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The role of 755-nm alexandrite picosecond laser in melasma management

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Melasma is a skin dyspigmentation condition that disproportionately affects women, particularly those of Latino, Black, and Asian ethnicities, significantly impacting their quality of life. Efforts to identify effective treatment options have led to the exploration of picosecond laser technology which utilizes brief pulse durations to break down pigment while minimizing thermal damage to surrounding tissue. The 755-nm alexandrite picosecond laser, currently FDA approved for benign pigmented lesion removal, including melasma, is a promising solution. We aim to assess the efficacy and safety of the 755-nm alexandrite picosecond laser both as a stand-alone treatment for melasma and in combination with topical agents. We conducted a PubMed search using “755-nm picosecond” AND “melasma,” “755-nm picosecond” AND “hydroquinone,” and “755-nm picosecond” AND “tranexamic acid.” English-written studies examining this laser as monotherapy or in combination with the topical agents were included. Those not meeting the criteria or lacking data related to melasma improvement were excluded. Monotherapy with the 755-nm picosecond laser led to a 50–75% improvement in melasma appearance in 40% of participants and a significant reduction in the average Melasma Area and Severity Index (MASI) score (p < 0.001) in all patients of one study. Notably, the use of topical tranexamic acid (TTA) in conjunction with the picosecond laser exhibited the most significant degree of improvement in hemi-MASI scores compared to the laser monotherapy group at one- and three-months post-treatment (p < 0.05). Patient satisfaction was also significantly higher for the combination group (p < 0.05). In contrast, combining hydroquinone (HQ) with the picosecond laser demonstrated no significant difference in outcomes compared to HQ alone, both of which were less effective than TTA with picosecond laser. The combination of the 755-nm picosecond laser with TTA proves promising, outperforming both laser monotherapy and laser with HQ. While monotherapy with the picosecond laser or topical agents is effective, literature favors combination therapy, especially the 755-nm picosecond laser with TTA, for superior benefits and minimal side effects. Ultimately, individualized regimens, considering factors like skin type, should be prioritized, given the heightened risk of postinflammatory hyperpigmentation, especially in skin of color patients.

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  1. Kyoung CP (2014) Melasma and common pigmentary dermatoses in asian individuals and an overview of their treatment. J Clin Investig Dermatol.

  2. Pichardo R, Vallejos Q, Feldman SR et al (2009) The prevalence of melasma and its association with quality of life in adult male Latino migrant workers. Int J Dermatol 48(1):22–26.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Freedman JR, Kaufman J, Metelitsa AI, Green JB (2014) Picosecond lasers: the next generation of short-pulsed lasers. Semin Cutan Med Surg 33(4):164–168.

    Article  PubMed  Google Scholar 

  4. Tanghetti EA (2016) The histology of skin treated with a picosecond alexandrite laser and a fractional lens array. Lasers Surg Med 48(7):646–652.

    Article  PubMed  Google Scholar 

  5. Gibboney D, Corporation C, Ma M. 3. Official correspondent.

  6. Chen YT, Lin ET, Chang CC et al (2019) Efficacy and safety evaluation of picosecond alexandrite laser with a diffractive lens array for treatment of melasma in Asian patients by VISIA imaging system. Photobiomodulation Photomed Laser Surg 37(9):559–566.

    Article  CAS  Google Scholar 

  7. Lin ET, Chiang HM, Lin BS, Huang YH, Chang CC (2021) Photoaging reversibility in Asian patients with melasma treated using picosecond lasers with a diffractive lens array: a 1-year prospective observational cohort study. Dermatol Surg Off Publ Am Soc Dermatol Surg Al 47(1):e10–e14.

    Article  CAS  Google Scholar 

  8. Polnikorn N, Tanghetti E (2020) Treatment of refractory melasma in Asians with the picosecond alexandrite laser. Dermatol Surg Off Publ Am Soc Dermatol Surg Al 46(12):1651–1656.

    Article  CAS  Google Scholar 

  9. Manuskiatti W, Yan C, Tantrapornpong P, Cembrano KAG, Techapichetvanich T, Wanitphakdeedecha R (2021) A prospective, split-face, randomized study comparing a 755-nm picosecond laser with and without diffractive lens array in the treatment of melasma in Asians. Lasers Surg Med 53(1):95–103.

    Article  PubMed  Google Scholar 

  10. Lee MC, Lin YF, Hu S et al (2018) A split-face study: comparison of picosecond alexandrite laser and Q-switched Nd:YAG laser in the treatment of melasma in Asians. Lasers Med Sci 33(8):1733–1738.

    Article  PubMed  Google Scholar 

  11. Del Rosario E, Florez-Pollack S, Zapata L et al (2018) Randomized, placebo-controlled, double-blind study of oral tranexamic acid in the treatment of moderate-to-severe melasma. J Am Acad Dermatol 78(2):363–369.

    Article  CAS  PubMed  Google Scholar 

  12. Atefi N, Dalvand B, Ghassemi M, Mehran G, Heydarian A (2017) Therapeutic effects of topical tranexamic acid in comparison with hydroquinone in treatment of women with melasma. Dermatol Ther 7(3):417–424.

    Article  Google Scholar 

  13. Kim SJ, Park JY, Shibata T, Fujiwara R, Kang HY (2016) Efficacy and possible mechanisms of topical tranexamic acid in melasma. Clin Exp Dermatol 41(5):480–485.

    Article  CAS  PubMed  Google Scholar 

  14. Cho YH, Park JE, Lim DS, Lee JS (2017) Tranexamic acid inhibits melanogenesis by activating the autophagy system in cultured melanoma cells. J Dermatol Sci 88(1):96–102.

    Article  CAS  PubMed  Google Scholar 

  15. Li Y, Yao C, Zhang H, Li L, Song Y (2022) Efficacy and safety of 755-nm picosecond alexandrite laser with topical tranexamic acid versus laser monotherapy for melasma and facial rejuvenation: a multicenter, randomized, double-blinded, split-face study in Chinese patients. Lasers Med Sci 37(7):2879–2887.

    Article  PubMed  Google Scholar 

  16. Manuskiatti W, Yan C, Gulfan MCB, Techapichetvanich T, Wanitphakdeedecha R (2022) 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. Lasers Surg Med 54(10):1245–1250.

    Article  PubMed  Google Scholar 

  17. Montroy J, Hutton B, Moodley P et al (2018) The efficacy and safety of topical tranexamic acid: a systematic review and meta-analysis. Transfus Med Rev. doi:

  18. Mamdouh KDS, Hegab DS, Mohamed El MG, Ahmad El-Ashmawy A (2023) Efficacy and safety of topical tranexamic acid alone or in combination with either fractional carbon dioxide laser or microneedling for the treatment of melasma. Dermatol Pract Concept 13(3):e2023195.

  19. Davis EC, Callender VD (2010) Postinflammatory hyperpigmentation: a review of the epidemiology, clinical features, and treatment options in skin of color. J Clin Aesthetic Dermatol 3(7):20–31

    Google Scholar 

  20. Basit H, Godse KV, Al Aboud AM (2023) Melasma. In: StatPearls. StatPearls Publishing. Accessed 12 Nov, 2023

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AP, DJ, and YA all contributed to performing a comprehensive search and writing the manuscript. KN provided us with his guidance, support, and constructive feedback throughout the process. KN also reviewed the final version of our paper to ensure it was well-prepared for submission.

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Correspondence to Anika Pulumati.

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Pulumati, A., Jaalouk, D., Algarin, Y.A. et al. The role of 755-nm alexandrite picosecond laser in melasma management. Arch Dermatol Res 316, 60 (2024).

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