Successful treatment of melasma using a combination of microdermabrasion and Q-switched Nd:YAG lasers

Background and Objective A common, disfiguring problem in women, melasma is often refractory to treatment, and long-term remissions are difficult to achieve. This study assessed the safety and effectiveness of a procedure combining microdermabrasion, a topical regimen, and low fluence Q-switched Nd:YAG laser treatment. Materials and Methods: In this observational study of 27 female subjects, phototypes II-V, referred for treatment of mixed-type melasma refractory to previous therapies, low-fluence QS Nd: YAG laser treatment of 1.6-2 J/ cm 2 with 5 or 6 mm spot was administered immediately following microdermabrasion. Daily application of a broad-spectrum sunscreen began immediately; subjects used a topical skin care regimen of hydroquinone with tretinoin or vitamin C. Treatments were repeated at 4-week intervals. Follow-up assessment was done 3-12 months after the last treatment. Adverse effects were recorded at each visit. Standardized digital photographs obtained before each treatment session and at follow-up visits were objectively assessed by blinded comparison using a quartile grading system. Results: Treatment was successful in all skin types, deemed painless by all subjects, and required no anesthesia. Average number of treatments was 2.6. Twenty-two subjects (81%) had > 75% clearance of melasma; 11 subjects (40%) achieved > 95% clearance. Most subjects showed > 50% clearance of their melasma 1 month after the first treatment. Side effects were limited to mild posttreatment erythema, which developed after the microdermabrasion and lasted approximately 30-60 minutes. Four subjects noted temporary exacerbation of melasma after inadvertent sun exposure, but this resolved within several weeks of resuming the topical skin care regime. Remission lasted at least 6 months. Conclusion: Microdermabrasion plus low-fluence QS Nd: YAG laser treatment is a simple, non-invasive procedure with minimal risk, no recovery time, and long-lasting remission. Treatment works on all skin phototypes in just two to three treatment sessions. Subject compliance with skin care was excellent, probably due to the dramatic improvement observed within 4 weeks. Lasers Surg. Med. 44: 117-124, 2012. (C) 2011 Wiley Periodicals, Inc.