摘要

Objectives: To present a dermal targeted therapeutic strategy using low fluence microsecond pulse Q switched 1064 nm laser for long term control of refractory dermal melasma. Introduction: Melasma is a chronic and relapsing pigmentary disorder increasingly understood as a dysregulated cutaneous microenvironment rather than a purely melanocytic condition. Recent evidence highlights the role of dermal alterations, particularly the accumulation of senescent fibroblasts and their senescence associated secretory phenotype, in sustaining melanocyte stimulation and contributing to recurrence. Materials / method: A 45 year old female patient with an 8 year history of recurrent centrofacial melasma refractory to conventional topical and procedural therapies was treated using a serial low fluence microsecond pulse Q switched 1064 nm laser protocol. Treatment parameters were selected to favor dermal penetration and controlled photomechanical modulation while minimizing thermal injury. Sessions were performed sequentially followed by non hydroquinone topical maintenance therapy. Results: Significant pigment reduction and improved skin homogeneity were observed without post inflammatory hyperpigmentation. Sustained remission was documented at 24 month follow up with no significant relapse and no rebound hyperpigmentation. Clinical stability was maintained with topical therapy alone. Conclusion: This case supports the hypothesis that dermal microenvironment modulation particularly targeting senescent fibroblasts may contribute to long term disease control in refractory dermal melasma. Moving beyond pigment clearance toward biological modulation may represent a strategic shift in melasma management.