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The Low-Fluence Q-Switched Nd:YAG Laser Treatment for Melasma: A Systematic Review. Medicina (B Aires) 2022; 58:medicina58070936. [PMID: 35888655 PMCID: PMC9323185 DOI: 10.3390/medicina58070936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022] Open
Abstract
Melasma is a common pigmentary disorder with a complex pathogenesis, of which the treatment is challenging. Conventional treatment often leads to inconsistent results with unexpected pigmentary side effects and high recurrence rates. Recently, the low-fluence Q-switched Nd:YAG laser (LFQSNY) has been widely used for treating melasma, especially in Asia. We reviewed literatures on the LFQSNY treatment of melasma published between 2009 and May 2022 to evaluate the efficacy and adverse events, including its combination therapy. A systematic PubMed search was conducted and a total of 42 articles were included in this study. It was hard to summarize the heterogenous studies, but LFQSNY appeared to be a generally effective and safe treatment for melasma considering the results of previous conventional therapies. However, mottled hypopigmentation has been occasionally reported to develop and persist as an adverse event of LFQSNY, which may be associated with the high accumulated laser energy. When used aggressively, even LFQSNY can induce hyperpigmentation via unwanted inflammation, especially in darker skin. Although few studies have reported considerable recurrence rates three months after treatment, unfortunately, there is a lack of the long-term follow-up results of LFQSNY in melasma. To enhance the effectiveness and reduce the adverse events, LFQSNY has been used in combination with other treatment modalities in melasma, including topical bleaching agents, oral tranexamic acid, chemical peeling, or diverse energy-based devices, which generally reduced side effects with or without significant superior efficacy compared to LFQSNY alone.
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Choi YJ, Nam JH, Kim JY, Min JH, Park KY, Ko EJ, Kim BJ, Kim WS. Efficacy and safety of a novel picosecond laser using combination of 1 064 and 595 nm on patients with melasma: A prospective, randomized, multicenter, split-face, 2% hydroquinone cream-controlled clinical trial. Lasers Surg Med 2017; 49:899-907. [DOI: 10.1002/lsm.22735] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2017] [Indexed: 01/29/2023]
Affiliation(s)
- Young-Jun Choi
- Department of Dermatology; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| | - Jae-Hui Nam
- Department of Dermatology; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| | - Jung Yup Kim
- Department of Dermatology; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| | - Joon Hong Min
- Department of Dermatology; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| | - Kui Young Park
- Department of Dermatology; Chung-Ang University Hospital; Chung-Ang University School of Medicine; Seoul Republic of Korea
| | - Eun Jung Ko
- Department of Dermatology; Myongji Hospital; Seonam University College of Medicine; Goyang Republic of Korea
| | - Beom Joon Kim
- Department of Dermatology; Chung-Ang University Hospital; Chung-Ang University School of Medicine; Seoul Republic of Korea
| | - Won-Serk Kim
- Department of Dermatology; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
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Sarkar R, Aurangabadkar S, Salim T, Das A, Shah S, Majid I, Singh M, Ravichandran G, Godse K, Arsiwala S, Arya L, Gokhale N, Sarma N, Torsekar RG, Sonthalia S, Somani VK. Lasers in Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group. Indian J Dermatol 2017; 62:585-590. [PMID: 29263531 PMCID: PMC5724305 DOI: 10.4103/ijd.ijd_488_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Lasers have come up as the newest therapeutic modality in dermatological conditions including melasma. In this article, as a group of experts from Pigmentary Disorders Society in collaboration with South Asian Pigmentary Disorders Forum (SPF), we have tried to discuss the lasers which have been used in melasma and formulate simple consensus guidelines. Following thorough literature search, we have summarised the rationale of using the lasers and the supporting evidences have also been provided. It is clear that laser cannot be the first line treatment for melasma. However, it can be used as an adjuvant therapy in resistant cases, provided the selection of patient and counselling has been done properly.
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | | | - T Salim
- Consultant Dermatologist, Cutis Institute of Dermatology and Aesthetic Sciences, Calicut, Kerala, India
| | - Anupam Das
- Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Swapnil Shah
- Consultant Dermatologist, Solapur, Maharashtra, India
| | - Imran Majid
- Dermatology, Govt Medical College, Srinagar, Kashmir, India
| | - Mohan Singh
- Consultant Dermatologist, Mohan Singh Diseases Hospital, Phagwara, Punjab, India
| | - G Ravichandran
- Senior Consultant and Coordinator, Dermatology, Apollo Hospitals, Chennai, India
| | - Kiran Godse
- Dermatology, D Y Patil Hospital, Navi Mumbai, India
| | - Shehnaz Arsiwala
- Consultant Dermatologist, Saifee Hospital, Prince Aly Khan Hospital, Mumbai, India
| | - Latika Arya
- Consultant Dermatologist, L A Skin & Aesthetic Clinic, New Delhi, India
| | - Narendra Gokhale
- Consultant Dermatologist, Sklinic Skin Clinic, Indore, Madhya Pradesh, India
| | - Nilendu Sarma
- Dermatology, Dr. B.C. Roy Postgraduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
| | - R G Torsekar
- Consultant Dermatologist, Fortis Hospital, Mulund, Mumbai, India
| | - Sidharth Sonthalia
- Consultant Dermatologist, Skinnocence: The Skin Clinic, Gurgaon, Haryana, India
| | - V K Somani
- Consultant Dermatologist, Skintrendz, Himayat Nagar, Hyderabad, India
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Sarma N, Chakraborty S, Poojary SA, Rathi S, Kumaran S, Nirmal B, Felicita J, Sarkar R, Jaiswal P, D'Souza P, Donthula N, Sethi S, Ailawadi P, Joseph B. Evidence-based Review, Grade of Recommendation, and Suggested Treatment Recommendations for Melasma. Indian Dermatol Online J 2017; 8:406-442. [PMID: 29204385 PMCID: PMC5707834 DOI: 10.4103/idoj.idoj_187_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Treatment of melasma is known to be less satisfactory, often incomplete, and relapse is frequent. Although many treatment options are available, they are either known to be unsafe on long-term use or their long-term safety profile is unknown. Patients often use various drugs, even topical steroid-based preparation without any medical supervision for long period of time, making the skin unsuitable for many of the drugs available. Thus, there has been gross disparity among the treating physician about what drugs and what regimen are best suitable for various categories of melasma patients and in different situations. With this background, numerous newer drugs, mostly combinations of some proprietary molecules or even unknown plant extracts, have flooded the market for the management of melasma. Information on efficacy or safety of these products are almost unknown. Studies on Asian people, especially Indian population, are far less commonly available. Therapeutic guideline for use on Indian patients with melasma is almost missing. Extrapolation of data from Caucasian people for use on Asian people may not be scientifically justifiable because Caucasian and Asian people are known to have inherent difference in their response as well as tolerance to the drugs used for melasma. With this background, we have extensively evaluated, following a strict, scientifically designed protocol, all the available studies on melasma management till May 2016 and prepared this document on level of evidence, grade of recommendation and suggested therapeutic guideline for melasma as per the method proposed by Oxford Centre of Evidence-Based Medicine. Various ethical, social, logical, regional, and economic issues in the context of Indian and similar populations were given due importance while preparing the suggested therapeutic recommendation.
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Affiliation(s)
- Nilendu Sarma
- Department of Dermatology, Dr B C Roy Post Graduate Institute of Pediatric Science, Kolkata, West Bengal, India
| | | | - Shital A Poojary
- Department of Dermatology, K J Somaiya Medical College, Mumbai, Maharashtra, India
| | | | - Sendhil Kumaran
- Department of Dermatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Balakrishnan Nirmal
- Department of Dermatology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - Joan Felicita
- Department of Dermatology, Dr. Somervell Memorial CSI Medical College, Karakonam, Trivandrum, Kerala, India
| | - Rashmi Sarkar
- Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, Basaidarapur, New Delhi, India
| | - Prashansa Jaiswal
- ESI- Post Graduate Institute of Medical Science and Research, Basaidarapur, New Delhi, India
| | - Paschal D'Souza
- ESI- Post Graduate Institute of Medical Science and Research, Basaidarapur, New Delhi, India
| | - Nagaraju Donthula
- Department of Dermatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sumit Sethi
- Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, Basaidarapur, New Delhi, India
| | - Pallavi Ailawadi
- Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, Basaidarapur, New Delhi, India
| | - Bebisha Joseph
- Department of Dermatology, Dr. Somervell Memorial CSI Medical College, Karakonam, Trivandrum, Kerala, India
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Jang HW, Chun SH, Park HC, Ryu HJ, Kim IH. Comparative study of dual-pulsed 1064 nm Q-switched Nd:YAG laser and single-pulsed 1064 nm Q-switched Nd:YAG laser by using zebrafish model and prospective split-face analysis of facial melasma. J COSMET LASER THER 2016; 19:114-123. [PMID: 27911108 DOI: 10.1080/14764172.2016.1262958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Recently dual-pulsed low-fluence 1064-nm Q-switched Nd:YAG (QSNY) laser has been developed for reducing complication during melasma treatment. OBJECTIVE Comparison of the efficacy and safety between dual-pulsed mode and single-pulsed mode for the treatment of melasma. MATERIALS AND METHODS In preclinical study, adult zebrafish were irradiated with dual-pulsed and single-pulsed mode. Changes of melanophore and cell death were assessed. In split-face clinical study, dual-pulsed and single-pulsed mode were irradiated on the left and right side of the face, respectively. L* value, clinical digital photos, modified Melasma Area and Severity Index (MASI) scores, and side effects were measured. RESULTS As compared to single-pulsed mode and dual-pulsed mode with longer intervals, zebrafish melanophore was cleared quickly at dual-pulsed mode with 80-μsec interval and 0.3 J/cm2 fluence. Dual-pulsed mode showed the least regeneration of melanophore at 4 weeks after irradiation and no cell death was observed with 80-μsec interval. Both pulse modes improved melasma significantly but modified MASI score and L* value were not significantly different between each other. Lesser pain and shorter duration of post-laser erythema were observed with dual-pulsed mode. CONCLUSION Dual-pulsed mode was as effective as single-pulsed mode for the treatment of melasma and revealed less side effects.
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Affiliation(s)
- Hee Won Jang
- a Department of Dermatology , Arumdaun Nara Dermatologic Clinic , Seoul , Korea
| | - Seung Hyun Chun
- b Department of Dermatology, College of Medicine , Korea University Ansan Hospital , Ansan , Korea
| | - Hae Chul Park
- c Laboratory of Neurodevelopmental Genetics, Graduate School of Medicine , Korea University , Ansan , Korea
| | - Hwa Jung Ryu
- b Department of Dermatology, College of Medicine , Korea University Ansan Hospital , Ansan , Korea
| | - Il-Hwan Kim
- b Department of Dermatology, College of Medicine , Korea University Ansan Hospital , Ansan , Korea
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Zhou HL, Hu B, Zhang C. Efficacy of 694-nm fractional Q-switched ruby laser (QSRL) combined with sonophoresis on levorotatory vitamin C for treatment of melasma in Chinese patients. Lasers Med Sci 2016; 31:991-5. [DOI: 10.1007/s10103-016-1938-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
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