title: Combined use of intense pulsed light and Q-switched ruby laser for complex dyspigmentation among Asian patients.
abstract: BACKGROUND
  Dyspigmentation is a common cosmetic concern among Asians. Many individuals exhibit mixed pigmentary entities including melasma, flat/small seborrheic keratoses, ephelides, solar lentigines and acquired bilateral nevus-of-Ota-like macules (ABNOM). We term this phenomenon complex dyspigmentation (CD) and suggest that a combination strategy may be more efficacious than any singular modality.
  
  
  OBJECTIVE
  To determine the effectiveness of combined intense-pulsed light (IPL) for global photorejuvenation along with Q-switched ruby laser (QSRL) for targeted pigment dissolution.
  
  
  METHODS
  Twenty-five Korean women with CD (defined as >2 types of facial pigmentary disorders) were initially treated with IPL followed by repeat treatments every 3-4 weeks as needed. The QSRL treatments, set at low fluence, were added either during the same session or within 1 week of the IPL treatment. Improvement was assessed by the patient, the treating physician and a blinded evaluation of pre- and post-treatment photographs.
  
  
  RESULTS
  Using a 4-point scale (1 = poor, 2 = fair, 3 = good, 4 = excellent), 19/25 patients (76%) reporting good-to-excellent response (score "3" or "4"). Two independent physician assessment revealed that 15/25 patients (60%) showed 76-100% improvement while 19/25 patients (76%) showed at least 50% improvement. Side-effects were minimal: 3 patients had transient post-inflammatory hyperpigmentation (12%) and 1 patient (4%) had linear hypopigmentation.
  
  
  CONCLUSIONS
  Combination treatment with IPL and QSRL is an effective and safe treatment for CD among Asian patients.
authors.affiliation: Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
authors.forename: Jong Min
authors.initials: JM
authors.lastname: Park
authors.forename: Hensin
authors.initials: H
authors.lastname: Tsao
authors.forename: Sandy
authors.initials: S
authors.lastname: Tsao
mesh_terms: D000328:Adult; D044466:Asian People; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D017495:Hyperpigmentation / Q000208:ethnology* / Q000473:pathology / Q000628:therapy*; D007723:Korea; D053685:Laser Therapy / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D010789:Phototherapy / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome