New laser treatment for melasma

June 1, 2008

New technologies, including several fractional resurfacing devices at multiple wavelengths, are helping treat melasma, pigmented lesions, and hyperpigmentation today, explains Ranella Hirsch, M.D, a dermatologist in practice in Cambridge, Mass.

Key Points

Dark-skinned patients tend to have melasma more frequently.

Several studies with promising results have recently been published concerning the new fractional resurfacing devices and recalcitrant dermal melasma.

Laser therapies

Laser treatment is now being utilized more frequently in patients who do not respond to conventional topical agents. Fractional photothermolysis (FP) combines some of the benefits of ablative technologies with the improved tolerability of nonablative laser treatments.

In a study published in Lasers in Surgery and Medicine this year, Goldberg et al demonstrated a successful improvement in melasma with fractional photothermolysis.

Researchers set out to evaluate the ultrastructural changes associated with fractional laser treatment of melasma. Post-treatment ultrastructural changes are consistent with an elimination process, and may help to explain clinical improvement following laser treatment, they found.

They looked at 10 subjects with skin types III and IV and a clinical diagnosis of epidermal melasma who were treated with a 1,550 nm erbium glass laser delivering light in a fractional manner (Fraxel SR 750, Reliant Technologies) every two weeks for a total of four sessions.

Light microscopy on post-treatment specimens showed a relative decrease in melanocytes compared to pre-treatment specimens.

Post-treatment electron microscopy revealed fewer melanocytes and a relative absence of melanin in the surrounding keratinocytes compared to pre-treatment specimens.

In another study, published in the Journal of Laser and Cosmetic Therapy last year, Naito et al reported on the use of fractional photothermolysis treatment for resistant melasma in Chinese females. Six female patients (Fitzpatrick skin types III-IV) were treated with fractional photothermolysis at approximately four-week intervals.

"All patients who participated in the study experienced at least 20 percent improvement in the appearance of their melasma lesions," Dr. Hirsch says.

Combination therapy

Park et al reported in a recent study in Lasers in Surgery and Medicine on the successful combined use of intense pulsed light and Q-switched ruby laser for complex dyspigmentation (CD) in Asian women. Twenty-five Korean women with dyspigmentation (defined as >2 types of facial pigmentary disorders) were initially treated with IPL followed by repeat treatments every three to four weeks as needed. The QSRL treatments, performed at low fluence, were added either during the same session or within one week of the IPL treatment.

"Physician assessments revealed that 60 percent of patients showed 76 to 100 percent improvement, while 76 percent of patients showed at least 50 percent improvement," Dr. Hirsch says.

They "concluded that combination treatment with IPL and QSRL is an effective and safe treatment for CD among Asian patients."