Laser toning refers to a melasma treatment that uses repeated high Hz irradiation of a low power Q-switched Nd:YAG laser. It has been established as a popular treatment of melasma in Korea and is widely used as an aggressive treatment for the condition in Japan as well.

 

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Various countries around the world use the Q-switched Nd:YAG laser as well as Q-switched Alexandrite laser, KTP laser, and even Long Pulsed laser or Fractional Ruby laser, etc. in laser toning. A laser that minimizes epidermal damage and causes no downtime (crusting and erythema, etc.) can be used in laser toning. However, many uncertainties remain as to which device may be more appropriate. Moreover, high performance means stronger effect on melanin as well as higher risk of skin damage and side effects. Therefore, the balance between efficacy and risk is important.

Laser toning has been recognized as a major treatment modality for melasma in Asian countries. However, in Japan, skepticism exists regarding the use of a Q-switched Nd:YAG laser in laser toning. Controversy also exists over using lasers with different wavelengths.

Melasma arises from friction and some doctors argue that avoiding excessive rubbing can improve melasma. Friction is one of major causes of melasma along with sun exposure, hormonal imbalance, and dryness. However, friction alone cannot sufficiently explain pathophysiology of melasma which arises from complicated interaction of various factors such as direct and indirect causes of abnormal melanogenesis and external stimulation. The argument for avoiding friction seems convincing to many as avoiding friction does improve melasma to a degree.

 

-To be continued-