Postinflammatory and rebound hyperpigmentation as a complication after treatment efficacy of telangiectatic melasma with 585 nanometers Q‐switched Nd: YAG laser and 4% hydroquinone cream in skin phototypes III‐V

Background The potential efficacy of vascular component‐targeted laser has been evaluated for the treatment of melasma, which commonly found with the co‐existence of telangiectasia. Aims To evaluate the treatment efficacy and safety of 585‐nm QSNYL and 4% HQ cream combination vs 4% HQ cream alone for telangiectatic melasma in the skin phototypes III‐V. Patients/Methods Twenty‐one Thai female patients with telangiectatic melasma and Fitzpatrick skin phototypes (FPTs) III‐V were randomly treated with the 585‐nm QSNYL on one side of the face for five sessions at 2‐week intervals. All patients were assigned to apply HQ cream daily at night on both sides of the face for 10 weeks and a broad‐spectrum sunscreen regularly throughout the study. The treatment efficacy and safety were evaluated using the Modified Melasma Area and Severity Index (mMASI), biometric evaluation, patient assessment, and adverse effects. Results The combination‐treated side yielded more significant improvement of mMASI than the topical‐treated side at weeks 2, 4, and 8, respectively. However, 19% of the patients developed postinflammatory hyperpigmentation (PIH) on the laser‐treated side, especially in FPTs IV‐V and rebound hyperpigmentation. There was a significant improvement of hemoglobin and melanin index, but without statistical difference between the two treatment groups. Conclusions The combination of 585‐nm QSNYL and HQ treatment yields treatment efficacy and skin rejuvenation effects for telangiectatic melasma. Nonetheless, a high incidence of PIH and rebound hyperpigmentation is adversely developed in dark FPT. Thus, this laser treatment should be cautiously applied in those with dark FPTs IV‐V to avoid laser‐induced pigment alteration.