High-Potency Depigmenting Mask Delivered via 1,927-nm Fractional Laser in Refractory Melasma: A Pilot Case Series

Melasma is a chronic, relapsing hyperpigmentation disorder and may remain refractory despite multiple topical agents and procedural approaches.

We report a case series of six women with Fitzpatrick skin types III-V and longstanding, treatment-resistant facial melasma managed with a multimodal protocol consisting of (1) a 16-week home regimen (twice-daily depigmenting cosmeceutical serum and daily high-protection sunscreen) and (2) two sessions of low-energy, low-density 1,927-nm fractional thulium laser at 4-week intervals, immediately followed by laser-assisted delivery of a compounded depigmenting mask (hydroquinone, retinoic acid, kojic acid, triamcinolone acetonide, vitamins C and E). Clinical response was assessed using the Melasma Severity Scale (MSS), standardized photography, and patient satisfaction. At week 16, all patients improved: 4 achieved >75% clinical improvement and 2 achieved 50-75% improvement, with high satisfaction and no significant adverse events beyond transient darkening and mild desquamation. Clinical benefits remained stable 12 weeks after the final laser session.

This case series suggests that 1,927-nm fractional thulium laser-assisted delivery of a high-potency depigmenting compound, supported by topical priming and strict photoprotection, may be a feasible option for selected patients with refractory melasma.