Abstract：
Melasma is a common acquired skin pigmentation disorder. The treatment is urgent but challenging. Ablative fractional laser (AFL) can improve pigmentation, but the efficacy and potential side effects are still debatable. This study aimed to evaluate the efficacy and safety of ablative fractional lasers in the treatment of melasma. A comprehensive systematic search of literature published before June 20, 2023, was conducted on online databases, including PubMed, Embase, Cochrane Library, and Web of Science. The data obtained were analyzed using Review Manager 5.4 software. Fourteen randomized controlled trials, comprising 527 patients, were included. Compared to the drug alone, the combination of AFL and the drug showed improved therapeutic efficacy in the melasma area and severity index (MASI) (MD = 1.54, 95% CI [0.16, 2.92], P = 0.03) and physician global assessment (RR = 1.61, 95% CI [1.08, 2.41], P = 0.02). However, no statistically significant results were found in patient self-assessment (RR = 1.56, 95% CI [0.88, 2.76], P = 0.12). As an individual therapy, AFL is not superior to any other lasers in terms of MASI (MD = 2.66, 95% CI [-1.32, 6.64], P = 0.19) or melanin index (MD = -7.06, 95% CI [-45.09, 30.97], P = 0.72). Common adverse events included transient erythema, burning, edema, and superficial crusting. Only a few patients experienced reversible post-inflammatory hyperpigmentation, herpes labialis, and acne breakouts. These results support the application of AFL as a viable treatment option for melasma, particularly in refractory and severe cases. Rational parameterization or combination therapy may lead to significant clinical improvement with fewer complications.
摘要：
黄褐斑是一种常见的获得性皮肤色素沉着障碍。治疗是紧急但具有挑战性的。消融点阵激光（AFL）可以改善色素沉着，但疗效和潜在的副作用仍有争议。本研究旨在评价剥除性点阵激光治疗黄褐斑的疗效和安全性。在在线数据库上对2023年6月20日之前发表的文献进行了全面系统的检索，包括PubMed,Embase,科克伦图书馆,和WebofScience。使用ReviewManager5.4软件分析获得的数据。14项随机对照试验,包括527名患者，包括在内。与单独的药物相比，AFL和药物的组合在黄褐斑面积和严重程度指数（MASI）（MD=1.54，95％CI[0.16，2.92]，P=0.03）和医师全球评估（RR=1.61，95%CI[1.08，2.41]，P=0.02)。然而,患者自我评估结果无统计学意义(RR=1.56,95%CI[0.88,2.76],P=0.12）。作为一种个体治疗，AFL在MASI方面并不优于任何其他激光器(MD=2.66，95%CI[-1.32，6.64]，P=0.19)或黑色素指数(MD=-7.06，95%CI[-45.09，30.97]，P=0.72）。常见的不良事件包括短暂性红斑，燃烧,水肿,和表面结痂。只有少数患者出现可逆性的炎症后色素沉着过度，唇疱疹,和痤疮爆发。这些结果支持AFL作为黄褐斑的可行治疗选择的应用，特别是在难治性和严重的情况下。合理的参数化或联合治疗可能导致显着临床改善，并发症少。
