Resumen

Objectives: Abstract Introduction: Lichenoid pigmentary dermatoses, including erythema dyschromicum perstans (EDP), ashy dermatosis, and lichen planus pigmentosus (LPP), are chronic conditions with limited response to conventional therapies and a significant impact on patients’ quality of life. The lack of standardized treatment guidelines hampers appropriate therapeutic decision‑making. Introduction: Aisma: To describe the evolution and outcomes of a multimodal therapeutic protocol for refractory lichenoid pigmentary dermatoses. Materials / method: Patients/Methods: We conducted a retrospective descriptive case series including six female patients older than 18 years with Fitzpatrick skin phototypes III–VI and a confirmed diagnosis of one of these dermatoses, unresponsive to conventional treatments. The protocol consisted of a structured topical skincare routine, oral astaxanthin, three monthly sessions of Q‑switched Nd:YAG 1064‑nm laser, followed by intradermal application of recombinant enzymes (collagenase, lipase, and hyaluronidase). Clinical response was assessed through standardized photographic records and physician evaluation. Results: Results: Most patients achieved near‑complete pigment clearance or marked improvement, with minimal complications. Conclusion: Conclusion: This multimodal protocol yielded promising clinical outcomes in reducing hyperpigmentation and improving aesthetic appearance, offering a viable therapeutic option in an area with limited evidence‑based alternatives. These results highlights the need for strengthened clinical research and the development of consensus‑based guidelines for complex pigmentary dermatoses.