Laser and Light-Based Therapies for Treating Melasma: An In-Depth Review

BACKGROUND Melasma is a chronic, relapsing hyperpigmentation disorder with a multifactorial etiology, posing significant treatment challenges. It is associated with substantial psychological and social burdens, often impairing quality of life. OBJECTIVE This review comprehensively explores current and emerging laser and light-based treatments for melasma, evaluating their clinical applicability, efficacy, and safety. MATERIALS AND METHODS The National Library of Medicine database (PubMed) was searched for studies published through April 2024. Studies were selected based on relevance to laser and light-based therapies for melasma, including intense pulsed light devices, Q-switched nanosecond lasers, ablative and nonablative fractionated resurfacing lasers, and picosecond lasers. RESULTS Current treatments such as intense pulsed light and Q-switched nanosecond lasers offer promising results for treatment of melasma but have risks including disease recurrence and postinflammatory pigmentary changes. Emerging treatments such as picosecond lasers show promise in reducing melanin index and improving skin texture with fewer adverse effects, showing significant reductions in melasma area and severity index scores and high patient satisfaction. CONCLUSION Laser and light-based therapies continue to evolve, with growing support for multimodal approaches that address the complex pathophysiology of melasma. Their advancement provides a nuanced approach to this challenging condition, emphasizing the need for individualized treatment plans and consideration of psychosocial impacts on patients.