The treatment of melasma with fractional photothermolysis: A pilot study

BACKGROUND. Melasma is a common pigmentary disorder that remains resistant to available therapies. Facial resurfacing with the pulsed CO₂ laser has been reported successful but requires significant downtime, and there is a risk of adverse sequelae. OBJECTIVE. To determine if melasma will respond to a new treatment paradigm, fractional resurfacing. METHODS. Ten female patients (Fitzpatrick skin types III-V) who were unresponsive to previous treatment were treated at 1- to 2-week intervals with the Fraxel laser (Reliant Technologies, Palo Alto, CA, USA). Wavelengths of 1,535 and 1,550 nm were both used, and 6 to 12 mJ per microthermal zone with 2,000 to 3,500 mtz/cm² were the treatment parameters. Four to six treatment sessions were performed. Responses were evaluated according to the percentage of lightening of original pigmentation. Two physicians evaluated the photographs, and each patient evaluated her own response. RESULTS. The physician evaluation was that 60% of patients achieved 75 to 100% clearing and 30% had less than 25% improvement. The patients' evaluations agreed, except for one patient, who graded herself as 50 to 75% improved as opposed to the physician grading of over 75%. There was one patient with postinflammatory hyperpigmentation and no patient with hypopigmentation. No downtime was necessary for wound healing. CONCLUSIONS. Fractional resurfacing affords a new treatment algorithm for the treatment of melasma that combines decreased risk and downtime with significant efficacy. This treatment modality deserves further exploration to maximize benefits.