title: Successful treatment of melasma using a combination of microdermabrasion and Q-switched Nd:YAG lasers.
abstract: OBJECTIVE
  A common, disfiguring problem in women, melasma is often refractory to treatment, and long-term remissions are difficult to achieve. This study assessed the safety and effectiveness of a procedure combining microdermabrasion, a topical regimen, and low fluence Q-switched Nd:YAG laser treatment.
  
  
  METHODS
  In this observational study of 27 female subjects, phototypes II-V, referred for treatment of mixed-type melasma refractory to previous therapies, low-fluence QS Nd:YAG laser treatment of 1.6-2 J/cm(2) with 5 or 6 mm spot was administered immediately following microdermabrasion. Daily application of a broad-spectrum sunscreen began immediately; subjects used a topical skin care regimen of hydroquinone with tretinoin or vitamin C. Treatments were repeated at 4-week intervals. Follow-up assessment was done 3-12 months after the last treatment. Adverse effects were recorded at each visit. Standardized digital photographs obtained before each treatment session and at follow-up visits were objectively assessed by blinded comparison using a quartile grading system.
  
  
  RESULTS
  Treatment was successful in all skin types, deemed painless by all subjects, and required no anesthesia. Average number of treatments was 2.6. Twenty-two subjects (81%) had >75% clearance of melasma; 11 subjects (40%) achieved >95% clearance. Most subjects showed >50% clearance of their melasma 1 month after the first treatment. Side effects were limited to mild post-treatment erythema, which developed after the microdermabrasion and lasted approximately 30-60 minutes. Four subjects noted temporary exacerbation of melasma after inadvertent sun exposure, but this resolved within several weeks of resuming the topical skin care regime. Remission lasted at least 6 months.
  
  
  CONCLUSIONS
  Microdermabrasion plus low-fluence QS Nd:YAG laser treatment is a simple, non-invasive procedure with minimal risk, no recovery time, and long-lasting remission. Treatment works on all skin phototypes in just two to three treatment sessions. Subject compliance with skin care was excellent, probably due to the dramatic improvement observed within 4 weeks.
authors.affiliation: New York Laser & Skin Care, New York, NY 10028, USA. info@nylaserskincare.com
authors.forename: Arielle N B
authors.initials: AN
authors.lastname: Kauvar
mesh_terms: D000328:Adult; D000975:Antioxidants / Q000627:therapeutic use; D001205:Ascorbic Acid / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003869:Dermabrasion / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006873:Hydroquinones / Q000627:therapeutic use; D007641:Keratolytic Agents / Q000627:therapeutic use; D007834:Lasers; D053844:Lasers, Solid-State / Q000009:adverse effects / Q000627:therapeutic use*; D008548:Melanosis / Q000628:therapy*; D008875:Middle Aged; D016037:Single-Blind Method; D013473:Sunscreening Agents / Q000627:therapeutic use; D016896:Treatment Outcome; D014212:Tretinoin / Q000627:therapeutic use
chemical_list: D000975:Antioxidants; D006873:Hydroquinones; D007641:Keratolytic Agents; D013473:Sunscreening Agents; D014212:Tretinoin; D001205:Ascorbic Acid; C031927:hydroquinone