Combination of a 755-nm picosecond laser and hydroquinone 2% cream versus hydroquinone 2% cream alone for the treatment of melasma: A randomized, split-face, and controlled trial.

BACKGROUND

While combined laser and topical treatments are currently a common approach to melasma treatment, data on the efficacy and safety of this combined therapy remain scarce, with studies showing varied results.

OBJECTIVE

To compare the efficacy and safety of hydroquinone (HQ) cream alone versus HQ cream combined with 755-nm picosecond (PS) laser in the treatment of melasma.

METHOD: Twenty subjects presenting with mixed-type melasma were enrolled in the study. All patients were instructed to apply 2% HQ cream to both sides of the face for 4 weeks. Randomly assigned hemifaces of all patients thereafter received 5 biweekly PS laser treatments. Objective (measurement of average melanin content and melanin index) and subjective (grading of modified melasma area and severity index [mMASI] score and global percentage of pigment clearance) assessments of melasma clearance, and occurrence of adverse effects were evaluated at 1-, 3-, and 6-months after the final laser treatment.

RESULTS

mMASI scores were significantly improved from baseline for both sides (p = 0.006 HQ alone, p < 0.001 HQ + PS laser), with no statistically significant difference when comparing HQ alone versus HQ + PS laser. Objective assessments (measurements of average melanin content and melanin index) of melasma clearance corresponded to the clinical evaluation using mMASI score. Mild postinflammatory hyperpigmentation was observed in 15% of the patients on the laser-treated side, while no adverse effects were reported on the HQ monotherapy side.

CONCLUSIONS

Adjunctive treatment with a 755-nm PS laser does not provide additional benefit to topical HQ in the treatment of melasma. ClinicalTrail.gov PRS. number: NCT04597203.