Effectiveness of low-fluence and short-pulse intense pulsed light in the treatment of melasma: A randomized study.

Background: Various treatment protocols for melasma have been suggested in the literature, but the efficacy and safety of treatment varies according to the report. Objective: To investigate the selective photothermolytic effect of fluence-dependent intense pulsed light (IPL) in the treatment of melasma. Methods: Twenty Korean adults with melasma were enrolled, randomly assigned to two groups and treated at fluences of 10 or 13 J/cm(2) of IPL weekly over 6 weeks. Subjects were evaluated at baseline and weekly during the 6 weeks of treatment and at 3 weeks following the final treatment. Melanin and erythema indices were scored using a spectrophotometer. Results: The modified Melasma Area Severity Index (MASI) score of 20 patients at inclusion was 11.6 (+/- 0.9). Both 10J and 13J IPL treatment groups had decreased modified MASI scores from 2 weeks onward at statistically significant levels. Both 10J and 13J IPL treatment groups showed decreased melanin indices with statistically significant differences from 3 weeks onward. The effect of IPL on melasma was slightly greater in patients treated with 13J of IPL than in those treated with 10J over the entire duration of the study. The erythema index was transiently increased in weeks 1-3, but after 4 weeks it decreased to sub-baseline levels. Conclusion: We suggest that a low-fluence IPL protocol could provide more effective treatment for melasma with minimal side effects in Asian skin.