1. Introduction

Melasma affects all ethnicities and genders but is more prevalent in women with darker skin types [1]. While dermatological aesthetic laser applications in European dermatology practices tend to focus on vasodilation and associated disease patterns, skin types III and IV struggle with pigmentary shifts such as melasma, often with vascular involvement [1]. Current standard treatment for melasma includes chemical peels, laser and light, oral and topical treatments, with hydroquinone considered the gold standard, and triple combination creams (with corticosteroid, tretinoin and hydroquinone) [2 – 5]. Therapy using 577nm HOPSL diode laser has been shown to be safe and proven, with studies concluding that the addition of 577nm laser in the treatment of melasma leads to maintenance of improvement and reduction in recurrence rate, compared to hydroquinone [6].

2. Materials and Methods

Treatment data and photos for this case report were retrospectively gathered from routine consultations and treatment of a 46-year-old female patient with melasma. Following an anamnesis using black light and light dermatoscopy, and classification according to the Melasma Severity Index (MSI) score, an individualized treatment plan was developed. This plan addressed both the pigmented and vascular components of the melasma using a 577 nm diode laser with High-power Optically Pumped Semiconductor Laser (HOPSL) technology.

In the present case, laser treatment was administered using the QuadroStar PRO YELLOW (Asclepion Laser Technologies GmbH) across three sessions, each spaced one month apart. The treatment parameters were as follows:

Step 1: Scanner mode with a fluence of 12 J/cm², pulse duration of 19 ms, and 80% coverage

Step 2: YellowShower with the focused single-spot handpiece, set in expert mode, at a distance of 3 – 5 cm, with a fluence of 13 J/cm² and a pulse duration of 24 ms.

Before treatment, the area was cleaned with a skin disinfectant, and a thin layer of clear ultrasound gel was applied.

During the first step, the scanner mode was used to ensure the entire area was treated with minimal thermal effect and high coverage. In the second step, the single-spot focused handpiece was defocused by approximately 3 – 5 cm, creating a fine laser mist. This final step provided superficial treatment to the remaining pigment, aiming to address pigmentation at all levels (Fig. 1). If pronounced erythema occurs from the previous steps, the fluence should be reduced in subsequent treatments.

Fig. 1: Treatment procedure using the YellowShower technique.

For photographic documentation of the baseline and progress of the treatment pictures were taken directly before and 3 months after the laser treatment. They were used for measuring clinical outcomes of the laser treatments. Improvement was rated comparing the MSI before and after the treatment. The after-treatment procedure consisted of post-cooling and sunscreen.

3. Results

The treatment was well tolerated by the patient, with significant improvements in the visibility of melasma, as evidenced by a reduction in the Melasma Severity Index (MSI) score (Fig. 2). The patient expressed high satisfaction with the overall outcome of the treatment. During the procedure, the patient reported a pain level of 5/10 on the Hayes and Patterson Visual Analog Scale (VAS) [8]. Post-treatment side effects were mild and included slight edema occurring within a few hours after the procedure, and erythema that persisted for 2 to 3 days. No additional adverse effects were noted in this patient.

Fig. 2: Female patient with melasma, 46 years old. Appearance before (A) and 3 months after (B) 2-step melasma treatment, including YellowShower.

4. Conclusion

Following numerous treatments with the QuadroStarPRO YELLOW, Dr. Gloria Novelita has found the HOPSL laser to be a safe and effective method, offering a compelling alternative to topical treatments alone. Comprehensive photographic documentation of the initial condition and the progress throughout the treatment is highly recommended to ensure satisfactory long-term outcomes for both practitioners and patients.

This method has proven effective not only for treating melasma but also for addressing diffuse redness, individual telangiectasias, and vascular areas, depending on the specific indication and severity of the melasma. For ongoing maintenance, it is advised to combine laser therapy at the 577nm wavelength with regular follow-up treatments at intervals recommended by the physician, alongside strict adherence to sun avoidance and proper skin care routines.

Overall, the treatment demonstrated significant effectiveness with minimal side effects. The marked reduction in melasma visibility, coupled with the high level of patient satisfaction, highlights the efficacy of this approach and supports its continued use in managing similar cases of melasma.

5. Compliance with ethical guidelines

Conflicts of interest for the study:

The author declares that she has no competing interests. The author has legally purchased the laser mentioned in this article and used it in her practice. Her research did not involve animals.  Written Informed consent was obtained. The author has indicated no significant interest with commercial supporters.

All Photos courtesy of Dr. Gloria Novelita, Skin & Co Skin Care Laser Clinic Jakarta, Indonesia