Polnikorn NTreatment of refractory dermal melasma with the MedLite C6 Q-switched Nd:YAG laser: two case reports. J Cosmet Laser Ther 10:167-173

Kasemrad Aesthetics Center, Kasemrad Hospital Prachacheun, Bangkok, Thailand.
Journal of Cosmetic and Laser Therapy (Impact Factor: 1.11). 10/2008; 10(3):167-73. DOI: 10.1080/14764170802179687
Source: PubMed


Dermal melasma in Fitzpatrick skin types III-V usually does not respond to topical treatments. Laser resurfacing often either fails to treat these lesions or results in severe postinflammatory hyperpigmentation (PIH) or permanent hypopigmentation. Two cases of refractory dermal melasma are reported, which responded to treatment with the MedLite C6 Q-switched Nd:YAG laser.
Case 1: A 50-year-old Asian female with refractory dermal melasma and severe PIH received 10 weekly laser treatments combined with 7% alpha arbutin and a broad-spectrum sunscreen. Case 2: A 45-year-old Asian female with refractory dermal melasma received 10 weekly laser treatments combined with 7% alpha arbutin and a broad-spectrum sunscreen.
In both cases, there was a greater than 80% reduction in epidermal and dermal hyperpigmentation. The melanin index at the site of the lesions decreased from 50 to 35 and 45 to 33, respectively. There was no recurrence of melasma at 1 year (case 1) or 6 months (case 2).
Even in cases of long-standing refractory dermal melasma in a darker skin type, combination therapy has been shown to be an effective treatment for this difficult condition.

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    • "The average improvement of 28.61% at 6 weeks and 52.10% at 12 weeks in mean MASI score was obtained in laser group with no side effects. In a study by Polnikorn et al., two cases of long standing refractory dermal melasma responded to treatment with the Medlite C6 using once weekly treatment for 10 weeks with 1064-nm QSNYL at sub photothermolytic fluence (<5 J/cm2), resulting in reduction of epidermal and dermal pigment.[17] In 2009, Cho et al. demonstrated that use of 1064 nm QSNYL with low pulse energy in 25 patients at 2 weekly intervals (2.5 J/cm2, 6-mm spot size, two passes with appropriate overlapping) as an effective treatment for melasma.[13] "
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    ABSTRACT: Melasma is an acquired symmetric hypermelanosis characterised by irregular light to gray-brown macules on sun-exposed skin with a predilection for the cheeks, forehead, upper lip, nose and chin. The management of melasma is challenging and requires meticulous use of available therapeutic options. To compare the therapeutic efficacy of low-fluence Q-switched Nd: YAG laser (QSNYL) with topical 20% azelaic acid cream and their combination in melasma in three study groups of 20 patients each. Sixty Indian patients diagnosed as melasma were included. These patients were randomly divided in three groups (group A = 20 patients of melasma treated with low-fluence QSNYL at weekly intervals, group B = 20 patients of melasma treated with twice daily application of 20% azelaic acid cream and group C = 20 patients of melasma treated with combination of both). Study period was of 12 weeks each. Response to treatment was assessed using melasma area and severity index score. The statistical analysis was done using Chi-square test, paired and unpaired student t-test. Significant improvement was recorded in all the three groups. The improvement was statistically highly significant in Group C as compared to group A (P < 0.001) and group B (P < 0.001). This study shows the efficacy of low-fluence QSNYL, topical 20% azelaic acid cream and their combination in melasma. The combination of low-fluence QSNYL and topical 20% azelaic acid cream yields better results as compared to low-fluence QSNYL and azelaic acid alone.
    Journal of Cutaneous and Aesthetic Surgery 10/2012; 5(4):266-72. DOI:10.4103/0974-2077.104915
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    • "The repetitive treatments of QS Nd:YAG laser of the fluence was just enough to damage the melanosomes subcellularly, which can induce excellent clinical results without the high risk of rebounding hyperpigmentation17,18. The QS Nd:YAG laser treatment may also produce nonspecific dermal wound and induce inflammation, facilitating a migration of melanophages4,8,17. There was no epidermal disruption when low fluence of the laser was used. "
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    ABSTRACT: Recently, low fluence collimated Q-switched (QS) Nd:YAG laser has drawn attention for the treatment of melasma. However, it needs a lot of treatment sessions for the substantial results and repetitive laser exposures may end up with unwanted depigmentation. We evaluated the clinical effects and safety of the combinational treatment, using intense pulsed light (IPL) and low fluence QS Nd:YAG laser. Retrospective case series of 20 female patients, with mixed type melasma, were analyzed using medical records. They were treated with IPL one time, and 4 times of weekly successive low fluence Nd:YAG laser treatments. At each visit, digital photographs were taken under the same condition. Melanin index (MI) and erythema index (EI) were measured on the highest point on the cheekbones. Modified melasma area and severity index (MASI) scores were calculated by two investigators using digital photographs. The mean values of MI and EI decreased significantly after treatments. The modified MASI score has decreased by 59.35%, on average. Sixty percents of the participants did not require any more treatments, and no clinical aggravations were observed during the follow-up period (mean 5.9 months). IPL and low fluence laser may elicit a clinical resolution in the mixed type melasma with long term benefits.
    Annals of Dermatology 08/2012; 24(3):267-73. DOI:10.5021/ad.2012.24.3.267 · 1.39 Impact Factor
    • "Laser toning involves the use of a large spot size (6–8 mm), low fluence (1.6–3.5 J/cm2), multiple passed QS 1064 nm Nd:YAG laser performed every 1-2 weeks for several weeks.[22] While few studies document good efficacy with this Technique,[2628] several others have found hypopigmentation and depigmentation after a series of laser toning.[182229] Chan et al. treated five Chinese patients with melasma with laser toning.[22] "
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    ABSTRACT: Hyperpigmentary disorders, especially melasma and post-inflammatory hyperpigmentation (PIH), cause significant social and emotional stress to the patients. Although many treatment modalities have been developed for melasma and PIH, its management still remains a challenge due to its recurrent and refractory nature. With the advent of laser technology, the treatment options have increased especially for dermal or mixed melasma. To review the literature on the use of cutaneous lasers for melasma and PIH. We carried out a PubMed search using following terms "lasers, IPL, melasma, PIH". We cited the use of various lasers to treat melasma and PIH, including Q-switched Nd:YAG, Q-switched alexandrite, pulsed dye laser, and various fractional lasers. We describe the efficacy and safety of these lasers for the treatment of hyperpigmentation. Choosing the appropriate laser and the correct settings is vital in the treatment of melasma. The use of latter should be restricted to cases unresponsive to topical therapy or chemical peels. Appropriate maintenance therapy should be selected to avoid relapse of melasma.
    Journal of Cutaneous and Aesthetic Surgery 04/2012; 5(2):93-103. DOI:10.4103/0974-2077.99436
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