Nordahl, Emma J. B.

ABSTRACT Melasma is a chronic hyperpigmentation disorder that disproportionately affects women and individuals with darker skin types, leading to a significant psychosocial burden. This meta‐analysis aims to evaluate the safety and efficacy of the 755‐nm picosecond alexandrite laser (PSAL) compared with conventional therapies in the management of melasma. PubMed, Ovid Medline, Embase, Cochrane Library, and Google Scholar were searched from inception to April 10, 2025, in accordance with PRISMA guidelines. Randomised controlled trials (RCTs) assessing PSAL versus control comparators in adults with melasma and reporting Melasma Area and Severity Index (MASI) or Modified MASI outcomes were included. The review was registered prospectively on PROSPERO (CRD420251022381). Risk of bias was assessed using ROB2. Pooled effect sizes were calculated using a random‐effects model. Five RCTs ( n = 139 patients) were included. Change in MASI favoured triple combination cream (TCC) over PSAL therapy (MD = 1.82, 95% CI: 1.11, 2.52, I 2 = 0%). Post‐inflammatory hyperpigmentation was more common in the PSAL group compared to topical creams (OR = 6.86, 95% CI: 1.47, 32.07, I 2 = 0%) but had no difference with the Q ‐switched lasers (OR = 4.09, 95% CI: 0.62, 26.97, I 2 = 0%). There was no incidence of hypopigmentation or infection reported. PSAL appears inferior to the TCC in reducing MASI scores. Overall certainty is low due to small, heterogenous trials. Low rates of irreversible adverse events with PSAL may support trials in refractory cases, but long‐term RCTs with larger sample sizes are required to evaluate durability and recurrence outcomes.

Objective To evaluate the safety and efficacy of Grayson's presurgical nasoalveolar molding (PNAM) technique on nasal and alveolar morphology in infants with unilateral cleft lip and palate (UCLP). Design Systematic review and meta-analysis. Setting : Multicenter international literature across clinical and academic institutions. Patients, Participants Infants with UCLP reported in 21 eligible studies (n = 534), of whom 368 received PNAM. Interventions Presurgical nasoalveolar molding (PNAM) according to the Grayson protocol. Main Outcome Measure(s) : Changes in nasal symmetry (nostril width ratio, columellar angle) and alveolar morphology (alveolar gap dimensions, intertuberosity distance). Results PNAM was performed for an average duration of 96 days with 11 adjustments per patient. Pooled analyses demonstrated significant improvements in nasal symmetry: nostril width ratio decreased from 2.4 (95% CI, 1.7–3.1; I² = 98%) to 1.8 (95% CI, 0.9–2.6; I² = 97%), and the columellar angle increased from 52° (95% CI, 42.0–62.8; I² = 100%) to 70° (95% CI, 59.1–80.6; I² = 98%). Alveolar gap narrowed from 10.7 mm (95% CI, 9.5–11.9; I² = 92%) to 3.9 mm (95% CI, 3.1–4.8; I² = 93%). Intertuberosity distance increased slightly, from 31.3 mm (95% CI, 29.3–33.3; I² = 95%) to 31.8 mm (95% CI, 28.9–34.8; I² = 98%). Conclusions Grayson's PNAM appears to improve nasal and alveolar morphology in infants with UCLP prior to definitive surgery. Standardized outcome measures and long-term prospective studies are needed to confirm these findings and refine clinical protocols.