Efficacy of Fractional Picosecond Nd:YAG Laser for Lichen Planus Pigmentosus: A Randomized Comparative Study

Background: Lichen planus pigmentosus (LPP) is a chronic dermal pigmentary disorder predominantly affecting individuals with darker skin types. Traditional treatments often fail to clear residual pigmentation. Picosecond-domain lasers have emerged as promising tools due to their photoacoustic mechanism, minimal thermal damage, and potential for deeper dermal remodeling. Method: This prospective, randomized, assessor-blinded study included 20 Indian patients with stable facial LPP. Participants were divided equally into two groups. Group A received four sessions of fractional 1064 nm picosecond Nd:YAG laser followed by toning every 4–6 weeks. Group B underwent four sessions of laser toning alone at 2–3 week intervals. Efficacy was assessed using QuantifiCare® 3D imaging, expert grading, and patient satisfaction scores. Safety and adverse events were documented. Results: Group A showed superior pigment clearance with a mean reduction of 36.2% vs. 21.8% in Group B. Sixty percent of Group A achieved >75% clinical improvement compared to 10% in Group B. Patient satisfaction scores were higher in Group A (6.7 vs. 4.6). No long-term adverse effects were observed. Conclusion: Fractional picosecond Nd:YAG laser combined with toning offers enhanced efficacy and safety in treating LPP, particularly in darker skin types.