PHOENIX – Treating moderate to severe melasma with a 50-ns, 1,064-nm Q-switched neodynium:YAG laser produced equivalent temporary results with less pain than did a 5-ns, 1,064-nm Q-switched Nd:YAG laser in a split-face study of 10 women.
In the 6-month study, scores on a melasma area and severity index decreased by 16% using the 50-ns pulse width, and by 27% using the 5-ns pulse width at month 4, which was 1 month after the last of three monthly treatments that combined microdermabrasion, laser therapy, and a topical therapy regimen. Changes from both lasers were statistically significant compared with baseline, but not significantly different between laser groups, Dr. Vineet Mishra reported at the annual meeting of the American Society for Laser Medicine and Surgery.
Courtesy Dr. Vineet Mishra
Melasma before treatment.
The investigators sought to optimize laser settings for treating melasma to see whether lasers could be used in combination with other melasma therapies, Dr. Mishra said in an interview.
"During the study, everybody improved," Dr. Mishra said.
Melanin (as measured by a reflectance spectrophotometer at each visit) decreased by 20% with the 50-ns pulse width and by 17% with the 5-ns pulse width during the study.
However, pigment relapsed in both treatment areas after the study, to a level not significantly different from that at baseline. This was not unexpected when treating melasma, and was "likely due to sun exposure in sunny San Diego," said Dr. Mishra, director of Mohs surgery and procedural dermatology at the University of Texas Health Science Center, San Antonio.
Courtesy Dr. Vineet Mishra
The same face after two monthly treatments with the 5-ns laser.
Patients who completed the study rated pain from the procedure as a mean of 1.2 on the side of the face treated with the 50-ns laser and 2.9 with the 5-ns laser, using a 10-point scale with 0 representing no pain and 10 the worst pain, Dr. Mishra said.
Each treatment session consisted of microdermabrasion of the entire face followed by treatment with the 50-ns laser on one side and treatment with the 5-ns laser on the other side. Two laser passes were applied using a fluence of 1.6 J/cm2 and a 5-mm spot size. For 2 weeks prior to each treatment session and starting 2 days after each laser treatment, patients were asked to follow a daily skin care regimen that consisted of topical 4% hydroquinone, 0.05% tretinoin cream, and sunscreen with a sun protection factor of 50.
"Lasers have exploded on the market" but can be tricky to use against melasma, Dr. Mishra said. Too-high levels of laser energy can cause postinflammatory hyperpigmentation, which can worsen melasma, he noted.
Courtesy Dr. Vineet Mishra
Three months after the third 5-ns laser treatment, the melasma is back.
Melasma is a difficult condition to treat, but "combination therapy is optimal," Dr. Mishra added in an interview. Next steps for research should include longer-term studies to determine how patients would fare if they continued with the combination treatment regimen. In addition, using a picosecond laser for melasma "would be a new frontier" to explore in long-term studies, he said.
The study won an award at the meeting.
The study received funding from Syneron and Candela, which market the 50-ns laser, and one of Dr. Mishra’s coinvestigators reported financial associations with Syneron and Candela and with Cynosure, which markets the 5-ns laser.
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