Assessing the Safety and Efficacy of Picosecond Alexandrite Lasers in the Management of Melasma: A Systematic Review and Meta-Analysis of Randomised Control Trials

评估皮秒翠绿宝石激光治疗黄褐斑的安全性与有效性：随机对照试验的系统评价与Meta分析

Melasma is a chronic hyperpigmentation disorder that disproportionately affects women and individuals with darker skin types, leading to a significant psychosocial burden. This meta-analysis aims to evaluate the safety and efficacy of the 755-nm picosecond alexandrite laser (PSAL) compared with conventional therapies in the management of melasma. PubMed, Ovid Medline, Embase, Cochrane Library, and Google Scholar were searched from inception to April 10, 2025, in accordance with PRISMA guidelines. Randomised controlled trials (RCTs) assessing PSAL versus control comparators in adults with melasma and reporting Melasma Area and Severity Index (MASI) or Modified MASI outcomes were included. The review was registered prospectively on PROSPERO (CRD420251022381). Risk of bias was assessed using ROB2. Pooled effect sizes were calculated using a random-effects model. Five RCTs (n = 139 patients) were included. Change in MASI favoured triple combination cream (TCC) over PSAL therapy (MD = 1.82, 95% CI: 1.11, 2.52, I2 = 0%). Post-inflammatory hyperpigmentation was more common in the PSAL group compared to topical creams (OR = 6.86, 95% CI: 1.47, 32.07, I2 = 0%) but had no difference with the Q-switched lasers (OR = 4.09, 95% CI: 0.62, 26.97, I2 = 0%). There was no incidence of hypopigmentation or infection reported. PSAL appears inferior to the TCC in reducing MASI scores. Overall certainty is low due to small, heterogenous trials. Low rates of irreversible adverse events with PSAL may support trials in refractory cases, but long-term RCTs with larger sample sizes are required to evaluate durability and recurrence outcomes.

黄褐斑是一种慢性色素沉着疾病，尤其好发于女性和深肤色人群，造成显著的心理社会负担。本Meta分析旨在评估755 nm皮秒翠绿宝石激光（PSAL）与常规疗法相比治疗黄褐斑的安全性和有效性。按照PRISMA指南，检索了PubMed、Ovid Medline、Embase、Cochrane Library和Google Scholar自建库至2025年4月10日的文献。纳入评估PSAL与对照干预措施治疗成人黄褐斑的随机对照试验（RCT），且报告黄褐斑面积和严重程度指数（MASI）或改良MASI结局。本综述已在PROSPERO前瞻性注册（CRD420251022381）。采用ROB2评估偏倚风险。采用随机效应模型计算合并效应量。共纳入5项RCT（n = 139例患者）。MASI评分变化三联乳膏（TCC）优于PSAL治疗（MD = 1.82，95% CI：1.11，2.52，I2 = 0%）。炎症后色素沉着在PSAL组较外用霜剂更为常见（OR = 6.86，95% CI：1.47，32.07，I2 = 0%），但与Q开关激光相比无差异（OR = 4.09，95% CI：0.62，26.97，I2 = 0%）。未报告色素减退或感染的发生。PSAL在降低MASI评分方面似乎劣于TCC。由于试验规模小且异质性大，总体证据确定性较低。PSAL不可逆的不良事件发生率低，可能支持在难治性病例中开展试验，但仍需更大样本量的长期RCT来评估持久性和复发结局。

Chua KR, Vankayalapati DK, Shami MZ, Antoniou V, Nordahl EJB, Abdul-Aziz K, Bayan L, Lee SC, Nakanishi H, Than CA, Lim D. Assessing the Safety and Efficacy of Picosecond Alexandrite Lasers in the Management of Melasma: A Systematic Review and Meta-Analysis of Randomised Control Trials. Australas J Dermatol. 2026 May;67(3):140-150.

Aust J Dermatology - 2026.pdf