Treatment of Melasma and the Use of Intense Pulsed Light: A Review

November 2012 | Volume 11 | Issue 11 | Original Article | 1316 | Copyright © 2012

Abstract

Melasma is a complex multifactorial disorder whose pathogenesis is not well understood. In addition to increased pigmentation, increased vascularity associated with pigmentation is present. A variety of topical treatments targeting pigmentation are available with temporary improvement of mainly the epidermal components of melasma. Intense pulsed light (IPL) is a broadband light source that can target a wide range of cutaneous structures, including deeper pigmentation and vasculature. We describe 5 cases of persistent facial melasma treated with the IPL and a hydroquinone-based skin care system (Obagi Nu-Derm; Obagi Medical Products, Long Beach, CA), showing improvement of facial melasma pigmentation and vascularity.

J Drugs Dermatol. 2012;11(11):1316-1230.

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INTRODUCTION

Melasma is a complex multifactorial disorder whose pathogenesis is not well understood. In addition to increased superficial and/or deep pigmentation, increased vascularity is often present. Vascular endothelial growth factor (VEGF) is an angiogenic factor demonstrated within melasma patches that is a likely cause of the increased vasculature. Interactions between melanocytes and the cutaneous vasculature may influence the development of pigmentation. Topical treatments targeting pigmentation are available with temporary improvement of mainly the epidermal component of melasma.1 Intense pulsed light (IPL) is a broadband light source that can target a wide range of cutaneous structures, including deeper pigmentation and the increased vasculature. With a lower side effect profile compared with other devices used to treat melasma, IPL is a good potential treatment option for dermal and mixed forms of melasma. 2 We describe 5 cases of persistent facial melasma treated with IPL and a hydroquinone (HQ)-based skin care system (Obagi Nu-Derm; Obagi Medical Products, Long Beach, CA), showing improvement of facial melasma pigmentation and vascularity.

CASE REPORTS

Case 1

A 45-year-old Hispanic female presented with facial melasma and was started on the Obagi Nu-Derm System, which includes HQ, α-hydroxy and β-hydroxy acids, cleanser, and toner used twice daily, a sunscreen with a sun protection factor of 30+ in the daytime, and tretinoin cream 0.025% nightly (Figure 1a-c). One month later, she was treated with IPL using a 590-nm filter amd a double-pulse technique with 3-ms pulse duration, 40-ms delay, and a fluence of 14 J/cm2. Cold-air cooling was used intraoperatively. The Obagi Nu-Derm system was restarted and continued for 5 months until the patient's follow-up visit, which demonstrated clinical improvement of her melasma (Figure 1d-f).

Case 2

A 42-year-old Asian woman presented with a several-year history of facial melasma (Figure 2a-c). Intense pulsed light was used with a 590-nm filter and a double-pulse technique with 3-ms pulse duration, 40-ms delay, and a fluence of 17 J/cm2. Cold-air cooling was used intraoperatively. She was instructed to immediately start the Obagi Nu-Derm System. She developed mild erythema on postoperative day 6 that resolved with fluocinolone acetonide cream 0.025% twice daily for a week and a light-emitting diode (LED) photomodulation treatment (Gentle Waves; Light BioScience, LLC, Virginia Beach, VA). At the 1-month follow-up visit, clinical improvement of her melasma was demonstrated (Figure 2d-f).

Case 3

A 35-year-old Hispanic woman presented with a several-year history of facial melasma (Figure 3a-c). She underwent 2 IPL treatments spaced 6 weeks apart. A double-pulse technique with 3-ms pulse duration for both pulses was used, with a 560-nm filter, 30-ms delay, and a fluence of 17 J/cm2 for the first treatment and 18 J/cm2 for the second treatment. Cold-air cooling was used intraoperatively. She was then instructed to start the Obagi Nu-Derm System after her second IPL treatment. At the 6-month follow-up visit following the last IPL treatment, clinical improvement of her melasma was demonstrated (Figure 3d-f).

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