Fractional 694-Nm Ruby Laser Therapy for Melasma

BACKGROUNDMelasma is a chronic, relapsing pigmentary disorder with a significant psychosocial impact, particularly in darker skin types. Despite various therapeutic options, its resistance to treatment necessitates optimized laser protocols and more precise evaluation tools.

AIMSThis study follows a dual objective: to evaluate the efficacy and safety of a low-fluence fractional 694-nm Q-switched Ruby laser (QSRL) protocol in Asian patients, and to validate a novel AI-assisted region-of-interest (ROI) chromatic analysis for objective clinical assessment.

METHODSA retrospective analysis was conducted on patients (Fitzpatrick III–V) treated with at least four treatments using a 694 nm (QSRL) at 3–8 weeks intervals (0.77 and 0.94 J/cm2). Clinical outcomes were assessed using a digital imaging framework incorporating advanced feature-alignment algorithms (SURF and RANSAC) for precise longitudinal ROI tracking. Objective improvement was quantified via Gray-Level Co-occurrence Matrix (GLCM) texture analysis and luminosity coefficients.

RESULTSSixteen patients completed the study. Significant reductions in hyperpigmentation were recorded in midfacial regions. The AI-assisted analysis demonstrated high sensitivity in capturing localized improvements and textural shifts often missed by global clinical impressions. Notably, no cases of PIH or rebound pigmentation occurred during the 1-year follow-up. High patient satisfaction correlated strongly with quantitative pigmentary transitions.

CONCLUSIONLow-fluence fractional 694-nm QSRL provides a safe, effective treatment option for melasma in Asian skin. Moreover the study validates the AI-assisted ROI analysis provides a superior assessment tool. This dual approach offers a promising paradigm for long-term melasma management, combining an optimized laser protocol with a robust, reproducible benchmark for precision dermatology.

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