Abstract

Hyperpigmentary disorders, especially melasma and post-inflammatory hyperpigmentation (PIH), cause significant social and emotional stress to the patientsIn this we are describing a case with recalcitrant dermal melasma and acute PIH treated with laser treatments combined with 7% alpha arbutin and a broad‐spectrum sunscreen. There was more than 80% decrease in epidermal and dermal hyperpigmentation. The melanin manifestation at the site of the lesions reduced from 50 to 35 and 45 to 33, respectively. There was no reappearance of melasma for 1 year. 

Introduction

Melasma is the most common hyperpigmentation disorder which is hard to treat. Management for this mutilating condition accounts for more than 50% of aesthetic consultations. The lesions mainly occur on sun-exposed areas of the face, particularly on the cheeks, forehead and upper lip. The pathogenesis of melasma is multifaceted and interconnected to genetics and hormonal factors as well as to photodamage. 

With the beginning of laser technology, the treatment possibilities have improved especially for dermal or mixed melasma.Though many treatment modalities have been established for melasma and PIH, its management still remains a challenge owing to its recurring and refractory nature. 

Case Report

A 50-year-old woman came with recalcitrant melasma on her face which continued for more than six months.

The treatment started with the carefully cleaning of theface. Laser pulses were transportedupright to the surface with 10% linear overlying in a small treatment plot for 8-10 passes. The path of the laser beam was then changed and transportedupright to the prior line of management for another 10 passes. The treatment was stretched to cover the whole face. Instantaneously after the treatment of each area the following clinical endpoints were observed: 1. Whitening of fine hair2Grayish darkening of dermal hyperpigmented lesions 3. Lightening of epidermal hyperpigmentation 4. Perilesional erythema

After treatment,she was asked to apply a topical 7% alpha arbutin solution 2 times a day with a broad-spectrum sunscreen of SPF 50 and PFA +++. She was also advised to avoid sunlight.The patient showed a reduction of hyperpigmentation beginning with the first treatment, after completing of the first ten laser treatments.

Clinical improvement continued even after the conclusion of the intensive weekly treatment phase.

Conclusion

Combination therapy, laser treatments combined with 7% alpha arbutin and a broad-spectrum sunscreenis an active and well-tolerated treatment for refractory melisma.Also in cases of long‐standing recalcitrant dermal melasma in a dimmer skin type, combination therapy has been shown to be an active treatment for this difficult condition.

Suggested Reading

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