Journal of Clinical and Aesthetic Dermatology

JUN 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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58 JCAD journal of clinical and aesthetic dermatology June 2017 • volume 10 • Number 6 r E v I E w MELASMA Melasma is a challenging condition for both patient and doctors alike. Quality-of-life studies have shown significant negative impact of melasma on emotional wellbeing, social life, and leisure activities. 30 sun protection, bleaching creams, and chemical peels remain the first-line treatment modalities. Combination therapies are generally needed to tackle melasma owing to its chronic relapsing nature. limited numbers of studies in the past have assessed the use of fractional laser in skin of color melasma patients (table 5). 31–38 Goldberg et al 32 performed a histological and clinical analysis of the effect of nonablative fractional laser in melasma. they noted a relative decrease in the number of melanocytes in the and clinical improvement post treatment. Wind et al 33 performed a split-face study comparing 1550 nonablative laser with triple combination cream (tCC). Worsening of hyperpigmentation was reported in nine (31%) patients on the laser treatment side. overall patient satisfaction was significantly lower on laser side as compared to tCC side. at the end of the study, most patients preferred tCC over laser. table 5: nonablative fractional lasers for melasma in spt iv to vi autHors, yEar sKin t ypEs no. oF patiEnts spt Hiv, v, vii trEatmEnt modalit y postinFlammatory HypErpigmEntation HpiH %i Naito et al, 2007 3 1 III–IV 6 3,0,0 1550nm Er:YAG fractional laser 16.6% Goldberg et al, 2008 32 III–IV 10 4,0,0 1550nm Er:Glass fractional laser No PIH observed Wind et al, 2010 33 II–V 29 8,3,0 Split face: One side of face 1550nm Er:YAG laser and other side TCC NAF: 31% No PIH on TCC side Kroon et al, 2011 34 III–V 20 5,2,0 Randomized trial Group A: 1550nm Er:Glass laser Group B: TCC No PIH observed in either group Hong et al, 2012 3 5 III–IV 18 Not mentioned Split face: One side 1550nm Er:YAG laser and other side 15% TCA peel 28 % (5 patients developed PIH on both sides) Wanitphakdeedecha et al, 2012 36 III–V 30 Not mentioned Randomized Split face – 1410nm: Group A: 20mJ, 5% coverage Group B: 20mJ, 20% coverage Group A: 8.33% Group B: 14.16% Kim et al, 2013 37 III–V 26 Not mentioned Split face: One side of face – Q switched Nd:YAG Other side – Q switched Nd:YAG + 1550nm Er:YAG Tourlaki et al, 2014 38 II–V 76 13,0,0 Combination of 1540 nm Er:Glass laser + TCC No PIH observed SPT: Fitzpatrick skin photo type

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