Army Medical College, Pakistan
Title: Lasers and light based treatments for refractory melasma in Asian patients: Where do we stand?
Zafar Shaikh is Professor of Dermatology at Army Medical College, and Consultant Dermatologist Military Hospital Pakistan. He is trained in Dermato-Venereology at University Hospitals, London and Manchester (UK), and in Cutaneous Laser Surgery at the Skin & Laser Surgery Center Boston, USA. He is member of the faculty of Dermatology College of Physicians & Surgeons Pakistan and an associate member of the American Society of Laser Medicine & Surgery. He is also member of the editorial boards of Journal of Pakistan Association of Dermatologists and Pakistan Armed Forces Medical Journal. He has published 30 research papers in indexed journals.
Melasma is acquired disorder of hypermelanosis with great psychosocial concern. The treatments with various conventional therapies are often unsatisfactory and recurrence following cessation of these treatments is frustrating both for physicians and patients. Lasers and light sources have been used to treat melasma, but in Asian skin with higher melanin content such treatments may be challenging. The pigment specific lasers such as QS Nd:YAG, QS Ruby and QS Alexandrite have shown variable results. A "confetti-like" hypopigmented macules and rebound hyperpigmentation were reported in Asian patients treated with low fluence QS Nd:YAG (1,064 nm) laser. Promising results were reported with fractional photothermolysis (1,550nm), but published data shows that this may not be the treatment of choice for darker complexions. Some studies documented favorable outcomes in melasma treated with Intense Pulsed Light but darkening and sloughing of skin at treated sites, and post-inflammatory dyspigmentation were noteworthy side effects. To improve the treatment outcome several trials combined lasers and light based therapies with topical bleaching agents like hydroquinone (modified Kligman's formula), azelaic acid and glycolic acid. Better results were observed with combination therapies than monotherapy. We conducted a clinical trial on 65 patients with refractory melasma and Fitzpatrick skin phototypes III to V, using Fluorescent Pulsed Light (570-950nm) and topical 5% magnesium ascorbyl phosphate. The results of our trial and most other studies on treatment of melasma with lasers and light based therapies demonstrated suppression of melanogenesis but the effect was not sustained and additional treatment sessions were recommended for maintenance.