Punctate Leucoderma After 1,064-nm Q-Switched Neodymium-Doped Yttrium Aluminum Garnet Laser with Low-Fluence Therapy

Abstract

Melasma is a common pigmentary disorder in Asian populations. Recently, treatment using 1,064-nm Qswitched neodymium-doped yttrium aluminum garnet laser (QSNY) with low fluence has been reported to be effective for Asian patients with melasma, 1,2 but this treatment modality can rarely induce punctate hypopigmentation, and histopathology of the lesion has not been evaluated so far. 1,2 In this report, we would like to demonstrate histopathologic features of a punctate hypopigmentation that occurred after several sessions of 1,064-nm QSNY with low-fluence therapy.

LOW FLUENCE Q-SWITCHED Nd: YAG LASER TONING AND Q-SWITCHED RUBY LASER IN THE TREATMENT OF MELASMA:A COMPARATIVE SPLIT-FACE ULTRASTRUCTURAL STUDY

“…1,3) Recently, many studies have reported the clinical effectiveness of laser toning with the Q-switched Nd-YAG laser for the treatment of melasma. [4][5][6] In this study, the clinical effects of laser toning on melasma were investigated and the results were compared with those of a Q-switched ruby laser from a histopathological point of view.…”

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

“…14,15 It applies very low fluence and does not destroy active melanocytes with melanosomes. [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. 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.…”

“…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.…”

“…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. 18,19 Treatment intervals also varied in previous reports (weekly, every 2 weeks, every 3 weeks, or monthly). [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.…”

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

“…Leukoderma secondary to laser toning has been reported to be a melanocytopenic disorder according to biopsy results and is refractory to treatment . Narrow‐bandUVB and a 308‐nm excimer laser have gained variable success but can aggravate the pre‐existing melasma lesions .…”