{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T09:48:39Z","timestamp":1782294519572,"version":"3.54.5"},"reference-count":6,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Cosmetic Dermatology"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Melasma is a chronic hyperpigmentation disorder with high relapse rates, particularly in Fitzpatrick skin types III\u2013V. Increasing evidence implicates cytokine\u2010driven inflammation and visible light\u2013induced melanogenesis as key contributors to disease persistence. These mechanisms support the rationale for exploring a multimodal therapeutic approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A woman in her early 30s with phototype IV presented with a 5\u2010year history of recalcitrant centrofacial melasma. Previous treatments\u2014including hydroquinone, oral tranexamic acid, and superficial chemical peels\u2014produced only transient and incomplete improvement. Baseline Melasma Severity Index (MSI) score was 7.9, consistent with moderate\u2010to\u2010severe disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>Treatment consisted of low\u2010fluence picosecond 755\u2009nm alexandrite laser, short\u2010term topical corticosteroid post\u2010procedure, initiation of topical tofacitinib 2% cream twice daily for 11\u2009months, and continuous iron oxide\u2013based visible light\u2013blocking photoprotection. Laboratory monitoring during therapy remained normal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome<\/jats:title>\n                    <jats:p>At 11\u2009months, the patient achieved near\u2010total clearance with an MSI reduction from 7.9 to 0.10 (98.7% improvement). No adverse events, post\u2010inflammatory hyperpigmentation, or relapse were observed, including 3\u2009months after treatment cessation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case illustrates the potential clinical value of combining pigment\u2010targeted picosecond laser therapy with topical JAK inhibition and visible light\u2013specific photoprotection for recalcitrant melasma. The durable remission achieved supports further investigation into anti\u2010inflammatory and photoreactive pathway modulation as adjunctive strategies in melasma management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jocd.70783","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T06:34:56Z","timestamp":1774506896000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multimodal Approach for Recalcitrant Melasma Using Picosecond Laser and Topical\n                    <scp>JAK<\/scp>\n                    Inhibition: A Case Report"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6785-8920","authenticated-orcid":false,"given":"Hasan","family":"Ashkanani","sequence":"first","affiliation":[{"name":"Department of Dermatology Al\u2010Amiri Hospital  Kuwait City Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"AlZaabi","sequence":"additional","affiliation":[{"name":"Department of Dermatology Mubarak Al\u2010Kabeer Hospital  Jabriya Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulaziz","family":"AlRasheed","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Kuwait Hospital  Sabah AlSalem Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wael","family":"AlDaraji","sequence":"additional","affiliation":[{"name":"Dr. Gera Tagani Research Centre, Newcastle University  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/jid.2010.95"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2016.12.004"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(20)30609\u20107"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/phpp.12086"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00403\u2010023\u201002794\u20100"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/phpp.12783"}],"container-title":["Journal of Cosmetic Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jocd.70783","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jocd.70783","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jocd.70783","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T09:24:42Z","timestamp":1782293082000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jocd.70783"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,25]]},"references-count":6,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1111\/jocd.70783"],"URL":"https:\/\/doi.org\/10.1111\/jocd.70783","archive":["Portico"],"relation":{},"ISSN":["1473-2130","1473-2165"],"issn-type":[{"value":"1473-2130","type":"print"},{"value":"1473-2165","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,25]]},"assertion":[{"value":"2025-12-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70783"}}