We found no systematic review. We found one RCT34 in eight dark-skinned people (skin phototype IV-VI) with dermal melasma diagnosed by Wood's lamp. The article does not provide any detail of the demographics of participants. All participants received a 14-day course of 0-05% tretinoin cream, 4% hydroquinone cream and 1% hydrocortisone cream, applied twice daily. All participants were asked to use a sunblock of SPF15 or higher. Participants had a 1 cm2 area of the face exposed to one pass of the 950-microsecond pulsed carbon dioxide laser with a computerised pattern generation set at 300 mJ/cm2. The intervention group received, in addition to the above, another pass with Q-switched alexandrite pigmented dye laser at a dose of 6 J/cm2. The treated area was evaluated after 6 months. Normal skin was found in three participants of the intervention group and one of the control group. However, the sample size is too small to draw valid conclusions, and confounding factors such as the use of different sunblock preparations was not accounted for.
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