Successful treatment of melasma using a combination of microdermabrasion and Q‐switched Nd:YAG lasers

Background and Objective A common, disfiguring problem in women, melasma is often refractory to treatment, and long‐term remissions are difficult to achieve. This study assessed the safety and effectiveness of a procedure combining microdermabrasion, a topical regimen, and low fluence Q‐switched Nd:YAG laser treatment. Materials and Methods In this observational study of 27 female subjects, phototypes II–V, referred for treatment of mixed‐type melasma refractory to previous therapies, low‐fluence QS Nd:YAG laser treatment of 1.6–2 J/cm2 with 5 or 6 mm spot was administered immediately following microdermabrasion. Daily application of a broad‐spectrum sunscreen began immediately; subjects used a topical skin care regimen of hydroquinone with tretinoin or vitamin C. Treatments were repeated at 4‐week intervals. Follow‐up assessment was done 3–12 months after the last treatment. Adverse effects were recorded at each visit. Standardized digital photographs obtained before each treatment session and at follow‐up visits were objectively assessed by blinded comparison using a quartile grading system. Results Treatment was successful in all skin types, deemed painless by all subjects, and required no anesthesia. Average number of treatments was 2.6. Twenty‐two subjects (81%) had >75% clearance of melasma; 11 subjects (40%) achieved >95% clearance. Most subjects showed >50% clearance of their melasma 1 month after the first treatment. Side effects were limited to mild post‐treatment erythema, which developed after the microdermabrasion and lasted approximately 30–60 minutes. Four subjects noted temporary exacerbation of melasma after inadvertent sun exposure, but this resolved within several weeks of resuming the topical skin care regime. Remission lasted at least 6 months. Conclusion Microdermabrasion plus low‐fluence QS Nd:YAG laser treatment is a simple, non‐invasive procedure with minimal risk, no recovery time, and long‐lasting remission. Treatment works on all skin phototypes in just two to three treatment sessions. Subject compliance with skin care was excellent, probably due to the dramatic improvement observed within 4 weeks. Lasers Surg. Med. 44:117–124, 2012. © 2012 Wiley Periodicals, Inc.