Assessing the Safety and Efficacy of Picosecond Alexandrite Lasers in the Management of Melasma: A Systematic Review and Meta-Analysis of Randomised Control Trials

Kangjie R Chua; Dilip K Vankayalapati; M Zaid Shami; Valeria Antoniou; Emma J B Nordahl; Kowthar Abdul-Aziz; Laith Bayan; Sum-Yu C Lee; Hayato Nakanishi; Christian A Than; Davin Lim

doi:10.1111/ajd.70051

Assessing the Safety and Efficacy of Picosecond Alexandrite Lasers in the Management of Melasma: A Systematic Review and Meta-Analysis of Randomised Control Trials

Australas J Dermatol. 2026 May;67(3):140-150. doi: 10.1111/ajd.70051. Epub 2026 Jan 26.

Authors

Kangjie R Chua¹, Dilip K Vankayalapati^{2

3}, M Zaid Shami⁴, Valeria Antoniou⁵, Emma J B Nordahl⁵, Kowthar Abdul-Aziz⁶, Laith Bayan⁷, Sum-Yu C Lee⁵, Hayato Nakanishi⁸, Christian A Than^{9

10}, Davin Lim^{11

12}

Affiliations

¹ Royal Prince Alfred Hospital, Camperdown, Australia.
² John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
³ Wollongong Hospital, Wollongong, Australia.
⁴ HCA Florida Aventura Hospital, Florida, USA.
⁵ Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus.
⁶ The University of Manchester, Manchester, UK.
⁷ The Queen Elizabeth Teaching Hospital King's Lynn NHS Foundation Trust, Norfolk, UK.
⁸ Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
⁹ Cambridge University Hospitals NHS Foundation Trust, Addenbrookes Hospital, Cambridge, UK.
¹⁰ School of Biomedical Sciences, The University of Queensland, Brisbane, Australia.
¹¹ Cutis Clinic, Indooroopilly, Australia.
¹² The Melasma Clinic, Sydney, Australia.

PMID: 41589005
DOI: 10.1111/ajd.70051

Abstract

Melasma is a chronic hyperpigmentation disorder that disproportionately affects women and individuals with darker skin types, leading to a significant psychosocial burden. This meta-analysis aims to evaluate the safety and efficacy of the 755-nm picosecond alexandrite laser (PSAL) compared with conventional therapies in the management of melasma. PubMed, Ovid Medline, Embase, Cochrane Library, and Google Scholar were searched from inception to April 10, 2025, in accordance with PRISMA guidelines. Randomised controlled trials (RCTs) assessing PSAL versus control comparators in adults with melasma and reporting Melasma Area and Severity Index (MASI) or Modified MASI outcomes were included. The review was registered prospectively on PROSPERO (CRD420251022381). Risk of bias was assessed using ROB2. Pooled effect sizes were calculated using a random-effects model. Five RCTs (n = 139 patients) were included. Change in MASI favoured triple combination cream (TCC) over PSAL therapy (MD = 1.82, 95% CI: 1.11, 2.52, I² = 0%). Post-inflammatory hyperpigmentation was more common in the PSAL group compared to topical creams (OR = 6.86, 95% CI: 1.47, 32.07, I² = 0%) but had no difference with the Q-switched lasers (OR = 4.09, 95% CI: 0.62, 26.97, I² = 0%). There was no incidence of hypopigmentation or infection reported. PSAL appears inferior to the TCC in reducing MASI scores. Overall certainty is low due to small, heterogenous trials. Low rates of irreversible adverse events with PSAL may support trials in refractory cases, but long-term RCTs with larger sample sizes are required to evaluate durability and recurrence outcomes.

Keywords: hyperpigmentation; melasma; meta‐analysis; solid‐state lasers; systematic review.

Publication types

Systematic Review
Meta-Analysis

MeSH terms

Humans
Lasers, Solid-State* / adverse effects
Lasers, Solid-State* / therapeutic use
Low-Level Light Therapy* / adverse effects
Low-Level Light Therapy* / methods
Melanosis* / radiotherapy
Melanosis* / therapy
Randomized Controlled Trials as Topic
Treatment Outcome