THE ® September/October 2010 HOYA ConBio Lasers Successfully Treat Melasma By Bob Kronemyer, Associate Editor Practitioners are increasingly turning to light sources to effectively manage melasma, a pigment condition most commonly presented in Asian populations. The RevLite and MedLite C6, both Q-switched Nd:YAG lasers from HOYA ConBio (Fremont, Calif.), are showing some very promising results. In a recently published prospective study that appeared in the Journal of Cosmetic and Laser Therapy (2010; 12:126-131), treatment of refractory melasma with the MedLite C6 laser and alpha-arbutin found that 30% of patients achieved more than 81% improvement and 37% of patients achieved between 51% and 80% improvement at six months. Patients were treated every week, for a total of ten sessions, with 10 to 20 passes per session using a 6 mm spot size at 3 J/cm2 to 3.4 J/cm2. “Even though the MedLite C6 has a nearly perfect flat beam profile and high energy pulse, the skill of the physician in placement of pulses, stacking of pulses, angle of exposures and recognition of clinical tissue reactions, are crucial factors that determine success or failure of treatment,” reported study author Niwat Polnikorn, M.D., director of Kasemrad Aesthetic Center in Bangkok, Thailand. “Keeping good photographic records of patient results and hands-on training with experienced physicians is also important.” Mixed type melasma before Tx Photos courtesy of Niwat Polnikorn, M.D. been treating melasma with the MedLite C6 laser since 2006. “We’ve been able to successfully treat melasma that is recalcitrant to topical therapies alone because the laser has the ability to reach deeper into the dermis, whereas topical fade creams cannot,” he said. Niwat Polnikorn, M.D. Medical Director Kasemrad Aesthetic Center Bangkok, Thailand However, Dr. Polnikorn pointed out that high energy alone is not enough for precise breakage of melanins. “You need a large spot size (at least 6 mm) to go deeper and a flat beam for even pigment breakage, without damage to the basement membrane,” he explained. These features are found in the MedLite C6 laser, plus high energy fluence (> 1,000 mJ). The flat beam also provides for minimal tissue injuries. Moreover, the laser allows “for perpendicular and steady hand movement speed for minimal overlapping between pulses,” Dr. Polnikorn noted. “Closely monitoring clinical endpoints is critical as well.” In particular, Dr. Polnikorn prefers the Medlite C6 and RevLite as first line treatment in skin types IV through VI “due to the predictable results, less post-inflammatory hyperpigmentation and the additional benefits of overall skin lightening and rejuvenation.” G. Anthony Slagel, D.O., a dermatologist in private practice in Fayetteville, Ga., has Mixed type melasma after ten bi-weekly treatments Rebound melasma before Tx Photos courtesy of Niwat Polnikorn, M.D. G. Anthony Slagel, D.O. Dermatologist Fayetteville, GA Patients schedule eight sessions, approximately three weeks apart. The first treatment is typically at a fluence between 2.5 J/cm2 to 3.0 J/cm2, depending on skin type, along with a 6 mm spot size and 10 Hz. “With each subsequent treatment, we adjust the fluence upwards, about 10%,” Dr. Slagel advised. After a series of treatments, “the vast majority of even the most hyperpigmented areas of melasma are either gone or lightened to the point where they are much more easily concealed with a little make-up.” After completing the series, patients return for a quick touch-up once every three months, in which the initial setting is repeated. “These touch-ups basically allow us to keep the melasma from returning,” Dr. Slagel said. Rebound melasma after two treatments, two weeks apart Dr. Slagel has seen patients burned with intense pulsed light (IPL) devices; therefore, he believes that Q-switched Nd:YAG technology achieves safer and superior results than IPL for treating melasma. The 1064 nm “is such a safe wavelength.” Medical Insight, Inc.® • 120 Vantis #470, Aliso Viejo, CA 92656 • (949) 830-5409 • Facsimile: (949) 830-8944 • www.miinews.com