Melasma lasers

Despite the fact that several lasers have been used to try to depigment patients with melasma, none of them has been proven to be useful. 

Topical treatments for melasma usually include tyrosinase inhibitors, with or without tretinoin or one of its precursors. Azelaic acid is also a viable treatment option. A corticosteroid can be combined with it to counter any potential active inflammation. Lasers, intense pulsed light (IPL), dermabrasion and microdermabrasion have also been suggested, but often cause post-inflammatory hyperpigmentation. TCA can be an excellent treatment for melasma it eliminates the melanin stored in the papillary dermis and epidermis (Figure 13.8). Mesotherapy has been recently reputed as an effective treatment of melasma. ... 

PIH, whether caused by trauma (e.g. a mosquito bite, scratch or wound), by laser or intense pulsed light (IPL) treatment, or by another peel, usually responds to four sessions of ETCA following the same guidelines as for melasma treatment. 

Melasma can either be treated with superficial or medium-depth peels. Though medium-depth peels can yield good results if done with utmost care, superficial peels are currently the preferred and most frequently performed peels. It is effective and safer to use for all skin phototypes (Fitzpatrick 1-6) but with precautionary measures and care for daiker skin [30, 125]. Intense pulsed light, laser resurfacing, and dermabrasion have essentially supplanted medium-depth and deep peels [9]. 

Comparing the QS laser with the long-pulsed 532-nm Nd YAG laser in the treatment of melasma, the latter produced less PIH because it lacks the photomechanical effects of the QS laser [126]. QS alexandrite laser or PLDL combined with 15-25% TCA peel and/or Jessner s solution was shown to be effective, safe, and relatively inexpensive treatment modalities in the recalcitrant pigmentary disorders [92]. Combination of QS alexandrite and ultrapulse CO lasers yielded statistically significant result in improving refractory melasma compared to QS alexandrite laser alone [5]. Erbium YAG used on patients with skin phototypes II-V may have demonstrated improvement but transient PIH developed 3-6 weeks after laser treatment [100]. 

Using a mid-infrared 1,550 nm laser produced a low incidence of pigmentary changes associated with traditional resurfacing techniques. There was minimal downtime and erythema. For daiker skin patients with epidermal melasma, long-pulsed 532 nm QS laser and the nonablative 1,540 nm CO laser may prove safer and efficacious, with care in the choice of fluence and spot size [126]. 

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Taylor CR, Anderson RR (1994) Ineffective treatment of refractory melasma and post-infleunmatory hyperpigmentation by Q-switched ruby laser. J Dermatol Suig Oncol 20 592-597... 

Wolkerstorfer A. Non-ablative 1,550 nm fractional laser therapy versus triple topical therapy for the treatment of melasma a randomized controlled spht-face study. Lasers Surg Med 2010 42(7) 607-12. 

Rivas S, Pandya AG. Treatment of melasma with topical agents, peels, and lasers an evidence-based review. Am J Clin Derm 2013 14(5) 359-76. Le Q, Wang X, Lv L, Sun X, Xu J. In vivo laser scanning confocal microscopy of the cornea in patients with silicone oil tamponade after vitreoretinal surgery. Cornea 2012 31(8) 876-82. 

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