title: Ineffective treatment of refractory melasma and postinflammatory hyperpigmentation by Q-switched ruby laser.
abstract: BACKGROUND
  Melasma and postinflammatory pigmentation are cosmetic problems with limited options for treatment.
  
  
  OBJECTIVE
  To determine whether selective photothermolysis of pigmented cells by Q-switched ruby laser treatment would produce clinical benefit in these disorders.
  
  
  METHODS
  Eight subjects with melasma or postinflammatory hyperpigmentation refractory to traditional treatments were treated with Q-switched ruby laser pulses (694 nm, 40 nanoseconds) at fluences of 15-7.5 J/cm2, and followed. Histology was obtained before and after treatment.
  
  
  RESULTS
  Regardless of fluence, no permanent improvement and, in some cases, darkening was seen in each type of lesion. Except for small depression at high fluences in black patients, there were no textural changes after healing. Immediately after treatment, there was epidermal and dermal injury, with extracellular melanin. Several months later, epidermal pigmentation had returned to baseline and dermal macrophages were apparently focally increased.
  
  
  CONCLUSIONS
  The Q-switched ruby laser by itself does not provide an effective treatment for refractory melasma or postinflammatory hyperpigmentation.
authors.affiliation: Wellman Laboratories of Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston 02114.
authors.forename: C R
authors.initials: CR
authors.lastname: Taylor
authors.forename: R R
authors.initials: RR
authors.lastname: Anderson
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017495:Hyperpigmentation / Q000473:pathology / Q000532:radiotherapy*; D017496:Hypopigmentation / Q000209:etiology / Q000473:pathology; D015603:Keratinocytes / Q000473:pathology / Q000528:radiation effects; D053685:Laser Therapy; D008297:Male; D008543:Melanins / Q000528:radiation effects; D008544:Melanocytes / Q000473:pathology / Q000528:radiation effects; D008548:Melanosis / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D012677:Sensation / Q000528:radiation effects; D012867:Skin / Q000473:pathology / Q000528:radiation effects; D017211:Treatment Failure
chemical_list: D008543:Melanins