https://links.lww.com/DSS/B174

(1)

Table S1. Characteristics of the Included Studies for the Efficacy.

Study (first author,

year) Country Study type

Complete d (drop-

out)

FST

Age (mean

)

Male

(%) Study arms

LT settings (spot size (mm),

fluence (J/cm2), frequency)

Outcome Wattanakr

ai, 2010¹

Thailan d

RCT (split- face)

22 (0) III-V 46.8 4.5 HQ/LT vs. HQ 6, 3.0-3.8, qw x 5 mMASI, RL*I, PA

Jeong,

2010² Korea RCT (split-

face) 13 (0) III-IV 43.0 7.7 LT/TC vs. TC/LT 7, 1.6-2.0, qw x 8 MASI, L value, deltaE*ab, PA Suh,

2011³ Korea Single-arm

clinical trial 23 (0) III-V 41.0 0.0 LT 4-8, 3.0, qw x 10 MASI, L value, PA Choi,

2010⁴

Korea Single-arm clinical trial

20 (0) III-IV 39.2 5.0 LT 6, 2.0-3.5, qw x 5 MI, L value, Cutometer, SEw, corneometer Mun,

2011⁵ Korea Single-arm

clinical trial 16 (0) NR 44.3 6.3 LT 7, 1.6-2.0, qw x 8 MASI, L value, deltaE*ab, EM Zhou,

2011⁶

China Single-arm clinical trial

50 (0) III-IV 38.6 6.0 LT 6, 2.5-3.4, qw x 9 MASI, MI, PA, confocal analysis

Na,

2013⁷ Korea Retrospective

cohort 15 (0) vs.

20 (0) III-IV vs. III- IV

38.7 vs.

42.0 0.0 vs.

0.0

LT vs. LT/IPL 6, 2.0-2.5, qw x 5 vs. 6, 2.0-2.5, qw x 4

mMASI, MI, EI

Park, 2011⁸

Korea RCT (split- face)

16 (0) III-IV 43.9 0.0 LT vs. LT/CP 6, 2.0-2.3, qw x 6 mMASI, MI, PGA, PA Brown,

2011⁹ USA Single-arm

clinical trial 20 (0) II-IV 41.7 5.0 LT 8-10, 2.0-4.0, qw x

8 MASI, PGA

Cho,

2013¹⁰ Korea Retrospective

cohort 24 (0) vs.

39.6 vs.

41.5

0.0 oral TXA/IPL/LT vs.

IPL/LT 8, 1-1.2, q1-2w x 3- 4 vs. 8, 1-1.2, q1-2w x 3-4

mMASI, PA

Kar, 2012¹¹

India RCT 21 (4) vs.

19 (6) vs.

20 (5)

IV-V vs. IV- V vs.

IV-V

NR NR LT vs. CP vs. high fluence Nd:YAG laser

6-8, 0.5-1, qw x 12 MASI

Na,

2012¹² Korea Retrospective

case series 20 (0) III-IV 42.0 0.0 IPL/LT 6, 2.0-2.5, qw x 4 mMASI, MI, EI Sim, Korea Single-arm 50 (0) NR 40.1 0.0 LT 8, 2.8, qw x 15 PGA, PA, pigment

(2)

Complete d (drop-

out)

FST

Age (mean

)

Male

(%) Study arms

Outcome

2014¹³ clinical trial imaging technology

Shin,

2013¹⁴ Korea RCT 21 (3) vs.

43.2 vs.

44.4 0.0 vs.

0.0

LT vs. LT/oral TXA 7, 2, q4w x 2 mMASI, MI, PA

Bansal,

2012¹⁵ India RCT 20 (0) vs.

20 (0) vs.

20 (0)

III-V

(all) 37.7 (all) 1.6

(all) LT vs. AA vs. LT/AA 6-8, 0.5-1, qw x 12 MASI Kim,

2013¹⁶ Korea RCT (split-

face) 26 (0) III-V 45.0 0.0 LT vs. LT/1,550 nm

laser 6, 1.2-1.4, q2w x 10 mMASI, PGA, PA Lee,

2014¹⁷ Korea RCT 26 (0) vs.

26 (0) NR 42.1 vs.

40.9

0.0 LT vs. LT/CP 7, 1-1.7, q2w x 10 MASI, PGA, PA

Longo,

2014¹⁸ Italy Single-arm

clinical trial 8 (0) III 36.7 0.0 LT 6, 2.8-3.2, qw x 10 MASI, confocal analysis

Chung,

2014¹⁹ Korea RCT (split-

face) 12 (0) NR 37.4 0.0 IPL/LT vs. IPL 8, 1.0-1.2, q2w x 6 mMASI, MI, EI, PGA Jalaly,

2014²⁰

Iran RCT (split- face)

40 (0) II-IV 42.5 0.0 LT vs. fractional CO2 laser

7, 1.5-2.0, q3w x 5 mMASI, MI, PA Yun,

2014²¹

Korea RCT 12 (0) vs.

12 (0)

III-IV vs. III- IV

42.6 vs.

43.4 0.0 vs.

0.0

IPL/LT vs. IPL 6, 1.5-2.0, q2w x 6 partial MASI, MI, EI, PA

Choi, 2015²²

Korea Retrospective cohort

177 (0) vs. 183 (0)

III-IV vs. III- IV

36.8 vs.

32.0 1.1 vs.

2.2

LT vs. LT (dual toning)

6, 2.5-3.0, qw x 10 mMASI

Vachiramo n, 2015²³

Thailan d

RCT (split- face)

18 (2) NR 47.5 0.0 LT vs. LT/IPL 6, 2.6-2.8, qw x 5 mMASI, R*LI, PA Choi,

2015²⁴

30 (0) III-IV 37.8 0.0 LT (dual toning) 6/7, 2.1-2.5/15-17, qw x 10/q2wk x 4/qm x 3, 3 months later

mMASI, PGA

Vachiramo

n, 2015²⁵ Thailan

d RCT (split-

face) 12 (3) III-V 45.0 100.0 LT vs. CP/LT 6, 2.2-2.8, qw x 5 mMASI, RL*I, PA Cunha,

2015²⁶

Brazil Single-arm clinical trial

6 (4) III-IV 35.5 NR IPL/LT (fractional mode)

5, 0.8-1.0J/P, qm x 3 MASI Hofbauer Brazil Single-arm 16 (4) III-V 47.1 0.0 LT 8, 0.8-1.6, qw x 10 mMASI,

(3)

Complete d (drop-

out)

FST

Age (mean

)

Male

(%) Study arms

Outcome Parra,

2016²⁷

clinical trial histopathology

Kim, 2016²⁸

Korea Single-arm clinical trial

22 (0) III-IV 41.0 0.0 LT (PTP mode) 7, 2.5, q2w x 5 MASI, L value, PGA, PA

Gokalp,

2016²⁹ Turkey Retrospective

cohort 34 (0) II-IV 39.6 8.8 LT 6, 2.5, q2w x 6-10 mMASI, PA Yue,

2016³⁰ China Single-arm

clinical trial 27 (3) III-IV 39.0 3.7 LT (fractional Pixel) 8.5, 2.6-3.6, q2-3w

x 8 MASI, MI, EI, L value, PGA, PA

Jang,

2017³¹ Korea Nonrandomiz ed controlled trial (split- face)

25 (3) III-IV 45.7 0.0 LT vs. LT (dual

toning) 7, 1.4, qw x 8 vs. 7,

0.7 x 2, qw x 8 mMASI, L value, PGA

Kaminaka, 2017³²

Japan RCT (split- face)

12 (1) III-IV 47.7 0.0 LT vs. control 6, 2.0-2.5, qw x 10 MI, EI, PGA, PA, histopathology Ustuner,

2017³³

Turkey RCT (split- face)

16 (2) II-III 37.7 6.3 LT vs. LT/MN/Vitamin C

8/6/4, 2.0/3.5/3.2, q4w x 4

MASI, PGA, MelasQoL- TR

Choi,

2017³⁴ Korea RCT (split-

face) 39 (0) III-IV 48.4 0.0 LT

(pico1064/532)/HQ vs. HQ

7-10, 0.2-1.5, qw x

2-6 mMASI, RL*I, PA

Alavi,

2017³⁵ Iran RCT 20 (3) vs.

21 (2) NR 42.6 vs.

38.6 0.0 vs.

0.0

LT vs. LT/fractional

erb:YAG laser 8, 0.769-0.995, q2w

x 4 (both groups) Visioface score, MI, EI Saleh,

2018³⁶

Egypt Nonrandomiz ed controlled trial (split- face)

19 (0) III-IV 37.2 0.0 LT vs. LT/CP 6-8, 1.2-3.5, q2w x 6

mMASI, PGA, histopathology

Kong,

2018³⁷ Korea RCT (split-

face) 17 (0) III-V 41.0 0.0 LT vs. LT/pulsed dye

laser 7, 1.2-2.0, qw x 9 MASI Laothawor

n, 2018³⁸ Thailan

d RCT (split-

face) 25 (0) III-V 44.8 4.0 LT vs. LT/topical TXA 6, 2.0-3.0, q4w x 2 mMASI scores, MI, PA Kwon,

2019³⁹

58 (0) vs.

56 (0)

III-V vs. III- V

33.7 vs.

32.4 3.4 vs.

5.4

LT (PTP) vs.

LT (PTP)/MNRF

7-8, 3, qw x 10 mMASI, PGA

Choi, Korea Retrospective 40 (0) III-IV 50.0 15.0 LT 8, 1.2-2.0, q 1-4w x mMASI, severity of

(4)

Complete d (drop-

out)

FST

Age (mean

)

Male

(%) Study arms

Outcome

2018⁴⁰ cohort range 5-150 erythema, PGA

Gao,

2019⁴¹ China Single-arm

clinical trial 25 (0) III-IV 34.0 0.0 LT 6, 2.0-3.0, qw x 10 MI, confocal analysis, TEWL

Jin, 2019⁴²

China Retrospective cohort

20 (0) vs.

20 (0)

III-IV vs. III- V

41.3 vs.

42.8 0.0 vs.

0.0

LT vs. LT/traditional Chinese medicine

6, 2.5-3.5, q4w x 6 MASI, total skin damage score Garg,

2019⁴³ India RCT 20 (0) vs.

20 (0) vs.

20 (0)

III-IV

(all) 22-46 (all) 20.0

(all) LT (pixel) vs. super skin rejuvenation vs. pixel erb:YAG laser

Pixel, 1.2, q3w x 5 mMASI

Guo, 2019⁴⁴

China Nonrandomiz ed controlled trial (split- face)

12 (0) III-IV 29-45 0.0 LT vs. LT (PTP) 7, 1.8, q4w x 5 vs.

7, 0.9 x2, q4w x 5

mMASI, PGA, PA

Kim,

2020⁴⁵ Korea Single-arm

clinical trial 11 (0) III-IV 47.6 0.0 LT (picosecond) 7, 0.4-0.7, q2w x 6 pigmentation area and severity index, MI, EI, PGA

Abdel Hay,

2020⁴⁶ Egypt Single-arm

clinical trial 31 (0) II-V 39.1 3.2 LT 8, 2, q2w x 5 mMASI, MI, EI Yip,

2020⁴⁷ Canada Case study 6 (0) IV 53.6 0.0 LT/HA injections/LT 8, 1.7-2.0, x 8-12 mMASI Karadağ

Köse, 2021⁴⁸

Turkey Single-arm clinical trial

15 (0) III-IV 42.4 0.0 LT/MN/biomimetic peptides

6/4, 2.0-2.4 (whole face)/2.4-3.0 (lesions), q2w x 5

mMASI, PA

Dev,

2020⁴⁹ India RCT (split-

face) 28 (10) IV-V 37.0 NR LT vs. triple

combination cream 6, 1.5, qw x 12 mMASI, MI Vachiramo

n, 2021⁵⁰

Thailan d

RCT (split- face)

24 (1) III-IV 48.0 8.3 LT vs.

LT/isobutylamido thiazolyl resorcinol

6, 2.1-2.4, qw x 5 RL*I, facial

hyperpigmentation severity score on the malar area, PA

Abbreviations: NR, not reported; FST, Fitzpatrick skin type; RCT, randomized controlled trial; LT, laser toning; HQ, hydroquinone;

TC, tiple combination cream; IPL, intense pulsed light; CP, chemical peeling; TXA, tranexamic acid; AA, azelaic acid; PTP, pulse- to-pulse; MN, microneedling; MNRF, microneedling radiofrequency; HA, hyaluronic acid; qw, weekly; q2w, every other week; qm, monthly; MASI, Melasma Area and Severity Index; mMASI, modified Melasma Area and Severity Index; MI, melanin index; EI, erythema index; RL*I, relative lightness index; PGA, physician global assessment; PA, patient assessment; SEw, index of skin

(5)

wrinkling by the visioscan; EM, electron microscopy; TEWL, transepidermal water loss; MelasQoL-TR, Turkish version of melasma quality of life

(6)

Table S2A. Quality assessment of selected randomized controlled study using the Cochrane risk of bias assessment tool. (low risk:

green, high risk: red, unclear: yellow)

Study

First author, year Adequate generation sequence Allocation concealment Blinding of participants Blinding of assessors outcome Incomplete addressed outcome data Selective the results reporting of Wattanakrai, 2010¹

Jeong, 2010² Park, 2011⁸ Kar, 2012¹¹ Shin, 2013¹⁴ Bansal, 2012¹⁵ Kim, 2013¹⁶ Lee, 2014¹⁷ Chung, 2014¹⁹ Jalaly, 2014²⁰ Yun, 2014²¹

Vachiramon, 2015²³ Vachiramon, 2015²⁵ Kaminaka, 2017³² Ustuner, 2017³³ Choi, 2017³⁴ Alavi, 2017³⁵ Kong, 2018³⁷

Laothaworn, 2018³⁸ Garg, 2019⁴³

Dev, 2020⁴⁹

Vachiramon, 2020⁵⁰

(7)

Table S2B. Quality assessment of selected non-randomized studies using the ROBINS-I. (low risk: green, high risk: red, unclear: yellow, not available: gray)

Study First author, year

Confounding Selection of participantsinto the study Classification ofinterventions Deviations from intendedinterventions Missing data Measurement of outcomes Selective reporting ofthe results

Suh, 2011³ Choi, 2010⁴ Mun, 2011⁵ Zhou, 2011⁶ Na, 2013⁷ Brown, 2011⁹ Cho, 2013¹⁰ Na, 2012¹² Sim, 2014¹³ Longo, 2014¹⁸ Choi, 2015²² Choi, 2015²⁴ Cunha, 2015²⁶ Hofbauer Parra, 2016²⁷

Kim, 2016²⁸ Gokalp, 2016²⁹ Yue, 2016³⁰ Jang, 2017³¹ Saleh, 2018³⁶ Kwon, 2019³⁹ Choi, 2018⁴⁰ Gao, 2019⁴¹ Jin, 2019⁴² Guo, 2019⁴⁴ Kim, 2020⁵¹ Abdel Hay, 2020⁴⁶ Yip, 2020⁴⁷

Karadag Kose, 2021⁴⁸

(8)

Table S3. Evaluation of publication bias by Trim-and-Fill method.

Outcome No of

studies Observed mean difference (95%

CI)

No of studies imputed

Imputed

mean difference (95%

CI) MASI/mMASI

< 4 weeks 34 -1.03 (-1.63, -0.44) 2 -0.71 (-1.48, 0.06) 4-<8 weeks 13 -1.09 (-1.79, -0.39) 1 -0.97 (-1.69, -0.25) 8-<12

weeks

8 -0.86 (-1.51, -0.22) 0 -0.86 (-1.51, -0.22) 12-<24

weeks

7 -0.92 (-1.58, -0.26) 1 -0.81 (-1.45, -0.16)

≥

24 weeks

5 -0.51 (-1.21, 0.19) 1 -0.29 (-1.06, 0.48) Melanin

Index

< 4 weeks 13 -39.32 (-49.89, -28.76) 4 -45.06 (-55.63, -34.49) 4-<8 weeks 7 -24.70 (-39.49, -9.90) 0 -24.70 (-39.49, -9.90) 8-<12

weeks 1 -6.00 (-61.66, 49.66) N/A N/A

12-<24

weeks 2 -21.61 (-59.63, 16.42) 0 -21.61 (-59.63, 16.42)

≥

24 weeks

2 -11.80 (-85.83, 62.23) 0 -11.80 (-85.83, 62.23) Erythema

Index

< 4 weeks 6 -13.35 (-28.87, 2.17) 3 -9.51 (-22.30, 3.28) 4-<8 weeks 3 -18.73 (-65.83, 28.38) 0 -18.73 (-65.83, 28.38) 8-<12

weeks

N/A N/A N/A N/A

12-<24 weeks

1 -44.60 (-76.74, -12.46) N/A N/A

≥

24 weeks

2 -8.59 (-108.07, 90.88) 0 -8.59 (-108.07, 90.88) L value

< 4 weeks 6 1.25 (0.10, 2.40) 0 1.25 (0.10, 2.40)

4-<8 weeks 3 1.78 (0.45, 3.11) 1 1.95 (0.71, 3.18)

8-<12 weeks

1 0.90 ( -1.65, 3.45) N/A N/A

12-<24 weeks

1 0.60 (-1.56, 2.76) N/A N/A

≥

24 weeks

N/A N/A N/A N/A

RL*I

< 4 weeks 5 -3.01 (-4.39, -1.64) 0 -3.01 (-4.39, -1.64) 4-<8 weeks 3 -3.65 (-4.81, -2.50) 1 -3.71 (-4.78, -2.65) 8-<12

weeks

1 -2.90 (-7.60, 1.80) N/A N/A

12-<24 weeks

1 -2.70 (-7.40, 2.00) N/A N/A

≥

24 weeks

N/A N/A N/A N/A

(9)

Abbreviations: N/A, not applicabl

(10)

Table S4. Characteristics of the Included Studies for the Adverse Events.

year)

No of

pts Study arms Spot (mm

)

Fluence (J/cm2)

Tx schedule

Hypo (%)

Hyper (%)

Recurren ce (%)

FU (wks

)

Other complications Cho,

2009⁵² 25 LT 6/4 2.5/4.0-

5.0 q2w x 5-

15 8.0 0.0 12.0 8-24 Mild prickling sensation, mild erythema

Wattanak

rai, 2010¹22 HQ/LT 6 3.0-3.8 qw x 5 13.6 (improv ed FU)

18.2 100.0 12 Erythema, transient burning, slight edema

Jeong,

2010² 13 TC/LT 7 1.6-2.0 qw x 8 0.0 NR 69.2

(mildly worse)

44 Irritation after TC, mild pain, and erythema after LT

Jeong,

2010² 13 LT/TC 7 1.6-2.0 qw x 8 0.0 NR 69.2

(mildly worse)

44 Irritation after TC, mild pain, and erythema after LT

Suh, 2010³

23 LT 4,6,8 2.0-4.0 qw x 10 4.3 (resolve d 3 mo)

13.0 (resolve d 1-2 mo)

0.0 12 Mild transient erythema (all),

prolonged erythema (13.0%, resolved after 3–5 days)

Polnikorn,

2010⁵³ 35 LT/arbutin 6 3.0-3.4 qw x 10 8.6 0.0 5.7 8 Discomfort (100.0%), erythema (100.0%), whitening of fine hair (100.0%) and physical urticaria (5.7%)

Choi, 2010⁴

20 LT 6 2.0-3.5 qw x 5 0.0 0.0 NR 4 None

Mun, 2011⁵

16 LT 7 1.6-2.0 qw x 8 0.0 0.0 NR 0 None

Zhou,

2011⁶ 50 LT 6 2.5-3.4 qw x 9 0.0 0.0 64.0 12 Warm or slight burning sensation and slight erythema (majority), nonpruritic wheal (0.4%), tiny purpura (0.4%), tiny purpura (0.4%)

Na, 2013⁷

15 LT 6 2.0-2.5 qw x 5 0.0 0.0 NR 0 Mild erythema, prickling sensation

Na, 2013⁷

20 IPL/LT 6 2.0-2.5 qw x 4 0.0 0.0 0.0 24 Mild erythema, prickling sensation, no recurrence in 12 out of 20 of available for FU

Park, 2011⁸

16 LT 6 2.0-2.3 qw x 6 0.0 0.0 100.0 20 Slight increase MI/mMASI

(11)

year)

No of

)

Fluence (J/cm2)

Tx schedule

Hypo (%)

Hyper (%)

Recurren ce (%)

FU (wks

)

Other complications Park,

2011⁸ 16 LT/CP 6 2.0-2.3 qw x 6 0.0 0.0 100.0 20 Erythema, transient burning, slight edema, superficial desquamation, slight increase MI/mMASI

Brown, 2011⁹

20 LT 8-10 2.0-4.0 qw x 8 NR NR Common

3 mo

12 NR Cho,

2013¹⁰ 24 Oral TXA/IPL/LT 8 1.0-1.2 q1-2w x

3-4 0.0 0.0 NR 2 Transient headache (16.7%) from oral TXA

Cho,

2013¹⁰ 27 IPL/LT 8 1.0-1.2 q1-2w x

3-4 0.0 0.0 NR 2 None

Kauvar, 2012⁵⁴

27 MD/LT/HQ/tretin oin or vit C

5 or 6

1.6-2.0 q4w for 1-4

0.0 0.0 16.0 24 Mild post-treatment erythema after the microdermabrasion, temporary exacerbation of melasma after sun exposure (14.8%)

Kar,

2012¹¹ 21 LT 6-8 0.5-1.0 qw x 12 4.8 0.0 Worsenin

g of MASI (13.04)

12 None

Na, 2012¹²

20 IPL/LT 6 2.0-2.5 qw x 4 0.0 0.0 Slight

increase of MI*

8-52 Mild erythema and prickling sensation (95.0%)

Sim, 2014¹³

50 LT 8 2.8 qw x 15 0.0 0.0 NR 0 Erythema, transient burning, and

slight edema (most) Shin,

2013¹⁴ 21 LT 7 2.0 q4w x 2 0.0 0.0 NR 4 Transient erythema

Shin,

2013¹⁴ 23 LT/oral TXA 7 2.0 q4w x 2 0.0 0.0 NR 4 Heartburn (8.7%) and nausea (4.35%) from oral TXA, transient erythema Bansal,

2012¹⁵

20 LT 6-8 0.5-1.0 qw x 12 0.0 0.0 NR 0 None

Bansal, 2012¹⁵

20 LT/AA 6-8 0.5-1.0 qw x 12 0.0 0.0 NR 0 Erythema (5.0%), slight burning sensation (5.0%)

Kim,

2013¹⁶ 26 LT 6 1.2-1.4 q2w x 10 0.0 0.0 0.0 12 Erythema, transient burning, slight edema of the face

Kim, 2013¹⁶

26 LT/1550 nm laser

6 1.2-1.4 q2w x 10 0.0 7.7 (faded 1 mo)

0.0 12 Erythema, transient burning, slight edema of the face

Kang,

2011⁵⁵ 30 LT (dual toning) 8/5 1.2/7.0 q2w x

10-12 0.0 0.0 0.0 6 Prickling or mild stinging from Q- switched mode, mild heating

(12)

year)

No of

)

Fluence (J/cm2)

Tx schedule

Hypo (%)

Hyper (%)

Recurren ce (%)

FU (wks

)

Other complications sensation from micropulsed mode Lee,

2014¹⁷

26 LT 7 1.0-1.7 q2w x 10 0.0 0.0 NR 0 Mild pain, erythema

Lee,

2014¹⁷ 26 LT/CP 7 1.0-1.7 q2w x 10 0.0 0.0 NR 0 Burning sensation from CP (15.4%), mild pain and erythema after LT Longo,

2014¹⁸ 8 LT 6 2.8-3.2 qw x 10 0.0 0.0 50.0 12 Erythema, edema, scaling

Chung, 2014¹⁹

12 IPL/LT 8 1.0-1.2 q2w x 6 0.0 0.0 0.0 24 Mild pain or heating sensation from IPL

Jalaly, 2014²⁰

40 LT 7 1.5-2.0 q3w x 5 0.0 0.0 0.0 8 Sunburn-like erythema, transient slight edema

Fabi,

2014⁵⁶ 20 LT 8 1.0-2.0 qw x 6 0.0 5.0 Some 24 Mild erythema

Yun, 2014²¹

12 IPL/LT 6 1.5-2.0 q2w x 6 0.0 0.0 0.0 8 First degree burn (8.3%), dry skin (25.0%)

Moubashe r, 2014⁵⁷

15 LT 4-6 3.0-3.8 q4w x up

to 6

0.0 53.3 Almost all

12 None Lee,

2015⁵⁸ 8 LT 8/6/4 2.0/3.5/

3.2 q4w x 4 0.0 0.0 0.0 12 None

Lee, 2015⁵⁸

8 LT/vit C 8/6/4 2.0/3.5/

3.2

q4w x 4 0.0 0.0 0.0 12 None

Choi, 2015²²

177 LT 6 2.5-3.0 qw x 10 0.6 0.0 1.1 8 NR

Choi,

2015²² 183 LT (dual toning) 6/7 2.1-2.5/

15.0-17.0qw x 10 11.5 0.0 14.1 8 NR Alsaad,

2014⁵⁹ 7 MD/LT (50 ns) 5-6 1.6 q4w x 3 0.0 0.0 Some

relapse 24 Mild erythema, mean pain score (1.2/10)

Alsaad, 2014⁵⁹

7 MD/LT (5 ns) 5-6 1.6 q4w x 3 0.0 0.0 Some relapse

24 Mild erythema, mean pain score (2.9/10)

Vachiram on, 2015²³

18 LT 6 2.6-2.8 qw x 5 5.6 0.0 11.1 12 Slight erythema, mild stinging Vachiram

on, 2015²³18 LT/IPL 6 2.6-2.8 qw x 5 5.6 0.0 33.3 12 Microcrust (approximately 70%), slight erythema, mild stinging, Choi,

2015²⁴

30 LT (dual toning) 6/7 2.1-2.5 /15.0- 17.0

qw x 10, q2w x 4, qm x 3

0.0 0.0 0.0 52-

156 None

(13)

year)

No of

)

Fluence (J/cm2)

Tx schedule

Hypo (%)

Hyper (%)

Recurren ce (%)

FU (wks

)

Other complications Sugawara

, 2015⁶⁰ 26 LT/oral TXA/HQ 5 1.6-2.0 qw x 7-

43 3.8 NR NR NR NR

Sugawara

, 2015⁶⁰ 49 LT/oral TXA/HQ 5 1.6-2.0 q2w x 6-

27 4.1 NR NR NR NR

Sugawara , 2015⁶⁰

72 LT/oral TXA/HQ 5 1.6-2.0 q4w x 5- 23

0.0 NR NR NR NR

Vachiram on, 2015²⁵

12 LT 6 2.2-2.8 qw x 5 8.3 16.6 Observed 12 Burning/stinging (41.6%), erythema/edema (25.0%) Vachiram

on, 2015²⁵12 CP/LT 6 2.2-2.8 qw x 5 8.3 16.6 Observed 12 Burning/stinging (58.3%),

erythema/edema (41.6%), superficial peeling (8.3%)

Cunha,

2015²⁶ 6 IPL/LT

(fractional) 5 0.8-1.0J/P qw x 3 0.0 0.0 NR 0 Mild pain, redness, peeling (all) Hofbauer

Parra, 2016²⁷

16 LT 8 0.8-1.6 qw x 10 0.0 0.0 81.0 24 Mild erythema, local warmth

Chen,

2016⁶¹ 12 LT or LT

(1064/532)/vit C

7 1.6-1.8 q4w x 5 0.0 50.0 21.7 (both dyschrom ia/melas ma)

≥

52

Dryness (16.7%), scale (16.7%), erythema (33.3%), pruritus (33.3%)

Kim,

2016²⁸ 22 LT (PTP mode) 7 2.5 q2w x 5 0.0 0.0 NR 2 Erythema, dryness, and itching (few), pain (13.6%), fine facial hair

whitening (some) Gokalp,

2016²⁹

34 LT 6 2.5 q2w x 6-

10

0.0 0.0 58.8 52 Pain (3.9/10) Yue,

2016³⁰ 27 LT (fractional

Pixel) 8.5 2.6-3.6 q2-3w x

8 0.0 0.0 82.4 24 Slight burning or tingling (all), slight erythema

Jang,

2017³¹ 25 LT 7 1.4 qw x 8 0.0 0.0 NR 0 Pain (4.6/10), erythema, edema,

dryness Jang,

2017³¹

25 LT (dual pulsed) 7 0.7 x 2 qw x 8 0.0 0.0 NR 0 Pain (3.3/10), erythema, edema, dryness

Tian,

2017⁶² 3897

0 LT 8 2.0 qw x 12 NR NR NR NR Mild, transient facial erythema,

stinging sensation Kaminaka

, 2017³² 12 LT 6 2.0-2.5 qw x 10 0.0 NR 16.7 24 Slight, transient erythema, swelling, mild pain, skin dryness (15.0%),

(14)

year)

No of

)

Fluence (J/cm2)

Tx schedule

Hypo (%)

Hyper (%)

Recurren ce (%)

FU (wks

)

Other complications pruritus (5.0%)

Ustuner, 2017³³

16 LT 8, 6,

4

2.0, 3.5, 3.2

q4w x 4 0.0 14.3 43.8 24 Irritation (6.3%) Ustuner,

2017³³ 16 LT/MN/vit C 8, 6,

4 2.0, 3.5,

3.2 q4w x 4 12.5 6.3 31.3 24 Irritation (12.5%) Choi,

2017³⁴ 39 LT (pico 1064/

532 nm)/HQ 7-10 0.2-1.5 qw x 2-6 0.0 0.0 76.9 12 Mild dermatitis (5.0%), mild pain Alavi,

2017³⁵

20 LT 8 0.769-

0.995

q2w x 4 0.0 0.0 NR 4 Erythema

Alavi, 2017³⁵

21 LT/fractional erb:YAG

8 0.769- 0.995

q2w x 4 0.0 0.0 NR 4 Erythema

Saleh,

2018³⁶ 19 LT 6-8 1.2-3.5 q2w x 6 21.1 0.0 NR 4 Mild erythema, burning, edema Saleh,

2018³⁶

19 LT/CP 6-8 1.2-3.5 q4w x 3 0.0 0.0 NR 4 Mild erythema, burning, edema, erythema, edema, exfoliation Tian,

2017⁶³

23 LT 10 2.0 3 per

week x 24

100.0 NR NR 16 NR

Kong, 2018³⁷

17 LT 7 1.2-2.0 qw x 9 0.0 0.0 0.0 8 Mild burning sensation, mild erythema Kong,

2018³⁷ 17 LT/pulsed dye

laser 7 1.2-2.0 qw x 9 0.0 5.9 5.9 8 Mild burning, mild erythema, focal purpura (5.9%)

Laothawo

rn, 2018³⁸25 LT 6 2.0-3.0 q4w x 2 0.0 0.0 NR 4 Mild erythema, burning sensation (8.0%)

Laothawo rn, 2018³⁸

25 LT/topical TXA 6 2.0-3.0 q4w x 2 0.0 0.0 NR 4 Mild erythema, burning sensation (8.0%)

Lee, 2018⁶⁴

12 LT 8/6/4 2.0/3.5/

3.2

q4w x 4 0.0 0.0 0.0 12 Temporary erythema Kwon,

2019³⁹ 58 LT (PTP) 7-8 3.0 qw x 10 13.8 0.0 15.5 12 Erythema, edema, dryness Kwon,

2019³⁹ 56 LT/MNRF 7-8 3.0 qw x 10 8.9 0.0 8.9 12 Pain (3.8/10), erythema, edema, dryness

Choi, 2018⁴⁰

40 LT 8 1.2-2.0 q1-4w x

5-150

5.0 0.0 5.0 4 None

Gao,

2019⁴¹ 25 LT 6 2.0-3.0 qw x 10 NR NR 68.0 12 NR

(15)

year)

No of

)

Fluence (J/cm2)

Tx schedule

Hypo (%)

Hyper (%)

Recurren ce (%)

FU (wks

)

Other complications Jin,

2019⁴² 20 LT 6 2.5-3.5 qmenstru

al cycle x 6

NR NR 0.0 72 None

Jin, 2019⁴²

20 LT/traditional Chinese medicine

6 2.5-3.5 qmenstru al cycle x 6

NR NR 0.0 72 None

Garg, 2019⁴³

20 LT (pixel) pixel tip

1.2 q3w x 5 0.0 15.0 (lasted 7-10 days)

0.0 8 Acne breakouts (10.0%)

Guo,

2019⁴⁴ 12 LT 7 1.8 q4w x 5 0.0 0.0 25.0 12 Urticaria, little visible petechiae and severe erythema (8.3%), tingling sensation, slight burning, mild to moderate skin erythema

Guo,

2019⁴⁴ 12 LT (PTP) 7 0.9 x 2 q4w x 5 0.0 0.0 25.0 12 Minor pain, slighter skin erythema reaction, tingling sensation, slight burning, mild to moderate skin erythema

Rivera, 2019⁶⁵

64 LT 8 1-2 qw x 8 NR NR NR NR Minimal pain and mild erythema

Agamia,

2021⁶⁶ 30 LT/oral TXA 4 2.0 q2w x 6 6.7 0.0 3.3 12 Long standing erythema (6.7%), itching/discomfort (13.3%) Kim,

2020⁵¹ 18 LT 6/4 2.5-

3.0/3.5 1 time 0.0 0.0 NR 2 None

Kim,

2020⁵¹ 18 LT/topical

antioxidant 6/4 2.5-

3.0/3.5 1 time 0.0 0.0 NR 2 None

Kim,

2020⁴⁵ 11 LT (picosecond) 7 0.4-0.7 q2w x 6 0.0 0.0 NR 12 Pain, post treatment erythema/crusting Abdel

Hay, 2020⁴⁶

31 LT 8 2.0 q2w x 5 0.0 0.0 NR 2 Transient mild erythema

Yip, 2020⁴⁷

6 LT/HA injections/LT

8 1.7-2.0 X 8-12 NR NR 0.0 20-

24 NR Karadag

Kose, 2021⁴⁸

15 LT/MN/biomimet ic peptides

6/4 2.0- 2.4/2.4- 3.0

q2w x 5 0.0 0.0 6.7 52 Mild to moderate erythema

(16)

year)

No of

)

Fluence (J/cm2)

Tx schedule

Hypo (%)

Hyper (%)

Recurren ce (%)

FU (wks

)

Other complications Dev,

2020⁴⁹ 28 LT 6 1.5 qw x 12 0.0 0.0 100.0 12 Acute urticarial reaction (3.6%) Vachiramo

n, 2021⁵⁰

24 LT 6 2.1-2.4 qw x 5 0.0 0.0 58.3 12 Mild erythema, slight burning sensation

Vachiramo n,

2021⁵⁰

24 LT/isobutylamid o thiazolyl resorcinol

6 2.1-2.4 qw x 5 0.0 0.0 29.2 12 Mild erythema, slight burning sensation, tingling

Abbreviations: Hypo., hypopigmentation; hyper, hyperpigmentation; qw, weekly; q2w, every other week; qm, monthly; NR, not reported; *, statistically non-significant; HQ, hydroquinone; TC, triple combination cream; TXA, tranexamic acid; AA, azelaic acid;

PTP,pulse-to-pulse; MN, microneedling; MNRF, microneedling radiofrequency; HA, hyaluronic acid; MD, microdermabrasion; vit C, vitamin C.

(17)

References

1. Wattanakrai P, Mornchan R, Eimpunth S. Low-fluence Q-switched neodymium-doped yttrium aluminum garnet (1,064 nm) laser for the treatment of facial melasma in Asians.

Dermatol Surg 2010;36:76-87.

2. Jeong SY, Shin JB, Yeo UC, Kim WS, et al. Low-fluence Q-switched neodymium-doped yttrium aluminum garnet laser for melasma with pre- or post-treatment triple combination cream. Dermatol Surg 2010;36:909-18.

3. Suh KS, Sung JY, Roh HJ, Jeon YS, et al. Efficacy of the 1064-nm Q-switched Nd:YAG laser in melasma. J Dermatolog Treat 2011;22:233-8.

4. Choi M, Choi JW, Lee SY, Choi SY, et al. Low-dose 1064-nm Q-switched Nd:YAG laser for the treatment of melasma. J Dermatolog Treat 2010;21:224-8.

5. Mun JY, Jeong SY, Kim JH, Han SS, et al. A low fluence Q-switched Nd:YAG laser modifies the 3D structure of melanocyte and ultrastructure of melanosome by subcellular-selective photothermolysis. J Electron Microsc (Tokyo) 2011;60:11-8.

6. Zhou X, Gold MH, Lu Z, Li Y. Efficacy and safety of Q-switched 1,064-nm neodymium- doped yttrium aluminum garnet laser treatment of melasma. Dermatol Surg 2011;37:962-70.

7. Na SY, Cho S, Lee JH. Better clinical results with long term benefits in melasma patients. J Dermatolog Treat 2013;24:112-8.

8. Park KY, Kim DH, Kim HK, Li K, et al. A randomized, observer-blinded, comparison of combined 1064-nm Q-switched neodymium-doped yttrium-aluminium-garnet laser plus 30%

glycolic acid peel vs. laser monotherapy to treat melasma. Clin Exp Dermatol 2011;36:864-70.

9. Brown AS, Hussain M, Goldberg DJ. Treatment of melasma with low fluence, large spot size, 1064-nm Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser for the treatment of melasma in Fitzpatrick skin types II-IV. J Cosmet Laser Ther 2011;13:280-2.

10. Cho HH, Choi M, Cho S, Lee JH. Role of oral tranexamic acid in melasma patients treated with IPL and low fluence QS Nd:YAG laser. J Dermatolog Treat 2013;24:292-6.

11. Kar HK, Gupta L, Chauhan A. A comparative study on efficacy of high and low fluence Q- switched Nd:YAG laser and glycolic acid peel in melasma. Indian J Dermatol Venereol Leprol 2012;78:165-71.

12. Na SY, Cho S, Lee JH. Intense Pulsed Light and Low-Fluence Q-Switched Nd:YAG Laser Treatment in Melasma Patients. Ann Dermatol 2012;24:267-73.

13. Sim JH, Park YL, Lee JS, Lee SY, et al. Treatment of melasma by low-fluence 1064 nm Q- switched Nd:YAG laser. J Dermatolog Treat 2014;25:212-7.

14. Shin JU, Park J, Oh SH, Lee JH. Oral tranexamic acid enhances the efficacy of low-fluence 1064-nm quality-switched neodymium-doped yttrium aluminum garnet laser treatment for melasma in Koreans: a randomized, prospective trial. Dermatol Surg 2013;39:435-42.

15. Bansal C, Naik H, Kar HK, Chauhan A. A Comparison of Low-Fluence 1064-nm Q-Switched Nd: YAG Laser with Topical 20% Azelaic Acid Cream and their Combination in Melasma in Indian Patients. J Cutan Aesthet Surg 2012;5:266-72.

16. Kim HS, Kim EK, Jung KE, Park YM, et al. A split-face comparison of low-fluence Q-

switched Nd: YAG laser plus 1550 nm fractional photothermolysis vs. Q-switched Nd: YAG

monotherapy for facial melasma in Asian skin. J Cosmet Laser Ther 2013;15:143-9.

(18)

17. Lee DB, Suh HS, Choi YS. A comparative study of low-fluence 1064-nm Q-switched Nd:YAG laser with or without chemical peeling using Jessner's solution in melasma patients. J Dermatolog Treat 2014;25:523-8.

18. Longo C, Pellacani G, Tourlaki A, Galimberti M, et al. Melasma and low-energy Q- switched laser: treatment assessment by means of in vivo confocal microscopy. Lasers Med Sci 2014;29:1159-63.

19. Chung JY, Choi M, Lee JH, Cho S, et al. Pulse in pulse intense pulsed light for melasma treatment: a pilot study. Dermatol Surg 2014;40:162-8.

20. Jalaly NY, Valizadeh N, Barikbin B, Yousefi M. Low-power fractional CO(2) laser versus low-fluence Q-switch 1,064 nm Nd:YAG laser for treatment of melasma: a randomized, controlled, split-face study. Am J Clin Dermatol 2014;15:357-63.

21. Yun WJ, Moon HR, Lee MW, Choi JH, et al. Combination treatment of low-fluence 1,064- nm Q-switched Nd: YAG laser with novel intense pulse light in Korean melasma patients: a prospective, randomized, controlled trial. Dermatol Surg 2014;40:842-50.

22. Choi CP, Yim SM, Seo SH, Ahn HH, et al. Retrospective analysis of melasma treatment using a dual mode of low-fluence Q-switched and long-pulse Nd:YAG laser vs. low-fluence Q- switched Nd:YAG laser monotherapy. J Cosmet Laser Ther 2015;17:2-8.

23. Vachiramon V, Sirithanabadeekul P, Sahawatwong S. Low-fluence Q-switched Nd: YAG 1064-nm laser and intense pulsed light for the treatment of melasma. J Eur Acad Dermatol Venereol 2015;29:1339-46.

24. Choi CP, Yim SM, Seo SH, Ahn HH, et al. Retreatment using a dual mode of low-fluence Q-switched and long-pulse Nd:YAG laser in patients with melasma aggravation after previous therapy. J Cosmet Laser Ther 2015;17:129-34.

25. Vachiramon V, Sahawatwong S, Sirithanabadeekul P. Treatment of melasma in men with low-fluence Q-switched neodymium-doped yttrium-aluminum-garnet laser versus combined laser and glycolic acid peeling. Dermatol Surg 2015;41:457-65.

26. Cunha PR, Pinto CA, Mattos CB, Cabrini DP, et al. New insight in the treatment of refractory melasma: Laser Q-switched Nd: YAG non-ablative fractionated followed by intense pulsed light. Dermatol Ther 2015;28:296-9.

27. Hofbauer Parra CA, Careta MF, Valente NY, de Sanches Osorio NE, et al. Clinical and Histopathologic Assessment of Facial Melasma After Low-Fluence Q-Switched Neodymium- Doped Yttrium Aluminium Garnet Laser. Dermatol Surg 2016;42:507-12.

28. Kim JY, Choi M, Nam CH, Kim JS, et al. Treatment of Melasma with the Photoacoustic Twin Pulse Mode of Low-Fluence 1,064 nm Q-Switched Nd:YAG Laser. Ann Dermatol

2016;28:290-6.

29. Gokalp H, Akkaya AD, Oram Y. Long-term results in low-fluence 1064-nm Q-Switched Nd:YAG laser for melasma: Is it effective? J Cosmet Dermatol 2016;15:420-26.

30. Yue B, Yang Q, Xu J, Lu Z. Efficacy and safety of fractional Q-switched 1064-nm neodymium-doped yttrium aluminum garnet laser in the treatment of melasma in Chinese patients. Lasers Med Sci 2016;31:1657-63.

31. Jang HW, Chun SH, Park HC, Ryu HJ, et al. Comparative study of dual-pulsed 1064 nm Q-

switched Nd:YAG laser and single-pulsed 1064 nm Q-switched Nd:YAG laser by using zebrafish

model and prospective split-face analysis of facial melasma. J Cosmet Laser Ther 2017;19:114-

23.

(19)

32. Kaminaka C, Furukawa F, Yamamoto Y. The Clinical and Histological Effect of a Low- Fluence Q-Switched 1,064-nm Neodymium: Yttrium-Aluminum-Garnet Laser for the Treatment of Melasma and Solar Lentigenes in Asians: Prospective, Randomized, and Split-Face

Comparative Study. Dermatol Surg 2017;43:1120-33.

33. Ustuner P, Balevi A, Ozdemir M. A split-face, investigator-blinded comparative study on the efficacy and safety of Q-switched Nd:YAG laser plus microneedling with vitamin C versus Q- switched Nd:YAG laser for the treatment of recalcitrant melasma. J Cosmet Laser Ther

2017;19:383-90.

34. Choi YJ, Nam JH, Kim JY, Min JH, et al. 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. Lasers Surg Med

2017;49:899-907.

35. Alavi S, Abolhasani E, Asadi S, Nilforoushzadeh M. Combination of Q-Switched Nd:YAG and Fractional Erbium:YAG Lasers in Treatment of Melasma: A Randomized Controlled Clinical Trial. J Lasers Med Sci 2017;8:1-6.

36. Saleh F, Moftah NH, Abdel-Azim E, Gharieb MG. Q-switched Nd: YAG laser alone or with modified Jessner chemical peeling for treatment of mixed melasma in dark skin types: A comparative clinical, histopathological, and immunohistochemical study. J Cosmet Dermatol 2018;17:319-27.

37. Kong SH, Suh HS, Choi YS. Treatment of Melasma with Pulsed-Dye Laser and 1,064-nm Q-Switched Nd:YAG Laser: A Split-Face Study. Ann Dermatol 2018;30:1-7.

38. Laothaworn V, Juntongjin P. Topical 3% tranexamic acid enhances the efficacy of 1064- nm Q-switched neodymium-doped yttrium aluminum garnet laser in the treatment of melasma.

J Cosmet Laser Ther 2018;20:320-25.

39. Kwon HH, Choi SC, Jung JY, Park GH. Combined treatment of melasma involving low- fluence Q-switched Nd:YAG laser and fractional microneedling radiofrequency. J Dermatolog Treat 2019;30:352-56.

40. Choi JE, Lee DW, Seo SH, Ahn HH, et al. Low-fluence Q-switched Nd:YAG laser for the treatment of melasma in Asian patients. J Cosmet Dermatol 2018;17:1053-58.

41. Gao YL, Jia XX, Wang M, Hua Y, et al. Melanocyte activation and skin barrier disruption induced in melasma patients after 1064 nm Nd:YAG laser treatment. Lasers Med Sci

2019;34:767-71.

42. Jin Y, Jiang W, Yao Y, Huang H, et al. Clinical efficacy of laser combined with menstrual regulation in the treatment of female melasma: a retrospective study. Lasers Med Sci

2019;34:1099-105.

43. Garg S, Vashisht KR, Makadia S. A prospective randomized comparative study on 60 Indian patients of melasma, comparing pixel Q-switched NdYAG (1064 nm), super skin rejuvenation (540 nm) and ablative pixel erbium YAG (2940 nm) lasers, with a review of the literature. J Cosmet Laser Ther 2019;21:297-307.

44. Guo X, Cai X, Jin Y, Zhang T, et al. Q-PTP is an optimized technology of 1064-nm Q-

switched neodymium-doped yttrium aluminum garnet laser in the laser therapy of melasma: A

prospective split-face study. Oncol Lett 2019;18:4136-43.

(20)

45. Kim YJ, Suh HY, Choi ME, Jung CJ, et al. Clinical improvement of photoaging-associated facial hyperpigmentation in Korean skin with a picosecond 1064-nm neodymium-doped yttrium aluminum garnet laser. Lasers Med Sci 2020;35:1599-606.

46. Abdel Hay R, Mohammed FN, Sayed KS, Abd El Fattah NA, et al. Dermoscopy as a useful tool for evaluating melasma and assessing the response to 1064-nm Q-switched Nd:YAG laser.

Dermatol Ther 2020;33:e13629.

47. Yip DL. A pilot study on the use of a non-crosslinked hyaluronic acid with associated anti- oxidant ingredients to improve the effectiveness of Nd:YAG laser toning in the treatment of melasma in six patients. J Cosmet Dermatol 2020;19:2212-18.

48. Karadag Kose O, Borlu M. Efficacy of the combination of Q-switched Nd:YAG laser and microneedling for melasma. J Cosmet Dermatol 2021;20:769-75.

49. Dev T, Sreenivas V, Sharma VK, Sahni K, et al. A split face randomized controlled trial comparing 1,064 nm Q-switched Nd-YAG laser and modified Kligman's formulation in patients with melasma in darker skin. Int J Dermatol 2020;59:1525-30.

50. Vachiramon V, Leerunyakul K, Kositkuljorn C, Chayavichitsilp P. Combined isobutylamido thiazolyl resorcinol and low-fluence Q-switched Nd: YAG laser for the treatment of facial

hyperpigmentation: A randomized, split-face study. J Cosmet Dermatol 2021;20:1724-31.

51. Kim J, Kim J, Lee YI, Almurayshid A, et al. Effect of a topical antioxidant serum containing vitamin C, vitamin E, and ferulic acid after Q-switched 1064-nm Nd:YAG laser for treatment of environment-induced skin pigmentation. J Cosmet Dermatol 2020;19:2576-82.

52. Cho SB, Kim JS, Kim MJ. Melasma treatment in Korean women using a 1064-nm Q- switched Nd:YAG laser with low pulse energy. Clin Exp Dermatol 2009;34:e847-50.

53. Polnikorn N. Treatment of refractory melasma with the MedLite C6 Q-switched Nd:YAG laser and alpha arbutin: a prospective study. J Cosmet Laser Ther 2010;12:126-31.

54. Kauvar AN. Successful treatment of melasma using a combination of microdermabrasion and Q-switched Nd:YAG lasers. Lasers Surg Med 2012;44:117-24.

55. Kang H, Kim J, Goo B. The dual toning technique for melasma treatment with the 1064 nm Nd: YAG laser: A preliminary study. Laser Ther 2011;20:189-94.

56. Fabi SG, Friedmann DP, Niwa Massaki AB, Goldman MP. A randomized, split-face clinical trial of low-fluence Q-switched neodymium-doped yttrium aluminum garnet (1,064 nm) laser versus low-fluence Q-switched alexandrite laser (755 nm) for the treatment of facial melasma.

Lasers Surg Med 2014;46:531-7.

57. Moubasher AE, Youssef EM, Abou-Taleb DA. Q-switched Nd: YAG laser versus

trichloroacetic acid peeling in the treatment of melasma among Egyptian patients. Dermatol Surg 2014;40:874-82.

58. Lee MC, Chang CS, Huang YL, Chang SL, et al. Treatment of melasma with mixed parameters of 1,064-nm Q-switched Nd:YAG laser toning and an enhanced effect of ultrasonic application of vitamin C: a split-face study. Lasers Med Sci 2015;30:159-63.

59. Alsaad SM, Ross EV, Mishra V, Miller L. A split face study to document the safety and efficacy of clearance of melasma with a 5 ns q switched Nd YAG laser versus a 50 ns q switched Nd YAG laser. Lasers Surg Med 2014;46:736-40.

60. Sugawara J, Kou S, Kou S, Yasumura K, et al. Influence of the frequency of laser toning for

melasma on occurrence of leukoderma and its early detection by ultraviolet imaging. Lasers

Surg Med 2015;47:161-7.

(21)

61. Chen YT, Chang CC, Hsu CR, Shen JH, et al. Combined vitamin C sonophoresis and neodymium-doped yttrium aluminum garnet (NdYAG) laser for facial hyperpigmentation: An outcome observation study in Asian patients. Indian J Dermatol Venereol Leprol 2016;82:587.

62. Tian B. Laser toning for melasma: A single-centre experience with 38 970 cases. J Cosmet Laser Ther 2017;19:140-42.

63. Tian B. The Asian Problem of Frequent Laser Toning for Melasma. J Clin Aesthet Dermatol 2017;10:40-42.

64. Lee MC, Lin YF, Hu S, Huang YL, et al. A split-face study: comparison of picosecond alexandrite laser and Q-switched Nd:YAG laser in the treatment of melasma in Asians. Lasers Med Sci 2018;33:1733-38.

65. Rivera Z, Ollarves V, Rivera I, Hagel I. Clinical factors affecting the efficacy of melasma treatment using the Q-switched 1064 Nd: YAG laser mode in a group of Venezuelan female patients. J Cosmet Laser Ther 2019;21:398-403.