Bas S. Wind

Non-ablative 1,550 nm fractional laser therapy versus triple topical therapy for the treatment of melasma: A randomized controlled split-face study†‡

Melasma is a uichronic, often relapsing skin disorder, with poor long‐term results from all current therapies.

Nonablative 1550-nm fractional laser therapy versus triple topical therapy for the treatment of melasma: A randomized controlled pilot study

BACKGROUND Various treatments are currently available for melasma. However, results are often disappointing. OBJECTIVE We sought to assess the efficacy and safety of nonablative 1550-nm fractional laser therapy and compare results with those obtained with triple topical therapy (the gold standard). METHODS Twenty female patients with moderate to severe melasma and Fitzpatrick skin types II to V were treated either with nonablative fractional laser therapy or triple topical therapy (hydroquinone 5%, tretinoin 0.05%, and triamcinolone acetonide 0.1% cream) once daily for 8 weeks in a randomized controlled observer-blinded study. Laser treatment was performed every 2 weeks for a total of 4 times. Physician Global Assessment was assessed at 3 weeks, 3 months, and 6 months after the last treatment. RESULTS Physician Global Assessment improved (P < .001) in both groups at 3 weeks. There was no difference in Physician Global Assessment between the two groups. Mean treatment satisfaction and recommendation were significantly higher in the laser group at 3 weeks (P < .05). However, melasma recurred in 5 patients in both groups after 6 months. Side effects in the laser group were erythema, burning sensation, facial edema, and pain; in the triple group side effects were erythema, burning, and scaling. LIMITATIONS Limitations were: small number of patients; only one set of laser parameters; and a possible difference in motivation between groups. CONCLUSIONS Nonablative fractional laser therapy is safe and comparable in efficacy and recurrence rate with triple topical therapy. It may be a useful alternative treatment option for melasma when topical bleaching is ineffective or not tolerated. Different laser settings and long-term maintenance treatment should be tested in future studies.

Spatiotemporal closure of fractional laser-ablated channels imaged by optical coherence tomography and reflectance confocal microscopy.

Optical coherence tomography (OCT) and reflectance confocal microscopy (RCM) offer high‐resolution optical imaging of the skin, which may provide benefit in the context of laser‐assisted drug delivery. We aimed to characterize postoperative healing of ablative fractional laser (AFXL)‐induced channels and dynamics in their spatiotemporal closure using in vivo OCT and RCM techniques.

Melanocyte antigen‐specific antibodies cannot be used as markers for recent disease activity in patients with vitiligo

Background  Objective parameters to assess disease activity in non‐segmental vitiligo are lacking. Melanocyte antigen‐specific antibodies are frequently found in the sera of patients with vitiligo and the presence of these antibodies may correlate with disease activity.

Non-ablative 1550 nm fractional laser therapy not effective for erythema dyschromicum perstans and postinflammatory hyperpigmentation: a pilot study

Abstract Background: Erythema dyschromicum perstans and postinflammatory hyperpigmentation (PIH) are characterized by papillary dermal pigmentation or pigment incontinence. To date, no standard treatment is available. Fractional laser therapy (FLT) was recently reported to improve different pigment disorders. Objectives: To assess the efficacy and safety of non-ablative FLT in the treatment of erythema dyschromicum perstans and PIH. Methods: Eight patients with erythema dyschromicum perstans and six patients with PIH were included. In each patient, two similar test regions were randomized to receive either five fractional laser treatments in combination with intermittent daily topical bleaching or the same intermittent regimen of topical bleaching alone. Three months after the last treatment, improvement of hyperpigmentation was assessed by melanin index, reflectance spectroscopy, physicians assessment, patients assessment and patients satisfaction. In addition, a biopsy of both laser treated and control site was evaluated by an independent blinded pathologist. Results: No clinical improvement of hyperpigmentation was observed. Reflectance spectroscopy, melanin index, number of melanocytes and amount of dermal melanin did not significantly differ. Patients considered FLT unsatisfactory. Moreover, three patients developed laser-induced PIH. Conclusions: With these specific laser settings, non-ablative FLT was not effective for the treatment of erythema dyschromicum perstans and PIH.

Low yield of routine screening for thyroid dysfunction in asymptomatic patients with vitiligo

Background  Nonsegmental vitiligo is considered to be an autoimmune disease and is known to be associated with other autoimmune diseases, particularly affecting the thyroid. Screening patients with nonsegmental vitiligo for thyroid function and for the presence of thyroid autoantibodies has been recommended.

Home vs. outpatient narrowband ultraviolet B therapy for the treatment of nonsegmental vitiligo: a retrospective questionnaire study

MADAM, Narrowband ultraviolet B (NB-UVB) therapy is considered the first-line therapy for nonsegmental vitiligo. A major drawback, though, is the fact that this treatment requires months to years of frequent visits to a clinic-based phototherapy unit. For that reason home UVB therapy was introduced in 1979, mainly for psoriasis, and in the early 1990s for vitiligo as well. However, the safety, effectiveness and compliance associated with home treatment have been debated. This study is the first to provide data on the pros and cons of home vs. outpatient UVB therapy in patients with nonsegmental vitiligo. (a) (b)

Punchgraft testing in vitiligo; effects of UVA, NB-UVB and 632.8 nm Helium-Neon laser on the outcome

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Formation of Fibrosis After Nonablative and Ablative Fractional Laser Therapy

Background Fractional laser therapy (FLT) has become a widely accepted modality for skin rejuvenation and has also been used in various other skin diseases. Objective To observe long‐term histologic effects of nonablative and ablative FLT in the treatment of pigment disorders. Methods A randomized controlled observer‐blinded study was performed in 18 patients with pigment disorders. Two similar test regions were randomized to receive FLT with intermittent topical bleaching or topical bleaching alone. Patients with ashy dermatosis (AD) and postinflammatory hyperpigmentation (PIH) were treated using nonablative 1,550‐nm FLT (15 mJ/microbeam, 14–20% coverage), whereas patients with Beckers nevus (BN) were treated with ablative 10,600‐nm FLT (10 mJ/microbeam, 35–45% coverage) for three to five sessions. Biopsies were obtained 3 months after the last treatment. Results At follow‐up, dermal fibrosis was observed in four of eight patients treated using ablative FLT and no patients treated using nonablative FLT (p < .05). Conclusions Assuming that the dermal response is comparable in AD, PIH, and BN, at the given settings, ablative FLT may induce fibrosis, whereas treatment with nonablative FLT does not. Whether formation of fibrosis has to be regarded as dermal remodeling or a subtle subclinical form of scarring should be investigated in future research.