Low Fluence Q-Switched Nd: YAG Laser Toning and Q-Switched Ruby Laser in the Treatment of Melasma:A Comparative Split-Face Ultrastructural Study

摘要

>Background: Melasma still presents as a difficult entity to treat, especially in the Asian skin phe-notype. Recently laser toning with the Q-switched Nd:YAG has attracted attention. The present study investigated the efficacy of Q-switched Nd:YAG laser toning for melasma, with a histopathological comparison with the Q-switched ruby laser.>Subjects and Methods: Eight Japanese females (41–57 yr, mean 52.5 yr) with Fitzpatrick skin type III and bilateral melasma participated in the study. One half of each subject's face (randomly chosen) was treated with Q-switched 1064 nm Nd:YAG laser toning (pulse width 5–20 ns; spot size, 6 mm diameter; fluence, 3.0 J/cm², 5–7 passes, once/week, 4 weeks: QS:YAG group), and the contralateral half with a single treatment using a Q-switched ruby laser (694.5 nm, pulse width 20 ns, spot size 4 mm diameter; fluence 4.0 J/cm2, 1 pass with approximately 20% overlap: QS:Ruby group). Skin biopsies were taken immediately after the 4^th Nd:YAG session and the single ruby session, and histopathological comparison was performed with light- and transmission electron microscopy (TEM).>Results: Improvement in melasma pigmentation was seen in both the QS:YAG- and QS:Ruby-treat-ed sides, and this was well-maintained in the QS:YAG group. Ultrastructurally, melanin granules were destroyed in both groups, but there was considerably more morphological epidermal and dermal damage in the QS:Ruby specimens compared with minimal epidermal disruption and cellular damage in the QS:YAG specimens.>Conclusions: Q-switched 1064 nm Nd:YAG laser toning offered superior results in the treatment of melasma in the Japanese skin type compared with the Q-switched ruby laser, both ultrastructurally with less immediately post-treatment cellular damage and macroscopically, and a longer recurrence-free interval.