Biography
Biography: Dr. Aslı Eralp
Abstract
Melasma therapy is so challenging and relapses are so frequent that we need different treatment modalities like lasers. Although lasers facilitate our therapy, they should be used cautiously, since they can also enhance melasma causing postinflamatory hyperpigmentation. Since melasma can be both epidermal and dermal and also can have vascular component, we need different wavelenghts so that we can achieve good results.
Melasma is a chronic and relapsing hyperpigmentation mostly of the face but sometimes of the neck, chest and forearms. Melasma occurs frequently during pregnancy and menapouse when there is hormonal alterations and also using birth control pills has a strong association with melasma. Since there is no definite etiology for melasma, treatment is a challenge for most of the dermatologists.
Melasma is classified by both location and depth of involvement. Based on the location the three most common types of melasma are centrofacial, malar and mandibular. If we consider the depth of melasma , it could be epidermal, dermal, mixed or intermediate. By the help of the Wood’s lamp, we can distinguish these entities.
Besides using topical medication such as “Kligman’s formula”, azelaic acid, retinoic acid, arbutin, kojic acid, there are different laser and light based devices to use in the treatment of melasma.
The five board categories of laser and light therapy include intense pulsed light (IPL), Q-switched lasers, picosecond lasers, ablative and nonablative fractionated resurfacing lasers (NAFL) and vascular lasers.
IPL therapy has a potential advantage over laser therapy, because it uses a spectrum of wavelengths that allow for the penetration of various levels of the skin and target both epidermal and dermal melasma simultaneously.
Studies done by low fluence Q switched Nd:yag lasers show that they are effective in dermal type of melasma and are safe to treat patients with melasma. However the recurrence rates suggest poor long-term results when the laser is used as monotherapy.
NAFLs utilize midinfrared wavelenghts that bypass the epidermis and penetrate from the dermal-epidermal junction to the midreticular dermis to induce neocollagenesis and remodeling. This facilitates the removel of dermal melanophages.
No matter which treatment is used there is always a risk of recurrence of melasma. The longest delay seems to be with NAFL treatments.