Efficacy and safety of a novel picosecond laser using combination of 1 064 and 595 nm on patients with melasma: A prospective, randomized, multicenter, split‐face, 2% hydroquinone cream‐controlled clinical trial

Background and Objectives Melasma is a common acquired, chronic hypermelanosis and still remains a therapeutic challenge. The low‐fluence 1 064 nm Q‐switched Nd:YAG laser is the most widely used for the treatment of moderate to severe melasma in Asia. Recently, the picosecond laser has been introduced for various pigmentary disorders such as melasma. We evaluated the efficacy and safety of a picosecond laser with dual‐wavelengths (1 064 and 595 nm) and topical 2% hydroquinone (HQ) combination therapy on patients with melasma, and compared results with those obtained with 2% HQ alone. Study Design/Materials and Methods This was a prospective, randomized, split‐face, controlled trial comparing two treatments with combined 7 week 2% HQ (daily) and 5 week picosecond laser (weekly) versus 7 week 2% HQ. The primary efficacy variable was the change rate of the relative lightness values (RL*I) at week 7 from baseline. RL*I at a follow‐up visit, modified melasma severity score (mMASI), and satisfaction were assessed. Results Picosecond laser and 2% HQ had superior efficacy to 2% HQ alone: 30/39 (76.92%) subjects on combination treatment achieved ≥51% improvement of RL*I versus 1/39 (2.56%) subjects on 2% HQ. The mMASI, RL*I, and satisfaction on the laser‐treated side at week 7 supported these results. Aside from RL*I, no difference between the laser‐treated versus control side was found after follow‐up. No serious adverse events were reported. Conclusion A 750 picosecond laser using 1 064 and 595 nm was effective and safe for the treatment of Korean melasma patients. The picosecond laser with dual‐wavelength used in this study can reduce the photothermal effect generated during the removal of pigment and total duration of the procedure, and can be expected to reduce the occurrence of adverse events. Lasers Surg. Med. 49:899–907, 2017. © 2017 Wiley Periodicals, Inc.