A pilot study on the use of a non‐crosslinked hyaluronic acid with associated anti‐oxidant ingredients to improve the effectiveness of Nd:YAG laser toning in the treatment of melasma in six patients

Background Melasma is a common skin disorder. Nd:YAG laser toning is a popular treatment for melanin clearance. Treatment efficacy is limited by factors such as presence of reactive oxygen species, DNA damage, TEWL, and skin barrier disruption. Aims The purpose of this pilot study is to explore the efficacy of a non‐crosslinked hyaluronic acid with anti‐oxidant ingredients in mitigating the above‐stated factors in the treatment of melasma using Nd:YAG laser toning. Method In this pilot retrospective study of six cases with melasma, Nd:YAG laser toning was performed for each case until improvement of melasma has plateaued (after 4‐6 sessions) and at which point treatment was paused. After injecting non‐crosslinked hyaluronic acid (9‐12 mL) with anti‐oxidant ingredients into the face with focus on the lesional skin, further sessions (4‐6) of Nd:YAG laser toning was resumed. Before, interim (improvement has plateaued), and after (on completion of the remaining sessions of laser toning after hyaluronic acid injection) photos of the six cases were scored using modified MASI. ANOVA analysis was applied to the scores. Results All six melasma cases had further improvement in melasma clearance after hyaluronic acid injection beyond the point when improvement has plateaued. ANOVA analysis of before, interim, and after scores showed statistical significance in difference between the three groups. Conclusion This pilot study of six cases suggests that the use of a non‐crosslinked hyaluronic acid with anti‐oxidants may improve the efficacy of Nd:YAG laser toning in the treatment of melasma.