Q-switched Nd-Yag lasers have proven useful for treating deep-pigmented lesions, such as nevi of Ota and tattoos in dark skinned persons, with a reduction in the risk of epidermal injury (57). Freckles and lentigines in Fitzpatrick prototypes IV or prototypes IV-IV can also be successfully treated with the Q-Switched Nd-Yag laser. Minimum adverse reactions and […]

Q-switched alexandrite lasers combined with chemical peels have been used to successfully treat acquired bilateral nevus of Ota, freckles, PIH, and recalcitrant dermal melasma in Korean patients with Fitzpatrick skin types IV-VI. The combination is effective and safe (55) . Statistically significant results were achieved in a study group of Koreans with Fitzpatrick skin types […]

Pigment-specific lasers (pulse-dye pigment, Q-switched alexandrite CO2, Q-switched ruby, and Q-switched Nd-Yag) are generally recommended only for recalcitrant melasma following the failure of all other therapies. On the other hand, these lasers are the treatment of choice for isolated pigmented lesions, such as lentigos (49). Q-Switched Ruby Lasers Q-switched ruby lasers have been successfully used […]

The combination of CO2 and Q-switched alexandrite lasers has produced better results than the Q-switched alexandrite laser alone. In a study done in Thailand, six women were treated on one side of the face with combined ultrapulse CO2 laser and Q-switched alexandrite laser, and on the other side with the Q-switched alexandrite laser alone. The […]

CO2 and erbium resurfacing lasers are commonly used in the treatment of photoaging and acne scarring. They are seldom used for treating pigmentary disorders. Although no general consensus exists on the value of CO2 laser treatment for hyperpigmentation disorders, some authors have reported its use in recalcitrant melasma.

Dermabrasion is rarely used in pigmentary disorders. One Asian study involving 410 patients with recalcitrant melasma treated with dermabrasion reported 97% clearing. Erythema and PIH was seen following dermabrasion, and partial recurrence of pigmentation can occur following initial clearance of melasma (43). No clinical trials of combination therapy with dermabrasion and other physical therapies or […]

Aluminum oxide crystal microdermabrasion was developed in 1995 (41). This process produces superficial epidermal abrasion, and has been used primarily for facial scarring and photodamage. No clinical studies have been done in melasma or any other hyperpigmentation disorder. Although data are lacking in this regard, the effect of microdermabrasion on accelerating the epidermal barrier function […]

Chemical peels with glycolic acid, trichloroacetic acid, Jessner’s solution, kojic acid, salicylic acid, and tretinoin are used in the treatment of melasma. Peels are usually done as adjunctive therapy or when faster results are desired. Glycolic acid peels in concentrations ranging from 10% to 70% can produce excellent results in dark skinned patients, as well […]

This section will focus on physical therapies and lasers, concentrating on the most common hyperpigmenting disorders seen in our daily dermatology practice: lentigines, melasma, pigmentation of aging, and PIH. We will also discuss the use of combination therapies in managing these disorders. Most authors believe that physical therapies have a place in the treatment of […]