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Level of Evidence for Using Lasers and Light Procedures for Treating Melasma Using the GRADE Working Group Recommendation [38-40]

Levels of evidence for aesthetic procedures

Level of evidence	Quality of evidence and definitions
A: High	Further research is very unlikely to change our confidence in the estimate of effect Several high quality studies with consistent results
B: Moderate	Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate One high quality study or several studies with limitations
C: Low	Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate One or more studies with limitations
D: Very low	Any estimate of effect is very uncertain Expert opinion with No direct research experience One or more studies with very severe limitations

GRADE Working Group [38], Guyatt et al. [39]

Reference	Procedures	Quality of evidence (A-D)
[5-7]	Full ablative lasering	D (very low)
[11, 13, 14]	Fractional lasers	B (moderate)
[2-4]	QS Nd:YAG laser	C (low)
[18-22, 28]	QS Nd:YAG laser toning	A (high)
[26, 27, 29]	Intense pulsed light	C (low)
[33, 34]	Pulsed dye laser	C (low)
[37, 38]	Copper bromide laser	C (low)

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The Role of Lasers and Light Devices for the Treatment of Melasma
Chee Leok Goh Melasma is a common pigmentary disorder among Asians, Hispanics, and the Mediterraneans. The etiology is multifactorial, and there is no single treatment (topical or procedural) that can completely cure melasma. The first-line treatment of melasma is sun avoidance, sun protection,...
(Melasma and Vitiligo in Brown Skin)
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