Erbium:YAG laser resurfacing for refractory melasma

BACKGROUND. Melasma is a facial dyspigmentation which is a common complaint in patients with darker skin tones. Many current therapies used for this condition are ineffective and can cause significant adverse effects. OBJECTIVE. The purpose of this study was to evaluate the role of erbium:YAG laser resurfacing in the management of refractory melasma. METHODS. Ten female patients with melasma unresponsive to previous therapy of bleaching creams and chemical peels were included in this study. Full face skin resurfacing using an erbium: YAG laser (2.94 mu m) was performed using 5.1-7.6 J/cm(2) energy. Clinical evaluations using the Melasma Area and Severity Index (MASI) and melanin reflectance spectrometry measurements were taken preoperatively and at 0.5, 1, 1.5, 3, and 6 weeks and 3, 5, and 6 months postoperatively. Adverse effects after laser resurfacing such as prolonged erythema, infection, and hyperpigmentation were recorded. RESULTS. There was marked improvement of the melasma immediately after laser surgery using the parameters outlined; however, between 3 and 6 weeks postoperatively, all patients exhibited post-inflammatory hyperpigmentation. Decreased MASI and melanin reflectance spectrometry measurement scores were noted after biweekly glycolic acid peels and at the end of 4 months, significant clinical improvement in the melasma was seen compared to the preoperative evaluation. CONCLUSION. Erbium:YAG laser resurfacing effectively improves melasma; however, the almost universal appearance of transient post-inflammatory hyperpigmentation necessitates prompt and persistent intervention. The use of this laser therapy is recommended only for refractory melasma.