Non-ablative dermal remodeling lasers in acquired dermal macular hyperpigmentation: A scoping review

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.