Skip to main content
SpringerLink
Log in

Melasma and low-energy Q-switched laser: treatment assessment by means of in vivo confocal microscopy

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

Abstract

Melasma is an acquired disorder of pigmentation for which several therapeutical options are currently available. Among them, low-energy Q-switched Nd:YAG laser (1,064 nm) has been successfully applied in case series although its long-term efficacy has yet to be proven. In vivo confocal microscopy is a novel imaging technique that permits to explore the skin tissue at a nearly histologic resolution. The aim of our study was to evaluate the laser treatment efficacy by means of confocal microscopy at different time points to elucidate the mechanism of action of the laser and its possible drawbacks. Eight women who presented with melasma on the face were subjected to low-energy Q-switched Nd:YAG laser treatment and then analyzed by means of confocal microscopy. An overall improvement of melasma was noticed clinically and microscopically by means of confocal microscopy. Four cases revealed the presence of dendritic-shaped cells upon confocal microscopy and those patients were the ones presenting with a relapse of the disease. The interpretation of these cells is that they could represent reasonably activated melanocytes. This opens the question whether laser treatment should be modulated to avoid side-effects associated with its use. Confocal microscopy has emerged as an excellent tool for a better understanding of the changes occurring during laser treatment.

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

Abbreviations

DEJ:

Dermo-epidermal junction

References

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  3. Rendon M, Berneburg M, Arellano I, Picardo M (2006) Treatment of melasma. J Am Acad Dermatol 54:S272–S281

    Article  PubMed  Google Scholar 

  4. Wanitphakdeedecha R, Manuskiatti W, Siriphukpong S, Chen TM (2009) Treatment of melasma using variable square pulse Er:YAG laser resurfacing. Dermatol Surg 35:475–481

    Article  CAS  PubMed  Google Scholar 

  5. Angsuwarangsee S, Polnikorn N (2003) Combined ultrapulse CO2 laser and Q-switched alexandrite laser compared with Q-switched alexandrite laser alone for refractory melasma: split-face design. Dermatol Surg 29:59–64

    Article  PubMed  Google Scholar 

  6. Tourlaki A, Galimberti MG, Pellacani G, Bencini PL (2012) Combination of fractional erbium-glass laser and topical therapy in melasma resistant to triple-combination cream. J Dermatolog Treat 12 Apr 2012. doi:10.3109/09546634.2012.671911

  7. Bansal C, Naik H, Kar HK, Chauhan A (2012) A comparison of low-fluence 1,064-nm Q-Switched Nd: YAG Laser with topical 20 % azelaic acid cream and their combination in melasma in Indian patients. J Cutan Aesthet Surg 5(4):266–272

    Article  PubMed Central  PubMed  Google Scholar 

  8. Bansal C, Naik H, Kar HK, Chauhan A (2012) Efficacy and safety of Q-Switched 1,064-nm neodymium-doped yttrium aluminum garnet laser treatment of melasma. J Cutan Aesthet Surg 5(4):266–272

    Article  PubMed Central  PubMed  Google Scholar 

  9. Bencini PL, Cazzaniga S, Tourlaki A, Galimberti MG, Naldi L (2012) Removal of tattoos by q-switched laser: variables influencing outcome and sequelae in a large cohort of treated patients. Arch Dermatol 148(12):1364–1369

    Article  PubMed  Google Scholar 

  10. Kim JE, Chang SE, Yeo UC, Haw S, Kim IH (2013) Histopathological study of the treatment of melasma lesions using a low-fluence Q-switched 1,064-nm neodymium:yttrium-aluminium-garnet laser. Clin Exp Dermatol 38(2):167–171

    Article  CAS  PubMed  Google Scholar 

  11. Longo C, Zalaudek I, Argenziano G, Pellacani G (2012) New directions in dermatopathology: in vivo confocal microscopy in clinical practice. Dermatol Clin 30(4):799–814

    Article  CAS  PubMed  Google Scholar 

  12. Longo C, Galimberti M, De Pace B, Pellacani G, Bencini PL (2013) Laser skin rejuvenation: epidermal changes and collagen remodeling evaluated by in vivo confocal microscopy. Lasers Med Sci 28(3):769–776

    Article  PubMed  Google Scholar 

  13. Longo C, Casari A, Beretti F, Cesinaro AM, Pellacani G (2013) Skin aging: in vivo microscopic assessment of epidermal and dermal changes by means of confocal microscopy. J Am Acad Dermatol 68(3):e73–e82

    Article  PubMed  Google Scholar 

  14. Kang HY, Bahadoran P, Suzuki I, Zugaj D, Khemis A, Passeron T, Andres P, Ortonne JP (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 

  15. Ardigo M, Cameli N, Berardesca E, Gonzalez S (2010) Characterization and evaluation of pigment distribution and response to therapy in melasma using in vivo reflectance confocal microscopy: a preliminary study. J Eur Acad Dermatol Venereol 24(11):1296–1303

    Article  CAS  PubMed  Google Scholar 

  16. Scope A, Benvenuto-Andrade C, Agero AL, Malvehy J, Puig S, Rajadhyaksha M, Busam KJ, Marra DE, Torres A, Propperova I, Langley RG, Marghoob AA, Pellacani G, Seidenari S, Halpern AC, Gonzalez S (2007) In vivo reflectance confocal microscopy imaging of melanocytic skin lesions: consensus terminology glossary and illustrative images. J Am Acad Dermatol 57(4):644–658

    Article  PubMed  Google Scholar 

  17. Langley RG, Burton E, Walsh N, Propperova I, Murray SJ (2006) In vivo confocal scanning laser microscopy of benign lentigines: comparison to conventional histology and in vivo characteristics of lentigo maligna. J Am Acad Dermatol 55(1):88–97

    Article  PubMed  Google Scholar 

  18. Guitera P, Pellacani G, Crotty KA, Scolyer RA, Li LX, Bassoli S, Vinceti M, Rabinovitz H, Longo C, Menzies SW (2010) The impact of in vivo reflectance confocal microscopy on the diagnostic accuracy of lentigo maligna and equivocal pigmented and nonpigmented macules of the face. J Invest Dermatol 130(8):2080–2091

    Article  CAS  PubMed  Google Scholar 

  19. Middelkamp-Hup MA, Park HY, Lee J, Gilchrest BA, Gonzalez S (2006) Detection of UV-induced pigmentary and epidermal changes over time using in vivo reflectance confocal microscopy. J Invest Dermatol 126(2):402–407

    Article  CAS  PubMed  Google Scholar 

  20. 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 

Download references

Acknowledgement

We thank Doctor Alex Witkowski for the English editing of this manuscript.

Conflicts of interest

The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy

    Caterina Longo

  2. Dermatology Unit, University of Modena and Reggio Emilia, 41121, Modena, Italy

    Giovanni Pellacani

  3. I.C.L.I.D. (Institute of Surgery and Laser surgery in Dermatology), 20121, Milan, Italy

    Athanasia Tourlaki, Michela Galimberti & Pier Luca Bencini

Authors
  1. Caterina Longo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giovanni Pellacani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Athanasia Tourlaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michela Galimberti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pier Luca Bencini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Caterina Longo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Longo, C., Pellacani, G., Tourlaki, A. et al. Melasma and low-energy Q-switched laser: treatment assessment by means of in vivo confocal microscopy. Lasers Med Sci 29, 1159–1163 (2014). https://doi.org/10.1007/s10103-013-1498-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10103-013-1498-8

Keywords

Search

Navigation