Combination of fractional erbium-glass laser and topical therapy in melasma resistant to triple-combination cream

J Dermatolog Treat. 2014 Jun;25(3):218-22. doi: 10.3109/09546634.2012.671911. Epub 2012 Apr 12.


Background: Melasma is a common melanosis often difficult to treat.

Objective: The aim of this paper was to report on the safety and efficacy of non-ablative fractional photothermolysis combined with the use of triple-combination cream (TCC) on a large population with melasma resistant (i.e., with no complete/near-complete clearing) to TCC alone.

Methods: Seventy-six patients with resistant melasma underwent a combined treatment protocol. The protocol consisted of a TCC (hydroquinone 4%, retinoic acid 0.03%, hydrocortisone butyrate 0.1%) applied daily for 10 days followed by four laser treatments performed in 3-week intervals with a fractional 1540-nm erbium-glass laser. During these intervals, and for 3 months after the last laser session, TCC was also applied daily following a "pulse-therapy" scheme. Improvement was assessed by the melasma-area-and-severity-index (MASI) score.

Results: At 1 month, marked (>75%) and moderate (51-75%) clearing of melasma were observed in 46 of 76 (67.1%) and 12 of 76 (21%) cases, respectively. At 6 months, we noticed a marked improvement in 16 of 76 (21.1%) and no improvement in 33 of 76 (43.4%) patients.

Conclusion: Our study proposes the combination of NFP/TCC as a useful therapy for patients with melasma resistant to TCC alone, but it shows that its long-term efficacy is limited.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Combined Modality Therapy
  • Dermatologic Agents / administration & dosage*
  • Female
  • Humans
  • Hydrocortisone / administration & dosage
  • Hydroquinones / administration & dosage
  • Lasers, Solid-State / therapeutic use*
  • Low-Level Light Therapy*
  • Melanosis / drug therapy
  • Melanosis / radiotherapy
  • Melanosis / therapy*
  • Middle Aged
  • Treatment Failure
  • Treatment Outcome
  • Tretinoin / administration & dosage
  • Young Adult


  • Dermatologic Agents
  • Hydroquinones
  • Tretinoin
  • Hydrocortisone
  • hydroquinone