Influence of the frequency of laser toning for melasma on occurrence of leukoderma and its early detection by ultraviolet imaging

Sugawara, Jun; Kou, Seiko; Kou, Sousei; Yasumura, Keisuke; Satake, Toshihiko; Maegawa, Jiro

doi:10.1002/lsm.22325

Cited by 19 publications

(24 citation statements)

References 25 publications

(36 reference statements)

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“…With respect to post laser toning hypopigmentation, color changes are likely to be related to cumulative laser sessions and short interval between sessions17. This supports our finding of no leukoderma following laser toning in the patients treated for an average interval of 28.0 days, which was longer than the standard weekly or fortnightly schedules of treatment.…”

Section: Discussionsupporting

confidence: 85%

Beneficial Effect of Low Fluence 1,064 nm Q-Switched Neodymium:Yttrium-Aluminum-Garnet Laser in the Treatment of Senile Lentigo

et al. 2017

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BackgroundLow fluence 1,064 nm Q-switched (QS) Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser treatment, also known as laser toning, is widely used for pigmentary disorders. There has been no reliable evaluation of the effect of low fluence 1,064 nm QS Nd:YAG laser for senile lentigo.ObjectiveTo investigate the beneficial effect of low fluence 1,064 nm QS Nd:YAG laser in the treatment of senile lentigo on the face.MethodsA retrospective review was conducted on patients treated only with repetitive low fluence 1,064 nm QS Nd:YAG laser. Among them, 12 patients with multiple senile lentigines before treatment were included. All side effects were recorded to assess the safety of the modality.ResultsMean age was 56.1±7.8 years old and male-to-female ratio was 1:11. Mean treatment fluence was 1.62±0.16 J/cm2 and mean total treatment session was 8.8±2.6. Mean interval period between each session was 28.0±11.4 days and mean treatment session to reach marked and near total improvement was 8.7±2.8. At the final visit, seven of 12 (58.3%) patients reached marked and near total improvement, and three of 12 (25.0%) reached moderate improvement. No side effects occurred.ConclusionRepetitive low fluence 1,064 nm QS Nd:YAG laser treatment may be an effective and safe optional modality for senile lentigo.

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Section: Discussionsupporting

confidence: 85%

Beneficial Effect of Low Fluence 1,064 nm Q-Switched Neodymium:Yttrium-Aluminum-Garnet Laser in the Treatment of Senile Lentigo

et al. 2017

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“…The residual melanocytes facilitated the expediency of repigmentation by topical psoralen photochemotherapy, NB‐UVB phototherapy, ablative fractionated laser, or 308‐nm excimer laser. In contrast, leukoderma or mottled hypopigmentation associated with QS Nd‐YAG laser toning often persists for many years despite a variety of treatments, including topical calcineurin inhibitors and phototherapy, because of lack of melanocytes . Weekly targeted NB‐UVB phototherapy and 308‐nm excimer laser treatments have been recommended to provide some clinical improvement, but they both can potentially worsen melasma.…”

Section: Discussionmentioning

confidence: 99%

“…Since 2007, 1064‐nm Q‐switched neodymium‐doped yttrium aluminium garnet (QS Nd‐YAG) laser toning with low fluence, large spot size, and multiple passes has been commonly used for non‐ablative skin rejuvenation and the treatment of melasma in Asian countries . It can temporarily improve melasma lesions with minimal downtime.…”

Section: Introductionmentioning

confidence: 99%

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Epidermal grafting for leukoderma resulting from 1064‐nm quality‐switched neodymium‐doped yttrium aluminium garnet laser toning

Wang

Chang

2018

International Wound Journal

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Leukoderma secondary to Q-switched 1064-nm neodymium-doped yttrium aluminium garnet laser is usually refractory to treatment. The pathogenesis was cumulative phototoxic damage to melanocytes and eventually resulted in melanocytopenia. Wood's light or UV imaging can help observe early leukoderma before it becomes apparent clinically and determine the degree of melanocytopenia before conducting a biopsy. NB-UVB phototherapy and 308-nm excimer laser can potentially worsen the pre-existing melasma lesions and may not be effective if the lesions have already become melanocytopenic. Epidermal grafting can replenish the hypopigmented area with melanocytes without worsening melasma.

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“…27 They used 2,000 to 3,000 shots of the 1,064 nm QS Nd:YAG, (spot size 5 mm, 1.6-2.0 J/cm 2 fluences) until erythema developed. In Group A, who received treatments with 1-2 weeks of interval, 3 out of 75 patients developed hypopigmentation.…”

Section: Impact Of Each Parameter On the Risk Of Hypopigmentationmentioning

confidence: 99%

Mottled Hypopigmentation from Laser Toning in the Treatment of Melasma: A Catastrophic or Manageable Complication?

Park

Yeo²

2015

Medical Lasers

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Melasma is a common acquired pigmentary disorder and difficult to treat with a high rate of recurrence. Conventional methods in the treatment of melasma have drawbacks and limitations. The so-called "laser toning" treatment, which uses a collimated low-fluence 1,064 nm Q-switched neodymium-doped yttrium aluminum garnet laser, was introduced a few years ago for the treatment of melasma. Laser toning has attracted much popularity and attention, and has become a crucial method for treatment of melasma. Laser toning is now a mainstay for treatment and management of melasma, however some dermatologists have excessive concerns about the risk of hypopigmentation. This inordinate fear may have originated from a few studies which insisted that laser toning therapy has a high risk of hypopigmentation and should be considered as a second-line treatment, not a first-line treatment for melasma. In the current study, we suggest that hypopigmentation after laser toning is a preventable and controllable complication based on our clinical experiences and reviews of various literatures. Key words

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Influence of the frequency of laser toning for melasma on occurrence of leukoderma and its early detection by ultraviolet imaging

Cited by 19 publications

References 25 publications

Beneficial Effect of Low Fluence 1,064 nm Q-Switched Neodymium:Yttrium-Aluminum-Garnet Laser in the Treatment of Senile Lentigo

Beneficial Effect of Low Fluence 1,064 nm Q-Switched Neodymium:Yttrium-Aluminum-Garnet Laser in the Treatment of Senile Lentigo

Epidermal grafting for leukoderma resulting from 1064‐nm quality‐switched neodymium‐doped yttrium aluminium garnet laser toning

Mottled Hypopigmentation from Laser Toning in the Treatment of Melasma: A Catastrophic or Manageable Complication?

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