Abstract Background Melasma is a chronic, relapsing hyperpigmentation disorder that is difficult to treat, particularly in Fitzpatrick III–V skin, where energy-based devices frequently induce post-inflammatory hyperpigmentation (PIH). Radiofrequency microneedling (RFMN) has emerged as a promising alternative because it targets dermal pathology while minimizing epidermal injury. Objectives Systematically evaluate the efficacy, safety, and mechanistic rationale of RFMN for melasma. Methods A PRISMA-2020–compliant search of PubMed, Embase, Cochrane CENTRAL, and LILACS (2014–2025) identified clinical studies evaluating RFMN alone or in combination therapies. Risk of bias was assessed using JBI tools. Owing to clinical and methodological heterogeneity, a qualitative synthesis was performed. Results Across 12 included studies, RFMN consistently improved MASI/mMASI scores and melanin indices, with effects maintained up to six months. Histological evidence demonstrated reductions in dermal senescence markers and partial restoration of basement-membrane integrity. RFMN also showed a favorable safety profile, with a low incidence of PIH in darker phototypes. Combination treatment, particularly with low-fluence Q-switched Nd: YAG laser produced greater pigment reduction than monotherapy. Conclusions RFMN is an effective and safe modality for Melasma, offering advantages over pigment-directed lasers by addressing dermal mechanisms and limiting PIH risk. It may serve as a first-line energy-based therapy.
Kumar et al. (Thu,) studied this question.