Skip to main content
SpringerLink
Log in

Efficacy and safety of fractional Q-switched 1064-nm neodymium-doped yttrium aluminum garnet laser in the treatment of melasma in Chinese patients

  • Original Article
  • Published:
Lasers in Medical Science Aims and scope Submit manuscript

Abstract

Melasma is an acquired disorder of symmetrical hyperpigmentation commonly seen in patients with Fitzpatrick skin types III and IV. Various novel therapeutic modalities have emerged to treat melasma. The large-spot low-fluence QS Nd:YAG laser has been widely used in Asia; however, the modality needs to be optimized because of the high recurrence rate. The objective of this study is to explore the clinical efficacy and safety of fractional-mode (Pixel) Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) 1064-nm laser for treatment of melasma in Chinese patients. Twenty-seven patients were enrolled and completed all the treatment sessions and the 12-week follow-up. All were treated using the fractional-mode Pixel QS Nd:YAG (1064 nm) laser for eight sessions at a 2–3-week interval. Clinical photographs were taken using the Visia skin analysis imaging system. Two blinded assessors evaluated melasma area and severity index (MASI) scores before and 4 weeks after the final session. Melanin index (MI) and erythema index (EI) was measured before each treatment visit and after the final treatment. The degree of pigmentation and erythema was assessed using a tristimulus color analyzer. Physicians’ global assessment (PGA) and patients’ self-assessment were taken as the subjective assessments. Wilcoxon signed-rank test was performed to evaluate clinical response. Recurrence rate were also evaluated. Mean MASI scores decreased from 12.84 ± 6.89 to 7.29 ± 4.15 after treatment (p = 0.000). Seventy percent of patients got moderate to good improvements after all the treatment. Mean MI decreased significantly from 56.52 ± 23.35 to 32.75 ± 12.91 (p = 0.000). L value increased from 59.21 ± 2.22 before treatment to 61.60 ± 2.40 (p = 0.000) after therapy. The mean score of PGA was 3.76 ± 0.71, indicating a “moderate” clearance of the lesion. In patients’ self-evaluations, 70 % of the patients rated the result as “good” to “remarkable.” Partial recurrence was seen in 40 % patients at the 3-month follow-up. No severe adverse events were observed during the study, and the treatment was well tolerated. The fractional mode (Pixel) QS Nd:YAG 1064-nm laser is an effective and safe treatment for melasma. The recurrence rate was relatively lower than that reported in studies treating with large-spot low-fluence QS Nd:YAG laser.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Sheth VM, Pandya AG (2011) Melasma: a comprehensive update: part I. J Am Acad Dermatol 65(4):689–697, quiz 698

    Article  PubMed  Google Scholar 

  2. Grimes PE (1995) Melasma. Etiologic and therapeutic considerations. Arch Dermatol 131(12):1453–1457

    Article  CAS  PubMed  Google Scholar 

  3. Niepomniszcze H, Amad RH (2001) Skin disorders and thyroid diseases. Journal of Endocrinological Investigation 24(8):628–638

    Article  CAS  PubMed  Google Scholar 

  4. Gupta AK, Gover MD, Nouri K, Taylor S (2006) The treatment of melasma: a review of clinical trials. J Am Acad Dermatol 55(6):1048–1065

    Article  PubMed  Google Scholar 

  5. Sheth VM, Pandya AG (2011) Melasma: a comprehensive update: part II. J Am Acad Dermatol 65(4):699–714, quiz 715

    Article  PubMed  Google Scholar 

  6. Mun JY, Jeong SY, Kim JH, Han SS, Kim IH (2011) A low fluence Q-switched Nd:YAG laser modifies the 3D structure of melanocyte and ultrastructure of melanosome by subcellular-selective photothermolysis. J Electron Microsc (Tokyo) 60(1):11–18

    Article  CAS  Google Scholar 

  7. Kim JH, Kim H, Park HC, Kim IH (2010) Subcellular selective photothermolysis of melanosomes in adult zebrafish skin following 1064-nm Q-switched Nd:YAG laser irradiation. J Invest Dermatol 130(9):2333–2335

    Article  CAS  PubMed  Google Scholar 

  8. Zhou X, Gold MH, Lu Z, Li Y (2011) Efficacy and safety of Q-switched 1,064-nm neodymium-doped yttrium aluminum garnet laser treatment of melasma. Dermatol Surg 37(7):962–970

    Article  CAS  PubMed  Google Scholar 

  9. Cho SB, Kim JS, Kim MJ (2009) Melasma treatment in Korean women using a 1064-nm Q-switched Nd:YAG laser with low pulse energy. Clin Exp Dermatol 34(8):e847–e850

    Article  CAS  PubMed  Google Scholar 

  10. Suh KS, Sung JY, Roh HJ, Jeon YS, Kim YC, Kim ST (2011) Efficacy of the 1064-nm Q-switched Nd:YAG laser in melasma. J Dermatolog Treat 22(4):233–238

    Article  PubMed  Google Scholar 

  11. Wattanakrai P, Mornchan R, Eimpunth S (2010) Low-fluence Q-switched neodymium-doped yttrium aluminum garnet (1,064 nm) laser for the treatment of facial melasma in Asians. Dermatol Surg 36(1):76–87

    Article  PubMed  Google Scholar 

  12. Sim JH, Park YL, Lee JS et al (2014) Treatment of melasma by low-fluence 1064 nm Q-switched Nd:YAG laser. J Dermatolog Treat 25(3):212–217

    Article  CAS  PubMed  Google Scholar 

  13. Brown AS, Hussain M, Goldberg DJ (2011) Treatment of melasma with low fluence, large spot size, 1064-nm Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser for the treatment of melasma in Fitzpatrick skin types II-IV. J Cosmet Laser Ther 13(6):280–282

    Article  PubMed  Google Scholar 

  14. Anderson RR, Parrish JA (1983) Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science 220(4596):524–527

    Article  CAS  PubMed  Google Scholar 

  15. Kim MJ, Kim JS, Cho SB (2009) Punctate leucoderma after melasma treatment using 1064-nm Q-switched Nd:YAG laser with low pulse energy. J Eur Acad Dermatol Venereol 23(8):960–962

    Article  CAS  PubMed  Google Scholar 

  16. Kim T, Cho SB, Oh SH (2010) Punctate leucoderma after 1,064-nm Q-switched neodymium-doped yttrium aluminum garnet laser with low-fluence therapy: is it melanocytopenic or melanopenic? Dermatol Surg 36(11):1790–1791

    Article  CAS  PubMed  Google Scholar 

  17. Kroon MW, Wind BS, Beek JF et al (2011) Nonablative 1550-nm fractional laser therapy versus triple topical therapy for the treatment of melasma: a randomized controlled pilot study. J Am Acad Dermatol 64(3):516–523

    Article  PubMed  Google Scholar 

  18. Karsai S, Fischer T, Pohl L et al (2012) Is non-ablative 1550-nm fractional photothermolysis an effective modality to treat melasma? Results from a prospective controlled single-blinded trial in 51 patients. J Eur Acad Dermatol Venereol 26(4):470–476

    Article  CAS  PubMed  Google Scholar 

  19. Jang WS, Lee CK, Kim BJ, Kim MN (2011) Efficacy of 694-nm Q-switched ruby fractional laser treatment of melasma in female Korean patients. Dermatol Surg 37(8):1133–1140

    Article  CAS  PubMed  Google Scholar 

  20. Hilton S, Heise H, Buhren BA, Schrumpf H, Bolke E, Gerber PA (2013) Treatment of melasma in Caucasian patients using a novel 694-nm Q-switched ruby fractional laser. Eur J Med Res 18:43

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kim EH, Kim YC, Lee ES, Kang HY (2007) The vascular characteristics of melasma. J Dermatol Sci 46(2):111–116

    Article  CAS  PubMed  Google Scholar 

  22. Kang HY, Bahadoran P, Suzuki I et al (2010) In vivo reflectance confocal microscopy detects pigmentary changes in melasma at a cellular level resolution. Exp Dermatol 19(8):e228–e233

    Article  PubMed  Google Scholar 

  23. Lee DJ, Lee J, Ha J, Park KC, Ortonne JP, Kang HY (2012) Defective barrier function in melasma skin. J Eur Acad Dermatol Venereol 26(12):1533–1537

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Ms. Yue Hu (Dermatology, Huashan Hospital) for her assistance of the skin measurements of the trial.

Author information

Author notes

    Authors and Affiliations

    1. Department of Dermatology, Huashan Hospital, Fudan University, No. 12 Wulumuqi Road, Jing’an District, Shanghai, 200040, China

      Baishuang Yue, Qianli Yang, Jinhua Xu & Zhong Lu

    Authors
    1. Baishuang Yue
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Qianli Yang
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Jinhua Xu
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Zhong Lu
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Zhong Lu.

    Additional information

    Baishuang Yue and Qianli Yang contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Yue, B., Yang, Q., Xu, J. et al. Efficacy and safety of fractional Q-switched 1064-nm neodymium-doped yttrium aluminum garnet laser in the treatment of melasma in Chinese patients. Lasers Med Sci 31, 1657–1663 (2016). https://doi.org/10.1007/s10103-016-2034-4

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s10103-016-2034-4

    Keywords

    Search

    Navigation