Table 3.
Summary of advanced treatments for acquired dermal macular hyperpigmentation (lichen planus pigmentosus, Riehl’s melanosis, etc.) in SoC based on recent studies.
| Author | Study Type | Year | Laser | Therapy Parameters | Fitzpatrick Scale | No. of Cases | Clinical Outcome | Adverse Events |
|---|---|---|---|---|---|---|---|---|
| Kim et al. [37] | Open-label, Mixed-methods study | 2023 | Combination of fractional alexandrite picosecond laser and PDL | 3 to 7 sessions 4 weekly intervals. For ps-laser, single treatments, 2–3 passes, <10% overlap, ≥3000 pulses to full face, fluence 0.25 J/cm2, PD 750 ps, 10 mm spot, frequency 10 Hz. For PDL, fluence 7 J/cm2, PD of 6ms, 7 mm spot |
III–IV | 11 | Significant reduction in assessment scores in all patients—10 out of 11 reported being very satisfied or satisfied. Effective for both pigmentation and dilated vessels | Transient erythema and oedema |
| Kim et al. [38] | Retrospective Study | 2021 | Non-ablative 1927 nm Fractional Thulium Fiber Laser | 5 W for the output power and 10–20 mJ pulse energy at monthly intervals | III–IV | 9 | 6/9 had “marked”, 1/9 had “significant” and 2/9 had “moderate” improvement | Mild erythema, which faded away within 3 days |
| Bhari et al. [39] | Prospective, pilot study | 2020 | QS Nd:YAG 1064 nm laser | QS-NdYAG laser, toning protocol (3 J/cm2/6 mm/10 Hz), 6 sessions, 2 weekly intervals | IV–V | 9 | 25.7% improvement as per physician assessment. Moreover, 8/9 did not perceive any improvement. No change in melanin index or erythema index | Post-inflammatory hypopigmentation in one patient |
| Cho et al. [40] | Retrospective Study | 2020 | Mid-fluence QS Nd:YAG 1064-nm laser | 3.5–5 J/cm2, 5-mm spot, 10 Hz, 6 sessions, at 5-week interval | III–IV | 21 | 6/21 had “moderate”, 8/21 had “much” and 2/21 had “very much” improvement” |
No severe side effect |
| Shah et al. [41] | Open-label, non-randomized prospective pilot study | 2019 | QS Nd-YAG 1064 nm laser | 5 sessions, 4–8 weekly, 5-mm spot, fluence 3–4.6 J/cm2, 5 Hz, 5-mm, single pass with minimal overlap | IV–V | 13 | 38.4% had >90%, 38.4% had >75%, and 23% had >50% improvement |
Confetti-like depigmentation in one patient, mild scarring in the supraorbital area in one patient |
| Choi et al. [42] | Retrospective Study | 2019 | 1064-nm Nd:YAG laser | Fluence 0.9 J/cm2 to 2.0 J/cm2, 7 mm spot, 10 Hz, 3-week intervals with 4% HQ cream | III–IV | 10 | 7/10 “near total improvement” 2/10 “marked improvement” 1/10 “minimal improvement |
Three patients complained of guttate hypopigmentation |
| Kwon et al. [33] | Pilot study | 2017 | Low-fluence Q-switched 1064-nm Nd:YAG, combined with other lightening agents. | Fluence 1–1.3 J/cm2, 10 mm spot, 2–3 passes, at 3-week intervals, 4% HQ cream and oral tranexamic acid 250mg/day | III–V | 8 | 3/8 “almost clear” grade 5/8“marked improvement” grading | None |