INTRODUCTION
Melasma is a complex multifactorial disorder whose
pathogenesis is not well understood. In addition to
increased superficial and/or deep pigmentation, increased
vascularity is often present. Vascular endothelial growth
factor (VEGF) is an angiogenic factor demonstrated within melasma
patches that is a likely cause of the increased vasculature.
Interactions between melanocytes and the cutaneous vasculature
may influence the development of pigmentation. Topical treatments
targeting pigmentation are available with temporary improvement
of mainly the epidermal component of melasma.1 Intense
pulsed light (IPL) is a broadband light source that can target
a wide range of cutaneous structures, including deeper pigmentation
and the increased vasculature. With a lower side effect profile
compared with other devices used to treat melasma, IPL is a good
potential treatment option for dermal and mixed forms of melasma.
2 We describe 5 cases of persistent facial melasma treated
with IPL and a hydroquinone (HQ)-based skin care system (Obagi
Nu-Derm; Obagi Medical Products, Long Beach, CA), showing improvement
of facial melasma pigmentation and vascularity.
CASE REPORTS
Case 1
A 45-year-old Hispanic female presented with facial melasma
and was started on the Obagi Nu-Derm System, which
includes HQ, α-hydroxy and β-hydroxy acids, cleanser, and
toner used twice daily, a sunscreen with a sun protection factor
of 30+ in the daytime, and tretinoin cream 0.025% nightly
(Figure 1a-c). One month later, she was treated with IPL using
a 590-nm filter amd a double-pulse technique with 3-ms pulse
duration, 40-ms delay, and a fluence of 14 J/cm2. Cold-air cooling
was used intraoperatively. The Obagi Nu-Derm system
was restarted and continued for 5 months until the patient's
follow-up visit, which demonstrated clinical improvement of
her melasma (Figure 1d-f).
Case 2
A 42-year-old Asian woman presented with a several-year history
of facial melasma (Figure 2a-c). Intense pulsed light was
used with a 590-nm filter and a double-pulse technique with
3-ms pulse duration, 40-ms delay, and a fluence of 17 J/cm2.
Cold-air cooling was used intraoperatively. She was instructed
to immediately start the Obagi Nu-Derm System. She developed
mild erythema on postoperative day 6 that resolved with
fluocinolone acetonide cream 0.025% twice daily for a week
and a light-emitting diode (LED) photomodulation treatment
(Gentle Waves; Light BioScience, LLC, Virginia Beach, VA). At
the 1-month follow-up visit, clinical improvement of her melasma
was demonstrated (Figure 2d-f).
Case 3
A 35-year-old Hispanic woman presented with a several-year
history of facial melasma (Figure 3a-c). She underwent 2 IPL
treatments spaced 6 weeks apart. A double-pulse technique with
3-ms pulse duration for both pulses was used, with a 560-nm
filter, 30-ms delay, and a fluence of 17 J/cm2 for the first treatment
and 18 J/cm2 for the second treatment. Cold-air cooling
was used intraoperatively. She was then instructed to start the
Obagi Nu-Derm System after her second IPL treatment. At the
6-month follow-up visit following the last IPL treatment, clinical
improvement of her melasma was demonstrated (Figure 3d-f).
