A prospective, randomized, double-blind comparison of an ablative fractional 2940-nm erbium-doped yttrium aluminum garnet laser with a nonablative fractional 1550-nm erbium-doped glass laser for the treatment of photoaged Asian skin.

BACKGROUND: As compared with ablative fractional CO2 laser, ablative fractional erbium-doped yttrium aluminum garnet (Er:YAG) laser is considered to be a more suitable treatment option for photoaged skin in Asians due to the lower incidence of postinflammatory hyperpigmentation. OBJECTIVE: To compare the efficacy and safety of ablative fractional Er:YAG laser (ablative fractional resurfacing [AFR]) and nonablative fractional 1550-nm Er:glass laser (non-AFR [NAFR]) in the treatment of photoaging. METHODS: This was a prospective, randomized, double-blinded comparative study. In three sessions, at four-week intervals, 19 patients received Er:YAG AFR, and 15 patients received Er:glass NAFR. Pigmentation, uneven tone/erythema, wrinkles and overall features of photoaging were scored. Patient satisfaction, adverse effects and pain scores were recorded. Melanin and erythema indexes were measured. RESULTS: Reductions in pigmentation and uneven tone/erythema scores were significantly greater after Er:YAG AFR, while wrinkle score reduction was significantly greater after Er:glass NAFR. Physician and patient assessments for the overall features showed greater improvement in the Er:glass NAFR. Treatment-related pain or adverse events were less in the Er:YAG AFR. CONCLUSION: Both Er:YAG AFR and Er:glass NAFR are effective and safe and could be used in a complementary manner for treating photoaged Asian skin.

A prospective, split-face, randomized study of the efficacy and safety of a novel fractionated intense pulsed light treatment for melasma in Asians.

BACKGROUND: Intense pulsed light (IPL) has been reported to effectively treat melasma in previous studies, but an aggravation of pigmentation was noted. Fractionated IPL is a novel technique in which microsecond-domain fractionated pulses are delivered to the target area. OBJECTIVE: To compare the safety and efficacy of low-fluency, frequently scheduled fractionated IPL and conventional IPL for melasma treatment. MATERIALS AND METHODS: This was a 14-week, split-face study in which 30 Asian women were treated with weekly fractionated IPL on one side of the face and biweekly conventional IPL on the other side. RESULTS: The non-inferiority of a weekly fractionated IPL regimen to a biweekly conventional IPL regimen was verified by a lower margin of the 95% confidence interval for the difference in the Melasma Area and Severity Index (MASI) change from baseline of 2.61 for each side. This value was greater than the previously determined non-inferiority margin of -2.68 (P < 0.025). On the fractionated IPL side, the modified MASI score decreased continuously, but in the conventional IPL group, the MASI score rebounded during the treatment course. CONCLUSION: Fractionated IPL shows moderate efficacy as a melasma treatment and is therefore a good alternative to conventional IPL as there is no indication of melasma exacerbation. Fractionated IPL can also be used as a maintenance treatment for melasma.

Combination treatment of low-fluence 1,064-nm Q-switched Nd: YAG laser with novel intense pulse light in Korean melasma patients: a prospective, randomized, controlled trial.

BACKGROUND: Recently, intense pulsed light (IPL) and low-fluence Q-switched neodymium-doped yttrium aluminum (LF-QS-Nd:YAG) laser have been successfully used to treat melasma. OBJECTIVE: To evaluate the effectiveness and safety of combined novel fractionated IPL (IPL-F) with LF-QS-Nd:YAG laser in patients with melasma. METHODS: Twelve patients underwent 6 treatment sessions of concomitant IPL-F and LF-QS-Nd:YAG laser (combination group), and 12 patients underwent 6 treatment session of IPL-F alone (IPL only group). Partial melasma area and severity index (MASI) scores were evaluated by 2 dermatologists using digital photography. RESULTS: In the combination group, the partial MASI score has significantly decreased by 47% at 1 month after the treatment (p < .05) and 50% at 2 months after the last treatment (p < .01). At 1 month and 2 months after the treatment, the decrease in the partial MASI score of the combination group was significantly larger than that of the IPL only group (p < .05). In both groups, treatment with IPL-F and LF-QS-Nd:YAG laser was well tolerated. CONCLUSION: Our results suggest that the combination of the IPL-F with LF-QS-Nd:YAG laser may be an effective and safe modality for melasma patients.

Clinical efficacy of the dual-pulsed Q-switched neodymium:yttrium-aluminum-garnet laser: Comparison with conservative mode.

The quality (Q)-switched neodymium:yttrium-aluminum-garnet (Nd:YAG) laser is one of the first non-ablative lasers to be used for facial resurfacing and photorejuvenation. Recently, the method of low-fluence Q-switched Nd:YAG lasers known as 'laser toning' has been used for non-ablative skin rejuvenation and for the treatment of melasma in Asian countries. We report our experience of using a novel Q-switched Nd:YAG laser that was operated as a dual pulse at half fluence and 140-µs intervals compared with conservative mode laser.