Treatment of Melasma Using a Novel 1,927-nm Fractional Thulium Fiber Laser: A Pilot Study

Department of Dermatology, University of Texas at Houston, Houston, Texas, USA.
Dermatologic Surgery (Impact Factor: 2.11). 10/2011; 38(2):199-206. DOI: 10.1111/j.1524-4725.2011.02178.x
Source: PubMed


A 1,927-nm wavelength was recently added to the 1,550-nm erbium-doped fiber laser. This wavelength possesses a higher absorption coefficient for water than the 1,550-nm, conferring greater ability to target epidermal processes such as dyschromia.
To evaluate the efficacy and safety of a novel 1,927-nm fractional thulium fiber laser in the treatment of melasma.
Fourteen patients underwent three to four laser treatments (at 4-week intervals) at pulse energies of 10 to 20 mJ and total densities of 252 to 784 microscopic treatment zones per cm(2) (6-8 passes) using a 1,927-nm thulium fiber laser. Three blinded assessors and the patients evaluated clinical improvement of treatment areas at 1-, 3-, and 6-month follow-ups. Side effects were assessed, and pain was scored using a visual analog scale (0-10).
A statistically significant 51% reduction in MASI score was observed at 1-month post 3 to 4 laser treatments. A 33% (p = .06) and 34% (p = .07) reduction in Melasma Area and Severity Index score was observed at the 3- and 6-month follow-up visits, respectively. Skin responses observed after treatment were moderate erythema and mild edema. No scarring or postinflammatory hyper- or hypopigmentation was observed.
The 1,927-nm fractional thulium fiber laser is a safe, effective treatment for melasma.

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    • "II-iii C Erythema Pain PIH Fractional Ablative lasers Erbium:YAG (Attwa et al., 2014; Manaloto and Alster, 1999) II-iii C PIH CO2 (Jalaly et al., 2014; Neeley et al., 2010) II-iii C PIH Rebound melasma Vascular lasers PDL (Passeron et al., 2011) II-iii C PIH Fractional lasers Non-ablative (Wind et al., 2010) Non-ablative 1,550 nm fractional laser therapy I C Erythema, burning sensation, edema, pain and PIH 1,927-nm thulium fiber laser (Polder and Bruce, 2012) II-iii C Moderate erythema and mild edema * In accordance with the US Preventive Services Task Force levels of evidence for grading clinical trials (Sheth and Pandya, 2011b), (see Appendix A). Abbreviations: IPL, intense pulsed light; PDL, pulsed dye laser; PIH, postinflammatory hyperpigmentation. "
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    ABSTRACT: Skin of color comprises a diverse and expanding population of individuals. In particular, women of color represent an increasing subset of patients who frequently seek dermatologic care. Acne, melasma, and alopecia are among the most common skin disorders seen in this patient population. Understanding the differences in the basic science of skin and hair is imperative in addressing their unique needs. Despite the paucity of conclusive data on racial and ethnic differences in skin of color, certain biologic differences do exist, which affect the disease presentations of several cutaneous disorders in pigmented skin. While the overall pathogenesis and treatments for acne in women of color are similar to Caucasian men and women, individuals with darker skin types present more frequently with dyschromias from acne, which can be difficult to manage. Melasma is an acquired pigmentary disorder seen commonly in women with darker skin types and is strongly associated with ultraviolet (UV) radiation, genetic factors, and hormonal influences. Lastly, certain hair care practices and hairstyles are unique among women of African descent, which may contribute to specific types of hair loss seen in this population, such as traction alopecia, trichorrhexis nodosa and central centrifugal cicatricial alopecia (CCCA).
    Full-text · Article · May 2015
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    • "Cette approche ne prévient malheureusement pas les récidives. Le laser thulium fractionné a récemment montré une efÀ cacité dans une étude ouverte [26]. Les résultats étaient cependant modestes et signiÀ catifs seulement à 1 mois. "
    Article: [Lasers.]
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    ABSTRACT: Lasers are a very effective approach for treating many hyperpigmented lesions. They are the gold standard treatment for actinic lentigos and dermal hypermelanocytosis, such as Ota nevus. Becker nevus, hyperpigmented mosaicisms, and lentigines can also be succesfully treated with lasers, but they could be less effective and relapses can be observed. However, lasers cannot be proposed for all types of hyperpigmentation. Thus, freckles and café-au-lait macules should not be treated as the relapses are nearly constant. Due to its complex pathophysiology, melasma has a special place in hyperpigmented dermatoses. Q-switched lasers (using standard parameters or low fluency) should not be used because of consistent relapses and the high risk of post-inflammatory hyperpigmentation. Paradoxically, targeting the vascular component of the melasma lesion with lasers could have a beneficial effect. However, these results have yet to be confirmed. In all cases, a precise diagnosis of the type of hyperpigmentation is mandatory before any laser treatment, and the limits and the potential side effects of the treatment must be clearly explained to patients.
    Full-text · Article · Nov 2012 · Annales de Dermatologie et de Vénéréologie
    • "Recently, Polder et al. treated 14 patients of melasma with a novel 1927-nm fractional thulium fibre laser.[48] This wavelength has a higher absorption coefficient for water than the 1550 nm laser, hence targets the epidermal pigment with greater efficacy. "
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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.
    No preview · Article · Apr 2012 · Journal of Cutaneous and Aesthetic Surgery
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