• #7-2. Melasma Treatment: Basic Principles & Clinical Applications


    ▶ Previous Artlcle : #7-1. Melasma Treatment: Basic Principles & Clinical Applications


    Cases of Side Effects


    <Figure 5> shows a case of nevus-of-Ota like macule. She visited my clinic after sustaining wounds from a dot peeling procedure. I recommend avoiding dot peeling for ABNOM. Postprocedural side effects are the biggest challenge for dermatologists.


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    Figure 5


    Melasma in <Figure 6> can be easily removed by a properly-prescribed topical agent. This patient did not show much response to retinoid acid for the initial 6 months, but subsequently, the melasma was completely removed by increasing the concentration of retinoid acid. In most cases, melasma recurs within a certain period of time. However, patients always want complete removal of melasma and tend to go from one clinic to another looking for the perfect cure. Recurrence is inevitable even with laser toning. Conversely, if it does not recur, it may very well not be "real" melasma.


    Figure 6


    The patient in <Figure 7> underwent laser toning. You can see the depressed boundaries around where melasma was present. Patients express satisfaction when the melasma is visibly reduced, even only slightly, and complains when melasma becomes thicker. It is important that laser toning or IPL should be applied mildly. Relatively safe E-Toning can lead to side effects, if applied strongly.


    Figure 7


    <Figure 8> shows a case of IPL therapy. Side effects were predicted and even a reduced energy output resulted in black lesions (four days after the procedure). This case may seriously deteriorate if an average energy level of IPL is applied. Both sides of the forehead are vulnerable sites with abundant pigments. Even a mild irradiation led to such a result. As seen here, IPL procedures pose a lot of challenges to the practitioner.


    Figure 8

    IPL is not a simple procedure. The skin was originally weak and the patient experienced side effects, including itching and blisters after receiving IPL at another clinic.

    → So, I applied a low level of energy – (PE: the skin is thin and dark, with nevus-of-Ota like macules on both ends of the forehead.)

    → The patient said that, on one day after Tx, she has suffered from unbearable itching of the forehead and scratching led to blisters.


    Laser Therapy is a Fight to Reduce Side Effects


    <Figure 9-1> shows a case of a side effect from changing the IPL head, which increases energy output. It is a known fact that changing the head increases energy output, however, it is still habitually performed. I carefully selected low energy for several days after changing the head, and then one day set the Joules as usual out of habit.


    Figure 9-1


    <Figure 9-2> shows the patient cured of the side effect, after sixteen months of treatment. The lesion is only barely visible. If side effects cannot be avoided, the doctor should still make sure that it is reversible.


    Figure 9-2


    <Figure 10> shows blackened lesions after only a single procedure. It was considered as scattered blemishes at first, but a single test IPL revealed melasma. It is hard to predict melasma in a case like this. It is advisable to try E-Toning first, as a measure of safe IPL, when treating an unpredictable case.


    Figure 10


    Thank you for listening. I hope this lecture would be helpful for conducting safe IPL procedures for melasma treatment with minimal side effects.




    ❶ Chapter 5. Melanosome Thermal Relaxation Time. <Laser Treatment of Facial Pigment Disorders>. Written by Dr. Won Hyoung Kang. Hansol Medical. p217-235, 2013. (Korean)

    ❷ Dr. Kang's IPL Clinic by Won Hyoung Kang Hanmi Medical Publishing, 2nd ed.. p240, 2013. (English)


    -The end-

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