Recent studies have shown the potential effectiveness of targeting the vascular components of melasma. 1-4 copper bromide laser (Dual Yellow; Norseld is a laser with an accompanying output dual-wavelength light source consisting of 90% yellow light at 578nm, targeting vascular lesions, and 10% green light at 511nm, targeting pigmented lesions. There are two conflicting reports about the potential value of this laser treatment for melasma. 5,6 The objective of this study was to compare the effectiveness of copper bromide laser combined with Krigman's formula cream (a combination of hydroquinone 5%, dexamethasone acetate 0.1% and retinoic acid 0.1%) in the treatment of chloasma.

From February 2012 to June 2013, we conducted a single-center, prospective, clinical, randomized, face-divided blind evaluation study at the Dermatology department of the University Hospital of Nice. The study was approved by the Ethics Committee of the University Hospital of Nice with written informed consent from all patients. The complete study protocol can be found in the trial protocol in the appendix.

All patients applied the topical cream to their entire face once a day for 4 weeks. Half of the face was then randomly assigned to copper bromide laser treatment, while the other side of the face continued to be treated with a topical cream daily for 3 months. Four CuBr laser treatments were performed at weeks 4, 6, 9 and 12. Yellow and green wavelengths are produced simultaneously in a ratio of 9 to 1. The Settings applied during the first laser treatment are: flux, 12J/cm2; 0.6-mm contact tip; And 1 pass. As mentioned earlier, the fluency gradually improves. 5 Then use a 1mm spot size to make 4 passes each time. The launch time is 50 to 60 milliseconds, the cut-off time is 70 milliseconds, and 7.7 to 8.3 pulses per second. The end points are erythema and mild gray lesions. Before laser treatment, a colorless ultrasound gel is applied directly to the skin. The assessment was made by the two of us (H.M. and F.B.) using standardized photographs (VISIA-CR; Canfield Scientific), where they masked the treatment on both sides of the face. The melasma area and Severity Index (MASI) score for each half of the face was used to assess the effectiveness of the treatment. The follow-up time was 3 and 6 months, respectively. The primary assessment criteria was the patient's MASI score at 6 months after the end of treatment. Laser confocal microscopy (VivaScope; MAVIG) was used to assess the evolution of the lesions treated between baseline visits and 6 months after the end of treatment. At the end of the study, efficacy and tolerability (depending on the patient) were assessed using a visual analog scale of 0 to 10 points.