Non-ablative dermal remodeling lasers in acquired dermal macular hyperpigmentation: A scoping review
- 1Department of Dermatology, Universidad Americana (UAM), Managua, Nicaragua
- 2Department of Dermatology, Universidad de Ciencias Médicas y Enfermería "Dr. Julio Briceño Dávila", Managua, Nicaragua
- 3School of Medicine, Universidad Americana (UAM), Managua, Nicaragua
Abstract
Background: Acquired dermal macular hyperpigmentation (ADMH) encompasses a group of challenging pigmentary disorders characterized by dermal melanophages and variable lichenoid interface inflammation. Non-ablative dermal remodeling lasers (NADRL), which target water rather than melanin, have been proposed as a potential therapeutic option through neocollagenesis and modulation of the dermal microenvironment. However, the evidence base for these devices in ADMH has not been systematically characterized. Objective: To map and characterize the available evidence on NADRL for the treatment of ADMH, including study designs, laser parameters, clinical outcomes, and safety profiles, and to identify knowledge gaps. Methods: This scoping review followed the methodological frameworks of Arksey and O'Malley and Levac et al., and was reported according to PRISMA-ScR guidelines. A comprehensive search was conducted on June 2, 2026, across PubMed/MEDLINE, LILACS, SciELO, DOAJ, Cochrane Central, and clinical trial registries, supplemented by citation tracking. Studies evaluating NADRL (980–1940 nm) in patients with ADMH were included. Two reviewers independently screened records and extracted data. A narrative synthesis and risk of bias assessment using Cochrane RoB 2 and JBI checklists were performed. Results: Of 193 records identified through electronic database searches, seven studies met inclusion criteria; citation tracking of relevant reviews and included studies did not identify any additional eligible records. These comprised two randomized controlled trials, three retrospective case series, and two case reports, comprising 31 unique patients. The 1550 nm erbium-doped fractional laser was the most frequently investigated device. Two RCTs showed no clinical or histopathological improvement, whereas observational studies reported favorable outcomes, albeit with significant methodological limitations and concomitant therapies. Laser-induced post-inflammatory hyperpigmentation (PIH) was reported in 23% of patients in one RCT. Conclusions: Evidence supporting NADRL for ADMH remains limited, heterogeneous, and insufficient to establish independent efficacy. The proposed dermal remodeling mechanism remains largely untested, as most studies evaluated only pigmentary outcomes. Future research should prioritize standardized prospective studies with histological, molecular, and imaging endpoints to determine whether these devices provide true disease modification.
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BibTeX
@article{blandon2026nonablative,
title = {{Non-ablative dermal remodeling lasers in acquired dermal macular hyperpigmentation: A scoping review}},
author = {Virgilio Blandon and Halyma Gomez and Erick Correa and Miguel Borge and Maria-Jose Altamirano and Alessandro Alvarado and Taylys Leyton},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0359552},
url = {https://doi.org/10.1371/journal.pone.0359552},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Non-ablative dermal remodeling lasers in acquired dermal macular hyperpigmentation: A scoping review
AU - Virgilio Blandon
AU - Halyma Gomez
AU - Erick Correa
AU - Miguel Borge
AU - Maria-Jose Altamirano
AU - Alessandro Alvarado
AU - Taylys Leyton
PY - 2026
DA - 2026/09/28
JO - PLOS One
DO - 10.1371/journal.pone.0359552
UR - https://doi.org/10.1371/journal.pone.0359552
AB - Background: Acquired dermal macular hyperpigmentation (ADMH) encompasses a group of challenging pigmentary disorders characterized by dermal melanophages and variable lichenoid interface inflammation. Non-ablative dermal remodeling lasers (NADRL), which target water rather than melanin, have been proposed as a potential therapeutic option through neocollagenesis and modulation of the dermal microenvironment. However, the evidence base for these devices in ADMH has not been systematically characterized. Objective: To map and characterize the available evidence on NADRL for the treatment of ADMH, including study designs, laser parameters, clinical outcomes, and safety profiles, and to identify knowledge gaps. Methods: This scoping review followed the methodological frameworks of Arksey and O'Malley and Levac et al., and was reported according to PRISMA-ScR guidelines. A comprehensive search was conducted on June 2, 2026, across PubMed/MEDLINE, LILACS, SciELO, DOAJ, Cochrane Central, and clinical trial registries, supplemented by citation tracking. Studies evaluating NADRL (980–1940 nm) in patients with ADMH were included. Two reviewers independently screened records and extracted data. A narrative synthesis and risk of bias assessment using Cochrane RoB 2 and JBI checklists were performed. Results: Of 193 records identified through electronic database searches, seven studies met inclusion criteria; citation tracking of relevant reviews and included studies did not identify any additional eligible records. These comprised two randomized controlled trials, three retrospective case series, and two case reports, comprising 31 unique patients. The 1550 nm erbium-doped fractional laser was the most frequently investigated device. Two RCTs showed no clinical or histopathological improvement, whereas observational studies reported favorable outcomes, albeit with significant methodological limitations and concomitant therapies. Laser-induced post-inflammatory hyperpigmentation (PIH) was reported in 23% of patients in one RCT. Conclusions: Evidence supporting NADRL for ADMH remains limited, heterogeneous, and insufficient to establish independent efficacy. The proposed dermal remodeling mechanism remains largely untested, as most studies evaluated only pigmentary outcomes. Future research should prioritize standardized prospective studies with histological, molecular, and imaging endpoints to determine whether these devices provide true disease modification.
SN - 1932-6203
ER -