Combination treatment of melasma with pulsed CO₂ laser followed by Q- switched alexandrite laser: A pilot study

BACKGROUND. Melasma is very difficult to treat and often refractory to treatment with topical creams and pigmented-lesion lasers. OBJECTIVE. Pulsed CO₂ laser alone is compared with the combination of pulsed CO₂ laser followed by Q-switched alexandrite laser in the treatment of dermal-type melasma. This combination is proposed to be effective by first destroying the abnormal melanocytes with the pulsed CO₂ laser and then selectively eliminating the dermal melanin with the alexandrite laser. METHODS. Four patients were randomly chosen for each treatment arm. There were multiple follow-up visits for examination by an objective blinded investigator. RESULTS. All patients in the combination laser group showed complete resolution, and two patients in the CO₂ laser only group had peripheral hyperpigmentation in the long-term follow-up evaluation. CONCLUSION. These laser therapies are safe, as there was no scarring and no infection. The combination laser therapy was highly effective in removing the hyperpigmentation and all patients in this group showed complete resolution without any peripheral hyperpigmentation.