• #10-3. Treatment of pigmented lesions

     

    Some conservative patients are averse to Q-switched laser as it has a significant downtime with crusts and the necessity of wearing a protective tape. However, the mass media tout laser as the ultimate solution to melasma and as patients are already aware that they have to wear the post-treatment protective tape, those with a strong will to improve their melasma are becoming less resistant to laser. However, patients still need to have a better understanding of the possible PIH that can arise after treatment. PIH occurs in about half of Japanese patients. Some rush to the doctor’s office as soon as signs arise and demand more laser treatment. Many patients also have the unrealistic expectation that laser will magically clear away all melamsa lesions. It is important to clearly communicate with the patient before initiating the treatment.

    I have discussed the types of Q-switched laser in the previous articles. In Japan, two Japan-manufactured ruby lasers are commonly used. Imported alexandrite lasers are also in distribution but it is difficult to say which is superior. My practice has both lasers and I think each has unique advantages and disadvantages. Ruby laser has high absorption in melanin and is effective, whereas alexandrite has excellent depth of delivery and speed (number of oscillations per second). Q-switched KTP laser seems to be used in clinics that do not specialize in dermatologic laser treatments.

     

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    Many other lasers are used in melasma including long pulsed KTP laser, pulsed dye laser, or long pulsed alexandrite laser, etc. Especially, long pulsed alexandrite laser was originally used in hair loss and was popular in the so-called laser facial treatments where it was irradiated over the entire face for improving the overall tone and elasticity. This laser is still popular in many simple procedures.

    Many types of IPL devices are available. Most are directly imported by individual doctors and some are being officially imported as medical devices with the vague classification as therapeutic infrared devices with the approval of the Ministry of Health, Labour and Welfare. Korean doctors may find this difficult to understand. When doctors individually import these devices, leasing is not an option and the cost has to be paid either in entirety or installments. Approved devices can be leased and this makes it easier for doctors with limited funds to obtain them.

     

    -To be continued-

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