Efficacy of 694 nm Fractional Q-Switched ruby Laser for Treatment of Melasma in Thai

Sarawalai Rakchart; Wiwat Korkij; Ratchathorn Panchaprateep

Authors

Sarawalai Rakchart DIVISION OF DERMATOLOGY, DEPARTMENT OF MEDICINE, FACULTY OF MEDICINE, CHULALONGKORN UNIVERSITY, BANGKOK, THAILAND
Wiwat Korkij DIVISION OF DERMATOLOGY, DEPARTMENT OF MEDICINE, FACULTY OF MEDICINE, CHULALONGKORN UNIVERSITY, BANGKOK, THAILAND
Ratchathorn Panchaprateep DIVISION OF DERMATOLOGY, DEPARTMENT OF MEDICINE, FACULTY OF MEDICINE, CHULALONGKORN UNIVERSITY, BANGKOK, THAILAND

Keywords:

Fractional Q-switched ruby laser, Melasma

Abstract

Background: Melasma is very difficult to treat, and sometime refractory to treatment. Various pigment-specific lasers have been used in melasma with unsatisfactory results. Fractional 694 nm Q-switched ruby laser, a novel modality for facial rejuvenation, is expected to be the treatment of choice for melasma.

Objectives: To evaluate the efficacy and safety of 694 nm fractional Q-Switched ruby laser in the treatment of melasma.

Materials and Methods: Twenty-three patients with clinical diagnosis of mixed and dermal type melasma were the subjects of this split face randomized control study. All patients applied the sunscreen and were treated with 694 nm fractional Q ruby laser (4 mm spot size, 2.5-4 J/cm² fluence) on one half of the face for 4 sessions with 4 weeks intervals. Pigmentation was objectively evaluated by using a colorimeter (lightness index) and subjectively evaluated by using the modified Melasma Area and Severity Index (mMASI) score.

Results: Twenty-three females patients with skin phototype 3-4 were recruited into this study. The improvement rate of melasma on the laser sides after 1 and 3 months of the last treatment were about 2.54% and 1.18%, respectively. While the improvement rate of melasma on the control sides of the patients after 1 and 3 months of the last treatment were -4.06% and -1.48%, respectively. No statistical difference in the improvement rate of melasma was found between the control and laser groups (p-value ≥ 0.05). Evaluated by mMASI score, the laser sides show a decrease of mMASI from 16.5+8.1 to 14.6+6.5 and 15.2+6.5 at 1 and 3 months after the last treatment was completed but no statistically significant difference from the control sites (p-value = 0.736 and 0.812, respectively). The most common adverse effect was post-inflammatory hyperpigmentation, post-inflammatory hypopigmentation and urticarial rash were also found.

Conclusion: The fractional 694 nm Q-Switched ruby laser was not an effective treatment method for melasma in Thai patients. The laser treatment result in lightening of the melasma, but this is not different when compared to the sunscreen treatment.

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