Melasma is an acquired disorder of pigmentation that commonly affects women with
phototypes III-V, and it has a negative impact on the quality of life in affected individuals.
It presents clinically as symmetric tan or brown patches on the face, most often involving
the forehead, cheeks, perioral region, and periorbital region. On histologic examination,
there is increased melanin in the epidermis and/or an increased number of melanosomes
in the dermis, with a normal number of highly melanized and dendritic melanocytes. The
mainstay of treatment is the use of sunscreen along with topical medications that suppress
melanogenesis. Clearance is usually incomplete and recurrences or exacerbations are
frequent, probably because of the poor efficacy in clearing dermal melanosomes. Treatment
with high-energy pigment-specific lasers, ablative resurfacing lasers, and fractional lasers
results in an unacceptably high rate of postinflammatory hyper- and hypopigmentation and
rebound melasma. Recently, promising results have been achieved with low-fluence Qswitched
neodymium-doped yttrium aluminium garnet laser treatment, which can selectively
target dermal melanosomes without producing inflammation or epidermal damage, in
all skin phototypes. This article reviews the current treatment modalities for melasma, the
rationale for using and the clinical results of combination therapy with low-fluence Qswitched
neodymium-doped yttrium aluminium garnet lasers.
Semin Cutan Med Surg 31:126-132 © 2012 Elsevier Inc. All rights reserved.