OpenLB
Open Library of Bioscience
Advanced Search
Journal of cosmetic dermatology
Jul, 2022;21 (7):

Efficacy of low-fluence 1064 nm Q-switched Nd: YAG laser for the treatment of melasma: A meta-analysis and systematic review.

Jiaoquan Chen, Nanji Yu, Liqian Peng, Huaping Li, Yi Tang, Shanshan Ou, Huilan Zhu
Author Information
  1. Jiaoquan Chen: Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, China.
  2. Nanji Yu: Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, China.
  3. Liqian Peng: Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, China.
  4. Huaping Li: Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, China.
  5. Yi Tang: Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, China.
  6. Shanshan Ou: Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, China.
  7. Huilan Zhu: Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, China.
PMID: 35621242 DOI: 10.1111/jocd.15126

Abstract

BACKGROUND: Melasma is considered as a type of acquired facial pigmentary disorder that is challenging to treat. Low-fluence 1064 nm Q-switched Nd: YAG laser (LQSNY) has clinical benefits against melasma; however, there are some disputes.
OBJECTIVE: To explore these contentious views, we conducted a meta-analysis and systematic review to evaluate the efficacy and safety of LQSNY monotherapy and combined therapy for the treatment of melasma.
METHODS: The PubMed, Embase, Cochrane Library, and Web of Science databases were searched for relevant articles from inception to July 2021. The resulting data were analyzed using the Review Manager 5.3 software.
RESULTS: Twelve eligible studies comprising 358 patients were included. No significant differences in melasma area and severity index (MASI) were observed between the LQSNY and drug groups (mean difference (MD):-0.26, 95% confidence interval (CI):-1.16-0.64, p = 0.57). We found that combination therapy with LQSNY and drugs had a greater MASI improvement compared with LQSNY therapy alone (MD: 1.78, 95% CI 0.93-2.63, p < 0.0001); nevertheless, no statistically significant results were found in melanin index (MI) and self-assessment. The melasma improvement was similar when using LQSNY alone and LQSNY combined with other lasers in terms of RMASI (MD 0.05, 95% CI:-0.61, 0.70, p = 0.56). Compared with intense pulsed light (IPL) alone, LQSNY with IPL provided an added benefit for melasma severity (MD:3.23, 95% CI:0.65-5.81, p = 0.01).
CONCLUSION: Low-fluence 1064 nm Q-switched Nd: YAG laser can be applied as an alternative treatment for drug intolerance. Combination therapy with LQSNY and drugs or other lasers may have pleasantly surprising efficacy, but numerous studies are still needed to verify this.

Keywords

drugs low-fluence 1064 nm QSNYL melasma meta-analysis

References

Micek I, Pawlaczyk M, Kroma A, Seraszek-Jaros A, Urbańska M, Gornowicz-Porowska J. Treatment of melasma with a low-fluence 1064 nm Q-switched Nd: YAG laser: Laser toning in Caucasian women. Lasers Surg Med. 2021;54:366-373.
Ogbechie-Godec OA, Elbuluk N. Melasma: an up-to-date comprehensive review. Dermatol Ther (Heidelb). 2017;7:305-318.
Zhou LL, Baibergenova A. Melasma: systematic review of the systemic treatments. Int J Dermatol. 2017;56:902-908.
Passeron T. Melasma pathogenesis and influencing factors - An overview of the latest research. J Eur Acad Dermatol Venereol. 2013;27(Suppl 1):5-6.
Artzi O, Horovitz T, Bar-Ilan E, et al. The pathogenesis of melasma and implications for treatment. J Cosmet Dermatol. 2021;20:3432-3445.
Ikino JK, Nunes DH, Silva VP, et al. Melasma and assessment of the quality of life in Brazilian women. An Bras Dermatol. 2015;90:196-200.
Neagu N, Conforti C, Agozzino M, et al. Melasma treatment: a systematic review. J Dermatolog Treat. 2021;23:1-39.
Boukari F, Jourdan E, Fontas E, et al. Prevention of melasma relapses with sunscreen combining protection against UV and short wavelengths of visible light: a prospective randomized comparative trial. J Am Acad Dermatol. 2015;72:189-190.
Zhang Y, Zheng X, Chen Z, Lu L. Laser and laser compound therapy for melasma: a meta-analysis. J Dermatolog Treat. 2020;31:77-83.
Iranmanesh B, Khalili M, Mohammadi S, Amiri R, Aflatoonian M. The efficacy of energy-based devices combination therapy for melasma. Dermatol Ther. 2021;34:e14927.
Park KY, Kim DH, Kim HK, Li K, Seo SJ, Hong CK. A randomized, observer-blinded, comparison of combined 1064-nm Q-switched neodymium-doped yttrium-aluminium-garnet laser plus 30% glycolic acid peel vs. laser monotherapy to treat melasma. Clin Exp Dermatol. 2011;36:864-870.
Bansal C, Naik H, Kar HK, et al. A comparison of low-fluence 1064-nm Q-switched Nd: YAG Laser with topical 20% azelaic acid cream and their combination in melasma in Indian patients. J Cutan Aesthet Surg. 2012;5:266-272.
Lee DB, Suh HS, Choi YS. A comparative study of low-fluence 1064-nm Q-switched Nd: YAG laser with or without chemical peeling using Jessner's solution in melasma patients. J Dermatolog Treat. 2014;25:523-528.
Shin JU, Park J, Oh SH, Lee JH. Oral tranexamic acid enhances the efficacy of low-fluence 1064-nm quality-switched neodymium-doped yttrium aluminum garnet laser treatment for melasma in Koreans: a randomized, prospective trial. Dermatol Surg. 2013;39:435-442.
Ustuner P, Balevi A, Ozdemir M. A split-face, investigator-blinded comparative study on the efficacy and safety of Q-switched Nd: YAG laser plus microneedling with vitamin C versus Q-switched Nd: YAG laser for the treatment of recalcitrant melasma. J Cosmet Laser Ther. 2017;19:383-390.
Laothaworn V, Juntongjin P. Topical 3% tranexamic acid enhances the efficacy of 1064-nm Q-switched neodymium-doped yttrium aluminum garnet laser in the treatment of melasma. J Cosmet Laser Ther. 2018;20:320-325.
Kim HS, Kim EK, Jung KE, Park YM, Kim HO, Lee JY. A split-face comparison of low-fluence Q-switched Nd: YAG laser plus 1550 nm fractional photothermolysis vs. Q-switched Nd: YAG monotherapy for facial melasma in Asian skin. J Cosmet Laser Ther. 2013;15:143-149.
Kong SH, Suh HS, Choi YS. Treatment of melasma with pulsed-dye laser and 1,064-nm Q-switched Nd: YAG laser: a split-face study. Ann Dermatol. 2018;30:1-7.
Yun WJ, Moon HR, Lee MW, Choi JH, Chang SE. Combination treatment of low-fluence 1,064-nm Q-switched Nd: YAG laser with novel intense pulse light in Korean melasma patients: a prospective, randomized, controlled trial. Dermatol Surg. 2014;40:842-850.
Vachiramon V, Sirithanabadeekul P, Sahawatwong S. Low-fluence Q-switched Nd: YAG 1064-nm laser and intense pulsed light for the treatment of melasma. J Eur Acad Dermatol Venereol. 2015;29:1339-1346.
Kar HK, Gupta L, Chauhan A. A comparative study on efficacy of high and low fluence Q-switched Nd: YAG laser and glycolic acid peel in melasma. Indian J Dermatol Venereol Leprol. 2012;78:165-171.
Dev T, Sreenivas V, Sharma VK, Sahni K, Bhari N, Sethuraman G. A split face randomized controlled trial comparing 1,064 nm Q-switched Nd-YAG laser and modified Kligman's formulation in patients with melasma in darker skin. Int J Dermatol. 2020;59:1525-1530.
Yang X, Lu Y, He F, et al. Benzene metabolite hydroquinone promotes DNA homologous recombination repair via the NF-kappaB pathway. Carcinogenesis. 2019;40:1021-1030.
Tian WC. Novel technique to treat melasma in Chinese: the combination of 2940-nm fractional Er:YAG and 1064-nm Q-switched Nd: YAG laser. J Cosmet Laser Ther. 2016;18:72-74.
Lee HC, Thng TG, Goh CL. Oral Tranexamic Acid (TA) in the treatment of melasma: a retrospective analysis. J Am Acad Dermatol. 2016;75:385-392.
Kim JH, Kim H, Park HC, Kim IH. Subcellular selective photothermolysis of melanosomes in adult zebrafish skin following 1064-nm Q-switched Nd: YAG laser irradiation. J Invest Dermatol. 2010;130:2333-2335.
Ibrahim S, Farag AS, Ali MS, et al. Efficacy and safety of topical silymarin versus low fluence 1064-nm Q switched Nd: YAG laser in the treatment of melasma: a comparative randomized trial. Lasers Surg Med. 2021;53:1341-1347.
Schmults CD, Phelps R, Goldberg DJ. Nonablative facial remodeling: erythema reduction and histologic evidence of new collagen formation using a 300-microsecond 1064-nm Nd: YAG laser. Arch Dermatol. 2004;140:1373-1376.
Gaffey MM, Johnson AB. Laser Treatment of Pigmented Lesions. StatPearls Publishing; 2021.
Jeong SY, Shin JB, Yeo UC, et al. Low-fluence Q-switched neodymium-doped yttrium aluminum garnet laser for melasma with pre- or post-treatment triple combination cream. Dermatol Surg. 2010;36:909-918.
Saleh F, Moftah NH, Abdel-Azim E, Gharieb MG. Q-switched Nd: YAG laser alone or with modified Jessner chemical peeling for treatment of mixed melasma in dark skin types: a comparative clinical, histopathological, and immunohistochemical study. J Cosmet Dermatol. 2018;17:319-327.
Feng X, Su H, Xie J. Efficacy and safety of tranexamic acid in the treatment of adult melasma: an updated meta-analysis of randomized controlled trials. J Clin Pharm Ther. 2021;46:1263-1273.
Na SY, Cho S, Lee JH. Intense pulsed light and low-fluence Q-switched Nd: YAG laser treatment in melasma patients. Ann Dermatol. 2012;24:267-273.

Grants

  1. 2019A1515011593/the Natural Science Foundation of Guangdong Province

MeSH Term

Combined Modality Therapy
Face
Humans
Lasers, Solid-State
Low-Level Light Therapy
Melanosis
Treatment Outcome
Journal Article Meta-Analysis Systematic Review

Word Cloud

Similar Articles

Cited By