Combination Treatment of Melasma with Pulsed CO2 Laser Followed by Q-Switched Alexandrite Laser: A Pilot Study

Nouri, Keyvan; Bowes, Leyda E.; Chartier, Tim; Romagosa, Ricardo; Spencer, James M.

doi:10.1046/j.1524-4725.1999.08248.x

Cited by 114 publications

(87 citation statements)

References 14 publications

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“…Additionally, therapies that have shown at least some effectiveness in this condition are most commonly directed at either decreased production of melanin or improved degradation and elimination of the pigment. Until recently, these included topical preparations, such as bleaching agents [13], corticosteroids [14], and retinoids [15], as well as physical modalities, most commonly various chemical peels [16][17][18], dermabrasion [19], intense pulsed light [20], and ablative and non-ablative laser treatments [21][22][23]. However, the latter methods may result in significant epidermal damage, leading to stimulation of melanocytes at the periphery of the treatment area with subsequent post-inflammatory hyperpigmentation.…”

Section: Discussionmentioning

confidence: 99%

Histologic and ultrastructural analysis of melasma after fractional resurfacing

2008

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Background and Objective: Fractional photothermolysis is a popular treatment option for photodamaged skin and other cutaneous conditions. Recently, successful improvement in melasma has been achieved with this laser system. We undertook this study to evaluate the ultrastructural changes associated with fractional laser treatment of melasma. Study Design/Materials and Methods: Ten subjects with skin types III and IV and a clinical diagnosis of epidermal melasma were treated with a 1,550-nm erbium:-glass laser delivering light in a fractional manner (Fraxel SR 750, Reliant Technologies, Inc., Mountain View, CA) every 2 weeks for a total of four sessions. Biopsies were obtained from all subjects both before treatment and at 3 months following the final treatment. All biopsies were analyzed by light and electron microscopy for treatmentinduced changes. In addition, a secondary endpoint of the study was to assess for clinical improvement in melasma following fractional resurfacing. This assessment was performed by the investigator using pre-and post-treatment photographs. Results: Light microscopy on post-treatment specimens showed a relative decrease in melanocytes compared to the pre-treatment ones. Post-treatment electron microscopy revealed fewer melanocytes and a relative absence of melanin in the surrounding keratinocytes compared to pre-treatment specimens. In addition, six subjects with skin type III were determined to have good improvement, whereas four subjects with skin type IV had fair improvement, as assessed by the investigator. Conclusion: Post-treatment ultrastructural changes are consistent with an elimination process and may help to explain clinical improvement following laser treatment.

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Section: Discussionmentioning

confidence: 99%

Histologic and ultrastructural analysis of melasma after fractional resurfacing

2008

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“…They stated better results with combination therapy. 8 In another split-face study, Angsuwarangsee et al compared the results of treatment with QSAL alone with that of QSAL and FCOL combination in six patients with refractory melasma and reported better results with combination therapy with regard to MASI score and melanin index. 9 Although we could not find any study that had assessed the combination of QSEYL and FEYL, in treatment of melasma, both laser systems were employed previously and the results were compared with topical therapies.…”

Section: Discussionmentioning

confidence: 99%

Combination of Q-Switched Nd:YAG and Fractional Erbium:YAG Lasers in Treatment of Melasma: A Randomized Controlled Clinical Trial

et al. 2017

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Introduction: Ablative and nonablative lasers have been used to treat melasma. We aimed to assess and compare the combining Q-switched Nd:YAG laser (QSNYL) and fractional erbium:YAG laser (FEYL) with QSNYL alone in treatment of melasma. Methods: This randomized controlled clinical trial was performed in our Research Center during 2013-2014. Women with melasma and without a history of keloid formation, hypersensitivity to hydroquinone, or pigmentary changes due to laser therapy were randomly allocated to receive four sessions of either QSNYL-FEYL combination or QSNYL alone. All patients received topical treatment with Kligman's formula. Before laser therapy and 4 weeks after the last treatment session, patients' skin was assessed for changes in skin color, melanin content, and erythema intensity of melasma lesions quantitatively. ; P < 0.001). After adjustment for baseline values, the post treatment intensity of erythema was significantly lower in QSNYL-FEYL group (P < 0.001). The patients reported no adverse events. Conclusion: QSNYL-FEYL was significantly more effective in decreasing melanin content of lesions than QSNYL and led to a lighter skin.

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“…Preliminary studies onthe treatment of melasma with QS ruby (694 nm), QSalexandrite (755 nm) and QS Neodymium yttrium aluminumgarnet (Nd: YAG) (1064 nm) lasers resulted in worsening of melasma, PIH and sometimes, punctate depigmentation. These results were obtained on using QS lasers alone or in combination with ablative lasers [64][65][66]. The recent introduction of low energy Q-switched lasers (LEQL) with large spot size and low fluencies do not disrupt the epidermis allowing for selective melanosome damage.…”

Section: Other Botanicals As Potential Bleaching Agentsmentioning

confidence: 98%

Melasma, Novel Treatment Modalities

Abdallah¹

2014

Pigmentary Disorders

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Treatment of melasma remains challenging due to frequent relapses and the occurrence of post-inflammatory hyperpigmentation (PIH) following many interventions. Treatment goals are inhibition of melanin synthesis and transfer by sunscreens, sun avoidance and the use of bleaching agents on one hand and removal of already present pigment by peeling, lasers and light on the other hand. Triple combination creams (TCC) (also known as Kligman's formula utilizing hydroquinone and modifications of Kligman's formula) remain the mainstay of treatment. Newer bleaching agents derived from plants and synthetic compounds have been introduced and many of them are promising safe substitutes for hydroquinone.Peeling agents especially superficial and medium depth peels are effective treatment modalities for melasma. Newer peeling agents are less irritating and may thus lead to fewer side effects. Q-switched lasers, which target melanin, have led to PIH until the innovation of "laser toning" and fractional Qswitched ruby, which have better outcomes. Fractional non-ablative and ablative lasers are useful at lower fluencies. Pulsed dye laser, which targets the vascular component in melasma, is promising with less melasma rebound.Combinations of the above-mentioned modalities usually have a better treatment outcome than either alone. This review will focus on the more recently introduced therapies.

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Combination Treatment of Melasma with Pulsed CO2 Laser Followed by Q-Switched Alexandrite Laser: A Pilot Study

Abstract: These laser therapies are safe, as there was no scarring and no infection. The combination laser therapy was highly effective in removing the hyperpigmentation and all patients in this group showed complete resolution without any peripheral hyperpigmentation.

Cited by 114 publications

References 14 publications

Histologic and ultrastructural analysis of melasma after fractional resurfacing

Histologic and ultrastructural analysis of melasma after fractional resurfacing

Combination of Q-Switched Nd:YAG and Fractional Erbium:YAG Lasers in Treatment of Melasma: A Randomized Controlled Clinical Trial

Melasma, Novel Treatment Modalities

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