Mottled Hypopigmentation from Laser Toning in the Treatment of Melasma: A Catastrophic or Manageable Complication?

Melasma is a common acquired pigmentary disorder and difficult to treat with a high rate of recurrence. Conventional methods in the treatment of melasma have drawbacks and limitations. The so-called “laser toning” treatment, which uses a collimated low-fluence 1,064 nm Q-switched neodymium-doped yttrium aluminum garnet laser, was introduced a few years ago for the treatment of melasma. Laser toning has attracted much popularity and attention, and has become a crucial method for treatment of melasma. Laser toning is now a mainstay for treatment and management of melasma, however some dermatologists have excessive concerns about the risk of hypopigmentation. This inordinate fear may have originated from a few studies which insisted that laser toning therapy has a high risk of hypopigmentation and should be considered as a second-line treatment, not a first-line treatment for melasma. In the current study, we suggest that hypopigmentation after laser toning is a preventable and controllable complication based on our clinical experiences and reviews of various literatures.