Abstract
Introduction: In recent years, dermatology has advanced in its treatments with the introduction of laser technology. In particular, the pulsed-dye laser (PDL) has a wavelength of approximately 595 nm and is used to destroy hemoglobin in blood vessels. Melasma is an important target for PDL treatment. Objective: It was carried out a concise systematic review to highlight the major clinical studies on the use of pulsed-dye lasers in the treatment of melasma. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from February to April 2025 in the Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 87 articles were found, 19 articles were evaluated in full and 09 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 15 studies with a high risk of bias and 27 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=87.7%>50%. It was concluded that the combination of pulsed dye laser with low-fluence Q-switched Nd: YAG laser can be considered a safe and effective treatment for patients with melasma who present visibly dilated capillaries on dermoscopy. Both pulsed dye laser and intense pulsed light were effective and safe treatment modalities for the lightening of melasma. Furthermore, melasma lesions that present subtle or subclinical telangiectatic erythema can be improved by combining targeted vascular laser therapy and low-level fractional diode laser therapy. A parallel improvement in telangiectatic erythema suggests a relationship between the underlying vasculature and hyperpigmentation.