Menegament of Melasma with Ablative Laser Treatment ŞERAFETTİN SARAÇOĞLU, MD DERMATOLOGIST

Size: px

Start display at page:

Download "Menegament of Melasma with Ablative Laser Treatment ŞERAFETTİN SARAÇOĞLU, MD DERMATOLOGIST"

Winfred Harrison
5 years ago
Views:

1 Menegament of Melasma with Ablative Laser Treatment ŞERAFETTİN SARAÇOĞLU, MD DERMATOLOGIST

2 MELASMA Acquired Symetric Hypermelanosis Age years / : 90/10 Epidermal Dermal Mixt

3 Mechanism of action of main bleaching agents used to treat melasma (adapted Gupta et al., 2006) Mecanism of action Tyrosinase inhibition Non-selective suppretion of Melanogenesis İnhibition of ROS Melanin removal Thermal damage Substance Hydroquinone Tretinoine Azelaic acid Kojic Acid CS Azelaic acid Chemical peeling Lasers

4 Melasma Laser Treatment Non ablative Q-SW Ruby Q-SW Alexandrite Q-SW Nd-YAG Cu-Bromide FLPDL IPL Ablative CO2 Er-YAG Thulliım

5 Ablative Laser Treatment of Melasma Laser resurfacing Fractional resurfacing

6 Laser resurfacing; Er-YAG Rhesa May at al., Postpeel results Imidiate results excellent 3rd-6th week PIH (universal, all patients) GA peeling beweekly Bleaching regimen 6th month MASI score significantly decreased Conclusion: Perform just for refractory melasma patients Rhesa May, P. Manaloto and Tina Alster. Erbium:YAG Laser Resurfacing for Refractory Melasma. Dermatologic Surgery 1999 : 121

7 Melasma; Ablative Laser Treatment with Er-YAG Manaloto et al., 1999 CS, N=10 ER-YAG ( Continuum Biomedical, Dublin, CA) J ( J/cm2), 5 mm spot, 8 Hz PIH 3-6 weeks after procedure Azelaic acid 20% cream, GA peeling beweekly Manaloto RMP, Alster TS. Erbium:YAG laser resurfacing for refractory melasma. Dermatol Surg.1999;25:121 3

8 Fractional laser (nonablative) RokhsarCK, Fitzpatrick RE. The treatment of melasma with fractional photothermolisis: A Pilot study. Dermatologic Surgery. 2005;31: Geronemus, R. G. (2006), Fractional photothermolysis: Current and future applications. Lasers Surg. Med., 38: doi: /lsm Goldberg DJ, Berlin AL, Phelps R. Histologic and ultrastructural analysis of melasma after fractional resurfacing. Lasers Surg Med. 2008;40:134 8 Non-abalative Fractional treatment has signficant improvement effect on the melasma pecthes Melanocyte count is decresed But at 6th month follow-up, recurrence was noted in 50% patients

9 Melasma; Fractional Ablative Laser Treatment with Er-YAG Wanitphakdeedecha et al, 2009 CS, N=20, Epidermal Melasma, 2 treatments 1 month apart VSP Er-YAG ( FidelisM320A, Fotona, Ljubliana, Slovenia) 160 mj(0.4 J/cm2), 300 µs PW, 7 mm spot, 10 Hz PIH (n=3)cleared spontaneously within 2 weeks Acneiform eruption (n=2) treated with clindamycin and adapalene 15% of patient had 50 % improvement

10 Melasma; Fractional Ablative Laser Treatment with CO2 Trelles et al., 2010 RCCT 30 woman FSP II-V GroupA. Kligman s formula + TT2 cream (n=10) GroupB. CO2 laser ( n=10) GroupC. CO2 laser + TT2 cream ( n=10) Laser: Ultrapulse Active FX Lumenis, Yorknaem, Israel) 7.5 W, 150 mj( (11.3 J/cm2), 350 ms PW, 50 Hz 1st mounth A,B,C groups absence of complications QoL index 100% all groups MASI score decreased A,B group 12 mounth of follow-up, stabil at C group TrellesMA, Velez M, Gold MH. The treatment of melasma with topical creams alone, CO2 fractional ablative resurfaceing, or a combination of the two: a comperative study. J. Drugs Dermatol. 2010; 9: TT2: Hydroquinon2%,Kojic acid 2%, GA

11 Melasma; Fractional Ablative Laser Treatment with Thullium Laser Polder et al. CS, N=14 Thullium Fiber Laser ( Fraxel Dual, Solta Medical, USA)10-20 mj, MTZ/cm2, 3-4 treatment, 4 week intervals 51% improvement, PIH (-) 34% MASI score at 3rd-6th month post treatment follow-up Polder KD, Bruce S. Treatment of melasma using a novel 1,927 nm fractional thulium fiber laser: A pilot study. Dermatol Surg. 2012;38:

12 Melasma; Combined Ablative + Non-ablativeLaser Treatment Idea; Ablative: Remove epidermal melanin & melanocyt Non-Ablative: Remove melanin in dermal melanophages Angsuwarangsee et al. N=6, Right: QSAL Left: Ultrapulse CO2 + QSAL Significant response combination treatment site Contact dermatitis & PIH Hence: Just for refractory melasma Angsuwarangsee S, Polnikorn N. Combined ultrapulse CO2 laser and Q-switched alexandrite laser compared with Q-switched alexandrite laser alone for refractory melasma: Split face design. Dermatol Surg.2003;29:59 64

13 Coclusion In the management of melasma with ablative lasers is controversial Thullium laser seems to promissing laser type for epidermal melasma Needs further investigation Topical bleaching agents remain the gold standart treatment Combining pre&post laser and topical treatment greater efficacy compared to treatments alone

14 Melasma; My Treatment Approach Topical Treatment Kligman formulation or TTT Dermamelan peeling system Sunscreen SPF 30+ or opaque Oral Medication Tranexamic acid 1500 mg/day PO NAC 400 mg/day PO Mesotherapy Laser Tranexamic acid + NAC +Vit-C equal, 0.01 ml/ cm2 weekly intervals FPDL 585 nm, 7 mm spot, J/cm2 Q-SW Nd-YAG 1064 nm, 6 mm spot, J/cm2

15 Dermamelan Peeling Before 3 Month after

16 Melasma + PIH Before 8 Month After

18 Melasma + PIH Before 5 Month after

19 Melasma PIH Before 5 Month after

20 Thank you Serafettin Saracoglu, MD

Low-fluence Q-switched neodymium-doped yttrium aluminum garnet (1064nm) laser for the treatment of facial melasma in local population

Original Article Low-fluence Q-switched neodymium-doped yttrium aluminum garnet (1064nm) laser for the treatment of facial melasma in local population Tahir Kamal, Usma Iftikhar* Department of Dermatology,