Efficacy and Safety of Combination Therapy of Microneedling Radiofrequency, In‐Office and Home‐Based Topical Cysteamine in Refractory Melasma: A Split Face, Vehicle‐Control, Randomized Control Trial

ABSTRACT Background Refractory melasma remains a challenge in dermatology, necessitating the exploration of innovative treatments. Aims This study aims to evaluate the efficacy and safety of combining radiofrequency microneedling (RFM) with Cysteamine cream, applied both in‐office and as a part of a home‐care regimen, to treat refractory melasma. Patients/Methods A vehicle‐controlled, split‐face trial was conducted on 30 Fitzpatrick skin types III and IV participants. Subjects received RFM and Cysteamine serum on one side of the face and RFM with saline on the contralateral side. Additionally, a random half‐added Cysteamine cream was applied at home. The modified Melasma Area and Severity Index and VISIA skin analysis were used for assessment. Results Significant improvement in melasma severity and skin texture was noted on the sides treated with RFM and Cysteamine, including observable benefits from both in‐office and home‐based Cysteamine use with minimal adverse effects. Conclusions The combined approach of RFM with Cysteamine provides a promising and safe modality for managing refractory melasma, showing notable improvements.