Melasma treatment with the Q-switched 1,064 nm neodymium-doped yttrium aluminum garnet laser using a novel low-fluence large spot size approach in Colombia: retrospective study

Abstract

Background: Melasma remains a significant problem for dermatologists and their patients. While medication remains the first-line of treatment, advances in laser technology and understanding of laser-tissue interactions in melasma-affected skin have gained attention, particularly with respect to the low-fluence Q-switched 1,064 nm Nd:YAG (LFQ-YAG) laser. The present retrospective study shares the optimistic results of the treatment of melasma recalcitrant to conventional approaches with a new generation of this laser type. Methods: The study included 11 naïve patients and 33 recalcitrant (mean age: 38 ± 8 years), and Fitzpatrick phototypes II-V. Treatments were performed using an LFQ-YAG laser at 0.8 J/cm2 fluence, an 8 mm spot size, and a 10 Hz frequency, with 3 passes per session and 7-14 days between treatments. Pigmentation intensity was evaluated using the Melasma Area and Severity Index (MASI), while adverse events, including erythema, and patient satisfaction were also scored. Results: All the patients completed 3-5 sessions (average 4) with follow-up. Improvement was observed after an average of 2.5 ± 0.7 sessions. The mean MASI scores significantly decreased to 2.49 ± 1.77 (range: 0-6.3), demonstrating reduced melasma severity without exacerbation. For those with recurrence, pigmentation density remained lower than the baseline. All patients expressed satisfaction and willingness to repeat the treatment. Conclusion: Based on the results of this study on melasma patients in the Latin-American population with a wide variety of skin types, the 1,064 nm LFQ-YAG laser offers a viable, safe, and effective treatment for both treatment-naïve melasma and melasma recalcitrant to other methods.