OBJECTIVE: Dermal melasma in Fitzpatrick skin types III-V usually does not respond to topical treatments. Laser resurfacing often either fails to treat these lesions or results in severe postinflammatory hyperpigmentation (PIH) or permanent hypopigmentation. Two cases of refractory dermal melasma are reported, which responded to treatment with the MedLite C6 Q-switched Nd:YAG laser. METHODS: Case 1: A 50-year-old Asian female with refractory dermal melasma and severe PIH received 10 weekly laser treatments combined with 7% alpha arbutin and a broad-spectrum sunscreen. Case 2: A 45-year-old Asian female with refractory dermal melasma received 10 weekly laser treatments combined with 7% alpha arbutin and a broad-spectrum sunscreen. RESULTS: In both cases, there was a greater than 80% reduction in epidermal and dermal hyperpigmentation. The melanin index at the site of the lesions decreased from 50 to 35 and 45 to 33, respectively. There was no recurrence of melasma at 1 year (case 1) or 6 months (case 2). CONCLUSION: Even in cases of long-standing refractory dermal melasma in a darker skin type, combination therapy has been shown to be an effective treatment for this difficult condition.
OBJECTIVE: Dermal melasma in Fitzpatrick skin types III-V usually does not respond to topical treatments. Laser resurfacing often either fails to treat these lesions or results in severe postinflammatory hyperpigmentation (PIH) or permanent hypopigmentation. Two cases of refractory dermal melasma are reported, which responded to treatment with the MedLite C6 Q-switched Nd:YAG laser. METHODS: Case 1: A 50-year-old Asian female with refractory dermal melasma and severe PIH received 10 weekly laser treatments combined with 7% alpha arbutin and a broad-spectrum sunscreen. Case 2: A 45-year-old Asian female with refractory dermal melasma received 10 weekly laser treatments combined with 7% alpha arbutin and a broad-spectrum sunscreen. RESULTS: In both cases, there was a greater than 80% reduction in epidermal and dermal hyperpigmentation. The melanin index at the site of the lesions decreased from 50 to 35 and 45 to 33, respectively. There was no recurrence of melasma at 1 year (case 1) or 6 months (case 2). CONCLUSION: Even in cases of long-standing refractory dermal melasma in a darker skin type, combination therapy has been shown to be an effective treatment for this difficult condition.