In several observational studies, non-ablative fractional photothermolysis (FP) has been reported to bridge the gap between efficacy and tolerability in the treatment of melasma. While some beneficial effects have been attributed to non-ablative FP in treating melasma, methodological constraints (e.g., a limited number of patients; no control group assignment) impair efficacy assessment; currently published results neither allow researchers and clinicians to draw valid conclusions nor warrant recommendations for therapy. In particular, bias resulting from poorly designed trials may mislead clinicians into making a wrong decision and generate not only unnecessary treatment (i.e., costs), but also a risk of side effects for patients. Therefore, the purpose of this trial was to clarify the efficacy and safety of FP in the treatment of melasma as compared to the lone application of a sun-blocking lotion (SPF >50).

Inclusion Criteria:

• Adults (female/male) with clinical evidence of melasma;
• Fitzpatrick skin phototype I-III;
• Ability and willingness to comply with the requirements of the protocol.

Exclusion Criteria:

• Pregnancy or nursing;
• Inability to avoid sun exposure for occupational reasons (e.g., gardeners);
• Known history or clinically relevant allergy to components of the sunscreen or topical anaesthetic;
• Use of topical retinoids within 3 months prior to study enrolment;
• Use of topical hydroquinone within 6 months prior to study enrolment;
• Use of topical corticosteroids within 1 month prior to study enrolment;
• Use of topical cosmetic depigmenting agents within 2 weeks prior to study enrolment;
• Laser surgery procedures within the treatment region during the last 12 weeks prior to enrolment;
• Coagulation disorders or anticoagulant treatment;
• Photo-sensitizing medication (e.g., tetracyclines, gold).