Comparative spilt face study using different cut-off filters of intense pulsed light for the treatment of refractory melasma

Abstract

Background: Melasma is an acquired treatment-resistant hyperpigmentation of the skin especially in dermal and mixed type. Intense pulsed light (IPL) is one of an alternative treatment for refractory melasma, but there are few reports about IPL treatment for melasma in Asian people.

Objectives: To determine the effectiveness of IPL in treating refractory melasma in Asian skin and compare clinical outcomes between the cut-off filters of 535 and 615 nanometers (nm).

Materials and Methods:  12 Thai female patients with refractory melasma were treated using fluorescent pulsed light (Plasmalite^TM, Medical Bio Care).  The cut-off  filter of 535 nm  was  used on one side and 615 nm was used on the other side during 5 treatment sessions at 3 weeks interval. Patients were followed up for 16 weeks after the last treatment. Clinical outcomes were evaluated by using the modified Melasma Area and Severity Index (modified MASI) score, melanin reflectance spectrometry, colorimeter and patient satisfaction questionnaire before and after 5 treatment sessions.

Results: The significant improvement of refractory melasma after 5 treatment sessions was observed melanin reflectance spectrometry and colorimeter. The improvement rate was 40.45% measure with 36.61% measure with However, subjective evaluation by modified MASI score showed no statistical significant improvement 6 out of 12 patients scored more than 50% improvement in their self assessment questionnaire. There was no statistical significant different in clinical outcome between different cut-off filters. The improvement rates were still increased at 8 weeks after treatment. Unfortunately after 16 weeks most patients had recurrence of melasma.

Conclusion: Intense pulsed light is one of an effective but not curative treatment for refractory melasma. Optimal parameters is crucial to accomplish good results with few side effects.  For cost effectiveness, IPL should be preserved for patients who are not response to topical treatments.