Microdermabrasion Plus Nd:YAG Laser Improves Melasma

GRAPEVINE, TEX. – The combination of microdermabrasion and low-fluence Q-switched neodymium: YAG laser treatment in conjunction with pigment-reducing skin care produced consistent improvement in two or three treatments for 27 female patients with refractory facial melasma.

Previous attempts to treat melasma using various types of lasers have been associated with significant downtime, punctate hypopigmentation, melasma recurrence, and rebound hyperpigmentation.

Fractional lasers require four to six treatments and are associated with treatment pain, several days of recovery, and a high risk of rebound melasma. Higher-fluence Q-switched Nd:YAG laser therapy, performed with multiple laser passes during weekly treatments, is associated with pain, hair whitening, urticaria, punctuate hypopigmentation, and rebound melasma, said Dr. Arielle N.B. Kauvar at the annual meeting of the American Society for Laser Medicine and Surgery.

In this observational study, the 27 women had phototypes II-V with refractory mixed-type or dermal melasma. Their skin was first cleansed and then treated with diamond-chip microdermabrasion. Immediately after the microdermabrasion, 17 of the women received treatment with the Candela TriVantage (wavelength 1064 nm, nominal pulse width 50 ns, spot size 5 mm, fluence 1.6 J/cm²), while the other 10 women were treated with the Palomar Q-YAG (1064 nm, 5-7 ns, 6 mm, 1.8-2.0 J/cm²).

Patients began using a broad-spectrum sunscreen SPF 40 or higher immediately after treatment with the microdermabrasion and laser. For 2 days after each laser treatment, 4% hydroquinone twice daily plus 0.05% tretinoin at bedtime was applied until the day of the next microdermabrasion/laser treatment.

For patients with sensitive skin, 15% L-ascorbic acid was substituted for the tretinoin and used in the morning. Patients were maintained on skin care long term, said Dr. Kauvar, who is director of New York Laser & Skin Care.

The 27 women had a mean age of 37 years (range, 26-54 years). Four had skin type II, 11 type III, 7 type IV, and 5 type V. The mean number of treatments was 2.6. Mean clearance scores were 3.3 at 3 months, 3.2 at 6 months (25 patients), and 3.3 at 12 months (9); a score of 0 indicates less than 25% clearance, 1 = 25%-50% clearance, 2 = 51%-75%, 3 = 75%-95%, and 4 = greater than 95%.

Of the 27 patients, 22 had greater than 27% clearance of their melasma, while 11 had more than 95% clearance of pigmented patches. Most showed greater than 50% clearance at 1 month after the first treatment session, and only one patient had less than 25% clearance after one treatment, said Dr. Kauvar, who is in the department of dermatology at New York University.

The procedure was not associated with pain. All of the patients experienced very faint erythema that developed after the microdermabrasion, which lasted 30-60 minutes. Seven of the 27 had significant irritation from the skin care regimen, which resolved when the retinoid was discontinued. Another four had mild irritation from the skin care, which was successfully managed with reduction of the hydroquinone and retinoid applications. There was no incidence of hyperpigmentation or hypopigmentation.

Microdermabrasion decreases the scattering of laser light and increases epidermal cell turnover, while the low-fluence Q-switched YAG laser directly damages the melanocytes and melanosomes. The skin care regimen suppresses melanin production and protects against ultraviolet exposure, Dr. Kauvar explained.

"The combination of microdermabrasion and low-fluence Q-switched YAG laser treatment in conjunction with pigment-reducing skin care is a safe and effective treatment for melasma with minimal risks. This treatment offers substantial benefits over more invasive, higher-risk, costly procedures such as nonablative or ablative fractional laser treatment," she said.

Dr. Kauver stated that she has no disclosures.

GRAPEVINE, TEX. – The combination of microdermabrasion and low-fluence Q-switched neodymium: YAG laser treatment in conjunction with pigment-reducing skin care produced consistent improvement in two or three treatments for 27 female patients with refractory facial melasma.

Previous attempts to treat melasma using various types of lasers have been associated with significant downtime, punctate hypopigmentation, melasma recurrence, and rebound hyperpigmentation.

Fractional lasers require four to six treatments and are associated with treatment pain, several days of recovery, and a high risk of rebound melasma. Higher-fluence Q-switched Nd:YAG laser therapy, performed with multiple laser passes during weekly treatments, is associated with pain, hair whitening, urticaria, punctuate hypopigmentation, and rebound melasma, said Dr. Arielle N.B. Kauvar at the annual meeting of the American Society for Laser Medicine and Surgery.

In this observational study, the 27 women had phototypes II-V with refractory mixed-type or dermal melasma. Their skin was first cleansed and then treated with diamond-chip microdermabrasion. Immediately after the microdermabrasion, 17 of the women received treatment with the Candela TriVantage (wavelength 1064 nm, nominal pulse width 50 ns, spot size 5 mm, fluence 1.6 J/cm²), while the other 10 women were treated with the Palomar Q-YAG (1064 nm, 5-7 ns, 6 mm, 1.8-2.0 J/cm²).

Patients began using a broad-spectrum sunscreen SPF 40 or higher immediately after treatment with the microdermabrasion and laser. For 2 days after each laser treatment, 4% hydroquinone twice daily plus 0.05% tretinoin at bedtime was applied until the day of the next microdermabrasion/laser treatment.

For patients with sensitive skin, 15% L-ascorbic acid was substituted for the tretinoin and used in the morning. Patients were maintained on skin care long term, said Dr. Kauvar, who is director of New York Laser & Skin Care.

The 27 women had a mean age of 37 years (range, 26-54 years). Four had skin type II, 11 type III, 7 type IV, and 5 type V. The mean number of treatments was 2.6. Mean clearance scores were 3.3 at 3 months, 3.2 at 6 months (25 patients), and 3.3 at 12 months (9); a score of 0 indicates less than 25% clearance, 1 = 25%-50% clearance, 2 = 51%-75%, 3 = 75%-95%, and 4 = greater than 95%.

Of the 27 patients, 22 had greater than 27% clearance of their melasma, while 11 had more than 95% clearance of pigmented patches. Most showed greater than 50% clearance at 1 month after the first treatment session, and only one patient had less than 25% clearance after one treatment, said Dr. Kauvar, who is in the department of dermatology at New York University.

The procedure was not associated with pain. All of the patients experienced very faint erythema that developed after the microdermabrasion, which lasted 30-60 minutes. Seven of the 27 had significant irritation from the skin care regimen, which resolved when the retinoid was discontinued. Another four had mild irritation from the skin care, which was successfully managed with reduction of the hydroquinone and retinoid applications. There was no incidence of hyperpigmentation or hypopigmentation.

Microdermabrasion decreases the scattering of laser light and increases epidermal cell turnover, while the low-fluence Q-switched YAG laser directly damages the melanocytes and melanosomes. The skin care regimen suppresses melanin production and protects against ultraviolet exposure, Dr. Kauvar explained.

"The combination of microdermabrasion and low-fluence Q-switched YAG laser treatment in conjunction with pigment-reducing skin care is a safe and effective treatment for melasma with minimal risks. This treatment offers substantial benefits over more invasive, higher-risk, costly procedures such as nonablative or ablative fractional laser treatment," she said.

Dr. Kauver stated that she has no disclosures.

GRAPEVINE, TEX. – The combination of microdermabrasion and low-fluence Q-switched neodymium: YAG laser treatment in conjunction with pigment-reducing skin care produced consistent improvement in two or three treatments for 27 female patients with refractory facial melasma.

Previous attempts to treat melasma using various types of lasers have been associated with significant downtime, punctate hypopigmentation, melasma recurrence, and rebound hyperpigmentation.

Fractional lasers require four to six treatments and are associated with treatment pain, several days of recovery, and a high risk of rebound melasma. Higher-fluence Q-switched Nd:YAG laser therapy, performed with multiple laser passes during weekly treatments, is associated with pain, hair whitening, urticaria, punctuate hypopigmentation, and rebound melasma, said Dr. Arielle N.B. Kauvar at the annual meeting of the American Society for Laser Medicine and Surgery.

In this observational study, the 27 women had phototypes II-V with refractory mixed-type or dermal melasma. Their skin was first cleansed and then treated with diamond-chip microdermabrasion. Immediately after the microdermabrasion, 17 of the women received treatment with the Candela TriVantage (wavelength 1064 nm, nominal pulse width 50 ns, spot size 5 mm, fluence 1.6 J/cm²), while the other 10 women were treated with the Palomar Q-YAG (1064 nm, 5-7 ns, 6 mm, 1.8-2.0 J/cm²).

Patients began using a broad-spectrum sunscreen SPF 40 or higher immediately after treatment with the microdermabrasion and laser. For 2 days after each laser treatment, 4% hydroquinone twice daily plus 0.05% tretinoin at bedtime was applied until the day of the next microdermabrasion/laser treatment.

For patients with sensitive skin, 15% L-ascorbic acid was substituted for the tretinoin and used in the morning. Patients were maintained on skin care long term, said Dr. Kauvar, who is director of New York Laser & Skin Care.

The 27 women had a mean age of 37 years (range, 26-54 years). Four had skin type II, 11 type III, 7 type IV, and 5 type V. The mean number of treatments was 2.6. Mean clearance scores were 3.3 at 3 months, 3.2 at 6 months (25 patients), and 3.3 at 12 months (9); a score of 0 indicates less than 25% clearance, 1 = 25%-50% clearance, 2 = 51%-75%, 3 = 75%-95%, and 4 = greater than 95%.

Of the 27 patients, 22 had greater than 27% clearance of their melasma, while 11 had more than 95% clearance of pigmented patches. Most showed greater than 50% clearance at 1 month after the first treatment session, and only one patient had less than 25% clearance after one treatment, said Dr. Kauvar, who is in the department of dermatology at New York University.

The procedure was not associated with pain. All of the patients experienced very faint erythema that developed after the microdermabrasion, which lasted 30-60 minutes. Seven of the 27 had significant irritation from the skin care regimen, which resolved when the retinoid was discontinued. Another four had mild irritation from the skin care, which was successfully managed with reduction of the hydroquinone and retinoid applications. There was no incidence of hyperpigmentation or hypopigmentation.

Microdermabrasion decreases the scattering of laser light and increases epidermal cell turnover, while the low-fluence Q-switched YAG laser directly damages the melanocytes and melanosomes. The skin care regimen suppresses melanin production and protects against ultraviolet exposure, Dr. Kauvar explained.

"The combination of microdermabrasion and low-fluence Q-switched YAG laser treatment in conjunction with pigment-reducing skin care is a safe and effective treatment for melasma with minimal risks. This treatment offers substantial benefits over more invasive, higher-risk, costly procedures such as nonablative or ablative fractional laser treatment," she said.

Dr. Kauver stated that she has no disclosures.