Melasma and post-inflammatory hyperpigmentation (PIH) are common conditions that can cause distress to patients and make them visit dermatologists. While PIH can resolve over time once the underlying inflammation is controlled, melasma often requires prolonged treatment and maintenance. Treatment options for both conditions range from UV protection and topical therapies, such as hydroquinone, to more procedural-based options, including chemical peels, microneedling and energy-based devices.

A recent study investigated the use of various energy-based therapies, such as laser devices, intense pulsed light (IPL), high-frequency ultrasound and radiofrequency devices, in treating melasma and PIH. The study utilized PubMed with relevant terms to collect references.

The study found that:

• Lasers and IPL effectively target pigment in the epidermis and dermis, employing suitable wavelengths and principles like thermal relaxation time and photoacoustic damage. 
• Other lasers, like pulsed-dye laser (PDL), target the vascular element of melasma. 
• These devices can be used independently or in addition to topical treatments to improve melasma and PIH. 
• Additionally, some authors have investigated the use of fractionated lasers in device-assisted drug delivery of topical therapies.

The study concludes that the benefits of these devices are usually temporary and balanced against the potential side effects of dyspigmentation and scarring. Hence, a combination of topical therapies, procedures and energy-based devices is recommended for the best results, followed by a maintenance program.

Source: Reynal S, Martin E, Munavalli G. Energy-based devices for melasma and postinflammatory hyperpigmentation. Dermatol Rev. 2023;4(1):58-66.