High-Potency Depigmenting Mask Delivered via 1,927-nm Fractional Laser in Refractory Melasma: A Pilot Case Series.

Introduction: Melasma is a chronic, relapsing hyperpigmentation disorder and may remain refractory despite multiple topical agents and procedural approaches. Case Presentation: We report a case series of six women with Fitzpatrick skin types III-V and longstanding, treatment-resistant facial melasma managed with a multimodal protocol consisting of (1) a 16-week home regimen (twice-daily depigmenting cosmeceutical serum and daily high-protection sunscreen) and (2) two sessions of low-energy, low-density 1,927-nm fractional thulium laser at 4-week intervals, immediately followed by laser-assisted delivery of a compounded depigmenting mask (hydroquinone, retinoic acid, kojic acid, triamcinolone acetonide, vitamins C and E). Clinical response was assessed using the Melasma Severity Scale (MSS), standardized photography, and patient satisfaction. At week 16, all patients improved: 4 achieved >75% clinical improvement and 2 achieved 50-75% improvement, with high satisfaction and no significant adverse events beyond transient darkening and mild desquamation. Clinical benefits remained stable 12 weeks after the final laser session. Conclusion: This case series suggests that 1,927-nm fractional thulium laser-assisted delivery of a high-potency depigmenting compound, supported by topical priming and strict photoprotection, may be a feasible option for selected patients with refractory melasma.