Treatment of melasma with the 1,927‐nm fractional thulium fiber laser: A retrospective analysis of 20 cases with long‐term follow‐up

BACKGROUND: Melasma is a common acquired symmetrical hyperpigmentation that is often recurrent and refractory. OBJECTIVES: To investigate the efficacy and safety of a single administration of high-density fractional thulium fiber laser (1,927 nm) for the treatment of refractory melasma in 20 patients. MATERIALS AND METHODS: A retrospective chart and photographs review of 20 women (Fitzpatrick skin type II-IV) with clinical diagnosis of melasma treated with the 1,927-nm fractionated thulium laser at 10 or 20 mJ/cm(2) , with 60-70% surface area coverage. Four investigators independently evaluated Melasma Area Severity Index (MASI) scores before, 4 weeks, 3-6 months, and 6-12 months after treatment. RESULTS: Mean MASI scores decreased dramatically from 13.2 ± 5.4 before treatment to 8.5 ± 3.5 at 4 weeks after laser treatment (P = 0.004). Patient assessment revealed that 12 of the 20 subjects had more than 50% clearance of their melasma. Recurrence was reported by 7 out of 15 patients who were successfully followed-up (mean 10.2 months). Two patients developed postinflammatory hyperpigmentation that subsided with topical bleaching after 3 months. CONCLUSION: High-density coverage fractional 1,927-nm thulium laser proved to be safe and effective for melasma with long-term remission.