Ann Dermatol.  2018 Feb;30(1):1-7. 10.5021/ad.2018.30.1.1.

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

• Kong SH
• Suh HS
• Choi YS

• KMID: 2399747
• DOI: http://doi.org/10.5021/ad.2018.30.1.1

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.

Keyword

Dermoscopy; Melasma; Pulsed dye lasers; Q-switched lasers

MeSH Terms

Capillaries
Dermoscopy
Follow-Up Studies
Humans
Lasers, Dye
Melanosis*

Figure

• 

  Fig. 1 Schematized summary of treatment schedule. PDL: pulsed-dye laser, QSNY: Q-switched Nd:YAG laser.

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  Fig. 2 Dermoscopic image of a patient who showed visibly widened capillaries along with pigmentation of a pseudonetwork pattern at the first visit.

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  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).

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  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.

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