Letter: Punctate Leucoderma After Low-Fluence 1,064-nm Quality-Switched Neodymium-Doped Yttrium Aluminum Garnet Laser Therapy Successfully Managed Using a 308-nm Excimer Laser

Pulse in Pulse Intense Pulsed Light for Melasma Treatment: A Pilot Study

“…Repetitive sessions of laser toning exhaust melanocytes and inactivate them so that they no longer produce or transfer melanin pigments. 21 It has also been reported that repetitive treatment sessions of low-fluence QS Nd: YAG laser can induce these hypopigmented lesions. Moreover, this treatment does not involve downtime or pain, which makes some patients believe that this treatment is very safe and free of adverse effect, but nanosecond-domain QS laser exposure can provoke explosive mechanical waves even though it is set at a low fluence.…”

“…21 It has also been reported that repetitive treatment sessions of low-fluence QS Nd: YAG laser can induce these hypopigmented lesions. [18][19][20][21] Chan and colleagues 18 emphasized the risk of punctuate leukoderma when laser toning was considered for the treatment of melasma. It too from 6 to 50 treatment sessions for punctate leukoderma to develop (mean 22.1 sessions).…”

“…16,17 When Kim and colleagues 17 biopsied skin treated with multiple sessions of laser toning, the remaining melanocytes were found to be inactive but the treatment does not stimulate activity of these dormant melanocytes, hence, it can achieve clinical improvement in melasma. [18][19][20][21] Chan and colleagues 18 emphasized the risk of punctuate leukoderma when laser toning was considered for the treatment of melasma. 18 These characteristics, together with repeated treatments over a short period, may be responsible for punctate leukoderma, which is cosmetically unacceptable and may persist if left untreated.…”

“…[18][19][20] Punctate leukoderma or confetti-like hypopigmentation was first reported in patients who developed multiple hypo-or depigmented spots after oral psoralen with phototherapy. 21,22 Therefore, efforts to reduce the number of treatment session and to determine optimal treatment intervals and parameters while still achieving satisfactory results should be made in the clinical field. [18][19][20][21] Chan and colleagues 18 emphasized the risk of punctuate leukoderma when laser toning was considered for the treatment of melasma.…”

“…[18][19][20] Cumulative frequent sublethal insult to melanocytes might be associated with this adverse effect. 21,22 Therefore, efforts to reduce the number of treatment session and to determine optimal treatment intervals and parameters while still achieving satisfactory results should be made in the clinical field.…”