Fraktionierte Photothermolyse

Abstract

Melasma or chloasma is a common acquired hypermelanosis of the face and neck that is notoriously difficult to treat. Laser treatment has been employed in patients who do not respond to conventional topical agents but has failed to achieve an acceptable compromise between efficacy and side effects. Fractional photothermolysis (FP) combines the efficacy of ablative and the tolerability of non-ablative laser treatment in some skin conditions. There are few studies on using FP in melasma and its value cannot be estimated presently. Review of the literature and the authors' own experience show a definite potential which should be further investigated in systematic studies, but we cannot at this point subscribe to the euphoria expressed in some publications.

Lasers are not effective for melasma in darkly pigmented skin

“…In fact with the fractional lasers, a rebound hyperpigmentation has been noted in our analysis, which is similar to the results noted by Karsai et al .,[13]…”

“…[4567] Melasma has a high risk of recurrence with fractional laser therapy[7] and the relative high rate of re-pigmentation and sometimes even an increase in pigmentation after the treatment makes it a risky option. [713]…”

“…The use of lasers for the treatment of melasma cannot be recommended as a first line treatment of melasma due to their unpredictable efficacy and safety. [101112131415161718192021222324] They can be considered as third line treatment when all other modalities have failed and patient wishes to try alternative treatment. Such treatments are not curative and should be made clear to patients when such treatments are offered to the patient.…”