A New Hope for Melasma: Long‐Term Clearance With 755‐nm Picosecond Alexandrite Laser and Topical JAK Inhibition

Journal of Cosmetic DermatologyOctober 6

Open Access

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Clinical Summary

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What was studied

Single-patient case report of a 31-year-old Fitzpatrick IV woman with 4-year refractory malar melasma treated with one 755‑nm picosecond alexandrite laser session, then maintenance with topical tofacitinib 2% twice daily plus iron oxide–tinted sunscreen, followed for 9 months.

Key findings

Marked clearance with homogeneous tone after the single laser session, maintained for 9 months before gradual relapse; no adverse effects, post‑inflammatory hyperpigmentation, or rebound were reported.

Study limitations

Single patient with no comparator; multimodal regimen prevents attribution of benefit to any single component; follow‑up durability assessed only to 9 months.

Clinical implications

In darker phototypes with refractory melasma, a single 755‑nm picosecond alexandrite laser session followed by topical JAK inhibition and visible‑light photoprotection may achieve months‑long clearance without PIH, but this remains preliminary and needs confirmation in controlled studies.