Fractional CO2 laser and adjunctive therapies in skin of color melasma patients

BACKGROUND: Ablative lasers have long been considered an unfavorable option for melasma in patients with skin of color and continue to be underutilized. OBJECTIVE: To evaluate the safety and outcomes of ablative fractional CO(2) lasers on refractory melasma in patients with skin of color. METHODS: A retrospective chart review of 12 patients from a single-center dermatology clinic. The study included refractory melasma patients receiving ablative fractional CO₂ laser therapy alone or with laser toning and/or tranexamic acid (TXA). A validated modified Melasma Area and Severity Index (mMASI) scoring scale was used to assess disease severity at baseline and approximately 1 month after each treatment session. RESULTS: Among the 12 patients, 41.7% patients showed >50% reduction in mMASI scores with 33.3% of patients showing statistical significance (P < .05). The CO₂ laser therapy with the TXA cohort showed the largest decrease in the mean mMASI scores and the CO₂ laser with laser toning showed the lowest decrease in scores. Patients who started on oral TXA earlier, after their initial ablative laser session, showed better clinical improvement. LIMITATIONS: Retrospective study design with short follow-up period and a small sample size. CONCLUSION: Ablative CO(2) laser treatment may be a reasonable option for refractory melasma in patients with skin of color, though future research is needed.