Treatment of Melasma with Pulsed-Dye Laser and 1,064-nm Q-Switched Nd:YAG Laser: A Split-Face Study

Sook Hyun Kong, Ho Seok Suh, Yu Sung Choi, Sook Hyun Kong, Ho Seok Suh, Yu Sung Choi

Abstract

Background: Melasma is an acquired pigmentary disorder that is often therapeutically challenging. Recent evidence suggests that vascular abnormalities are involved in melasma pathogenesis. Pulsed-dye laser (PDL) is considered as standard therapy for vascular lesions.

Objective: To assess the efficacy of PDL combined with low-fluence Q-switched Nd:YAG laser (QSNY) in the treatment of melasma.

Methods: Seventeen melasma patients were enrolled in this study. All subjects were treated with a total of nine QSNY treatment sessions at one-week intervals. Three sessions of PDL were additionally performed immediately after QSNY treatment on the half of the face at baseline, week 4, and week 8. The melasma area and the severity index (MASI) score was calculated at the baseline, one week after the last treatment (week 9), as well as at the follow-up 8 weeks after the last treatment (week 16). Dermoscopic images at the baseline were classified as to whether the visibly widened capillaries were detected or not.

Results: MASI scores on the PDL+QSNY and QSNY side decreased significantly during the study period. There was no significant difference in the MASI score change between both sides in all periods. However, seven patients who had visibly widened capillaries on dermoscopy showed significant difference in both sides in terms of changes in the MASI score during treatment.

Conclusion: PDL combined with QSNY may be considered as a safe and effective treatment for melasma patients who show visibly widened capillaries on dermoscopy.

Keywords: Dermoscopy; Melasma; Pulsed dye lasers; Q-switched lasers.

Conflict of interest statement

CONFLICTS OF INTEREST: The authors have nothing to disclose.

Figures

Fig. 1. Schematized summary of treatment schedule.…
Fig. 1. Schematized summary of treatment schedule. PDL: pulsed-dye laser, QSNY: Q-switched Nd:YAG laser.
Fig. 2. Dermoscopic image of a patient…
Fig. 2. Dermoscopic image of a patient who showed visibly widened capillaries along with pigmentation of a pseudonetwork pattern at the first visit.
Fig. 3. Serial clinical photographs of a…
Fig. 3. Serial clinical photographs of a melasma patient with visibly widened capillaries on dermoscopy. Comparing the melasma area and severity index (MASI) score reduction from the baseline, pulsed-dye laser (PDL)+Q-switched Nd:YAG laser (QSNY) side (A, B, and C) revealed a significantly greater reduction of the MASI scores at week 9 and 16 than the QSNY side (D, E, and F). The PDL+QSNY side maintained a MASI score reduction at week 16 (C), while it increased for the QSNY side (F).
Fig. 4. The patient who exhibited a…
Fig. 4. The patient who exhibited a rebound hyperpigmentation without purpura on pulsed-dye laser (PDL)+Q-switched Nd:YAG laser (QSNY) side at week 16. PDL+QSNY side (A, B, and C) revealed a great reduction of the melasma area and severity index score at week 9 (B) from the baseline (A), but rebound hyperpigmentation occurred at week 16 (C). QSNY side (D, E, and F) showed no rebound hyperpigmentation.

References

    1. Grimes PE. Melasma. Etiologic and therapeutic considerations. Arch Dermatol. 1995;131:1453–1457.
    1. Cho SB, Kim JS, Kim MJ. Melasma treatment in Korean women using a 1064-nm Q-switched Nd:YAG laser with low pulse energy. Clin Exp Dermatol. 2009;34:e847–e850.
    1. Wattanakrai P, Mornchan R, Eimpunth S. Low-fluence Q-switched neodymium-doped yttrium aluminum garnet (1,064 nm) laser for the treatment of facial melasma in Asians. Dermatol Surg. 2010;36:76–87.
    1. Chan NP, Ho SG, Shek SY, Yeung CK, Chan HH. A case series of facial depigmentation associated with low fluence Q-switched 1,064 nm Nd:YAG laser for skin rejuvenation and melasma. Lasers Surg Med. 2010;42:712–719.
    1. Kim EH, Kim YC, Lee ES, Kang HY. The vascular characteristics of melasma. J Dermatol Sci. 2007;46:111–116.
    1. Kim EJ, Park HY, Yaar M, Gilchrest BA. Modulation of vascular endothelial growth factor receptors in melanocytes. Exp Dermatol. 2005;14:625–633.
    1. Geddes ER, Stout AB, Friedman PM. Long-pulsed dye laser of 595 nm in combination with pigment-specific modalities for a patient exhibiting increased vascularity within lesions of melasma. Dermatol Surg. 2016;42:556–559.
    1. Lee HI, Lim YY, Kim BJ, Kim MN, Min HJ, Hwang JH, et al. Clinicopathologic efficacy of copper bromide plus/yellow laser (578 nm with 511 nm) for treatment of melasma in Asian patients. Dermatol Surg. 2010;36:885–893.
    1. Passeron T. Long-lasting effect of vascular targeted therapy of melasma. J Am Acad Dermatol. 2013;69:e141–e142.
    1. Passeron T, Fontas E, Kang HY, Bahadoran P, Lacour JP, Ortonne JP. Melasma treatment with pulsed-dye laser and triple combination cream: a prospective, randomized, single-blind, split-face study. Arch Dermatol. 2011;147:1106–1108.
    1. Na JI, Choi SY, Yang SH, Choi HR, Kang HY, Park KC. Effect of tranexamic acid on melasma: a clinical trial with histological evaluation. J Eur Acad Dermatol Venereol. 2013;27:1035–1039.
    1. Grimes PE. The safety and efficacy of salicylic acid chemical peels in darker racial-ethnic groups. Dermatol Surg. 1999;25:18–22.
    1. Pathak MA, Fitzpatrick TB, Kraus EW. Usefulness of retinoic acid in the treatment of melasma. J Am Acad Dermatol. 1986;15:894–899.
    1. Mun JY, Jeong SY, Kim JH, Han SS, Kim IH. A low fluence Q-switched Nd:YAG laser modifies the 3D structure of melanocyte and ultrastructure of melanosome by subcellular-selective photothermolysis. J Electron Microsc (Tokyo) 2011;60:11–18.
    1. Kim JH, Kim H, Park HC, Kim IH. Subcellular selective photothermolysis of melanosomes in adult zebrafish skin following 1064-nm Q-switched Nd:YAG laser irradiation. J Invest Dermatol. 2010;130:2333–2335.
    1. Na SY, Cho S, Lee JH. Intense pulsed light and low-fluence Q-switched Nd:YAG laser treatment in melasma patients. Ann Dermatol. 2012;24:267–273.
    1. Park GH, Lee JH, Choi JR, Chang SE. The degree of erythema in melasma lesion is associated with the severity of disease and the response to the low-fluence Q-switched 1064-nm Nd:YAG laser treatment. J Dermatolog Treat. 2013;24:297–299.

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