Combination of Pulsed Wave Radiofrequency (RF) Microneedling and a Glutathione-Based Mesotherapy Solution for the Treatment of Hyperpigmentation in Darker Skin Types: A Case Study

Background: Treating hyperpigmentation in patients with Fitzpatrick skin type V – VI presents significant challenges due to high melanin content and the risk of Post-Inflammatory Hyperpigmentation (PIH). Traditional energy-based treatments often carry increased risk in darker skin tones. Dual-wave Radiofrequency (RF) microneedling, particularly in pulsed mode, offers a safer alternative for pigment correction with minimal epidermal damage. Mesotherapy solutions containing antioxidants and bioactive compounds may enhance treatment efficacy. Objective: To evaluate the safety and efficacy of combining pulsed wave RF microneedling (Sylfirm X) with a glutathione-based mesotherapy solution (Pink Glow, Koru Pharma) for hyperpigmentation in a patient with Fitzpatrick type VI. Methods: A 48-year-old female with diffuse facial hyperpigmentation underwent three sessions of pulsed wave RF microneedling (Sylfirm X, PW2 mode, 0.3 mm depth) spaced 3 weeks apart. Pink Glow, containing glutathione, hyaluronic acid, peptides, amino acids, vitamins, coenzymes, and minerals, was applied topically after each session to enhance absorption via microchannels. Skin analysis with the Quantificare LifeViz Mini 3D system assessed melanin index, evenness, and skin tone uniformity. Global improvement was evaluated using Investigator and Patient Global Assessments (IGA/PGA). Results: After three sessions, the melanin index decreased by ~31%, skin evenness improved by 67%, and tone uniformity increased by 58 percentage points. IGA and PGA scores improved from 4 to 2, indicating approximately 50% reduction in hyperpigmentation. No adverse effects, PIH, or irritation were observed. Conclusion: The combination of pulsed wave RF microneedling and a glutathione-based mesotherapy solution demonstrated a moderate-to-marked improvement in hyperpigmentation with excellent tolerability in a Fitzpatrick VI patient. This minimally invasive protocol appears promising for darker skin types, though larger, controlled studies are required to validate these findings.