Clinical Effective Analysis Of Two Lasers In Treating Melasma

Objective Melasma is a common pigmented skin disease in Asian women,and aging is the most important factor which correlated to the skin disease.The complete pathogenesis of melasma is not fully understood currently,and the area is often symmetrical on both cheeks,can also occur in the forehead,eyes,lips,nose and chin protrusions.Formation reasons are UV light,sun,genetic constitution,endocrine disorders,pregnancy,oral contraceptives,estrogen,emotional stress and anxiety,photo-toxicity drugs,antiepileptic drugs,improper use of skin care products or cosmetics and more.In the past,melasma is purely melanocyte overreaction.Recent study discovered number of blood vessels found below melasma area which associated with vascular endothelial growth factor,and highly in concentration of melanin.There are two types of treatment method,to use smear drugs,or laser treatment.Q-switched Nd:YAG laser with higher energy,multi-shot scans was used for the patients with poor response of drugs previously,but often in resulting of side effects of hyperpigmentation or hypopigmentation.Futhermore,add on with appropriate vascular laser is able to control abnormal vascular proliferation,thereby inhibiting the deterioration of melasma.In order to reduce the above side effects and enhance the efficacy of removing stains,to use both treatments are essential for best therapeutic effect.Methods1.This study used diode laser and 1064nm-Q switch Nd:YAG laser,two kinds of laser to do synchronous treatment.2.Total of 12 sessions,about 2 to 3 weeks per time.VISIA skin detector in spot percentage was taken in total of 4 times at preoperative,fourth,eighth and twelfth time point.Total of 112 patients completed the course of treatment and follow-up from January 2015 to December 2017.3.Diode laser is the first step each time,and had been setted in professional mode,spot size in 12 mm/150 ms,35 J/cm2,followed by Q-switched Nd:YAG laser which energy set to wavelength 1064 nm/spot size 6 mm,energy 3.6 J/cm2),the end point of treatment is erythema 2(E2).Results1.Patients have a positive response to various laser treatments.2.After eighth times of treatment,significant changes of spot improvement was observed,and low in risk of hyperpigmentation.3.112 patients who received 12 treatments with no repigmentation were observed.Three patients had slight depigmentation showed.Conclusion Based on the results,a variety of laser combined treatment for melasma patients shows better result,significantly improved after 8th treatment.Treatment of melanin and blood vessels in the same time provides the good result,and also reduces the side effects.There is no total cure solution for Melasma itself but we are able to control it.Also patient education and after treatment of self-care are essential to maintain a long-term treatment effect.