Melasma (also known as cholasma or mask of pregnancy) is a relatively common condition primarily affecting women, although 10% of cases also occur in men [29]. It is characterized by brown maculae that often occur symmetrically on the face; however, other sun-exposed areas may also be affected.
An initial case report [16] of a 31-year-old Caucasian woman with resistant melasma found marked improvement after two treatments with the Fraxel 1550 nm laser (6-8 mJ, total density 2000 MTZ/cm2). She continued to show improvement at her six-month follow-up.
Another pilot study [29] examined 10 female patients with melasma (skin types III-V) who received four to six Fraxel 1550 nm treatments (fluence 6-12 mJ, total density 2000-3500 MTZ/cm2). Sixty percent of these patients achieved 75-100% clearance. Interestingly, one of these patients was Hispanic, while other Hispanic subjects tended to respond less favorably. Another patient (Asian, Type IV skin) had 100% clearance without any incidence of hyper – or hypopigmentation.
Overall, patients with melasma should be treated at monthly or greater intervals using lower fluence levels and treatment densities to minimize the risk of postinflammatory change. Typically, multiple treatments are needed. It is also important to remind patients that melasma can be recurrent, especially when the causative melanocytes and hormonal profile are still present [18].