Melasma is a common hypermelanotic disorder affecting the facial area which has a considerable psychological impact on the patient. Managing melasma is a difficult challenge that requires long-term treatment with a number of topical agents, such as rucinol and sophora-alpha. Aims. We aim to compare the combined treatment of skin needling and depigmenting serum with that using depigmenting serum alone in the treatment of melasma, in order to evaluate the use of microneedles as a means to enhance the drug’s transdermal penetration. Methods. Twenty patients were treated with combined skin needling and depigmenting serum on one side of the face and with depigmenting serum alone on the other side. The outcome was evaluated periodically for up to two months using the Melasma Area Severity Index score and the Spectrocolorimeter X-Rite 968. Results. The side with combined treatment (skin needling + depigmenting serum) presented a statistically significant reduction in MASI score and luminosity index (L) levels compared to the side treated with depigmenting serum alone, and clinical symptoms were significantly improved. Conclusions. Our study suggests the potential use of combining skin needling with rucinol and sophora-alpha compounds to achieve better results in melasma treatment compared to rucinol and sophora-alpha alone. 1. Introduction Melasma is an extremely common disorder in women between 20 and 45 years of age which involves alterations in normal skin pigmentation, resulting from the hyperactivity of epidermal melanocytes. It is exacerbated by sun exposure, pregnancy, oral contraceptives, and certain antiepilepsy drugs. The women most likely to develop melasma are those of fertile age with intermediate skin phototypes. Three histological pigmentation patterns have been identified: epidermal, in which the pigment is deposited in the basal or suprabasal layer; dermal, with melanin-laden macrophages in the superficial and middermis; and mixed, which is characterized by features of both the epidermal, and the dermal patterns. Hypermelanosis may be epidermal (brown), dermal (blue-gray), or mixed (brown-gray). Wood’s lamp examination distinguishes epidermal from dermal hyperpigmentation in all skin phototypes except for V and VI, in which it is of no use. In skin phototypes I–IV, epidermal melasma is accentuated but dermal melasma is not. Clinically, the condition is characterized by irregularly shaped, asymptomatic spots ranging in color from beige to brown, which usually occur in the most photo-exposed areas: the upper lip, the cheeks, the cheekbones and
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