What You Need To Know About Lasers For Melasma

The relationship between laser technology and dermatology goes back to 1980 when Rox Anderson and John Parrish postulated that laser technology could be used to precisely remove unwanted tissue with minimal damage to the surrounding skin (Gianfaldoni). Four years later, the FDA would write the first regulations surrounding lasers and their use for removal of lesions of the skin. Today, we discuss how lasers for melasma can help improve the appearance of this chronic skin condition.

The Types of Lasers for Melasma

Laser therapy is a sought-after treatment for the removal of melasma. However, it is tertiary treatment behind more traditional topical treatments because it does not affect the underlying causes of melasma (Trivedi). Hydroquinone, for example, disrupts melasma genesis through the inhibition of its constituent cells.

Laser treatment is sought by those patients who exhibit treatment-resistant melasma. If this is the case, there are several different lasers for melasma. These include intense pulsed light (IPL), Q-switched lasers, picosecond or pico lasers, and fractionated resurfacing lasers. Broadly speaking, they are differentiated according to the laser’s medium. Beyond these four categories, there are several different popular proprietary brands, including Picosure, Spectra, Fraxel, and Clear and Brilliant. These brands are variants of the four main types of lasers for melasma.

Intense Pulsed Light (IPL)

IPL lasers for melasma are able to target the melanin in your skin and remove excess pigment. Your dermatologist might opt for IPL over other forms of therapy if your melasma is deep in the skin. Some people are lucky in that their melasma is superficial, while others need to deal with melasma that lies in the dermis. This form of treatment can be used in these types of cases.

Another advantage of this form of therapy is that it carries less risk for postinflammatory hyperpigmentation, one of the possible side effects of more traditional laser therapy (Trivedi).

Q-switched lasers

Q-switched lasers for melasma, including the Spectra laser, have a variety of dermal related applications, including removal of birthmarks, tattoos, and other cosmetic woes. When it comes to melasma, they are able to target the melanin responsible for dark patches on the skin.

There is some evidence that suggests that other laser treatments are preferable for the specific treatment of melasma. Several studies have concluded that Q-switched lasers are not optimal because melasma patients have seen rebound hyperpigmentation after treatment (Trivedi).

Picosecond lasers

Laser technology has progressed to the point that laser pulsation at a frequency of one pulse every trillionth of a second is now possible. This picosecond frequency from which the name is derived represents the forefront of laser technology. These pulsations are so fast that they create energy in the form of sound rather than heat. This has implications for dermatology and the removal of melasma lesions: the absence of heat bypasses the issue of thermal damage, a side effect of more traditional Q-switched laser treatment.

Unfortunately, the relative youth of this specific technology has meant that there is less research to establish its efficacy on par to similar to that of standard laser treatment. However, recent research into the effect of picosecond lasers on pig skin tissue has demonstrated an immediate reduction in the appearance of melanin in the epidermis (Lee). This remains a promising form of treatment and is most commonly available on the market as PicoSure.

Fractionated lasers

Fractional laser technology, known by such brand names as Fraxel or Clear and Brilliant, is another treatment option for melasma. The technology seeks to expel cells responsible for over-pigmentation and also causes a reaction that stimulates collagen production, resulting in healthier and younger-looking skin.

Side Effects Of Laser Treatments

Side effects will vary based on the specific treatment. All laser treatment carries the risk of damaging melanocytes in a way that leaves them discolored; darker skin types are more at risk for this specific side effect.

• IPL, fractionated, and picosecond lasers are relatively well-tolerated and carry few risks of side effects. Some of these include burning, redness, and symptoms similar to that of a sunburn.
• Q-switched lasers produce thermal energy associated with occasional inflammation and burns.

Topical Melasma Treatment

Ultimately, there are a variety of treatment options for melasma, and all of them are less expensive and time-consuming than laser therapy. Topical treatments are not only less intensive than laser therapy but have a better track record for treating melasma.

Much of the research into the efficaciousness of laser treatment for melasma compares it against combination creams to determine its relative value for dermatologists. Consult a board-certified dermatologists to guide you through your melasma journey.

References

• Gianfaldoni S, Tchernev G, Wollina U, et al. An Overview of Laser in Dermatology: The Past, the Present and … the Future (?). Open Access Maced J Med Sci. 2017;5(4):526–530. Published 2017 Jul 23. doi:10.3889/oamjms.2017.130 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5535675/
• Lee HC, Childs J, Chung HJ, Park J, Hong J, Cho SB. Pattern analysis of 532- and 1,064-nm picosecond-domain laser-induced immediate tissue reactions in ex vivo pigmented micropig skin [published correction appears in Sci Rep. 2019 Dec 2;9(1):18372]. Sci Rep. 2019;9(1):4186. Published 2019 Mar 12. doi:10.1038/s41598-019-41021-7 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6414522/
• Trivedi MK, Yang FC, Cho BK. A review of laser and light therapy in melasma. Int J Womens Dermatol. 2017;3(1):11–20. Published 2017 Mar 21. doi:10.1016/j.ijwd.2017.01.004 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418955/

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Brandon Kirsch, MD

Brandon Kirsch, MD, FAAD, is a board-certified dermatologist specializing in clinical drug development and medical innovation. He is the founder of Kirsch Dermatology in Naples, Florida and is also the Chief of Dermatology at the Naples Community Hospital.