Combo laser therapies boost melasma treatment, tattoo removal
Dermatologists are discovering new laser therapies that improve treatment for melasma (a skin disease that causes overproduction of melanin) and remove tattoos more safely and effectively than laser procedures used in the past.
Dermatologists are discovering new laser therapies that improve treatment for melasma (a skin disease that causes overproduction of melanin) and remove tattoos more safely and effectively than laser procedures used in the past, says dermatologist Arielle N.B. Kauvar, MD, FAAD, clinical professor of dermatology at New York University School of Medicine (New York, NY).
Fractional lasers have been used more recently in treating melasma, but there have been reports of an increased incidence of the disease recurring as well. Kauvar notes that effective treatment of mixed-type melasma requires a very low-energy and low-impact procedure because irritation and inflammation can worsen the disease. So Kauvar combines microdermabrasion, a low-energy laser treatment with a Q-switched YAG laser, and a topical, pigment-suppressing skin care regimen using hydroquinone and sunscreen, which has shown to be painless, noninvasive, safe on any skin type, and requires no downtime, she says.
The low-energy laser treatment is high enough to break up the pigment without heating the skin, says Kauvar. She notes that melasma is a chronic disease, like psoriasis or eczema, that can be controlled but not cured. With their combination therapy they have been able to control melasma more effectively and extend the remission periods, and patients are more motivated to continue their recommended skin care regimen to help control flares, she says.
In Kauvar’s study of 27 women with mixed-type melasma, 22 subjects (81 percent) experienced greater than 75 percent improvement of their melasma after an average of 2.6 laser treatments. Of those, 11 subjects (40 percent) achieved over 95 percent improvement of their melasma. In addition, she found that clearance of melasma was maintained for at least six months.
In tattoo removal, the biggest drawbacks are the time, expense, pain, and healing involved, as lasers have been used to remove tattoos for several years but the procedure requires multiple treatment sessions (typically six to 10 treatments or more) that are painful and require a few weeks of healing time between sessions, says Kauvar. What's more, the process of tattoo ink removal is inefficient since every color of ink absorbs different wavelengths of light, requiring the use of multiple lasers, she says. Some colors--such as yellow, orange, turquoise, or fluorescent ones--remain more difficult to treat.
A new study led by Kauvar uses the Q-switched YAG laser to treat a tattoo four times in one day. These four separate treatments are administered at 20-minute intervals and have demonstrated much faster clearance of tattoo inks. Other research involves the use of the fractional ablative laser in conjunction with traditional tattoo-removal lasers to speed up clearance, resulting in as much as 50-percent tattoo ink removal in just one treatment session. In another new study, Kauvar is investigating the effectiveness of administering two treatments in one day using a combination of laser wavelengths to target different ink colors. With this procedure, she first uses a Q-switched YAG laser on the tattoo, followed by a Q-switched alexandrite laser (which is better at treating blues and greens) 20 minutes after the first laser. Initial results of this procedure have shown significant improvement in removing blue, green, and black inks, but Kauvar notes that there is no ideal laser yet to remove all tattoo colors. However, new approaches have recently been introduced that appear to produce better results with fewer treatment sessions, she says.
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