New combination laser therapy effective in treating melasma

Feb 8 2012

On the surface, it would seem as though the skin condition melasma (commonly referred to as the "mask of pregnancy") and tattoos would have little in common. However, they both affect a person's skin, can be quite difficult to treat or remove and, now, dermatologists are discovering new laser therapies which enhance treatment for both conditions.

"Dermatologists are now finding that new laser therapies can significantly improve melasma and even remove tattoos more safely and effectively than laser procedures we have used in the past," said dermatologist Arielle N.B. Kauvar, MD, FAAD, clinical professor of dermatology at New York University School of Medicine in New York City.

Combination Laser Therapy Targets Melasma
Melasma is caused by an overproduction of melanin, a natural substance in the body that gives skin its color and can lead to dark patches on the face. While melasma may occur in anyone, the condition most commonly affects women with darker Mediterranean skin, Asians and Hispanics. Dr. Kauvar explained that melasma is typically controlled with topical medications that contain ingredients to lighten the skin, such as hydroquinone or retinoids. Along with regular use of broad-spectrum sunscreen with a Sun Protection Factor (SPF) of 30 or higher, this treatment can resolve the excess pigmentation and prevent further darkening of the skin.

However, this therapy may only provide temporary improvement in more difficult cases- particularly in patients with mixed-type melasma. In this type of melasma, excess pigment is produced in both the epidermis and dermis - the upper and lower levels of the skin. While high-energy lasers for pigment removal and laser resurfacing have been investigated to treat this type of melasma, Dr. Kauvar explained that the procedures were too harsh and could wound the skin, leading to increased pigment production and worsening of melasma. More recently, fractional lasers - which are less aggressive lasers - have been used, but there have been reports of an increased incidence of melasma recurring as well.

"Effective treatment of mixed-type melasma requires a very low-energy and low-impact procedure because irritation and inflammation can worsen melasma," said Dr. Kauvar. "Based on these requirements, I combined microdermabrasion, low-energy laser and a pigment-suppressing skin care regimen, which has shown to be painless, non-invasive, safe on any skin type and requires no downtime."

With the new combination therapy, the dermatologist performs a microdermabrasion immediately followed by a low-energy laser treatment with a Q-switched YAG laser. Patients then begin a topical regimen using hydroquinone and sunscreen.

In Dr. Kauvar's study of 27 women with mixed-type melasma, 22 subjects (81 percent) experienced greater than 75 percent improvement of their melasma after an average of 2.6 laser treatments. Of those, 11 subjects (40 percent) achieved over 95 percent improvement of their melasma. In addition, she found that clearance of melasma was maintained for at least six months.

"While this treatment uses a very low laser energy, it's high enough to break up the pigment without heating the skin," said Dr. Kauvar. "Melasma is a chronic disease, like psoriasis or eczema, which can be controlled but not cured. So far, we have been able to control melasma more effectively and extend the remission periods. I also find that patients are more motivated to continue their recommended skin care regimen to further help control flares."

Tattoos Getting the Boot with New Laser Therapies
While lasers have been used to remove tattoos for several years, the procedure requires multiple treatment sessions (typically six to 10 treatments or more) and treatments are painful, requiring a few weeks of healing time between procedures. Dr. Kauvar noted that the process of tattoo ink removal is inefficient since every color of ink absorbs different wavelengths of light, requiring the use of multiple lasers. Some colors - such as yellow, orange, turquoise or fluorescent ones - remain more difficult to treat.

"Unfortunately, there is no ideal laser to remove all tattoo colors, but new approaches have recently been introduced that appear to produce better results with fewer treatment sessions," said Dr. Kauvar.

One new study uses the Q-switched YAG laser to treat a tattoo four times in one day. These four separate treatments are administered at 20-minute intervals and have demonstrated much faster clearance of tattoo inks. Other research involves the use of the fractional ablative laser in conjunction with traditional tattoo-removal lasers to speed up clearance - resulting in as much as 50 percent tattoo ink removal in just one treatment session. In another new study, Dr. Kauvar is investigating the effectiveness of administering two treatments in one day using a combination of laser wavelengths to target different ink colors. With this procedure, Dr. Kauvar first uses a Q-switched YAG laser on the tattoo, followed by a Q-switched alexandrite laser (which is better at treating blues and greens) 20 minutes after the first laser. Dr. Kauvar noted that initial results of this procedure have shown significant improvement in removing blue, green and black inks.

"The biggest drawbacks to laser tattoo removal are the time, expense, pain and healing involved," said Dr. Kauvar. "The newest techniques being investigated are designed to reduce the number of treatment sessions required to remove a tattoo, which should make the process more appealing."