Lasers and Light Devices in the Treatment of Cosmetic Pigmentary Disorders in Asian Skin

Goh Chee Leok


Dermatology Nursing 

In This Article

Recent Advances in Treatment of Cosmetic Pigmentary Disorders in Asians

Nonpigment selective lasers, such as the carbon dioxide laser (10,600 nm) and the Er:YAG laser (2,940 nm), are primarily used for laser skin resurfacing (to treat wrinkles and scars) but may remove superficial pigmented lesions (e.g., seborrheic keratosis). Introduced 2 decades ago, ablative lasers are being replaced by pigment-selective lasers. The risk of post-inflammatory hyperpigmentation (PIH) and scarring from ablative lasers is high due to severe thermal damage and inflammatory changes, especially when used to treat pigmentary disorders. Recently, non-ablative and ablative fractional photothermolysis were introduced which cause minimal thermal damage and are associated with post-inflammatory pigmentation (Manstein, Herron, Sink, Tanner, & Anderson, 2004). However, these fractional resurfacing lasers are not pigment specific and are generally less effective for treating pigmentary disorders.

Pigment-selective lasers/light devices offer more precise removal of pigmented lesions with less risk of causing post-inflammatory pigmentation (Alster & Williams, 1995; Downs, Rickard, & Palmer, 2004; Jang et al., 2000; Kilmer, Wheeland, Goldberg, & Anderson, 1994; Todd, Rallis, Gerwels, & Hata, 2000; Tse, Levine, McClain, & Ashinoff, 1994). Such devices include:

  • Q-switched ruby laser (694 nm, 25–40 nanoseconds).

  • Q-switched alexandrite laser (755 nm, 50–100 nanoseconds).

  • Q-switched Nd:YAG laser (1,064 nm, 5–10 nanoseconds) which can be frequency-doubled to emit green light at 532 nm of the same pulse duration.

  • IPL (515/200 nm).

  • Pulsed-dye laser (585/595 nm, 1.5 msec).

Not all pigmented skin lesions respond equally to lasers or light devices. Some pigmented lesions can be cleared effectively (such as lentigines and Hori's naevus), while others tend to recur shortly after treatment (such as Becker's naevus and café-au-lait macules) or are associated with PIH (such as melasma). Table 2 lists the common pigmentary disorders and their response to laser/IPL treatment.