# Efficacy and safety of Q-switched laser combined with intense pulsed light in treating melasma: a meta-analysis

## TL;DR

Combining Q-switched laser and intense pulsed light improves melasma treatment outcomes compared to single therapies, without increasing side effects.

## Contribution

This study provides a meta-analysis showing combination therapy for melasma is more effective than monotherapy.

## Key findings

- Combination therapy reduced MASI scores significantly more than monotherapy.
- Combination therapy had a higher efficacy rate (92.0% vs. 77.4%) and lower recurrence rate.
- No significant difference in patient satisfaction or adverse events between groups.

## Abstract

Melasma is a common dermatological disorder characterized by hyperpigmented facial patches, which significantly impacting patients' quality of life and imposing substantial economic burdens. Given the multifaceted impact of melasma, there is a pressing need for effective therapeutic strategies. This meta-analysis evaluates the efficacy and safety of combining Q-switched (QS) laser with intense pulsed light (IPL) vs. monotherapy for melasma.

A systematic literature search of relevant databases was conducted to identify controlled trials comparing the combination therapy with monotherapy. Primary outcomes included changes in the Melasma Area and Severity Index (MASI) score and adverse reactions. Secondary outcomes comprised clinical efficacy rate, recurrence rate, and patient satisfaction rate. Data were pooled using a fixed-effects model.

A total of 31 studies involving 2,801 patients were included. Results showed that the combination therapy demonstrated a significantly greater reduction in MASI scores than monotherapy (standardized mean difference: 1.20, 95% CI: −1.36 to −1.05; p < 0.001). The pooled efficacy rate was also higher for the combination group (92.0% vs. 77.4%; risk ratio: 1.10, 95% CI: 1.03–1.17; p < 0.05). Moreover, the combination group exhibited a lower recurrence rate (8.5 vs. 17.8%; risk ratio: 0.54, 95% CI: 0.32–0.90; p < 0.05). However, no significant difference in patient satisfaction was observed between the two groups. The incidence of adverse events was comparable between the treatments.

This meta-analysis indicates that Q-switched laser combined with intense pulsed light results in greater objective improvement in melasma than monotherapy, without an increased risk of adverse events. In contrast, patient satisfaction shows no significant improvement, suggesting that patient-reported outcomes should be considered alongside clinician-assessed measures. Additional longitudinal studies are needed to establish sustained efficacy and clarify patient-perceived benefits to further refine clinical protocols.

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251170319, identifier: CRD420251170319.