Particular attention should be paid when using IPL for full facial skin rejuvenation in patients with darker skin, such as those with type V skin or type IV plus sun damage, because of the risk of epidermal burning. For patients with darker skin or melasma, it is preferable to use a long wavelength/low fluence setting for second passes over specific lesions with white paper covering the surrounding area, she said.
In a study, Dr. Negishi and her coinvestigators used an ultraviolet filter to identify very subtle epidermal melasma in 63 (28%) of 223 East Asian patients who had previously not been diagnosed with melasma. The patients who did not use sunscreen had a significantly higher risk of the condition than those who did use it (Dermatol. Surg. 2004;30:881-6). "This type of pigmentation tends to worsen with aggressive IPL treatment," she said.
Melasma in East Asians is thought to be epidermal, caused by an increased number of melanocytes and increased activity of melanogenic enzymes, which leaves the skin at a high risk for PIH.
IPL treatment alone is not enough to remove melasma, so Dr. Negishi commonly uses topical agents (such as 2%-5% hydroquinone, 5%-10% vitamin C derivative, or 0.025%-0.4% tretinoin) or oral tranexamic acid as her first choice to use in combination with IPL.
Oral tranexamic acid has been used for treating melasma in East Asians for more than 20 years, according to Dr. Negishi. When telangiectasias are present concurrently with melasma, she uses a long-pulse 1,064-nm Nd:YAG laser to reduce the vascular lesions while also stimulating epidermal turnover.
Dr. Negishi reported that she conducted much of her research with equipment borrowed from Cutera Inc., Danish Dermatologic Development A/S, Lumenis Ltd., and Syneron Inc., but she has no financial interests with any of these companies.