Punctate leucoderma after melasma treatment using 1064‐nm Q‐switched Nd:YAG laser with low pulse energy

Abstract

diarrhea. Alopecia, oedema, facial erythematous rash, hair depigmentation, stomatitis, xerosis and subungueal splinter haemorrhages have been reported. Two cases of inflammation of actinic keratoses and a case of erythema multiforme subsequent to therapy with sorafenib have also been described. 3,4 We have presented a particular case which represents a unique form of dermatologic toxicity to sorafenib that has not previously been described in the literature.The use of tyrosine kinase inhibitor may result in a wide range of cutaneous side effects. Thus, it is important to know them to adapt the management of these dermatologic toxicities. References 1 Wilhelm SM, Carter C, Tang L et al. BAY 43-9006 exhibits broad spectrum oral anti-tumor activity and targets the Raf/MEK/ERK pathway and receptor tyrosine kinases involved in tumor progression and angiogenesis. Cancer Res 2004; 64: 7099-7109. 2 Clark JW, Eder JP, Ryan D, Lathia C, Lenz HJ. Safety and pharmacokinetics of the dual action Raf kinase and vascular endothelial growh factor receptor inhibitor, BAY 43-9006, in patients with advanced, refractory solid tumors. Clin Cancer Res 2005; 11: 5472-5480. 3 Lacouture ME, Desai A, Soltani K et al. Inflammation of actinic keratoses subsequent to therapy with sorafenib, a multitargeted tyrosine-kinase inhibitor. EditorHerein, we would like to demonstrate three patients with melasma presenting punctate leucoderma after the treatment using 1064-nm Q-switched Nd:YAG laser (QSNY) with low pulse energy. A total of 259 patients (15 men, 244 women; mean age, 38 years; range, 21-67 years; Fitzpatrick skin types IV) had been treated using Figure 2 Image showing prominent follicular hyperplasia, mostly limited to the follicular isthmus, acanthosis with regenerative changes and a mild perifollicular lymphocytic inflammatory infiltration (haematoxylin-eosin. ×40). Figure 1Image showing multiple, grouped, monomorphous, follicular keratotic, skin coloured, 1-mm papules affecting the face.

Therapeutic Efficacy and Safety of Invasive Pulsed-Type Bipolar Alternating Current Radiofrequency on Melasma and Rebound Hyperpigmentation

“…Notwithstanding, the possibility of rebound hyperpigmentation (RH) and punctate leukoderma have since been found to be the major concerns for this treatment. 7,8 Studies have shown that the skin behaves like a semiconductor. 9 When emitted on the skin, radiofrequency (RF) elicits epidermal and dermal heating.…”

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

“…Kim et al 10 reported some interesting results. This study focused on punctate leukoderma developing after laser toning treatments performed in 259 patients.…”

“…In this study, the parameters were maintained the same as the authors' previous study, except for the fluence which was lowered to about 50-60% of that used in the previous study. 9,10 It is interesting to note that the rate of hypopigmentation is much lower in this study. Although the fluence was lower than the previous studies, it was still higher than the levels normally used in today's clinical practice (2.0 J/cm 2 or less).…”

Response to Intradermal Autologous Platelet Rich Plasma Injection in Refractory Dermal Melasma: Report of Two Cases

“…Although subthermolytic Q-switched 1064nm Nd Yag laser therapy has shown promising results, this treatment would require multiple sessions on a weekly basis, which would burden the patients (16,17). In addition, there are some reports of confetti-like hypopigmentation occurring after multiple treatment sessions (18,19). In general, epidermal type melasma respond well to these conventional treatment (20).…”