A disappointing conclusion was made from a recent study:
Treatment of Melasma Using Variable Square Pulse Er: YAG Laser Resurfacing
Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; 2: Department of Dermatology, MD Anderson Cancer Center, University of Texas, Houston, Texas
Source: Dermatologic Surgery, Volume 35, Number 3, March 2009 , pp. 475-482(8)

Treatment of melasma remains a challenge for dermatologic surgeons. Laser treatments show limited efficacy, with a high rate of recurrence and side effects. Variable-pulsed erbium:yttrium aluminum garnet (Er:YAG) lasers have shown favorable results in skin resurfacing, with minimal downtime and limited adverse effects.

Twenty Thai women with epidermal-type melasma were treated with two passes of variable square pulsed (VSP) Er:YAG laser resurfacing using a 7-mm spot size, pulse duration of 300 μs, and a fluence of 0.4 J/cm2. Two treatments were given 1 month apart. Visual analog scale (VAS), Melasma Area and Severity Index (MASI) score and melanin index (MI) were measured at baseline and 1, 2, and 4 months after treatment.

There was a significant improvement in VAS from baseline at 1-, 2-, and 4-month follow-up visits (p<.001). Significant improvement in MASI score at the 2-month visit from baseline (p=.004) was also observed. The average MI measured using melanin reflectance spectrometry measurements corresponded to MASI score rating.


VSP Er:YAG laser resurfacing effectively but temporarily improved epidermal-type melasma. Recurrence was observed after the treatment was discontinued.