A study of efficacy and safety of high‐intensity focused ultrasound for the treatment of melasma in Asians: A single‐blinded, randomized, split‐face, pilot study
Vasanop Vachiramon MD  Wimolsiri Iamsumang MD, MSc  Nongsak Chanasumon MD, MSc  Kunlawat Thadanipon MD  Korn Triyangkulsri MD
First published: 07 June 2019 https://doi.org/10.1111/jocd.13044
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Abstract
Background
A recent report suggested potential of high‐intensity focused ultrasound in improving UVB‐induced hyperpigmentation in patients with Fitzpatrick skin type IV, but reports regarding its efficacy in other hyperpigmented conditions including melasma are lacking.

Objectives
To investigate efficacy and safety of high‐intensity focused ultrasound for the treatment of melasma in Asians.

Methods
Each side of the face of 25 melasma patients was randomized to receive 3‐monthly sessions of high‐intensity focused ultrasound treatment or serve as control. Lightness index, Melasma Area and Severity Index of malar area (MASIm) by blinded dermatologists, self‐evaluated improvement and satisfaction scales by patients, and side effects were assessed every 4 weeks for 20 weeks.

Results
Twenty‐one patients with Fitzpatrick skin type III and IV completed the study. There was a greater reduction of relative lightness index and MASIm after treatment in high‐intensity focused ultrasound‐treated side. However, there were no statistically significant differences between both sides. More than 50% improvement on treatment side was rated in 11 patients (52.4%). Side effects were minimal. None had worsening of melasma.

Conclusions
High‐intensity focused ultrasound may be an adjuvant for treatment of melasma. Further studies with larger sample size and proper parameter settings are recommended to determine its efficacy.