Comparative Efficacy and Safety of 755‐nm Picosecond Alexandrite Versus Q‐Switched Nd:YAG Lasers for Nevus of Ota: A Systematic Review and Meta‐Analysis

Background Nevus of Ota is a pigmentary condition distinguished by blue to gray‐brown macules. In recent years, laser therapy has become the favored treatment method, with the 1064 nm Q‐switched Nd: YAG laser (QSNYL) considered the traditional treatment. 755‐nm Picosecond alexandrite lasers (PSAL) have demonstrated potential as effective alternatives; however, direct comparative research between these two modalities is limited. Objectives To present an updated comparison of the safety and efficiency of 755‐nm PSAL and QSNYL in the management of nevus of Ota. Methods A PubMed, ScienceDirect, and Google Scholar search was performed. Studies were eligible for inclusion if they involved patients with nevus of Ota who received treatment with 755‐nm PSAL or QSNYL and provided outcome data. Random‐effects meta‐analyses were performed using the R software. Results Twenty‐two studies included 2667 individuals with nevus of Ota. Success rates were markedly higher with PSAL (76.10%; 95% CI [33.62–95.24]) than with QSNYL (47.59%; 95% CI [19.48–77.31]). PSAL exhibited higher rates of post‐inflammatory hyperpigmentation (PSAL: 16.74% compared to QSNYL: 8.02%) and hypopigmentation (PSAL: 8.41% vs. QSNYL: 4.48%). The recurrence rate was relatively low for both lasers, with PSAL exhibiting a slightly higher rate (PSAL: 5.32% vs. QSNYL: 2.54%). Conclusion PSAL may have superior efficacy to QSNYL for pigment clearance in patients with nevus of Ota. However, they are also associated with a higher incidence of adverse events. Since QSNYL is an established, reliable traditional treatment, further research with direct comparison is still required to determine if PSAL is a reliable alternative.