The Efficacy of Laser Therapy in Melasma Treatment: A Systematic Review and Meta-Analysis

Abstract

Introduction Laser treatment is one of the most common methods currently used to treat melasma. Here in, we reviewed RCTs with at least one laser therapy arm used in net form for treatment, so as to assess the use of laser therapy for melasma treatment with a degree of certainty. Methods A systematic literature search was performed on the effectiveness of laser therapy for melasma treatment in the period from 2010 to 2024 using the keywords melasma, laser, and efficacy in the title. Finally, a meta-analysis was conducted using the mean and standard deviation of the Melasma Area and Severity Index (MASI) variations before and after each session of laser therapy in different studies. Results Sixteen RCTs on the efficacy, safety, and recurrence associated with laser therapy for melasma were eventually included and assessed. A total of 471 patients with a mean age of 35.3-46.4 years were examined. The 1064-nm Q-Switched Nd:YAG Laser (QSNd:YAG) was the most common laser investigated in the studies. There were 2-12 treatment sessions, with 1-4-week intervals, and the patients' follow-up period was 2-6 months. The use of SSR (Super Skin Rejuvenation, 540 nm), low-energy QSNDY, and pixel-Er:YAG (Erbium YAG) for five sessions at 3-week intervals showed a very significant decrease in the modified MASI (mMASI) score (p < 0.001). Pixel-Er:YAG showed the maximum mMASI reduction and homogeneity (p > 0.001). Epidermal melasma had the best results with SSR and PQSND (Y Pixel Q-Switched Nd:YAG Laser) (p < 0.001). Conclusion Among the reviewed RCTs, the largest weight was assigned to a 2014 study that examined 40 patients (4.79 weight). The standardized variation of the mean MASI was negative in all studies, except for a 2011 study, which had the lowest weight among the studies (2.84), indicating the mitigation of symptoms following laser therapy. A meta-analysis of 16 research studies (26 treatment arms) was performed to determine the efficacy of laser therapy for melasma. Treatment resulted in a significant improvement in MASI scores, with a pooled standardized mean difference of 0.88 (95 CI: 0.65-1.11, p < 0.00001). Due to moderate-to-high heterogeneity (I2 = 68.4), a random-effects model was employed. Overall, the findings indicate that for the majority of patients, laser therapy reduces pigmentation and lesion severity.