DRUG-LASER-PHOTON THERAPY IN THE TREATMENT OF MELASMA

BY, JASPER VICTORIA

Melasma is a dermatological condition characterized by dark, discolored or often brownish symmetrical patches on the skin of the face on areas exposed to sun such as the forehead, chin, cheek, nose, neck or forearms. 

An increased risk for melasma is often associated with estrogen & progesterone sensitivity i.e. birth control pills, thyroid, stress. Women are commonly affected and dark skinned individuals appear to have increased risk. The ultraviolet rays during exposure to sunlight interferes with the the melanocytes and cause pigmentation.

A visual diagnosis is often suitable, though Wood's lamp examination may also be done to rule out bacterial or fungal infections and to examine the layers of skin affected by melasma. A biopsy may also be performed.

The Journal of Cosmetic Dermatology published a study demonstrating the safety and efficacy of a systemic therapy combining drug, laser and photon to treat melasma. 75 patients having mixed-type melasma were enrolled in the randomized-retrospective study that was investigator-blinded. mMASI (modified Melasma Area and Severity Index) score was used to examine pictures taken by a digital imaging system that evaluates skin at sub-surface levels called Visia.

Erythema, petechiae, urticaria, edema, hyperpigmentation or hypopigmentation, burning or other side-effects were noted during every visit. Oral Tranexamic Acid was combined with 1064nm QS-ND: YAG laser, 1064 mixed with IPL, 20 which were found to be much beneficial than monotherapy.

The combination therapy provided a drastic drop to 3.84 in the mMASI score from 6.92. 10.17% patients felt much better, 30.51% patients felt 51-75% better, 45.76% patients reported to feel 26-50% better and 13.56% patients felt 1-25% better after the drug-laser-photon therapy.