User

Mixed-Type Melasma Treated with Low Fluence Q-Switched Nd-YAG 1064 nm Laser: A Case Report

Aninda Fitri Nugrahani, Sinta Murlistyarini

Abstract

Background: Melasma is an acquired, chro­nic hypermelanosis condition. Melasma is more common in women of all races and occur espe­cially on the face. The pathogenesis of melasma is very complex and the treatment is still a challenge. The purpose of this study was to report mixed-type melasma treated with low fluence Q-switched Nd-YAG 1064 nm laser.

Case Presentation: A case of melasma in 54 year old woman was reported. Dermatological examination showed presence of brownish macules and patches in the centro facial area with symmetrical distribution. Examination with wood lamp showed mixed type. Patients have received topical therapy but there were no improvement.

Results: The patient was then treated with low fluence Q-switched Nd-YAG 1064 nm laser for three sessions with an interval of 2 weeks. At 6 weeks of treatment the modified MASI (mMASI) value was reduced from 8.4 to 4.6 and the VAS value was increased from 2 to 8.

Conclusion: The depth of the pigment deter­mined the response to therapy. In the mixed type melasma the response for therapy is only partial. The low-fluence Q-switched Nd-YAG 1064 nm laser can penetrate deeper into the dermis and damage melanin in a short time.

Keywords: mixed typed melasma, low fluence, Q-switched Nd-YAG laser

Correspondence: Aninda Fitri Nugrahani. Department of Derma­tology and Venereology, DR. Saiful Anwar Hospital, Malang, East Java/ Faculty of Medi­cine, Universitas Brawijaya, Malang, East Java. Email: aninda16fitri@gmail.com

Indonesian Journal of Medicine (2020), 05(02): 95-101
https://doi.org/10.26911/theijmed.2020.05.02.01

Full Text:

PDF

References

Arora P, Sarkar R, Garg VK, Arya L (2012). Lasers for treatment of melasma and post-inflammatory hyperpigmentation. Journal of cutaneous and aesthetic surgery, 5(2): 93. doi: 10.4103/09742077.99436


Cestari T, Peruzzo J, Giongo N (2017). Definition, incidence, and etiology of melasma in brown skin. In Melasma and Vitiligo in Brown Skin. Springer, New Delhi.doi: 10.1007/9788132236641_3


Choi CP, Yim SM, Seo SH, Ahn HH, Kye YC, Choi JE (2015). Retrospective analysis of melasma treatment using a dual mode of low-fluence Q-switched and long pulse Nd: YAG laser vs. lowfluence Q-switched Nd: YAG laser mono therapy. Journal of Cosmetic and Laser Therapy, 17(1): 28. doi: 10.3109/14764172.2014.957217


Handel AC, Miot LDB, Miot HA (2014). Melasma: a clinical and epidemiological review. Anais brasileiros de dermatologia, 89(5): 771782. doi: 10.1590/abd18064841.20143063


Kim JE, Chang SE, Yeo UC, Haw S, Kim IH (2013). Histopathological study of the treatment of melasma lesions using a low‐fluence Q‐switched 1064‐nm neodymium: yttrium–aluminium–garnet laser. Clinical and Experimental Dermatology: Clinical dermatology, 38 (2): 167171. doi: 10.1111/j.1365-2230.2012.04473.x


KrupaShankar DSR, Somani VK, Kohli M, Sharad J, Ganjoo A, Kandhari S, Kadhe G (2014). A cross-sectional, multicentric clinic epidemiological study of melasma in India. Dermatol Ther (Heidelb), 4(1): 7181.doi: 10.1007/s13555-014-0046-1


Melyawati SS, Bernadette I, Legiawati L (2014). Perkembangan terbaru etiopatogenesis melasma. Media DermatoVenereologica Indonesiana, 41(3): 133-138. Retrieved from http://www.perdoski.or.id/doc/mdvi/fulltext/33/220/13_Tinjauan_Pustaka.pdf.


Moubasher AE, Youssef EM, Abou-Taleb DA (2014). Q-switched Nd: YAG laser versus trichloroacetic acid peeling in the treatment of melasma among Egyptian patients. Dermatologic Surgery, 40(8): 874882.doi: 10.1097/DSS.0000000000000065


Nouri K (2014). Handbook of Laser in Dermatology. London: Springer.


Rigopoulos D, Katoulis AC (2017). Hyperpigmentation. CRC Press. Retrieved from https://www.crcpress.com/Hyperpigmentation/Rigopoulos-Katou-lis/p/book/9781498740173


Sarkar R, Arora P, Garg VK, Sonthalia S, Gokhale N (2014). Melasma update. Indian dermatology online journal, 5(4): 426.doi: 10.4103/22295178.142484


Sim JH, Park YL, Lee JS, Lee SY, Choi WB, Kim HJ, Lee JH (2014). Treatment of melasma by low-fluence 1064 nm Q-switched Nd: YAG laser. Journal of Dermatological Treatment, 25(3): 212217. doi: 10.3109/09546634.2012.735639


Small R, Hoang DA (2016). Practical Guide to Laser Procedures. Philadelphia: Walters Kluwer


Tamega ADA, Miot LDB,Bonfietti C,Gige TC, Marques MEA,Miot HA (2013). Clinical patterns and epidemiological characteristics of facial melasma in Brazilian women. Journal of the European Academy of Dermatology and Venereology, 27(2): 151156. Retrieved from https://doi.org/10.1111/j.14683083.2011.04430.x


Trivedi MK, Yang FC, Cho BK (2017). A review of laser and light therapy in melasma. International journal of women's dermatology, 3(1): 1120. doi: 10.1016/j.ijwd.2017.01.004


Wasitaadmaja SM,Norawati L (2018). Pedoman Diagnosis dan Tata Laksana Melasma di Indonesia. Jakarta: Badan Penerbit FKUI


Wattanakrai P, Mornchan R, Eimpunth S (2010). Low-fluence Q-switched neodymiumdoped yttrium aluminium garnet (1.064 nm) laser for the treatment of facial melasma in Asians. Dermatologic surgery, 36(1): 7687. doi: 10.1111/j.15244725.2009.01383.x.

Refbacks

  • There are currently no refbacks.