Derm Topics

Lasers for Melasma and PIH: Know Your Boundaries and Skin Type

Next Steps in Derm, in partnership with Pigmentary Disorders Exchange (PDE) Symposium interviewed Dr. Arielle Kauvar, clinical professor of dermatology at NYU Grossman School of Medicine. Learn the unique role lasers can play in treating melasma and post-inflammatory hyperpigmentation, especially when patients don’t respond to conventional therapy. Hear from the expert on what lasers to use when treating darker skin tones. Plus find out Dr. Kauvar’s pre-and-post treatment tips for successful outcomes.

Further Reading

If you want to read more about lasers for melasma and PIH, check out the following articles published in the Journal of Drugs in Dermatology:

New Protocol for Long-Term Results With a Multi-Pulse Nd:YAG Laser for Melasma Treatment: A Descriptive Cohort Study


Background: Melasma is a photoaging condition with a typical clinical and histological pattern under a genetic and epigenetic context. Over the years, many treatments modalities have been proposed including topical agents, oral medication, procedures, and combination treatments aiming at different aspects of the pathogenesis including photodamage, inflammation, vascularity, and pigmentation. Recently, lasers have become an alternative for the treatment of melasma using thermal energy to target, in a selective way, the chromophore found in the skin such as melanin.
Objective: This study aimed to show how we have implemented a multifactorial approach that not only treats the symptoms but addresses the primary underlying cause of melasma.
Materials and Methods: Twenty female patients with dermal and mixed melasma were admitted to Medical Art between December 2017 and April 2018 and received a four-step Fotona laser protocol. Clinical evaluation of a clearance percentage of melasma was performed 1 month after the last session by a blinded dermatologist grading the images taken during the study. Follow-up evaluation was performed at 6 and 12 months following the completion of the laser treatment, which was 6 sessions. Patients were also asked following the end of the treatment about their satisfaction, which was evaluated with a 5-point scale.
Results: This descriptive cohort study included patients with melasma who underwent the four-step laser protocol treatment at 2-week intervals. The clearance percentage score showed 70% with excellent reduction, 25% with good reduction in appearance of melasma, none of the patients with a fair reduction, and 5% with a poor reduction. The mean score of patient satisfaction was 4,65 ± 0,93 (93%).
Conclusion: Results of this study indicate that the four-step Fotona laser protocol is a safe and effective treatment option for melasma.

Getting to the Core of Contemporary Therapies for Post-Inflammatory Hyperpigmentation


Post-inflammatory hyperpigmentation (PIH) is a typical complication of inflammatory dermatoses that more frequently and severely affects people with darker skin. External insults to the skin, such as burn injuries, dermatologic treatments, and intrinsic skin disorders (eg, eczema and acne), are common causes of PIH. Individuals with darker skin are prone to develop PIH, which can cause substantial psychological suffering. PIH can be prevented or alleviated. When this happens, it is essential to point out what is causing it and treat it as soon as possible to prevent inflammation and PIH from progressing. If the inflammatory symptoms go away or there is no evidence of inflammation at the time of diagnosis, PIH treatments should be evaluated. To hasten the resolution of PIH, treatment should begin as soon as possible. Treatment begins with the care of the initial inflammatory condition. Topical medications, chemical peels, laser and light-based treatment, phototherapy, and other therapeutic modalities are offered to treat PIH. Understanding the therapy options available helps the physician in choosing the best treatment for each patient. With these backgrounds, the current review aimed to discuss the epidemiology, pathogenesis, clinical presentation, and available treatment options for the PIH.

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