For clinicians engaged in aesthetic rehabilitation and dermatological care, the management of melasma remains a complex challenge. The pathogenesis of melasma is multifactorial, involving vascular, pigmentary, and inflammatory components that often resist monotherapeutic interventions. A recent Randomized Controlled Trial (RCT) published in the Journal of Cosmetic Dermatology (December 2025) explores a multimodal approach, investigating the efficacy of combining Intense Pulsed Light (IPL) with microneedling and a postbiotic formulation.
The Challenge of Refractory Pigmentation
Traditional monotherapies for melasma frequently yield suboptimal results or high recurrence rates. While IPL is well-documented for its selective photothermal effects in reducing pigmentation, it does not always address the full spectrum of melasma pathophysiology. Conversely, microneedling provides mechanical stimulation that enhances transdermal drug delivery and accelerates melanin clearance. The study by Li et al. (2025) aimed to validate the therapeutic synergy of these modalities when combined with a postbiotic formulation containing Lactobacillus fermentation lysate.
Study Design and Methodology
The research team enlisted 30 individuals diagnosed with facial melasma, randomly dividing them into two distinct treatment groups. The control group received standard IPL therapy at 4-week intervals over a 12-week period. The experimental group underwent a combination therapy protocol, receiving alternating sessions of IPL and microneedling every two weeks for the same duration. This alternating schedule allowed researchers to assess the cumulative effect of photothermal therapy alongside mechanical microneedling and topical postbiotic application.
Clinical Outcomes and Statistical Significance
Assessment utilized the Modified Melasma Area and Severity Index (mMASI) Score and the VISIA skin detection system to ensure objective data collection. Results indicated that while both groups experienced reductions in mMASI scores from baseline, the combination therapy group demonstrated significantly greater improvement (p < 0.05).
VISIA analysis corroborated these clinical findings, revealing significant decreases in scores related to speckle, brown speckle, red regions (indicating vascular components), and UV speckle. These objective measures suggest that the combination approach targets not just superficial pigment, but also the underlying inflammatory and vascular contributors to melasma.
Patient Satisfaction and Safety Profile
Beyond clinical metrics, patient reported outcomes are vital in aesthetic practice. The study reported a 73.3% satisfaction rate among participants. Clinical photography demonstrated visible reductions in both pigmentation and inflammation. Importantly, no severe adverse events were recorded, suggesting that the alternating protocol of IPL and microneedling is a safe therapeutic strategy.
Conclusion and Future Directions
The findings suggests that combining IPL and microneedling with a postbiotic formulation exhibits a multidimensional synergistic effect. For practitioners, this study highlights the importance of moving beyond monotherapy. By integrating photothermal reduction, mechanical stimulation, and advanced topical formulations, clinicians can offer superior outcomes for patients struggling with complex pigmentation disorders.
References
Li, Z., Xiang, Y., Meng, J., Wang, H., Wu, H., Li, T., Jiang, X., Wu, T., Zhang, Y., Xiao, X., Ma, X., Yang, M., Zhu, H., Bi, Y., Chen, Y., Lei, H., Hu, J., Huang, G., Cong, L., Wang, J., Yan, L., Zhou, H., Li, C., Zhang, X., Ou, M., & Meng, Q. (2025). Efficacy of the Combination Therapy of Intense Pulsed Light and Microneedling With a Postbiotic Formulation for Melasma. Journal of Cosmetic Dermatology. https://pubmed.ncbi.nlm.nih.gov/41347603/
