Study of the Incidence and Nature of “Very Subtle Epidermal Melasma” in Relation to Intense Pulsed Light Treatment

Abstract

BACKGROUND: Skin rejuvenation with intense pulsed light (IPL) is effective for clearing epidermal pigment disorders. Complications are mild and limited to epidermal burns caused by excessive settings. Some patients, however, experience IPL-induced melasma-like hyperpigmentation despite the appearance of normal skin. These patients seem to have very subtle epidermal melasma not visible to the naked eye. Ultraviolet photography has been useful in identifying these patients and preventing complications. OBJECTIVE: The study investigated the incidence of very subtle melasma in patients using UV photography, and assessed this tool in identifying high-risk patients. SUBJECTS AND METHODS: 223 Japanese women, 30-69 years old, participated in the study. Very subtle melasma invisible to the naked eye under normal light was diagnosed by UV photography by two physicians, and any relationship among the disease incidence, age, and regular sunscreen use was examined. RESULTS: Sixty-three cases of very subtle melasma (28.3%) were identified among the 223 subjects, with a significantly lower incidence in sunscreen users. CONCLUSIONS: Patients diagnosed with subtle epidermal melasma and treated with mild IPL parameters did not suffer induced secondary hyperpigmentaion. To help avoid complications after treatment, IPL users should be aware of the age and sunscreen-related incidence of this phenomenon in Asian patients. KEI NEGISHI, NOBUHARU KUSHIKATA, YUKIKO TEZUKA, KAORI TAKEUCHI, EIKO MIYAMOTO, AND SHINGO WAKAMATSU HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. UV PhotographyThe UV (364 nm) camera system (Canfield Imaging Systems, Fairfield, NJ) used in the study consisted of a r

Efficacy and Safety of Intense Pulsed Light in Treatment of Melasma in Chinese Patients

“…Without efficient cooling and other protection modalities, IPL may induce subtle melasma itself. 12 The traditional IPL devices (e.g., Vasculight used by Dr. Wang) do not have the cooling system, while the new device incorporates a cooling mechanism that provides continuous contact cooling to the treatment area. Instant cooling could minimize thermal injury, thus reducing possible complications, such as thermal necrosis, induced erythema, and hyperpigmentation.…”

Characteristics and management of Asian skin

“…Several authors have suggested the use of a lower energy to achieve minimal erythema, prevent excessive thermal damage to labile melanocytes, and reduce the risk of PIH. 1,45,46 Bae et al showed good results with IPL at a low energy and short-pulse À 10 or 13 J/cm 2 in all regions of the face, using weekly sessions (six in total), a wavelength of 550-800 nm, and two passes, with the purpose of protecting the superficial epidermis from excess heat and reducing side effects. 47 Yun et al…”

Photoaging and Nonablative Photorejuvenation in Ethnic Skin

“…More recently, Negishi and colleagues employed UV photography to identify and treat subclinical epidermal hyperpigmentation with IPL. 45 Other Asian investigators have had success with similar pulsed light parameters, with only one incidence of hypopigmentation in type IV and V Japanese and Taiwanese skin. 46,47 Chan described the use of IPL for treatment of hyperpigmentation, fine rhytids, and coarse texture using various pulsed light technologies, including the Danish Dermatologic Development Ellipse Flex (not available in the United States) and the Palomar Estelux/Medilux devices ( Figure 5).…”