Table 7.

Treatment mode and regimen for laser therapy

Type of laser	Mechanism	Treatment mode	Comments
QS Nd:YAG Laser 1,064 nm (low-fluence mode laser toning)	Photothermolysis of melanin in melanosomes in the melanocytes and keratinocytes. Also photoacoustic effect. Sub-cellular selective photothermolysis occurs in the low-fluence mode. Destroys melanin without cell damage	10 sessions, once weekly	End point is mild erythema, with no whitening. A large spot size (6 mm) should be exposed to 1–2 passes with minimal overlap. This treatment is recommended in all skin types. Priming with triple-combination cream prior to laser therapy is recommended [91, 96]. PIH and blotched depigmentation have been reported [91, 99]
Combination of QS Nd:YAG 1,064, with the fractional CO2 laser	Laser toning, using a large spot size with very low fluence giving multiple passes at frequent intervals	10 sessions, every 2–3 weeks	Promising treatment modality. Concomitant and post-therapy topical treatment to maintain remission. Maintenance sessions may be needed in case of relapse
IPL	Same as laser	–	Effective in treating refractory melasma in Asian patients [56, 67]
Combination of IPL with QS Nd:YAG laser 1,064 nm (low-fluence mode laser toning)	Same as laser	1st session IPL for clearing epidermal melasma followed by 4–5 sessions of QS Nd:YAG laser at 2-week intervals	Rapid resolution of mixed-type melasma with possible long-term benefits [67–69]. This treatment is recommended in all skin types

IPL intense pulsed light, Nd:YAG neodymium-doped yttrium aluminum garnet, PIH postinflammatory hyperpigmentation, QS Q switched