Efficacy Of Intense Pulsed Light (IPL) With Q-Switched Nd:YAG Laser (1064nm Wavelength) To Alleviate Melasma

Objective: To observe and evaluate the clinical efficacy and safety of a treatment method that combines Intense Pulsed Light(IPL)with Q-Switched Nd:YAG laser(1064nm wavelength)to alleviate melasma.Methods: The data of the study was selected from patients who visited the ANGEL WINGS METIME PLASTIC COSMETOLOGY HOSPITAL OF CHENGDU between May,2013 and Janury,2015 and demanded treatment of melasma.Medical history of those who accepted regular treatments and follow-up visits were closely examined.Some melasmic patients were treated with IPL using a Brilliant 360 platform manufactured in Israel by Alma Lasers Ltd.Others received Q-Switched Nd:YAG Laser therapy(1064nm wavelength)from a MedLiteC6 made in the US by HoYa ConBio Corporation.Another group of patients experienced the combined treatment of IPL and Q-Switched Nd:YAG Laser that we had mentioned above.All 87 of the samples were female patients,of which 32 cases were IPL treated,25 cases were Nd:YAG laser treated,and 30 cases were treated with combined treatment.The age of the patients averaged 29.7 years,while the average clinical history of melasma was 7.4 years.In response to the specific Fitzpatrick Classification Scale,skin color,patch color,and patch area,the treatment equipment was adjusted accordingly.Different wave lengths,energy densities,pulse widths,flare sizes and frequencies were configured on the platform.The course of the treatment lasted for 10 separate sessions,and the sessions took place every 4 weeks.One fixed spot of the skin was designated for observation.A VISIA skin analysis imaging system was employed to quantify and document the skin image,spot count,scores and percentile scores before each session.Before each session and as well as one month after the last session,the same medical staff collected the image data of the designated observation spot and kept the data on file.3 months after the course of treatment,patients' adverse reactions,if any existed,were carefully observed and reported during follow-up visits.Also,the subjective satisfaction levels of both the patient and the doctor were evaluated.Results: In the course of melasma treatments,The absolute value of number of patches decreases as the amount of sessions increases,the difference is statistically significant(P<0.05);When comparing the fading rate of the patches between IPL treatment and Nd:YAG laser treatment,we noticed that for the first 5 sessions of the treatment,the fading rate of IPL is obviously faster than Nd:YAG.However,after the 10 th treatment,the difference between the two groups is no longer statistically significant.The combined treatment of the two methods showed faster reaction than when used separately.In 3 months of follow-up visits,no patient reported adverse reactions whatsoever.The group with IPL treatment showed a basic cure rate of 50.0%,total effective rate of 78.1%;the group with Nd:YAG laser treatment had a basic cure rate of 72.0%,total effective rate of 84.0%;As for the combined treatment method,the basic cure rate was 86.7%,while total effective rate was 93.3%.The differences between the groups were statistically significant(P<0.05).The percentage of doctors satisfied by the treatment: IPL group was 71.9%,Nd:YAG laser group was 84.0%,combined treatment group had 93.3%.The percentage of patients satisfied by the treatment: 75.0% of the IPL group reported satisfactory results,while 88.0% of the Nd:YAG group,and 96.7% of the combined group claimed to be satisfied.The difference between the percentage of doctors and patients was not statistically significant(P>0.05).Conclusion: The combined treatment of Intense Pulsed Light(IPL)and Q-Switched Nd:YAG laser is significantly more effective than that used separately.This combined treatment is safe and free of adverse reactions.The rate at which the patch fades is dependent on the amount of sessions,color of the skin,color of the patch and the area of the patch before treatment.The combined treatment is satisfactory for both the patients and the doctors.