Melasma and pigmentation removal using Laser

Abstract

BACKGROUND:

Fractional photothermolysis (FP) is a popular treatment option for photodamaged skin and addresses shortcomings of ablative skin resurfacing and nonablative dermal remodeling. Previous studies have demonstrated that FP using the 1550nm wavelength has led to improvement of ultrastructural changes and clinical effects associated with photodamaged skin in the deeper dermal structures, while treatment with the 1927nm wavelength has shown clinical effects in the superficial dermis. Both wavelengths produce precise microscopic treatment zones (MTZs) in the skin. The two wavelengths used in combination may optimize the delivery of fractional nonablative resurfacing intended for dermal and epidermal coagulation of photodamage skin. Long-term exposure to sunlight, including ultraviolet A and B, produces signs associated with photoaging and photodamage, including laxity and discoloration of the skin. Initial laser treatment for dyspigmentation included the use of ablative lasers, followed by Q-switched lasers and more recently fractional lasers. Acne scarring is a frequent complication of acne and resulting scars may negatively impact on an affected person’s psychosocial and physical well-being. Although a wide range of interventions have been proposed, there is a lack of high-quality evidence on treatments for acne scars to better inform patients and their healthcare providers about the most effective and safe methods of managing this condition. This review aimed to examine treatments for atrophic and hypertrophic acne scars, but we have concentrated on facial atrophic scarring. 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 laserswhich 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. Melasma is a common acquired facial pigmentary disorder and challenging to treat. Triple combination (FTC) creams and sunscreens remain the cornerstone of therapy followed by maintenance with hydroquinone (HQ) and non-HQ skin-lightening agents. Peels have made successful inroads and are used frequently as an adjunct to medical management.  A variety of lasers and light devices have been used with varying degrees of success in melasma. The vast array of devices and combination protocols that have been tried in melasma clearly indicate that no single modality is singularly effective. Q-switched lasers (QSL), fractional lasers, ablative lasers, intense pulsed lights (IPLs), copper bromide laser, thulium laser, and their combinations have all been used, but response is unpredictable, and the pigmentation frequently recurs. Lasers can be used in selected patients with resistant melasma after thorough counseling and preferably after conducting test treatments. This article discusses available evidence and brings forward a suggested treatment algorithm by 15 experts from Pigmentary Disorders Society (PDS) in a collaborative discussion called South Asian Pigmentary Forum (SPF).

 

OBJECTIVES:

To evaluate the safety and efficacy of a 1550/1927 Laser System (Fraxel Dual, Solta), using both 1550nm and 1927nm wavelengths in combination for treatment of facial and non-facial photodamage.

METHODS: Prospective, multi-center, post-market study in subjects with clinically identifiable photodamage (N=35) (Fitzpatrick skin types I-IV). Both 1550nm and 1927nm wavelengths were used at each treatment visit. Investigator assessment of the affected area(s) occurred at one week, one month and 3 months after a series of up to four treatments. Severity of adverse events (AEs) were assessed using a 4-point scale (where 0=none and 3=marked). Assessments included erythema, edema, hyperkeratosis, hyper- and hypo-pigmentation, scarring, itchiness, dryness, and flaking. Severity of photoaging, fine and coarse wrinkling, mottled hyperpigmentation, sallowness, and tactile roughness at baseline was assessed using the same scale. Investigators and subjects assessed overall appearance of photodamage and pigmentation based on a 5-point quartile improvement scale at all follow-up visits (where 0=no improvement and 4=very significant improvement [76%-100%]). Prospective multi-center study of subjects with clinically identifiable photopigmentation. The study protocol was approved by BioMed Institutional Review Board (San Diego, CA). Subjects received two treatments with a non-ablative 1927nm fractionated thulium laser(Fraxel Dual 1550/1927 Laser System, Solta, Hayward CA), energy level of 10mJ, coverage of 40% and 4-6 passes. Subject pain, erythema and edema were recorded immediately after treatment. Two dimensional photography was obtained before each treatment and at one and three month follow up visits. Independent blinded physician assessment was performed evaluating overall improvement in appearance as well as pigment specific improvement

RESULTS:

There was a positive treatment effect at all study visits, with moderate improvement (average reduction in severity of 21%-43%) observed 3-months after final treatment. Greatest reduction in severity of other benefit areas was at the 3-month follow-up visit, with a 21% and 30% decrease in severity in fine wrinkling and tactile roughness. No AEs or serious AEs were reported. Pain sensation during treatment was tolerable. Anticipated moderate erythema (mean score 1.6±0.5) and mild edema (mean score 0.8±0.7) were transient and resolved within 7-10 days. Anticipated and transient mild dryness (52% of subjects) and flaking (30%) were reported at the 1-week follow-up. There were no incidences of hyperkeratosis, scarring, or itchiness. Forty men and women, ages 30 to 80 years, Fitzpatrick skin types I-IV, with photo-induced facial pigmentation were enrolled and treated, and 39 completed the three month follow up visit. Mean pain sensation for subjects during laser treatments was reported to be 4.3 on a 10-point scale. Mean scores for erythema, edema, and skin roughness throughout all treatments indicated moderate erythema, mild edema and mild skin roughness. Assessment of overall improvement was graded as moderate to very significant in 82% of subjects at one month and in 69% of subjects at three months after the second treatment. Assessment of lentigines and ephelides demonstrated moderate to very significant improvement in approximately 68% of subjects at the one month and in 51% of subjects at three months after the second treatment. Independent blinded physician assessment of randomized photography also demonstrated a durable response at three month follow up visit. Treatment was well tolerated and no serious adverse events related to treatment were observed or reported. Study limitations included a limited number of male subjects, lack of Fitzpatrick skin types V and VI, and decrease in improvement at 3 months post-treatment.

fraxel treatment

melasma before and after

melasma treatmentsin

CONCLUSION:

Treatments using both wavelengths associated with the combined 1550/1927 Laser System were well tolerated with limited, transient anticipated side effects and no serious AEs. Clinical efficacy in the appearance of photodamage and pigmentation was greatest following a series of up to 3 treatments. Two treatments with a 1927nm non-ablative fractionated thulium laser produced moderate to marked improvement in overall appearance and pigmentation with high patient satisfaction. The response to treatment was maintained at one and three months follow up.

 

 

Keywords

Skin tightening, skin rejuvenation, skin resurfacing, laser, laser treatment, fractional laser, wrinkles, wrinkle removal, surfacing laser, resurfacing laser, radio frequency, fractional radio frequency, microneedling, fraction microneedling, skin care, skincare, skin, beauty, beauty clinic, wrinkle removal, skin tightening, wrinkle, laser clinic, laser therapy, Ulthera, Ultherapy, skin clinic, beauty center, medical spa, scar removal, scar, scar removal, acne treatment, acne scars, acne treatment, scars, plasma injection, vampire facelift, vampire facial, PRP injection, Fraxel, fraxel laser, fraxel treatment, medical laser clinic, stretch marks, laser clinic, laser spa, skin tightening, wrinkle removal, pigmentation, pigmentation removal, pigmentation treatment, skin whitening, melasma treatment, melasma, blemish, blemish removal, blemish laser treatment, blemish treatment, microdermabrasion, silk peel, silkpeel, sun spots, face darkening, face spots, fillers, botox, lip fillers, Skin tightening, skin rejuvenation, skin resurfacing, laser, laser treatment, fractional laser, wrinkles, wrinkle removal, surfacing laser, resurfacing laser, radio frequency, fractional radio frequency, microneedling, fraction microneedling, skin care, skincare, skin, beauty, beauty clinic, wrinkle removal, skin tightening, wrinkle, laser clinic, laser therapy, Ulthera, Ultherapy, skin clinic, beauty center, medical spa, scar removal, scar, scar removal, acne treatment, acne scars, acne treatment, scars, plasma injection, vampire facelift, vampire facial, PRP injection, Fraxel, fraxel laser, fraxel treatment, medical laser clinic, stretch marks, laser clinic, laser spa, skin tightening, wrinkle removal, pigmentation, pigmentation removal, pigmentation treatment, skin whitening, melasma treatment, melasma, blemish, blemish removal, blemish laser treatment, blemish treatment, microdermabrasion, silk peel, silkpeel, sun spots, face darkening, face spots, fillers, botox, lip fillers, Skin tightening, skin rejuvenation, skin resurfacing, laser, laser treatment, fractional laser, wrinkles, wrinkle removal, surfacing laser, resurfacing laser, radio frequency, fractional radio frequency, microneedling, fraction microneedling, skin care, skincare, skin, beauty, beauty clinic, wrinkle removal, skin tightening, wrinkle, laser clinic, laser therapy, Ulthera, Ultherapy, skin clinic, beauty center, medical spa, scar removal, scar, scar removal, acne treatment, acne scars, acne treatment, scars, plasma injection, vampire facelift, vampire facial, PRP injection, Fraxel, fraxel laser, fraxel treatment, medical laser clinic, stretch marks, laser clinic, laser spa, skin tightening, wrinkle removal, pigmentation, pigmentation removal, pigmentation treatment, skin whitening, melasma treatment, melasma, blemish, blemish removal, blemish laser treatment, blemish treatment, microdermabrasion, silk peel, silkpeel, sun spots, face darkening, face spots, fillers, botox, lip fillers, Skin tightening, skin rejuvenation, skin resurfacing, laser, laser treatment, fractional laser, wrinkles, wrinkle removal, surfacing laser, resurfacing laser, radio frequency, fractional radio frequency, microneedling, fraction microneedling, skin care, skincare, skin, beauty, beauty clinic, wrinkle removal, skin tightening, wrinkle, laser clinic, laser therapy, Ulthera, Ultherapy, skin clinic, beauty center, medical spa, scar removal, scar, scar removal, acne treatment, acne scars, acne treatment, scars, plasma injection, vampire facelift, vampire facial, PRP injection, Fraxel, fraxel laser, fraxel treatment, medical laser clinic, stretch marks, laser clinic, laser spa, skin tightening, wrinkle removal, pigmentation, pigmentation removal, pigmentation treatment, skin whitening, melasma treatment, melasma, blemish, blemish removal, blemish laser treatment, blemish treatment, microdermabrasion, silk peel, silkpeel, sun spots, face darkening, face spots, fillers, botox, lip fillers, Skin tightening, skin rejuvenation, skin resurfacing, laser, laser treatment, fractional laser, wrinkles, wrinkle removal, surfacing laser, resurfacing laser, radio frequency, fractional radio frequency, microneedling, fraction microneedling, skin care, skincare, skin, beauty, beauty clinic, wrinkle removal, skin tightening, wrinkle, laser clinic, laser therapy, Ulthera, Ultherapy, skin clinic, beauty center, medical spa, scar removal, scar, scar removal, acne treatment, acne scars, acne treatment, scars, plasma injection, vampire facelift, vampire facial, PRP injection, Fraxel, fraxel laser, fraxel treatment, medical laser clinic, stretch marks, laser clinic, laser spa, skin tightening, wrinkle removal, pigmentation, pigmentation removal, pigmentation treatment, skin whitening, melasma treatment, melasma, blemish, blemish removal, blemish laser treatment, blemish treatment, microdermabrasion, silk peel, silkpeel, sun spots, face darkening, face spots, fillers, botox, lip fillers, Skin tightening, skin rejuvenation, skin resurfacing, laser, laser treatment, fractional laser, wrinkles, wrinkle removal, surfacing laser, resurfacing laser, radio frequency, fractional radio frequency, microneedling, fraction microneedling, skin care, skincare, skin, beauty, beauty clinic, wrinkle removal, skin tightening, wrinkle, laser clinic, laser therapy, Ulthera, Ultherapy, skin clinic, beauty center, medical spa, scar removal, scar, scar removal, acne treatment, acne scars, acne treatment, scars, plasma injection, vampire facelift, vampire facial, PRP injection, Fraxel, fraxel laser, fraxel treatment, medical laser clinic, stretch marks, laser clinic, laser spa, skin tightening, wrinkle removal, pigmentation, pigmentation removal, pigmentation treatment, skin whitening, melasma treatment, melasma, blemish, blemish removal, blemish laser treatment, blemish treatment, microdermabrasion, silk peel, silkpeel, sun spots, face darkening, face spots, fillers, botox, lip fillers, Skin tightening, skin rejuvenation, skin resurfacing, laser, laser treatment, fractional laser, wrinkles, wrinkle removal, surfacing laser, resurfacing laser, radio frequency, fractional radio frequency, microneedling, fraction microneedling, skin care, skincare, skin, beauty, beauty clinic, wrinkle removal, skin tightening, wrinkle, laser clinic, laser therapy, Ulthera, Ultherapy, skin clinic, beauty center, medical spa, scar removal, scar, scar removal, acne treatment, acne scars, acne treatment, scars, plasma injection, vampire facelift, vampire facial, PRP injection, Fraxel, fraxel laser, fraxel treatment, medical laser clinic, stretch marks, laser clinic, laser spa, skin tightening, wrinkle removal, pigmentation, pigmentation removal, pigmentation treatment, skin whitening, melasma treatment, melasma, blemish, blemish removal, blemish laser treatment, blemish treatment, microdermabrasion, silk peel, silkpeel, sun spots, face darkening, face spots, fillers, botox, lip fillers, Skin tightening, skin rejuvenation, skin resurfacing, laser, laser treatment, fractional laser, wrinkles, wrinkle removal, surfacing laser, resurfacing laser, radio frequency, fractional radio frequency, microneedling, fraction microneedling, skin care, skincare, skin, beauty, beauty clinic, wrinkle removal, skin tightening, wrinkle, laser clinic, laser therapy, Ulthera, Ultherapy, skin clinic, beauty center, medical spa, scar removal, scar, scar removal, acne treatment, acne scars, acne treatment, scars, plasma injection, vampire facelift, vampire facial, PRP injection, Fraxel, fraxel laser, fraxel treatment, medical laser clinic, stretch marks, laser clinic, laser spa, skin tightening, wrinkle removal, pigmentation, pigmentation removal, pigmentation treatment, skin whitening, melasma treatment, melasma, blemish, blemish removal, blemish laser treatment, blemish treatment, microdermabrasion, silk peel, silkpeel, sun spots, face darkening, face spots, fillers, botox, lip fillers, Skin tightening, skin rejuvenation, skin resurfacing, laser, laser treatment, fractional laser, wrinkles, wrinkle removal, surfacing laser, resurfacing laser, radio frequency, fractional radio frequency, microneedling, fraction microneedling, skin care, skincare, skin, beauty, beauty clinic, wrinkle removal, skin tightening, wrinkle, laser clinic, laser therapy, Ulthera, Ultherapy, skin clinic, beauty center, medical spa, scar removal, scar, scar removal, acne treatment, acne scars, acne treatment, scars, plasma injection, vampire facelift, vampire facial, PRP injection, Fraxel, fraxel laser, fraxel treatment, medical laser clinic, stretch marks, laser clinic, laser spa, skin tightening, wrinkle removal, pigmentation, pigmentation removal, pigmentation treatment, skin whitening, melasma treatment, melasma, blemish, blemish removal, blemish laser treatment, blemish treatment, microdermabrasion, silk peel, silkpeel, sun spots, face darkening, face spots, fillers, botox, lip fillers, Skin tightening, skin rejuvenation, skin resurfacing, laser, laser treatment, fractional laser, wrinkles, wrinkle removal, surfacing laser, resurfacing laser, radio frequency, fractional radio frequency, microneedling, fraction microneedling, skin care, skincare, skin, beauty, beauty clinic, wrinkle removal, skin tightening, wrinkle, laser clinic, laser therapy, Ulthera, Ultherapy, skin clinic, beauty center, medical spa, scar removal, scar, scar removal, acne treatment, acne scars, acne treatment, scars, plasma injection, vampire facelift, vampire facial, PRP injection, Fraxel, fraxel laser, fraxel treatment, medical laser clinic, stretch marks, laser clinic, laser spa, skin tightening, wrinkle removal, pigmentation, pigmentation removal, pigmentation treatment, skin whitening, melasma treatment, melasma, blemish, blemish removal, blemish laser treatment, blemish treatment, microdermabrasion, silk peel, silkpeel, sun spots, face darkening, face spots, fillers, botox, lip fillers, Skin tightening, skin rejuvenation, skin resurfacing, laser, laser treatment, fractional laser, wrinkles, wrinkle removal, surfacing laser, resurfacing laser, radio frequency, fractional radio frequency, microneedling, fraction microneedling, skin care, skincare, skin, beauty, beauty clinic, wrinkle removal, skin tightening, wrinkle, laser clinic, laser therapy, Ulthera, Ultherapy, skin clinic, beauty center, medical spa, scar removal, scar, scar removal, acne treatment, acne scars, acne treatment, scars, plasma injection, vampire facelift, vampire facial, PRP injection, Fraxel, fraxel laser, fraxel treatment, medical laser clinic, stretch marks, laser clinic, laser spa, skin tightening, wrinkle removal, pigmentation, pigmentation removal, pigmentation treatment, skin whitening, melasma treatment, melasma, blemish, blemish removal, blemish laser treatment, blemish treatment, microdermabrasion, silk peel, silkpeel, sun spots, face darkening, face spots, fillers, botox, lip fillers, Skin tightening, skin rejuvenation, skin resurfacing, laser, laser treatment, fractional laser, wrinkles, wrinkle removal, surfacing laser, resurfacing laser, radio frequency, fractional radio frequency, microneedling, fraction microneedling, skin care, skincare, skin, beauty, beauty clinic, wrinkle removal, skin tightening, wrinkle, laser clinic, laser therapy, Ulthera, Ultherapy, skin clinic, beauty center, medical spa, scar removal, scar, scar removal, acne treatment, acne scars, acne treatment, scars, plasma injection, vampire facelift, vampire facial, PRP injection, Fraxel, fraxel laser, fraxel treatment, medical laser clinic, stretch marks, laser clinic, laser spa, skin tightening, wrinkle removal, pigmentation, pigmentation removal, pigmentation treatment, skin whitening, melasma treatment, melasma, blemish, blemish removal, blemish laser treatment, blemish treatment, microdermabrasion, silk peel, silkpeel, sun spots, face darkening, face spots, fillers, botox, lip fillers, Skin tightening, skin rejuvenation, skin resurfacing, laser, laser treatment, fractional laser, wrinkles, wrinkle removal, surfacing laser, resurfacing laser, radio frequency, fractional radio frequency, microneedling, fraction microneedling, skin care, skincare, skin, beauty, beauty clinic, wrinkle removal, skin tightening, wrinkle, laser clinic, laser therapy, Ulthera, Ultherapy, skin clinic, beauty center, medical spa, scar removal, scar, scar removal, acne treatment, acne scars, acne treatment, scars, plasma injection, vampire facelift, vampire facial, PRP injection, Fraxel, fraxel laser, fraxel treatment, medical laser clinic, stretch marks, laser clinic, laser spa, skin tightening, wrinkle removal, pigmentation, pigmentation removal, pigmentation treatment, skin whitening, melasma treatment, melasma, blemish, blemish removal, blemish laser treatment, blemish treatment, microdermabrasion, silk peel, silkpeel, sun spots, face darkening, face spots, fillers, botox, lip fillers, Skin tightening, skin rejuvenation, skin resurfacing, laser, laser treatment, fractional laser, wrinkles, wrinkle removal, surfacing laser, resurfacing laser, radio frequency, fractional radio frequency, microneedling, fraction microneedling, skin care, skincare, skin, beauty, beauty clinic, wrinkle removal, skin tightening, wrinkle, laser clinic, laser therapy, Ulthera, Ultherapy, skin clinic, beauty center, medical spa, scar removal, scar, scar removal, acne treatment, acne scars, acne treatment, scars, plasma injection, vampire facelift, vampire facial, PRP injection, Fraxel, fraxel laser, fraxel treatment, medical laser clinic, stretch marks, laser clinic, laser spa, skin tightening, wrinkle removal, pigmentation, pigmentation removal, pigmentation treatment, skin whitening, melasma treatment, melasma, blemish, blemish removal, blemish laser treatment, blemish treatment, microdermabrasion, silk peel, silkpeel, sun spots, face darkening, face spots, fillers, botox, lip fillers, Skin tightening, skin rejuvenation, skin resurfacing, laser, laser treatment, fractional laser, wrinkles, wrinkle removal, surfacing laser, resurfacing laser, radio frequency, fractional radio frequency, microneedling, fraction microneedling, skin care, skincare, skin, beauty, beauty clinic, wrinkle removal, skin tightening, wrinkle, laser clinic, laser therapy, Ulthera, Ultherapy, skin clinic, beauty center, medical spa, scar removal, scar, scar removal, acne treatment, acne scars, acne treatment, scars, plasma injection, vampire facelift, vampire facial, PRP injection, Fraxel, fraxel laser, fraxel treatment, medical laser clinic, stretch marks, laser clinic, laser spa, skin tightening, wrinkle removal, pigmentation, pigmentation removal, pigmentation treatment, skin whitening, melasma treatment, melasma, blemish, blemish removal, blemish laser treatment, blemish treatment, microdermabrasion, silk peel, silkpeel, sun spots, face darkening, face spots, fillers, botox, lip fillers.

2018-01-18T04:09:26+00:00

About the Author:

Ph.D., MSc, CDE, CRE, APA, MBA candidate, Director of Albany Cosmetic and Laser Centre INC

5 Comments

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