CO2 laser on facial melasma. Ultrastructural pathology 43(4–5):135–44. https://doi.org/10.1080/01913123.2019.1673861CrossRefPubMed

28.

Hsiao CY, Yang SC, Alalaiwe A et al (2019) Laser ablation and topical drug delivery: a review of recent advances. Expert Opinion Drug Delivery 16(9):937–52. https://doi.org/10.1080/17425247.2019.1649655CrossRef

29.

Kaufman BP, Aman T, Alexis AF (2018) Postinflammatory Hyperpigmentation: Epidemiology, Clinical Presentation, Pathogenesis and Treatment. Am J Clin Dermatol. 19(4):489–503. https://doi.org/10.1007/s40257-017-0333-6CrossRefPubMed

30.

Tian WC (2016) Novel technique to treat melasma in Chinese: The combination of 2940-nm fractional Er:YAG and 1064-nm Q-switched Nd:YAG laser. J Cosmet Laser Ther 18(2):72–4. https://doi.org/10.3109/14764172.2015.1063662CrossRefPubMed

Titel: Efficacy and Safety of Ablative Fractional Laser in Melasma: A Meta-analysis and Systematic Review
verfasst von: Shasha Zhao
Meng Wang
Xiaodong Lai
Yan Yan
Publikationsdatum: 01.12.2024
Verlag: Springer London
Erschienen in: Lasers in Medical Science / Ausgabe 1/2024
Print ISSN: 0268-8921
Elektronische ISSN: 1435-604X
DOI: https://doi.org/10.1007/s10103-024-03972-w

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Efficacy and Safety of Ablative Fractional Laser in Melasma: A Meta-analysis and Systematic Review

Abstract

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

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