• #2-6. Mottled hypopigmentation from laser toning in the treatment of melasma : histopathologic characteristics and management



    4. Conclusion


     The pathogenesis if laser toning-induced hypopigmentation or dyspigmentation (LTID) has not been fully understood yet. Recent histopathological studies on LTID tend to agree that hypopigmentation is caused by impaired ability to create mature melanosomes in melanocytes, rather than cell death of melanocytes. However, this is yet to be proven and a controversial issue.


    There is serious lack of scientific evidence for LTID treatments and prognosis. As we have emphasized repeatedly, we believe that ‘prevention’ is the most important and effective action in the treatment of LTID. Once any sign suggesting the occurrence of hypopigmentation is observed, LT should be immediately stopped and phototherapy and other methods can be tried for functional improvement or replacement of melanocytes. To improve preexisting melasma and reduce the color contrast between melasma lesion and hypopigmentation, melasma treatment including LT can be resumed with much gentler parameters and more caution than those used in the previous treatment sessions.


    [Ad. ▶HYPERION(Nd:YAG) - Manufacturer: LASEROPTEK(www.laseroptek.com)

    HELIOSⅡ/LOTUSⅡ/HYPERION – Manufacturer: LASEROPTEK(www.laseroptek.com)



    The pathophysiology and etiology of hypopigmentation are still unclear. There are only few published literatures and no study has examined these topics systematically. Dermatologists should collect organized data from patients with LTID such as clinical manifestations of melasma, laser toning parameters, clinical and histological characteristics of hypopigmentation, and long-term follow-up outcome. As we analyze the data systematically, effectual and predictable treatment modalities in LTID can be established. Furthermore, this will serve as a foundation for improving our knowledge on pathophysiology of melasma and developing more effective melasma treatments.


    -To be continued.

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