Treatment of Refractory Melasma with Microwave-generated, Atmospheric-pressure, Non-thermal Nitrogen Plasma

Periorbital melasma is often refractory to treatment and highly associated with rebound hyperpigmentation or mottled hypopigmentation after laser treatment in Asian patients. In this report, we describe 2 patients with cluster-1 periorbital melasma and 1 patient with cluster-2 periorbital melasma who experienced remarkable clinical improvements after microwave-generated, atmospheric-pressure, non-thermal nitrogen plasma treatments. All patients exhibited limited clinical responses after combination treatments with topical bleaching agents, systemic oral tranexamic acid, and low-fluenced Q-switched neodymium (Nd):yttrium-aluminum-garnet (YAG) lasers. Low-energy nitrogen plasma treatment at 0.75 J elicited remarkable clinical improvement in the periorbital melasma lesions without post-laser therapy rebound hyperpigmentation and mottled hypopigmentation. We deemed that a single pass of nitrogen plasma treatment at 0.75 J induces mild microscopic thermal tissue coagulation and modification within the epidermis while preserving the integrity of the basement membrane in patients with periorbital melasma. Accordingly, nitrogen plasma-induced dermal tissue regeneration could play a role in the treatment of melasma lesions.