Lucas LC Chia: Treatment of Recalcitrant Melasma with Erbium:YAG Laser
Melasma represents a chronic inflammatory pigment disorder. Current treatment strategies aim at accelerating epidermal cell turnover, slowing down melanin synthesis, destroying melanin and melanosomes, reducing vascular inflammation and UV protection.
The treatment outcome of melasma is unpredictable and complications are often seen. It is not uncommon to encounter recalcitrant cases which can be traumatizing for both the clients and the clinicians.
The use of Erbium:YAG laser in treating recalcitrant cases are well documented. It is believed that the high affinity for water absorption of the Erbium:YAG laser can indirectly reduce melanin deposits from both the epidermis and dermis by vaporization of melanocytes, inducement of melanophage disruption as well as improved cellular turnover. Erbium:YAG laser is associated with long downtime and the outcome too can be unpredictable.
However, when using the SP Dynamis FS01 applicator (Fotona, Slovenia), a full epidermal thickness ablation can be safely achieved with minimal residual heat (heat can potentially worsen the melasma). Full epidermal thickness is important as the target is melanocytes which are located at the basal layer of the epidermis. Based on the various anecdotal evidence, the author has established that the most optimal parameter for the FS01 applicator for the treatment of melasma is a fluence of between 18-22 J/cm2, MSP.
The use of Erbium:YAG laser should not be restricted to patients with recalcitrant disease. It should be part of an early treatment protocol.
Further clinical studies are needed.