Journal of Clinical and Aesthetic Dermatology

APR 2018

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

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33 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY April 2018 • Volume 11 • Number 4 O R I G I N A L R E S E A R C H key since melasma is a recurrent skin condition. For this reason, we decided to follow some patients until 12 months (n=4). For at least three of these individuals, the response was maintained (data not shown). Surprisingly, a poorly responding patient (Patient 2) during the study showed a significant comeback at Month 12, particularly on the PBM-treated side after continued (at home) weekly use of PBM on her right side. This delayed response indicates that it might take more time in some patients for improvements to show and that continued use of this treatment modality might help in building a resistance to the sun. For practical reasons, we only performed a weekly treatment for eight weeks. However, tri-weekly treatments at home over the span of several months might be something to consider in future studies, not only to improve efficacy but also to achieve longer-term remission by treating for a longer period of time as a prophylactic modality. Even weekly treatments seemed to provide resistance to UV (photoprevention) during the course of our study, which took place in the summer. As for wavelength, 830nm and 850nm have been shown to downregulate pigmentation equally well in vitro, 23 so future studies using these wavelengths should to be considered. Finally, the partial improvement shown by the contralateral untreated side (Figure 7) suggests a possible response to the bilateral MCD treatment or a systemic effect of PBM. Indeed, it has been reported in the past that systemic effects of PBM might act at a site distant from the illumination site. 42,43 CONCLUSION This pilot study demonstrates that dermal melasma might be improved without tissue damage by using pulsed PBM photons. Interestingly, there might be an additional advantage to using PBM, in that it might precondition the skin, helping the patient to build a resistance to future solar UV ray exposure. This is an important finding, since the worst triggering factor in melasma is sun exposure. In addition, the use of sequential pulsing— similar to a Morse code—seems to play a role in the response to treatment. It represents an additional way of customizing LED treatment parameters to increase tissue response and reduce dermal hyperpigmentation. This new treatment approach is promising since, unlike topicals that are unable to reach the dermis easily, it provides a new way to reach and downregulate hyperactive dermal melanocytes without side effects. Although there are several study limitations (small sample size, n=7; no control with untreated skin; and limited long-term follow-up, n=4), the results are encouraging. Clearly, further studies are needed to validate the use of this new treatment approach and to optimize treatment parameters to ultimately better control this refractory pigmentary disorder. ACKNOWLEDGMENTS I am grateful to Greg Cormack for careful proofreading of this manuscript. REFERENCES 1. Sofen B, Prado G, Emer J. Melasma and post inflammatory hyperpigmentation: management update and expert opinion. Skin Therapy Lett. 2016;21(1):1–7. 2. Sarkar R, Arora P, Garg VK, et al. Melasma update. Indian Dermatol Online J. 2014;5(4):426–435. 3. Kauvar, AN. The evolution of melasma therapy: targeting melanosomes using low-fluence Q-switched neodymium-doped yttrium aluminium garnet lasers. FIGURE 7. Patient 1 ultraviolet photography shows significant pigment reduction on the photobiomodulation-treated side (LED). This patient also obtained a partial response on the untreated control side (CONTROL), probably due to the microdermabrasion or some systemic effects of photobiomodulation.

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