Efficacy of Low-Fluence Nd:YAG 1064 nm Laser for the Treatment of Post-Inflammatory Hyperpigmentation in the Axillary Area

November 2017 | Volume 16 | Issue 11 | Original Article | 1118 | Copyright © November 2017

Sahar Ghannam MD PhD,a,b Fatemah K. Al Otabi,c Konstantin Frank,d and Sebastian Cotofana MD PhDe

aDirector Sahar Polyclinic, Kuwait bDepartment of Dermatology, Venereology and Andrology, University of Alexandria, Egypt cDepartment of Surgery, Faculty of Medicine, Kuwait University, Kuwait dDepartment for Hand, Plastic and Aesthetic Surgery, Ludwig – Maximilian University Munich, Germany eDepartment of Medical Education, Albany Medical College, Albany, NY


OBJECTIVE: Post-inflammatory hyperpigmentation results in aesthetically unpleasant discoloration of the skin in the affected area. The efficacy of low-fluence Q-switched 1064-nm Nd:YAG laser has so far not been evaluated for the treatment of the axilla. This observational study was designed to evaluate whether the application of the laser treatment can satisfactorily reduce axillary hyperpigmentation. MATERIAL AND METHODS: 17 females (mean age, 34.27 ± 9.24; range, 19–48) were treated in a single center between 2014 and 2016 for post-inflammatory hyperpigmentation of the axillary area. One treatment session was done every 2 weeks. Pairwise pre- / post-treatment assessment was graded by the practitioner, the patient, and an independent non-medical observer for consistency using a standardized grading scale. RESULTS: Post-treatment evaluation revealed an improvement score of 4 ± 0.44; range, 4–5 (good improvement) with a variance of 0.19 after the treatment. The scoring of the practitioner rs= 0.31 correlated higher with the patient-related outcome than with the scoring of the independent non-medical observer rs= 0.17. The minimum number of sessions needed for an excellent patient-evaluated improvement was 3, but an increased number of sessions was not significantly correlated with the outcome. The results of the treatment lasted for at least 6 months after the last session. CONCLUSION: A low-fluence Q-switched 1064-nm Nd:YAG laser provided safe and effective treatment for post-inflammatory hyperpigmentation in the axillary area, with good-to-excellent improvement after a minimum of 3 sessions.

J Drugs Dermatol. 2017;16(11):1118-1123.


Post-inflammatory hyperpigmentation (PIH) is a common inflammatory disorder of the skin that occurs as a result of dermal and epidermal lesions leading to a change in color of the affected area.1,2 The etiology of PIH can be exogenous (allergic or irritant contact dermatitis, dermabrasion, laser therapy, and burns), endogenous (primary inflammatory or bullous dermatosis), or induced by infectious diseases (herpes zoster).3 The resulting acute inflammatory process can be understood as a healing response, during which a number of mediators (prostanoids, cytokines, chemokines, and reactive oxygen species) are released, triggering a plethora of different cell types. In the epidermis, melanocytes can be activated to release melanin, which ultimately results in a tan or brown pigmentation at the site of injury.4,5 In the dermis, PIH can activate basal keratinocytes, which can also release melanin, causing a blue-grayish appearance at the site of injury. A clear differentiation between these 2 activation pathways is not possible, which could thus lead to the assumption that PIH is a combination of both epidermal and dermal lesions.1 However, since melanocytes are hyperactive and release more melanin in darker skin types than in lighter skin types, PIH is frequently observed among populations with Fitzpatrick skin types IV to VI.2,6,7 Today, practitioners must face an increasing number of international patients with different ethnic and cultural backgrounds. To best understand their needs to treat them equally and aim for the best and safest outcome, one must account for these differences. Darkening of the skin of the knee, for instance, can result from kneeling and/or rubbing the knee during religious practice. A blue-greyish appearance of certain parts of the body could also result from procedures related to the “Moroccan bath,” which include the intense rubbing of the skin and can be related to frictional dermatitis and ultimately to PIH.