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

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


table 1

Case 4

A 35-year-old Hispanic woman presented with a 2-year history of facial melasma. She elected to first start with the Obagi Nu-Derm topical lightening system. After 8 months of use, she underwent 1 IPL treatment using a double-pulse technique with 3-ms pulse duration for both pulses, with a 560-nm filter, 30-ms delay, and a fluence of 18 J/cm2. Cold-air cooling was used intraoperatively. She was then instructed to continue using the Obagi Nu-Derm system. At the 1-month follow-up visit following the IPL treatment, clinical improvement of her melasma was demonstrated.

Case 5

A 33-year-old Hispanic woman presented with a several-year history of facial melasma. At the time of presentation, she was on the Obagi Nu-Derm system. She underwent 3 IPL treatments spaced 3 and 4 months apart. A double-pulse technique with 3-ms pulse duration was used, with a 560-nm filter, 20-ms delay, and a fluence of 17 J/cm2 for all 3 treatments. Cold-air cooling was used intraoperatively. She was instructed to continue on the Obagi Nu-Derm system. At the 6-month follow-up visit following the last IPL treatment, clinical improvement of her melasma was demonstrated.
table 2

DISCUSSION

Melasma is an acquired disorder of hyperpigmented macules or patches on sun-exposed areas of the body. Risk factors include a genetic predisposition, sun exposure, stress, medications, and pregnancy. Three types of melasma exist, with increased amounts of melanin, melanocytes, and melanosomes within the epidermis, dermis, or a mix of the two.3 A bimodal age response has been reported, with improved treatment response in patients younger than 35 years and older than 45 years. This is thought to be due to hormonal effects and increased dermal melasma in patients aged 35 to 45 years.4 Traditional therapies are more effective for epidermal melasma and include sunscreens, depigmenting agents, mild topical corticosteroids, tretinoin, and chemical peels.3 Intense pulsed light and various lasers have also been used, including the quality (Q)-switched ruby (694 nm), Q-switched neodymium- doped yttrium aluminum garnet (Nd:YAG; 1,064 nm), diode (840 nm), pulsed dye laser (595 nm), nonablative fractionated 1,550-nm erbium (Er)-doped laser, 2,940-nm Er:YAG with dermabrasion, and combined ultrapulsed CO2 laser with Q-switched alexandrite (755 nm).4-7