New Protocol for Long-Term Results With a Multi-Pulse Nd:YAG Laser for Melasma Treatment: A Descriptive Cohort Study

February 2021 | Volume 20 | Issue 2 | Original Article | 150 | Copyright © February 2021

Published online January 14, 2021

Julio César Vélez Ocampo MDa, Sebastian Vélez Ocampo MDa, Nathalia Correa Vélez MDb, Martin Braun MDc

aMedical Art, Bogotá D.C., Colombia
bDermatologist, Epidemiologist, Hospital San José (FUCS), Bogotá, Colombia
cVancouver Laser and Skin Care Centre, Vancouver, BC

Background: Melasma is a photoaging condition with a typical clinical and histological pattern under a genetic and epigenetic context. Over the years, many treatments modalities have been proposed including topical agents, oral medication, procedures, and combination treatments aiming at different aspects of the pathogenesis including photodamage, inflammation, vascularity, and pigmentation. Recently, lasers have become an alternative for the treatment of melasma using thermal energy to target, in a selective way, the chromophore found in the skin such as melanin.
Objective: This study aimed to show how we have implemented a multifactorial approach that not only treats the symptoms but addresses the primary underlying cause of melasma.
Materials and Methods: Twenty female patients with dermal and mixed melasma were admitted to Medical Art between December 2017 and April 2018 and received a four-step Fotona laser protocol. Clinical evaluation of a clearance percentage of melasma was performed 1 month after the last session by a blinded dermatologist grading the images taken during the study. Follow-up evaluation was performed at 6 and 12 months following the completion of the laser treatment, which was 6 sessions. Patients were also asked following the end of the treatment about their satisfaction, which was evaluated with a 5-point scale.
Results: This descriptive cohort study included patients with melasma who underwent the four-step laser protocol treatment at 2-week intervals. The clearance percentage score showed 70% with excellent reduction, 25% with good reduction in appearance of melasma, none of the patients with a fair reduction, and 5% with a poor reduction. The mean score of patient satisfaction was 4,65 ± 0,93 (93%).
Conclusion: Results of this study indicate that the four-step Fotona laser protocol is a safe and effective treatment option for melasma.

J Drugs Dermatol. 20(2):150-154. doi:10.36849/JDD.2021.1221


Melasma is a photoaging condition with a typical clinical and histological pattern under a genetic and epigenetic context. It is characterized by hyperpigmentation in sun-exposed areas of the skin, typically occurring on the face, with a higher prevalence in females and darker skin types.1 In this condition, a complex interaction is generated between melanocytes, fibroblasts, keratinocytes, and some immunological cells (mast cells) due to oxidative stress and the inflammatory pattern secondary to exposure to various forms of electromagnetic radiation.2

The prevalence varies depending on skin phototype, intensity of sun exposure, or ethnicity.3 It ranges between 1% and 50%.1 However, studies have reported higher prevalence among pigmented phototypes such as is found among patients of Asian, Indian, Mediterranean, and African descent.3 In America, it is more common between Latins who live in tropical areas, higher altitudes, and are more exposed to electromagnetic radiation.3 Normally, the age of onset is between 30 and 40 years.1 Lesions consist of reticulated hyperpigmented macules and patches that can be categorized by both the location and depth of involvement.4 Melasma occurs predominantly in centrofacial, malar, and mandibular areas of the face, but also can be seen on the rest of the body like the neck, chest, and forearms.5 It also can be categorized by the depth of involvement with four categories; epidermal, dermal, mixed, and indeterminate.3

The mayor etiologic factors include genetic predisposition, electromagnetic radiation such as ultraviolet energy, visible light and infrared light, pregnancy, contamination that has airborne particles and aromatic hydrocarbons, hormonal influences (mainly proopiomelanocortins, estrogens, and progestogens), prescription drugs, infections, and skin aging.4