A Randomized, Controlled, Split-Face Study of the Efficacy of a Picosecond Laser in the Treatment of Melasma

November 2019 | Volume 18 | Issue 11 | Original Article | 1104 | Copyright © November 2019

Alexis B. Lyons MD,ª Ronald L. Moy MD,B Jennifer L. Herrmann MDb,c

ªDepartment of Dermatology, Henry Ford Hospital, Detroit, MI

bMoy, Fincher, Chipps Facial Plastics & Dermatology, Beverly Hills, CA

cDepartment of Dermatology, Harbor UCLA, Torrance, CA

Introduction: Melasma is a common disorder where patients develop hyperpigmented macules and patches on the face and is thought to be the result of sun exposure and hormonal contributions, although the pathogenesis is not completely understood. Lasers have been used for melasma treatment with varying degrees of success.

Objectives: The objective of this study was to examine the safety and efficacy of a novel picosecond laser for the treatment of melasma.

Materials and Methods: Ten subjects received nine weekly laser treatments with a picosecond laser to a randomized half of their face. A lightening cream was applied to the entire face to serve as a control. The primary outcome measure was clinical efficacy measured by a patient-reported outcome survey, the Melasma Quality of Life (MELASQOL) questionnaire, and physician assessment with the Global Aesthetic Improvement Scale (GAIS). The secondary outcome measure was safety, which was assessed by monitoring for adverse events. Photos were taken before every treatment and at a 1-week follow-up.

Results: Ninety percent of subjects rated their melasma as at least slightly better, and 90% percent of subjects would recommend this laser treatment to others with melasma. MELASQoL questionnaire scores improved by an average of 5.7 points after laser treatment. Assessments by two board-certified dermatologists using the GAIS revealed an overall improvement in 80% of patients on the laser treatment side versus 20% on the control side. Side effects, including erythema and discomfort, were minimal and transient post-treatment.

Conclusions: This study suggests that picosecond laser treatments are a safe and efficacious way to treat melasma.

J Drugs Dermatol. 2019;18(11):1104-1107.


Melasma is a pigmentary disorder in which patients develop symmetric, hyperpigmented macules and patches most commonly on the face. Although the pathogenesis has not been completely elucidated, sun exposure and hormones are thought to contribute to the condition. It occurs most commonly in women and is more prevalent in darker skinned individuals but can occur in all skin types.1

With more than 5 million Americans affected, melasma is a common reason for dermatology appointments and can negatively impact the quality of life of patients.2,3 Despite its widespread prevalence, the treatment of melasma has proven to be difficult. The challenges of treatment are attributed to the chronicity, recurrence rate, and unclear pathogenesis. Many lasers have been used for the treatment of melasma with varying degrees of success. The aim of this study was to investigate the efficacy and safety of a novel picosecond laser for the treatment of melasma.


This was a randomized, controlled, split-face prospective study. A total of 10 subjects with a previous diagnosis of melasma were recruited from a dermatology office in Beverly Hills, CA. Inclusion criteria included subjects ages 18-65 with a diagnosis of melasma who were able to provide informed consent. Exclusion criteria included subjects under the age of 18 or over the age of 65, those who had used bleaching creams, chemical peels, or laser treatments within the past month prior to enrollment, those who were pregnant or breast feeding, and those who were on oral contraceptive pills.

Informed consent was obtained from subjects who fulfilled the eligibility criteria. Subjects were then randomized to laser treatment on one side of the face and underwent nine weekly picosecond laser treatments using the PiQo4 laser (Lumenis). Subjects were given and instructed to use a topical lightening cream containing .05% tretinoin/3% kojic acid/6% hydroquinone/1% hydrocortisone to their entire face daily for the duration