Successful Treatment of Recalcitrant Melasma with Picolaser and Isobionicamide-Cysteamine Combination.

Melasma is a highly recurrent disorder that is challenging to treat and significantly affects the quality of life of patients. Cysteamine is an endogenous antioxidant produced during the coenzyme A metabolism cycle and is naturally present in all mammalian cells. The depigmenting efficacy of topical cysteamine has been shown in several double-blind, randomized, placebo-controlled clinical trials. Isobionicamide is a derivative of vitamin B3 and a new depigmenting agent that inhibits melanosomal transfer and was found to potentiate cysteamine's inhibitory effect on tyrosinase. Picosecond lasers have been shown to be effective in treating melasma in dark-skinned individuals. Herein, we report the case of a 50-year-old patient (phototype V) with recalcitrant melasma who significantly responded to picosecond laser associated with the topical application of isobionicamide-cysteamine.