Treating melasma: Copper bromide laser effectively targets vasculature

November 1, 2008

Targeting the melanocytes in the hypermelanosis seen in melasma is a common and effective therapy. Many therapies exist, including topical approaches, lasers and light therapy. A new approach targeting the vasculature, not the melanocytes, using a copper bromide dual 578 nm yellow laser has proven very effective in the treatment of melasma, a recent study shows.

Key Points

Seoul, South Korea - A new study has shown that the use of a copper bromide 578 nm dual/yellow laser can significantly impact the hyperpigmentation seen in melasma lesions.

According to researchers, reducing the vascular endothelial growth factor (VEGF) seems to be an excellent approach in successfully treating melasma and significantly reducing hyperpigmentation.

Treatment overview

This targeted therapy can be done topically with the application of phenols, retinoids, corticosteroids and their combinations, or more invasively with the use of lasers and other light sources.

Many of these therapies have had mixed results and none has become the gold standard of treatment for melasma. While the melanocytes are a logical target for reducing the hyperpigmentation, and targeting therapy can improve melasma, some experts believe there are other structures within the melasma lesion that may also warrant attention and a targeted therapy.

"There has been a theory suggesting that the hyperpigmentation seen in melasma is not only due to the more active melanocytes within the lesion sites, but possibly also the increased vascularity consistently seen in melasma lesions, and that VEGF may be a major angiogenic factor for altered vessels found in melasma," says Hyunjung Kim, M.D., department of dermatology, Yongdong Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.

Copper bromide laser

According to Dr. Kim, the copper bromide dual 578 nm yellow laser has proven to be very effective in treating vascular lesions.

Dr. Kim and colleagues recently conducted a study in which 20 female Korean patients with facial melasma were treated with a copper bromide dual 578 nm yellow laser, once a week for a total of three treatments spaced three weeks apart, targeting the vascular structures within the melasma lesions.

Biopsies of pre-treatment and post-treatment melasma lesions were taken for histologic confirmation of study results, and immunohistochemistry was performed to determine the expression of factor VIIIa-related antigen, VEGF and thrombospondin in melasma.

Also, erythema intensity and pigmentation were quantified using a Mexameter (Courage-Khazaka).

Dr. Kim says the yellow laser was able to reduce the size and number of vessels within the melasma lesions, reducing the erythema of the treated lesions, which in turn reduced the perceived pigment within the lesions.

Results not only showed a decrease in the pigmentation of the melasma lesions reflected in the improvement of the melasma area and severity index (MASI) and physicians global assessment (PGA) scores, but also a decrease of the VEGF in post-treatment lesional skin compared to pre-treatment. Results also showed that the expression of thrombospondin in the melasma lesions increased after treatment with the yellow laser, leading to a better inhibition of VEGF.

"We have seen that patients treated with the yellow laser have longer-lasting results than with any other treatment we have tried for melasma.

"This may be, in part, due to the increased expression of thrombospondin, which inhibits VEGF and, in turn, inhibits the development of vasculature in the target area," Dr. Kim tells Dermatology Times.

The aim of the study was to decrease the vascularity found in melasma lesions that, in turn, would help reduce the hyperpigmentation of the skin condition.

Dr. Kim says melasma is not just a pigmentary disorder due to melanocytes, but the lesions are fraught with numerous, large blood vessels in the dermis, which also contribute to the dyspigmentation.

"If this vasculature were to be addressed and reduced, then the hyperpigmentation that characterizes these lesions would also be reduced," Dr. Kim says.

Combining lasers

In addition to directly treating the vascular structures with the yellow laser, Dr. Kim says reducing the VEGF is central in controlling angiogenesis, which results in a decreased pigmentation of melasma lesions.

Dr. Kim says she also likes to combine the yellow laser with other lasers, such as the Nd:YAG laser, for even better cosmetic results.

"The Nd:YAG laser addresses the melanocytes, and the yellow laser treats the vasculature. Combining the effects of these two lasers and approaching melasma lesions on two fronts results in an even more effective treatment of melasma with more dramatic results," Dr. Kim says.

Disclosure: This study was partially supported by Mirarush.

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