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Zhou Y, Li Y, Hamblin MR, Wen X. Comparison of 755-nm picosecond alexandrite laser versus 1064-nm Q-switched Nd:YAG laser for melasma: A randomized, split-face controlled, 2-year follow-up study. Lasers Surg Med 2024; 56:263-269. [PMID: 38282099 DOI: 10.1002/lsm.23763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVES Pulsed laser treatment of melasma has shown some promising results. To compare the effectiveness and safety of 755-nm picosecond alexandrite laser (PSAL) fitted with diffractive lens array (DLA) versus 1064-nm Q-switched neodynimum:yttrium aluminum garnet laser (QSNYL) for the treatment of melasma. METHODS We conducted a randomized, split face controlled, 2-year follow-up study. Each face was divided into two parts, each side receiving three treatments with either PSAL or QSNYL at 1 month intervals. Modified Melasma Area Severity Index scores (mMASI), pain scores, patient satisfaction and adverse events were recorded. In vivo reflectance confocal microscopy (RCM) images were acquired. RESULTS Twenty subjects were enrolled and three dropped out. At 6 months, mMASI scores were significantly lower than baseline for QSNYL sides (p = 0.022), with no statistically significant difference between PSAL sides before and after treatment, PSAL sides versus QSNYL sides, or patient satisfaction scores. QSNYL treatment was associated with less pain (p = 0.014). No serious adverse events were reported. In the PSAL sides RCM showed a large number of dendritic melanocytes infiltrated in the dermis at 2 weeks and 4 weeks after treatment. Ten patients (58.82%) reported recurrence or exacerbation at 2-year follow-up with no statistically significant difference between the two lasers. CONCLUSIONS QSNYL demonstrated short term clinical efficacy for melasma, but did not provide any additional benefit compared to PSAL with DLA. QSNYL was associated with less pain. There was a high recurrence rate at 2-year follow-up. RCM allowed the detection of cellular changes in melasma lesions.
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Affiliation(s)
- Yanjun Zhou
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Li
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Michael R Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein, South Africa
| | - Xiang Wen
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
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Wu W, Su Q, Zhang Y, Du Y, Hu Y, Wang F. Novel 532-nm Q-switched Nd: YAG laser for the treatment of melasma and rejuvenation: a prospective, randomized controlled comparison with 1,064-nm Q-switched Nd: YAG laser. Int J Dermatol 2024. [PMID: 38411341 DOI: 10.1111/ijd.17091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Melasma is a common pigmentary and photoaging disorder. Although various treatments, including 1,064-nm Q-switched neodymium-doped yttrium aluminum garnet (QS-Nd: YAG) laser toning, are available for melasma, results are often unsatisfactory. OBJECTIVE We aimed to determine the efficacy and safety of 532-nm QS-Nd: YAG laser (shortwave toning) in patients with melasma and facial rejuvenation. METHODS Fifty-two patients were recruited to receive either 1,064-nm QS-Nd: YAG laser or 532-nm QS-Nd: YAG laser every 2 weeks for 8 sessions and a 2-month follow-up visit in a randomized controlled double-blinded study. The primary outcome measure was the Melasma Area and Severity Index (MASI) score. Dermoscope and high-frequency ultrasound (HFUS) were used to assess the improvement of melasma and photoaging. RESULTS 532-nm QS-Nd: YAG laser achieved significantly higher improvement in the MASI score (P = 0.000). The Dermoscopic melasma score (DMS) displayed significant change and confirmed the improvement. HFUS showed a significant decrease in the thickness of the subepidermal low-echogenic band (SLEB) and increases in dermal thickness and dermal density in both groups (P = 0.000 for all). The rate of very satisfied responses was significantly higher in the 532-nm laser group (P = 0.001). There was no significant difference in the visual analog scale pain assessment score (P = 0.248) and recurrence rate (P = 0.734) between the two groups. CONCLUSION 532-nm QS-Nd: YAG laser (shortwave toning) proved to be an effective and safe treatment for melasma and rejuvenation. Shortwave toning was significantly better for pigmentation clearance, while 1,064-nm laser showed better improvement in skin rejuvenation.
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Affiliation(s)
- Wenjie Wu
- Department of Dermatology, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Qianya Su
- Department of Dermatology, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yuezhu Zhang
- Department of Dermatology, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yaxin Du
- Department of Dermatology, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yakun Hu
- Department of Dermatology, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Fei Wang
- Department of Dermatology, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
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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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Pan J, Zhao JH, Lv YW, Zeng SW, Zhao JY, Gao FL. Clinical Study of a Q-Switched Neodymium-Doped Yttrium Aluminum Garnet Laser with Different Parameters in the Treatment of Chloasma: A Randomized-Controlled Trial. Photobiomodul Photomed Laser Surg 2022; 40:183-188. [PMID: 35298285 DOI: 10.1089/photob.2021.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To explore the clinical efficacy of a Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser with different parameters in the treatment of chloasma. Methods: In this study, 30 patients with chloasma, symmetrically distributed on the left and right sides of the face and who were treated with a Fayton Q-switched 1064 nm Nd:YAG laser, were recruited. The patients were randomly selected for the treatment of facial lesions on the left and right sides of the face using a spot diameter of 9 mm and an energy density of 0.8 J/cm2 on one side, and, on the opposite side, a spot diameter of 6 mm with an energy density of 1.2 J/cm2. The laser frequency was 5 Hz and treatment was conducted once every 7-10 days and repeated eight times as a course of treatment. At the end of the course of treatment, as well as 1, 3, and 6 months after treatment, front-facing images and 45° left- and right-side images were taken, respectively. The curative effect of the treatment was evaluated using the Melasma Area Severity Index (MASI) score. Results: The results of this study showed that the total effective rate of a Fayton Q-switched 1064 nm Nd:YAG laser in the treatment of chloasma was 60%. Conclusions: Using a Q-switched 1064 nm Nd:YAG laser represents a safe and effective approach for the treatment of chloasma. The therapeutic effects of the parameter sets, that is, a spot diameter of 9 mm and an energy density of 0.8 J/cm2, and a spot diameter of 6 mm with an energy density of 1.2 J/cm2, were similar. The treatment time and average effective times of the latter were relatively shortened. Clinical Trial Registration number researchregistry6799.
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Affiliation(s)
- Jing Pan
- Department of Dermatology and Venereology and Beijing Jishuitan Hospital, Beijing, China
| | - Jing-Hui Zhao
- Department of Dermatology and Venereology and Beijing Jishuitan Hospital, Beijing, China
| | - Yan-Wei Lv
- Clinical Epidemiology Research Center, Beijing Jishuitan Hospital, Beijing, China
| | - Shu-Wen Zeng
- Department of Dermatology, Beijing Xiuzhong Medical Center, Beijing, China
| | - Jun-Ying Zhao
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Feng-Lin Gao
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Hong JK, Shin SH, Park SJ, Seo SJ, Park KY. A prospective, split-face study comparing 1,064-nm picosecond Nd:YAG laser toning with 1,064-nm Q-switched Nd:YAG laser toning in the treatment of melasma. J DERMATOL TREAT 2022; 33:2547-2553. [DOI: 10.1080/09546634.2022.2033674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jun Ki Hong
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sun Hye Shin
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Su Jung Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seong Jun Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kui Young Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
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Liu Y, Wu S, Wu H, Liang X, Guo D, Zhuo F. Comparison of the Efficacy of Melasma Treatments: A Network Meta-Analysis of Randomized Controlled Trials. Front Med (Lausanne) 2021; 8:713554. [PMID: 34660626 PMCID: PMC8511390 DOI: 10.3389/fmed.2021.713554] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Melasma is an acquired pigmentation disorder with challenges in treatment because of its refractory nature and high risk of recurrence. Objectives: This study aimed to compare the efficacy and side effects of 14 common therapies for melasma using a systematic review and network meta-analysis (NMA). Methods: The PubMed, Embase, and Cochrane Library databases were searched till December 2020 using the melasma area and severity index as a therapeutic index. A total of 59 randomized controlled trials (RCTs) met the inclusion criteria and were selected. Results: The ranking of relative efficacy compared with placebo in descending order was Q-switched Nd:Yag 1,064-nm laser (QSND), intense pulsed light, ablative fractional laser (AFL), triple combined cream (TCC), topical vitamin C, oral tranexamic acid (oTA), peeling, azelaic acid, microneedles (MNs), topical tranexamic acid (tTA), tretinoin, picosecond laser, hydroquinone (HQ), and non-AFL. Moreover, QSND was more effective than HQ and tTA against melasma. The ranking of percentage (%) of side effects in ascending order for each of 14 therapies with more than 80 participants was tretinoin (10.1%), oTA (17.6%), HQ (18.2%), AFL (20.0%), QSND (21.5%), TCC (25.7%), tTA (36.75%), peeling (38.0%), and MN (52.3%). Taking both efficacy and safety into consideration, TCC was found to be the most favorable selection among the topical drugs for melasma. QSND and AFL were still the best ways to treat melasma among photoelectric devices. oTA as system administration was a promising way recommended for melasma. Among 31 studies, 87% (27/31) studies showed that the efficacy of combination therapies is superior to that of single therapy. The quality of evidence in this study was generally high because of nearly 50% of split-face RCTs. Conclusions: Based on the published studies, this NMA indicated that QSND, AFL, TCC, and oTA would be the preferred ways to treat melasma for dermatologists. However, more attention should be paid to the efficacy and safety simultaneously during the clinical application. Most of the results were in line with those of the previous studies, but a large number of RCTs should be included for validation or update. Systematic Review Registration: identifier: CRD42021239203.
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Affiliation(s)
- Yi Liu
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shanshan Wu
- National Clinical Research Center of Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Haixuan Wu
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xuelei Liang
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Dechao Guo
- Department of General Surgery, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Fenglin Zhuo
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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GWAS Identifies Multiple Genetic Loci for Skin Color in Korean Women. J Invest Dermatol 2021; 142:1077-1084. [PMID: 34648798 DOI: 10.1016/j.jid.2021.08.440] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/29/2022]
Abstract
Human skin color is largely determined by genetic factors. Recent GWASs have reported several genetic variants associated with skin color, mostly in European and African populations. In this study, we performed GWAS in 17,019 Korean women to identify genetic variants associated with facial skin color, quantitatively measured as CIELAB color index. We identified variants in three, one, and six genomic loci associated with facial skin color index L∗, a∗, and b∗ values, respectively, and replicated the associations (combined analysis P-value < 5.0 × 10-8). The significant loci included variants in known genes (OCA2 rs74653330, BNC2 rs16935073, rs72620727 near KITLG, and SLC6A17 rs6689641) and to our knowledge previously unreported genes (SCARB1 rs10846744, SYN2 rs12629034, and LINC00486 rs6543678). This is GWAS to elucidate genetic variants of facial skin color in a Korean female population. Further functional characterizations of the investigated genes are warranted to elucidate their contribution to skin pigmentation-related traits.
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Micek I, Pawlaczyk M, Kroma A, Seraszek-Jaros A, Urbańska M, Gornowicz-Porowska J. Treatment of melasma with a low-fluence 1064 nm Q-switched Nd:YAG laser: Laser toning in Caucasian women. Lasers Surg Med 2021; 54:366-373. [PMID: 34473361 DOI: 10.1002/lsm.23474] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/22/2021] [Accepted: 08/21/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Melasma is a common, therapeutically challenging, and very often relapsing disorder of hyperpigmentation most often observed in women. Low-fluence, multipass technique with Q-switched-mode laser-"laser toning" is broadly used to treat melasma, especially in Asia. The study aimed to evaluate the effects of a series of laser treatments with very short, nanosecond pulses in the treatment of melasma in Caucasian women. MATERIAL AND METHODS Forty polish females with Fitzpatrick skin phototype II-III and melasma were treated with 1064 nm Q-switched neodymium:yttrium-aluminum-garnet (QSNY) laser (pulse with 5 ns; spot size, 6-8 mm; fluence, 1.7-3.2 J/cm2 ; 2-8 passes; nine treatments). Melanin index (MI), erythema index (EI) by Mexameter MX18®, the modified Melasma Area Severity Index (mMASI), and the participant's self-assessment were used to evaluate the treatment results. Twenty-one patients were subjected to a 1-year follow-up. RESULTS Significant improvement in melasma pigmentation was observed in the mean MI and mMASI score; both were significantly reduced (p < 0.0001). Significant erythema reduction was achieved (p < 0.001). In total, 70% of participants rated the laser as a method that met their expectations for treating melasma. Clinical follow-up after one year showed that the reduced melasma effect was still maintained. Patients also noticed improved skin conditions (radiance, smoothness, brightness, hydration, regeneration). No serious adverse effects were observed. CONCLUSIONS Low-fluence 1064 nm QSNY laser is an effective, safe, and noninvasive method with long-term results in melasma treatment. QSNY (1064 nm) improves the condition of melasma patients with erythema.
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Affiliation(s)
- Iwona Micek
- Department and Division of Practical Cosmetology and Skin Diseases Prophylaxis, Poznan University of Medical Sciences, Poznan, Poland
| | - Mariola Pawlaczyk
- Department and Division of Practical Cosmetology and Skin Diseases Prophylaxis, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Kroma
- Department and Division of Practical Cosmetology and Skin Diseases Prophylaxis, Poznan University of Medical Sciences, Poznan, Poland
| | - Agnieszka Seraszek-Jaros
- Department of Bioinformatics and Computational Biology, Poznan University of Medical Sciences, Poznan, Poland
| | - Maria Urbańska
- Department and Division of Practical Cosmetology and Skin Diseases Prophylaxis, Poznan University of Medical Sciences, Poznan, Poland
| | - Justyna Gornowicz-Porowska
- Department and Division of Practical Cosmetology and Skin Diseases Prophylaxis, Poznan University of Medical Sciences, Poznan, Poland
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Ibrahim SMA, Farag AS, Ali MS, El-Gendy WMAF. Efficacy and Safety of Topical Silymarin Versus Low Fluence 1064-nm Q Switched Nd:YAG Laser in the Treatment of Melasma: A Comparative Randomized Trial. Lasers Surg Med 2021; 53:1341-1347. [PMID: 34101206 DOI: 10.1002/lsm.23440] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/10/2021] [Accepted: 05/24/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES The management of melasma is challenging and requires multiple uses of available therapeutic options. To compare the short-term efficacy and safety of topical silymarin and low fluence 1064-nm Q-switched ND:YAG laser for treatment of melasma with dermoscopic follow-up. STUDY DESIGN/MATERIALS AND METHODS Fifty female patients with melasma were included in this study. They were randomly divided into two groups. Group A: 25 patients were treated with six sessions of low fluence Q switched ND:YAG 1064-nm laser, and group B: 25 patients were treated with topical silymarin cream 1.4% with a 3-month treatment duration. Patients were evaluated clinically by the modified melasma area and severity index (mMASI) score. Dermoscopic examinations were performed before and after the treatment sessions. RESULTS The severity of melasma, as evaluated dermoscopically and clinically by mMASI score, was significantly reduced after treatment in all patients with no recorded side effects. There was no statistically significant difference between both studied groups regarding the change in mMASI score and dermoscopic assessment of the patients after the treatment sessions. CONCLUSION Both low fluence Q switched ND:YAG 1064-nm laser and topical silymarin cream appear to be safe and effective modalities in the treatment of melasma. © 2021 Wiley Periodicals LLC.
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Affiliation(s)
- Shady M A Ibrahim
- Department of Dermatology, Faculty of Medicine, Al-Azhar University, Cairo, 11651, Egypt
| | - Asmaa S Farag
- Department of Dermatology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, 11651, Egypt
| | - Mona S Ali
- Department of Dermatology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, 11651, Egypt
| | - Wafaa M A F El-Gendy
- Department of Dermatology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, 11651, Egypt
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Comparative Efficacy of Fractional CO2 Laser and Q-Switched Nd:YAG Laser in Combination Therapy with Tranexamic Acid in Refractory Melasma: Results of a Prospective Clinical Trial. COSMETICS 2021. [DOI: 10.3390/cosmetics8020037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Melasma manifests as hyperpigmented macules and patches, usually affecting the face, neck, and rarely upper limbs. This study evaluated comparative efficacy of a fractional CO2 laser with a Q-Switched Nd:YAG laser in combination therapy with tranexamic acid in refractory melasma. A total of 30 patients with refractory melasma were included in this study. The fractional CO2 laser (power: 30 w, pulse energy: 30 mJ, tip type: 300, pulse rate: 100/cm2) was used on one side of the patients’ face and three passes of the Q-Switched Nd:YAG (QSNY) laser (Wavelength: 1064 nm, pulse energy: 750 mJ, fluence: 1.50 J/cm2, spot size: 4 mm × 4 mm, hand piece: fractional) were used on the opposite side of the same patient’s face for six sessions. During the course of laser therapy, all patients received oral tranexamic acid 250 mg twice daily. Melasma area and severity index (MASI) score and physician’s satisfaction and patient’s satisfaction were analyzed. Thirty patients (mean age 39.97) were included. Patient global assessment (PtGA) in the fractional CO2 laser group was significantly better than the Q-Switched Nd:YAG laser group at 4th, 8th and 12th weeks (p-value < 0.001). According to PtGA, the improvement was significant in both groups over time. Physician global assessment (PGA) at the 8th and 12th weeks, and physician satisfaction (PS) at the 8th week, in the fractional CO2 laser group was significantly better than the Q-Switched Nd:YAG laser group (p-value < 0.05). The PGA in both groups significantly reduced over time. The MASI score significantly decreased in both groups over time. The MASI score in the fractional CO2 laser group decreased more than the Q-Switched Nd:YAG laser group over time (p < 0.001). The most common side effects reported were erythema and discomfort, which subsided in less than 24 h. A fractional CO2 laser with oral tranexamic acid is an effective and well tolerated therapeutic method for the treatment of patients with refractory melasma.
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Dev T, Sreenivas V, Sharma VK, Sahni K, Bhari N, Sethuraman G. A split face randomized controlled trial comparing 1,064 nm Q-switched Nd-YAG laser and modified Kligman's formulation in patients with melasma in darker skin. Int J Dermatol 2020; 59:1525-1530. [PMID: 33017045 DOI: 10.1111/ijd.15229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND No randomized studies compared the efficacy and safety of modified Kligman's triple combination (TC) with 1,064 nm Q-switched Nd-YAG laser (QSNYL) in melasma in darker skin. OBJECTIVES To compare the efficacy and safety of QSNYL and TC in the treatment of melasma in Fitzpatrick skin types IV and V. METHODS In this split face randomized controlled trial, participants' cheeks were randomized to receive either weekly QSNYL (group A) or daily TC (group B) for 12 weeks, followed by 12 weeks of follow-up. RESULTS Twenty-eight patients completed the intervention, and 21 of them completed follow-up. We found a significant but modest reduction in mean melanin index, modified Melasma Area Severity Index (MASI), and photographic and patient's assessment in both modalities (P < 0.01). No significant differences were detected between the groups. All patients had reappearance of pigmentation by the end of follow-up. Adverse reactions were significantly more in group B (P < 0.001). LIMITATION The desired sample size could not be achieved. CONCLUSION AND RELEVENCE No statistically significant differences were observed between QSNYL and TC as monotherapy in melasma. Reappearance of melasma is inevitable after stopping treatment.
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Affiliation(s)
- Tanvi Dev
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Vinod K Sharma
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
| | - Kanika Sahni
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
| | - Neetu Bhari
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
| | - Gomathy Sethuraman
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
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GWAS Analysis of 17,019 Korean Women Identifies the Variants Associated with Facial Pigmented Spots. J Invest Dermatol 2020; 141:555-562. [PMID: 32835660 DOI: 10.1016/j.jid.2020.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 08/09/2020] [Accepted: 08/14/2020] [Indexed: 12/20/2022]
Abstract
Variation in skin pigmentation can be affected by both environmental factors and intrinsic factors such as age, gender, and genetic variation. Recent GWASs revealed that genetic variants of genes functionally related to a pigmentation pathway were associated with skin pigmentary traits. However, these GWASs focused on populations with European ancestry, and only a few studies have been performed on Asian populations, limiting our understanding of the genetic basis of skin pigmentary traits in Asians. To evaluate the genetic variants associated with facial pigmented spots, we conducted a GWAS analysis of objectively measured facial pigmented spots in 17,019 Korean women. This large-scale GWAS identified several genomic loci that were significantly associated with facial pigmented spots (five previously reported loci and two previously unreported loci, to our knowledge), which were detected by UV light: BNC2 at 9p22 (rs16935073; P-value = 2.11 × 10-46), PPARGC1B at 5q32 (rs32579; P-value = 9.04 × 10-42), 10q26 (rs11198112; P-value = 9.66 × 10-38), MC1R at 16q24 (rs2228479; P-value = 6.62 × 10-21), lnc01877 at 2q33 (rs12693889; P-value = 1.59 × 10-11), CDKN2B-AS1 at 9p21 (rs643319; P-value = 7.76 × 10-9), and MFSD12 at 19p13 (rs2240751; P-value = 9.70 × 10-9). Further functional characterization of the candidate genes needs to be done to fully evaluate their contribution to facial pigmented spots.
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Yip DLK. A pilot study on the use of a non‐crosslinked hyaluronic acid with associated anti‐oxidant ingredients to improve the effectiveness of Nd:YAG laser toning in the treatment of melasma in six patients. J Cosmet Dermatol 2020; 19:2212-2218. [DOI: 10.1111/jocd.13565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 06/17/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Daniel LK Yip
- Department of Family Practice Faculty of Medicine University of British Columbia Vancouver BC Canada
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14
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Abdel Hay R, Mohammed FN, Sayed KS, Abd El Fattah NA, Ibrahim S. Dermoscopy as a useful tool for evaluating melasma and assessing the response to 1064‐nm Q‐switched Nd:
YAG
laser. Dermatol Ther 2020; 33:e13629. [DOI: 10.1111/dth.13629] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/03/2020] [Accepted: 05/17/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Rania Abdel Hay
- Dermatology Department, Faculty of Medicine Cairo University Cairo Egypt
| | | | - Khadiga S. Sayed
- Dermatology Department, Faculty of Medicine Cairo University Cairo Egypt
| | | | - Sarah Ibrahim
- Dermatology Department, Faculty of Medicine Cairo University Cairo Egypt
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15
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Evaluating the Risk Factors of Post Inflammatory Hyperpigmentation Complications with Nd-YAG Laser Toning Using LASSO-Based Algorithm. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10062049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The neodymium-doped yttrium aluminum garnet (Nd-YAG) laser is used for removal of pigmented skin patches and rejuvenation of skin. However, complications such as hyperpigmentation, hypopigmentation, and petechiae can occur after frequent treatments. Therefore, identifying the risk factors for such complications is important. The development of a multivariable logistic regression model with least absolute shrinkage and selection operator (LASSO) is needed to provide valid predictions about the incidence of post inflammatory hyperpigmentation complication probability (PIHCP) among patients treated with Nd-YAG laser toning. A total of 125 female patients undergoing laser toning therapy between January 2014 and January 2016 were examined for post-inflammatory hyperpigmentation (PIH) complications. Factor analysis was performed using 15 potential predictive risk factors of PIH determined by a physician. The LASSO algorithm with cross-validation was used to select the optimal number of predictive risk factors from the potential factors for a multivariate logistic regression PIH complication model. The optimal number of predictive risk factors for the model was five: immediate endpoints of laser (IEL), α-hydroxy acid (AHA) peels, Fitzpatrick skin phototype (FSPT), acne, and melasma. The area under the receiver operating characteristic curve (AUC) was 0.79 (95% CI, 0.70–0.88) in the optimal model. The overall performance of the LASSO-based PIHCP model was satisfactory based on the AUC, Omnibus, Nagelkerke R2, and Hosmer–Lemeshow tests. This predictive risk factor model is useful to further optimize laser toning treatment related to PIH. The LASSO-based PIHCP model could be useful for decision-making.
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16
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Cho MY, Roh MR. Successful Treatment of Riehl's Melanosis With Mid‐Fluence Q‐Switched Nd:YAG 1064‐nm Laser. Lasers Surg Med 2020; 52:753-760. [DOI: 10.1002/lsm.23214] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2019] [Indexed: 01/25/2023]
Affiliation(s)
- Mi Yeon Cho
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute Yonsei University College of Medicine 211 Eonjuro Gangnam‐gu Seoul 06273 Korea
| | - Mi Ryung Roh
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute Yonsei University College of Medicine 211 Eonjuro Gangnam‐gu Seoul 06273 Korea
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17
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Leem S, Chang J, Kim Y, Shin JG, Song HJ, Lee SG, Yoo S, Lee J, Myoung J, Park SG, Kang NG. Repeated measurements of facial skin characteristics using the Janus-Ⅲ measurement system. Skin Res Technol 2019; 26:362-368. [PMID: 31859440 DOI: 10.1111/srt.12811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/08/2019] [Accepted: 11/09/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND For personalized skin care, noninvasive quantitative methods to evaluate facial skin characteristics are important. Janus-III is one of the most widely used imaging analysis devices in the skin care industry in Korea. Janus-III generates values for a range of skin characteristics. Due to the convenience of obtaining results for a variety of skin characteristics in a single measurement, the use of Janus-III in cosmetic stores and research institutes has been recently increasing. However, the consistency of skin measurements of Janus-III has not been elucidated yet. MATERIALS AND METHODS In this study, we repeated skin measurements three times for 70 different subjects and compared each numerical value in order to assess the consistency of the Janus-III. For this purpose, we compared between-sample distances and within-sample distances. RESULTS We found important patterns for future analyses in terms of consistency. First, the average values of skin measurement categories were more reliable than individual part values of facial segments. Second, center part values such as forehead and nose were more reliable than side part values such as left and right part segments. CONCLUSION If researchers who use Janus-III for studies of facial characteristics analyze average and center part values first, they can obtain relatively reliable patterns of facial skin characteristics.
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Affiliation(s)
- Sangseob Leem
- R&D Center, LG Household and Health Care, Ltd., Seoul, Korea
| | - Junghwa Chang
- R&D Center, LG Household and Health Care, Ltd., Seoul, Korea
| | - Yunkwan Kim
- R&D Center, LG Household and Health Care, Ltd., Seoul, Korea
| | - Joong-Gon Shin
- R&D Center, LG Household and Health Care, Ltd., Seoul, Korea
| | - Hae Jung Song
- R&D Center, LG Household and Health Care, Ltd., Seoul, Korea
| | - Seo-Gyeong Lee
- R&D Center, LG Household and Health Care, Ltd., Seoul, Korea
| | - Suji Yoo
- R&D Center, LG Household and Health Care, Ltd., Seoul, Korea
| | - Jinyong Lee
- R&D Center, LG Household and Health Care, Ltd., Seoul, Korea
| | - Joonoh Myoung
- R&D Center, LG Household and Health Care, Ltd., Seoul, Korea
| | - Sun Gyoo Park
- R&D Center, LG Household and Health Care, Ltd., Seoul, Korea
| | - Nae Gyu Kang
- R&D Center, LG Household and Health Care, Ltd., Seoul, Korea
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18
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Guo X, Cai X, Jin Y, Zhang T, Wang B, Li Q. Q-PTP is an optimized technology of 1064-nm Q-switched neodymium-doped yttrium aluminum garnet laser in the laser therapy of melasma: A prospective split-face study. Oncol Lett 2019; 18:4136-4143. [PMID: 31516612 PMCID: PMC6733004 DOI: 10.3892/ol.2019.10743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 07/09/2019] [Indexed: 01/20/2023] Open
Abstract
Quickly-pulse-to-pulse (Q-PTP) is the latest dual pulse mode Q-switched neodymium-doped yttrium aluminum garnet [QS Nd:YAG (QSNY)] laser technology that improves efficacy and minimizes side effects. In this study, the safety, efficacy, and advantages of Q-PTP and single-pulse laser mode of 1064-nm QSNY in the treatment of melasma were compared. Twelve healthy women were enrolled in this split-face study. Q-PTP and single-pulse laser mode of 1064-nm QSNY were applied to the treatment side and the control side, respectively. Physician's global assessment, patients' self-assessment and the modified melasma area and severity index (mMASI) scores were used to quantify pigmentation changes. Side effects were recorded. Mean mMASI scores were decreased significantly at the 4th and 12th-week follow-up visit compared to the baseline. Melasma lesion clearance was more than 50% in 58% of patients compared with the baseline. However, both sides of the same patient showed similar therapeutic effect. Minor pain experience and slighter skin erythema reaction were reported in Q-PTP laser mode treatment side compared with the control. No serious complications were found in any of the patients. Q-PTP laser mode of 1064-nm QSNY is an optimal laser therapy in the treatment of melasma with greater safety and superiority.
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Affiliation(s)
- Xiaorui Guo
- Plastic Surgery, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China.,Laser Cosmetics and Plastic Surgery, Zhongshan Second People's Hospital, Zhongshan, Guangdong 528400, P.R. China
| | - Xiaojian Cai
- Laser Cosmetics and Plastic Surgery, Zhongshan Second People's Hospital, Zhongshan, Guangdong 528400, P.R. China
| | - Yudan Jin
- Laser Cosmetics and Plastic Surgery, Zhongshan Second People's Hospital, Zhongshan, Guangdong 528400, P.R. China
| | - Taohua Zhang
- Laser Cosmetics and Plastic Surgery, Zhongshan Second People's Hospital, Zhongshan, Guangdong 528400, P.R. China
| | - Bulin Wang
- Plastic Surgery, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Qin Li
- Plastic Surgery, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China.,Laser Plastic Surgery Center, General Hospital of the Southern War Zone of the Chinese People's Liberation Army, Guangzhou, Guangdong 510000, P.R. China
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19
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Fong K, Goh BK. Epidermal cellular grafting as a treatment for punctate leukoderma secondary to laser toning. J Eur Acad Dermatol Venereol 2019; 33:e396-e397. [PMID: 31120157 DOI: 10.1111/jdv.15699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- K Fong
- National Skin Centre, 1 Mandalay Road, Singapore, 308205, Singapore
| | - B K Goh
- National Skin Centre, 1 Mandalay Road, Singapore, 308205, Singapore.,Skin Physicians, 3 Mount Elizabeth, #11-08 Mount Elizabeth Medical Centre, Singapore, 228510, Singapore
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20
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Jin Y, Jiang W, Yao Y, Huang H, Huang J. Clinical efficacy of laser combined with menstrual regulation in the treatment of female melasma: a retrospective study. Lasers Med Sci 2019; 34:1099-1105. [DOI: 10.1007/s10103-018-02698-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 11/27/2018] [Indexed: 11/30/2022]
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21
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Abstract
Melasma is a common acquired disorder of hyperpigmentation. A variety of treatment options has been suggested for the management of melasma. A range of different lasers had been tried in the treatment of melasma. Q-switched Nd-YAG laser (QSL) is the most commonly used laser in the treatment of melasma. Recently, laser toning or low-fluence, multi-pass technique has become popular in treatment of melasma. Authors aimed to review the procedure, its effectiveness, combination therapies using laser toning, and complications of laser toning. A PubMed search was made using keywords such as laser toning, QSL, melasma, and lasers in melasma, and relevant articles were reviewed.
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Affiliation(s)
- Swapnil D Shah
- Department of Dermatology, Ashwini Ruaral Medical college, Solapur, Maharashtra, India
| | - Sanjeev J Aurangabadkar
- Consultant Dermatologist, Dr. J W Aurangabadkar New Skin clinic, Hyderabad, Telangana, India
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22
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Gao YL, Jia XX, Wang M, Hua Y, Zheng H, Xiang WZ, Song XZ. Melanocyte activation and skin barrier disruption induced in melasma patients after 1064 nm Nd:YAG laser treatment. Lasers Med Sci 2018; 34:767-771. [DOI: 10.1007/s10103-018-2658-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/02/2018] [Indexed: 11/24/2022]
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23
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Choi JE, Lee DW, Seo SH, Ahn HH, Kye YC. Low‐fluence Q‐switched Nd:YAG laser for the treatment of melasma in Asian patients. J Cosmet Dermatol 2018; 17:1053-1058. [DOI: 10.1111/jocd.12760] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 04/05/2018] [Accepted: 07/31/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Jae Eun Choi
- Department of Dermatology, College of Medicine Korea University Seoul
| | - Dong Won Lee
- Department of Dermatology, College of Medicine Korea University Seoul
| | - Soo Hong Seo
- Department of Dermatology, College of Medicine Korea University Seoul
| | - Hyo Hyun Ahn
- Department of Dermatology, College of Medicine Korea University Seoul
| | - Young Chul Kye
- Department of Dermatology, College of Medicine Korea University Seoul
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24
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LaRosa C, Chiaravalloti A, Jinna S, Berger W, Finch J. Laser treatment of medical skin disease in women. Int J Womens Dermatol 2017; 3:131-139. [PMID: 28831422 PMCID: PMC5555278 DOI: 10.1016/j.ijwd.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 01/01/2023] Open
Abstract
Laser treatment is a relatively new and increasingly popular modality for the treatment of many dermatologic conditions. A number of conditions that predominantly occur in women and that have a paucity of effective treatments include rosacea, connective tissue disease, melasma, nevus of Ota, lichen sclerosus (LS), notalgia paresthetica and macular amyloidosis, and syringomas. Laser therapy is an important option for the treatment of patients with these conditions. This article will review the body of literature that exists for the laser treatment of women with these medical conditions.
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Affiliation(s)
- C. LaRosa
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - A. Chiaravalloti
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - S. Jinna
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - W. Berger
- Frank H. Netter MD School of Medicine, Quinnipiac University, North, Haven, CT
| | - J. Finch
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
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25
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Updates in the understanding and treatments of skin & hair disorders in women of color. Int J Womens Dermatol 2017; 3:S21-S37. [PMID: 28492036 PMCID: PMC5419061 DOI: 10.1016/j.ijwd.2017.02.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 04/15/2015] [Accepted: 04/15/2015] [Indexed: 12/19/2022] Open
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).
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26
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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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27
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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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28
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Beylot C, Raimbault-Gerard C. [Post-inflammatory hyperpigmentation occuring after cosmetic procedures]. Ann Dermatol Venereol 2016; 143 Suppl 2:S33-S42. [PMID: 29452657 DOI: 10.1016/s0151-9638(18)30082-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A post-inflammatory hyperpigmentation (PIHP) can occur after cosmetic procedures such as chemical peels and lasers. Patients must be informed about this risk. Precautionary measures before, during and after the procedure can prevent or reduce the risk of PIHP. These procedures should not be done in summer on suntanned skin and patients have to be aware of the importance of an effective photoprotection. The PIHP occurs more frequently on dark-skinned patients, in Asians as well as in women with melasma history. In these cases, risk/benefit assessment of the cosmetic procedure is required: no risky procedure in patients at risk! PIHP can also be related to technical errors such as too high concentration or too long exposure time during peel procedure as well as excessive threshold fluences during laser procedure. If many therapies for PIHP damages can be proposed, patients feel frequently that they are not as quickly effective as they would like. Patients must be reassured as many PIHP resolve spontaneously. If photoprotection is always required, it is also possible to accelerate the pigmentation's clearing using the Kligman trio or the numerous topical lightening agents targeting several steps of the hyperpigmentation process. More invasive and expensive therapies such as peels, lasers, IPL or radiofrequency might be used for refractory cases. As a pigmentary relapse might occur after these procedures, the traditional Kligman trio should be always considered.
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Affiliation(s)
- C Beylot
- Professeur Emérite de l'Université de Bordeaux.
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29
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Yue B, Yang Q, Xu J, Lu Z. Efficacy and safety of fractional Q-switched 1064-nm neodymium-doped yttrium aluminum garnet laser in the treatment of melasma in Chinese patients. Lasers Med Sci 2016; 31:1657-1663. [DOI: 10.1007/s10103-016-2034-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
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30
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Won KH, Lee SH, Lee MH, Rhee DY, Yeo UC, Chang SE. A prospective, split-face, double-blinded, randomized study of the efficacy and safety of a fractional 1064-nm Q-switched Nd:YAG laser for photoaging-associated mottled pigmentation in Asian skin. J COSMET LASER THER 2016; 18:381-386. [PMID: 27249461 DOI: 10.1080/14764172.2016.1191645] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Laser toning using low-fluence 1064-nm Q-switched neodymium-doped yttrium aluminum laser (QSNY) has gained popularity in the treatment of photoaging-associated mottled pigmentation (PMP). However, hypopigmentation or lack of efficacy has been reported depending on the fluences used. OBJECTIVE To compare a novel fractional 1064-nm QSNY with conventional 1064-nm QSNY for the treatment of photoaging-associated mottled pigmentary lesions except epidermal lesions of lentigines and freckles through a randomized, split-face, double-blind study. MATERIALS AND METHODS Thirteen Asian women were treated every week for 6 weeks with fractional 1064-nm QSNY on one side of the face and conventional 1064-nm QSNY on the other side. We evaluated the pigmentation area and severity index (PSI), melanin index, erythema index, and the patient's global assessment of improvement. RESULTS At three months post-treatment, the PSI score improved compared with baseline, by 14.48% on the conventional 1064-nm QSNY side and 21.81% on the fractional 1064-nm QSNY side. Both groups showed improvements in the melanin index. CONCLUSION Both fractional 1064-nm QSNY and strictly low-fluence conventional 1064-nm QSNY are moderately effective against PMP and other photoaging signs. Fractional laser toning shows better subjective outcomes than conventional toning.
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Affiliation(s)
- Kwang Hee Won
- a Department of Dermatology , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Korea
| | - Sang Hyung Lee
- a Department of Dermatology , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Korea
| | - Mi Hye Lee
- a Department of Dermatology , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Korea
| | | | - Un-Cheol Yeo
- c Jongno S and U Dermatologic Clinic , Seoul , Korea
| | - Sung Eun Chang
- a Department of Dermatology , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Korea
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Kim JY, Choi M, Nam CH, Kim JS, Kim MH, Park BC, Hong SP. Treatment of Melasma with the Photoacoustic Twin Pulse Mode of Low-Fluence 1,064 nm Q-Switched Nd:YAG Laser. Ann Dermatol 2016; 28:290-6. [PMID: 27274626 PMCID: PMC4884704 DOI: 10.5021/ad.2016.28.3.290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 07/13/2015] [Accepted: 07/14/2015] [Indexed: 02/01/2023] Open
Abstract
Background Low-fluence 1,064 nm Q-switched Nd:YAG laser has been widely used for the treatment of melasma. Although new Q-switched Nd:YAG lasers with photoacoustic twin pulse (PTP) mode have been recently developed for high-efficiency, there is limited information available for the new technique. Objective This study was designed to investigate the efficacy and adverse effects after few sessions of repeated low fluence 1,064 nm Q-switched Nd:YAG laser treatment with PTP mode in Asian women with melasma. Methods Twenty-two Korean women were treated with a total of five sessions of low-fluence PTP mode Nd:YAG laser treatment (Pastelle®) at 2 weeks interval. Responses to treatments were evaluated by using Melasma Area and Severity Index (MASI) scoring, colorimeter measurement, and the investigators' and patients' overall assessments. Adverse events were recorded at each visit. Results Investigators' and patients' overall assessment showed that 'significantly improved' was assessed by 13 (59.1%) and 19 of 22 patients (86.4%), respectively. MASI scores were significantly reduced by 20.4%. The lightness, measured by using a colorimeter, was significantly increased by 1.3 point. Notable adverse events were not observed. Conclusion After 5 sessions of laser therapy alone, about 60% of the subjects showed significant improvement. Few sessions of repeated laser toning treatment using the PTP mode is a safe and effective way to treat facial melasma.
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Affiliation(s)
- Jee Young Kim
- Department of Dermatology, Dankook University College of Medicine, Cheonan, Korea
| | - Misoo Choi
- Department of Dermatology, Dankook University College of Medicine, Cheonan, Korea
| | - Chan Hee Nam
- Department of Dermatology, Dankook University College of Medicine, Cheonan, Korea
| | - Ji Seok Kim
- Department of Dermatology, Dankook University College of Medicine, Cheonan, Korea
| | - Myung Hwa Kim
- Department of Dermatology, Dankook University College of Medicine, Cheonan, Korea
| | - Byung Cheol Park
- Department of Dermatology, Dankook University College of Medicine, Cheonan, Korea
| | - Seung Phil Hong
- Department of Dermatology, Dankook University College of Medicine, Cheonan, Korea
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Wong Y, Lee SSJ, Goh CL. Hypopigmentation Induced by Frequent Low-Fluence, Large-Spot-Size QS Nd:YAG Laser Treatments. Ann Dermatol 2015; 27:751-5. [PMID: 26719647 PMCID: PMC4695430 DOI: 10.5021/ad.2015.27.6.751] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 07/03/2015] [Accepted: 08/03/2015] [Indexed: 11/08/2022] Open
Abstract
The Q-switched 1064-nm neodymium-doped yttrium aluminum garnet (QS 1064-nm Nd:YAG) laser is increasingly used for nonablative skin rejuvenation or "laser toning" for melasma. Multiple and frequent low-fluence, large-spot-size treatments are used to achieve laser toning, and these treatments are associated with the development of macular hypopigmentation as a complication. We present a case series of three patients who developed guttate hypomelanotic macules on the face after receiving laser toning treatment with QS 1064-nm Nd:YAG.
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A low-fluence 1064-nm Q-switched neodymium-doped yttrium aluminium garnet laser for the treatment of café-au-lait macules. J Am Acad Dermatol 2015; 73:477-83. [DOI: 10.1016/j.jaad.2015.06.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 05/27/2015] [Accepted: 06/01/2015] [Indexed: 11/20/2022]
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Lawson CN, Hollinger J, Sethi S, Rodney I, Sarkar R, Dlova N, Callender VD. Updates in the understanding and treatments of skin & hair disorders in women of color. Int J Womens Dermatol 2015; 1:59-75. [PMID: 28491960 PMCID: PMC5418751 DOI: 10.1016/j.ijwd.2015.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 04/15/2015] [Accepted: 04/15/2015] [Indexed: 12/19/2022] Open
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).
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Affiliation(s)
- Christina N Lawson
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia.,Callender Dermatology & Cosmetic Center, Glenn Dale, Maryland
| | - Jasmine Hollinger
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
| | - Sumit Sethi
- Department of Dermatology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Ife Rodney
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
| | - Rashmi Sarkar
- Department of Dermatology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Ncoza Dlova
- Department of Dermatology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Valerie D Callender
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia.,Callender Dermatology & Cosmetic Center, Glenn Dale, Maryland
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Treatment of Melasma in Men With Low-Fluence Q-Switched Neodymium-Doped Yttrium–Aluminum–Garnet Laser Versus Combined Laser and Glycolic Acid Peeling. Dermatol Surg 2015; 41:457-65. [DOI: 10.1097/dss.0000000000000304] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sugawara J, Kou S, Kou S, Yasumura K, Satake T, Maegawa J. Influence of the frequency of laser toning for melasma on occurrence of leukoderma and its early detection by ultraviolet imaging. Lasers Surg Med 2015; 47:161-7. [DOI: 10.1002/lsm.22325] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Jun Sugawara
- Department of plastic and Reconstructive Surgery,; Yokohama City University Medical Center; Yokohama Japan
| | - Seiko Kou
- KO CLINIC for Antiaging; Yokohama Japan
| | - Sousei Kou
- Ko Ladies Clinic Enoshima; Fujisawa Japan
| | - Kazunori Yasumura
- Department of plastic and Reconstructive Surgery,; Yokohama City University Medical Center; Yokohama Japan
| | - Toshihiko Satake
- Department of plastic and Reconstructive Surgery,; Yokohama City University Medical Center; Yokohama Japan
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Choi CP, Yim SM, Seo SH, Ahn HH, Kye YC, Choi JE. Retrospective analysis of melasma treatment using a dual mode of low-fluence Q-switched and long-pulse Nd:YAG laser vs. low-fluence Q-switched Nd:YAG laser monotherapy. J COSMET LASER THER 2014; 17:2-8. [DOI: 10.3109/14764172.2014.957217] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Fabi SG, Friedmann DP, Niwa Massaki AB, Goldman MP. A randomized, split-face clinical trial of low-fluence Q-switched neodymium-doped yttrium aluminum garnet (1,064 nm) laser versus low-fluence Q-switched alexandrite laser (755 nm) for the treatment of facial melasma. Lasers Surg Med 2014; 46:531-7. [DOI: 10.1002/lsm.22263] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Sabrina G. Fabi
- Goldman, Butterwick, Fitzpatrick, Groff, & Fabi, Cosmetic Laser Dermatology; San Diego California
- Department of Dermatology/Medicine; University of California; San Diego California
| | - Daniel P. Friedmann
- Goldman, Butterwick, Fitzpatrick, Groff, & Fabi, Cosmetic Laser Dermatology; San Diego California
- Westlake Dermatology Clinical Research Center; Austin Texas
| | - Ane B. Niwa Massaki
- Goldman, Butterwick, Fitzpatrick, Groff, & Fabi, Cosmetic Laser Dermatology; San Diego California
| | - Mitchel P. Goldman
- Goldman, Butterwick, Fitzpatrick, Groff, & Fabi, Cosmetic Laser Dermatology; San Diego California
- Volunteer Clinical Professor of Dermatology/Medicine, University of California; San Diego California
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Hilton S, Heise H, Buhren BA, Schrumpf H, Bölke E, Gerber PA. Treatment of melasma in Caucasian patients using a novel 694-nm Q-switched ruby fractional laser. Eur J Med Res 2013; 18:43. [PMID: 24225160 PMCID: PMC3831591 DOI: 10.1186/2047-783x-18-43] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 10/29/2013] [Indexed: 11/12/2022] Open
Abstract
Background Melasma is a common hypermelanosis of the face. The use of a classical Q-switched ruby laser (QSRL) to treat melasma is discussed controversially and is associated with frequent adverse effects, such as hyper- or hypopigmentation. Recently a fractional-mode (FRx) QSRL was developed to minimize the adverse effects of classical QSRL. The objective of this research was to evaluate the efficacy and safety of a novel FRx-QSRL in the treatment of melasma in Caucasian patients. Methods We performed a retrospective study of 25 Caucasian melasma patients (Fitzpatrick skin types I to III). Patients received one to three FRx-QSRL treatments (Tattoostar FRx, Asclepion Laser Technologies, Jena, Germany) at pulse energies of 4 to 8 J/cm2. Three blinded investigators independently evaluated the melasma area and severity index (MASI) score before treatment and at the four- to six-week follow-ups. At additional three-month follow-ups, patients evaluated subjective improvement, pain and over-all satisfaction with the treatment according to a numeric analogue score (NAS). Side effects were documented. Results At four to six weeks post laser treatment for a mean of 1.4 sessions, we observed a significant (P = 0.0001) reduction of the MASI score from 6.54 to 1.98 (72.3%). Patients rated the pain of the intervention at a mean 2.46 points (0 = no pain; 10 = maximum pain), the improvement at a mean 5.55 points (0 = no improvement; 10 = maximum improvement) and the overall satisfaction at a mean 4.66 points (0 = not satisfied; 10 = maximum satisfaction). After three months, post-inflammatory hyperpigmentation (PIH) and/or recurring melasma were observed in 7 (28%) and 11 (44%) patients, respectively. Conclusion The 694-nm FRx-QSRL is a safe and effective option for treating melasma in Caucasian patients. Over periods of >3 months, PIH and/or recurring melasma may develop at significant rates and may reduce patient satisfaction. Multiple treatment sessions with lower pulse energies and/or a post-interventional therapy with hypopigmenting ointments and UV protection may help to minimize these complications.
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