Postinflammatory and rebound hyperpigmentation as a complication after treatment efficacy of telangiectatic melasma with 585 nanometers Q‐switched Nd: YAG laser and 4% hydroquinone cream in skin phototypes III‐V

Abstract

Background:The potential efficacy of vascular component-targeted laser has been evaluated for the treatment of melasma, which commonly found with the co-existence of telangiectasia. Aims:To evaluate the treatment efficacy and safety of 585-nm QSNYL and 4% HQ cream combination vs 4% HQ cream alone for telangiectatic melasma in the skin phototypes III-V.Patients/Methods: Twenty-one Thai female patients with telangiectatic melasma and Fitzpatrick skin phototypes (FPTs) III-V were randomly treated with the 585-nm QSNYL on one side of the face for five sessions at 2-week intervals. All patients were assigned to apply HQ cream daily at night on both sides of the face for 10 weeks and a broad-spectrum sunscreen regularly throughout the study. The treatment efficacy and safety were evaluated using the Modified Melasma Area and Severity Index (mMASI), biometric evaluation, patient assessment, and adverse effects. Results:The combination-treated side yielded more significant improvement of mMASI than the topical-treated side at weeks 2, 4, and 8, respectively. However, 19% of the patients developed postinflammatory hyperpigmentation (PIH) on the laser-treated side, especially in FPTs IV-V and rebound hyperpigmentation. There was a significant improvement of hemoglobin and melanin index, but without statistical difference between the two treatment groups. Conclusions:The combination of 585-nm QSNYL and HQ treatment yields treatment efficacy and skin rejuvenation effects for telangiectatic melasma. Nonetheless, a high incidence of PIH and rebound hyperpigmentation is adversely developed in dark FPT. Thus, this laser treatment should be cautiously applied in those with dark FPTs IV-V to avoid laser-induced pigment alteration.

Expert recommendations on supportive skin care for non‐surgical and surgical procedures

“…9 A combination treatment of YAG laser and hydroquinone cream, whilst showing good efficacy and skin rejuvenation effects for telangiectatic melasma, should be used cautiously in individuals with FPT IV-V to avoid laser-induced pigment alteration, PIH and rebound hyperpigmentation. 22,23 It is recommended to perform a test before doing the complete procedure. A long pulse duration coagulates the target without bursting the vessels and the vessels often disappear after the first laser pass leaving erythema and oedema.…”

“…Combining topical therapy with procedures such as chemical peels, IPL, fractional non‐ablative lasers or radiofrequency, pigment lasers (microsecond, picosecond, Q‐switched) and microneedling, may be required to treat melasma and PIH 9 . A combination treatment of YAG laser and hydroquinone cream, whilst showing good efficacy and skin rejuvenation effects for telangiectatic melasma, should be used cautiously in individuals with FPT IV‐V to avoid laser‐induced pigment alteration, PIH and rebound hyperpigmentation 22,23 . It is recommended to perform a test before doing the complete procedure.…”

Application of integrated skincare in medical aesthetics: A literature review

“…9,10 HQ (2%-4%) is widely prescribed for treating hyperpigmentation. Lueangarun et al 11 assessed the treatment efficacy and safety of 585 nm Q-switched neodymium-doped yttrium aluminium garnet (Nd:YAG) laser treatment combined with 4% HQ cream versus 4% HQ cream alone for telangiectatic melasma in 21 patients from Thailand. They observed a high incidence of PIH and rebound hyperpigmentation in patients with darker Fitzpatrick skin phototypes receiving Q-switched Nd:YAG laser treatment and 4% HQ cream, indicating the potential risk of this treatment regimen.…”

An Investigation into The Acute and Subacute Toxicity of Extracts of Cassipourea Flanaganii Stem Bark in vivo

“…Studies have shown that melasma is associated with a poor Quality of Life (QOL) in some affected individuals [20][21][22]. Although there is a wide variety of treatment interventions, the suitability of these treatment modalities is limited due to their negative side effects, particularly in people with darker skin [23][24][25][26], hence there is a necessity to investigate more treatment interventions that will be both safe and effective for all skin types. Tyrosinase inhibitors are extensively used as complexion modifiers in the cosmetic industry [27].…”