Refining tx approaches

Key Points

New techniques are firmly rooted in the high-tech arena, most notably with fractional resurfacing, according to Ranella Hirsch, M.D., a dermatologist and laser surgeon in Cambridge, Mass., and president-elect of the American Society of Cosmetic Dermatology and Aesthetic Surgery.

"The news is that, for the first time, fractional resurfacing either with the use of the Fraxel device (Reliant Technologies) or with any of a multiple of fractional handpieces that work with alternate devices (Cynosure, Palomar and others) has brought therapeutic results to the treatment of melasma and hyperpigmentation," Dr. Hirsch tells Dermatology Times.

Resurfacing for recalcitrant problems

"Treating epidermal pigmentation is something we have been able to successfully achieve for some time with a number of laser and nonlaser modalities.

"Now, with fractional resurfacing, we can get to some of the dermal hyperpigmentation which has been resistant in the past," Dr. Hirsch says.

Fractional resurfacing results in a specific thermal damage pattern, illustrated by multiple columns of thermal damage, or microthermal treatment zones. The skin around the damage is spared, according to Dr. Hirsch, and the result is microscopic epidermal necrotic debris sections (MENDS) in the treated areas, where the epidermis that is damaged is eliminated.

Dr. Hirsch cautions that the new technologies do not replace existing modalities; rather they are complementary to traditional therapies, including the use of hydroquinone. In addition, Dr. Hirsch stresses that the judicious use of sunscreen in all patients treated is vital.

Dr. Hirsch says the protocols vary according to the handful of manufacturers that make a version of the technology. In most cases, patients can expect mild bronzing for several days after the procedure.

For some patients, fractional resurfacing does not work, according to Dr. Hirsch.

"Better identification of these subsets is another area that we are working to optimize understanding of at this time," she says.

Dr. Hirsch adds that dermatologists are continuing to refine other approaches for treating hyperpigmentation, as well. Some are working with peeling agents, including the long-used trichloracetic acid peel. Another technology that holds promise in the treatment of melasma and other pigmentary problems is the 1,064nm Q-switched YAG laser, (Hoya ConBio).

Disclosure: Dr. Hirsch is an investigator for Palomar Medical Technologies, Cynosure Laser, Candela Laser and HOYA Conbio.