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IMCAS Asia 2019
Program

FOCUS ON S030

Melasma

Room: Room 3B
Date: Friday 5 July 2019 at 15:00 to 16:00
Format: FOCUS SESSION > lectures covering a major topic of the congress
Objectives: 1. Identify different treatment options for melasma 2. Elaborate on and emerging treatment plans for melasma 3. Discuss how to apply strategies to treat melasma for Asian patients

Chairs

Dr Moshe LAPIDOTH

Dermatologist

Israel

Dr Maylita SARI

Dermatologist

Indonesia

Lectures of the session

Hours	Speakers	Lecture title	Abstract	Number
15:00	Dr Nariaki MIYATA	New technology for melasma - Full face treatment by using 3 wavelength picosecond laser	View	86278
15:12	Dr Teresita Santillan FERRARIZ	PRP as adjuvant treatment for melasma	View	86443
15:24	Dr Wichai HONGCHARU	The science behind picosecond laser treatment for recalcitrant melasma		86245
15:36	Dr Prasetyadi MAWARDI	The hydroquinon-free bleaching agent for Asian ethnic melasma	View	84658
15:48	Dr Seiko KOU	The strategy of the balance of stability in Asian melasma and improvement of skin rejuvenation	View	88241
15:56		Questions and answers		88243

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Melasma

Pigmentation

Lasers

Photoaging

Skin aging

Dr Nariaki MIYATA

Plastic Surgeon

Japan

Other author(s) :

New technology for melasma - Full face treatment by using 3 wavelength picosecond laser

Objectives: Melasma treatment by using picosecond laser is effective and safe. However, melasma is usually complicated by various kinds of pigmentations. Therefore, laser irradiation with single wavelength and pulse duration is not enough for getting better results. How to combine the handpiece for melasma (& pigmentation) removal in technological aspect?

Introduction: Recently, picosecond laser treatments have been introduced and it has proven better outcomes and minimal complications for tattoo treatment. High photo-acoustic effect dramatically change the tattoo treatment.
However, pigmentation especially melasma treatment is more important issue for Asians, compared with tattoo treatment.
We should find the ideal setting of picosecond lasers for melasma treatment.

Materials / method: Laser irradiation combined with 3 different handpieces (532 nm axicon lens fractional, 785/730 nm titan-sapphire, 1064 nm large spot size) on same day was performed.

Results: We found measurable change by image analysis system and by clinical photos.

Conclusion: To treat melasma, pulse duration is important issue. However, there are large difference according to the model of picosecond laser devices. Shorter pulse duration with low fluence is better for treatment of melasma safely. Within stress relaxation time (SRT), shock wave is localized in melanosome.
And more, for Asians, picosecond laser need evolution and expanded utilization.
New wavelength and fractional handpiece of picosecond laser are required for patients’ satisfaction. In technological aspect, I will show ideal combination of picosecond laser irradiation for melasma treatment.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
Yes
Please specify entities (individual, company, society): KOL for Candela

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Teresita Santillan FERRARIZ

Dermatologist

Philippines

Other author(s) :

PRP as adjuvant treatment for melasma

Objectives: The objective of this lecture is to show the effect of Platelet Rich Plasma (PRP ) in the treatment of Melasma.

Introduction: Melasma is a common acquired disorder of hyperpigmentation char. by light brown to gray patches seen in the face and caused by several factors like heredity,UV radiation, hormonal changes, etc..Principles of Melasma Rx are protection from sun exposure, inhibition of Tyrosinase activity and removal and disruption of melanin granules.Treatment of Melasma has always been a big challenge for both patients and dermatologists as it can be resistant to diff therapeutic approaches and high relapse rate.So there's need for other treatment options like PRP, an autologous plasma containing GF/cytokines.

Materials / method: PRP kits includes Test tube with anticoagulant
EMLA,Centrifuge,Syringes-10,5,1 mls,g 30 needles
Method:
Extraction of 8 ml blood from the patient and placed in an anti coagulated test tube and centrifuged(Regen lab) for 8 min at 3500 RPM,separating the platelets from the rest of the blood.Then 5 ml of PRP is pipetted from the test-tube and transferred to 5 1 ml syringes.The Prp is then ready for injections to target areas.

Results: Improvement is seen 3-4 weeks after first injection.Aside from attenuation of pigmentation,improvement of skin texture is seen.But it needs several treatments at 2-4 weeks interval for more dramatic results.
Of course, it is not a stand alone treatment.Other standard treatment options like bleaching agents, antioxidants,Vit C,Tranexamic acid,Intraceutical Oxygen facial were given either before, during or after PRP depending on the response of the patient.

Conclusion: PRP may serve as an adjunct or alternative treatment of long standing Melasma or to other skin conditions with currently no gold standard mode of therapy.

PRP is not a stand alone treatment.For optimal result, it may be combined with other treatment modalities like topicals (sunscreen, bleaching agents)micro needling,chemical peeling and lasers.

Effect of PRP on Melasma is probably secondary to the inhibition of Tyrosinase by Transforming Growth Factor-B1.
Further Studies are encouraged to substantiate the efficiency and safety of PRP.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Wichai HONGCHARU

Dermatologist

Thailand

Other author(s) :

The science behind picosecond laser treatment for recalcitrant melasma

Objectives: The picosecond laser is a groundbreaking innovation that can be applied for the removal of tattoos and the treatment of various pigmentary conditions., Picoway is the only device in its class to feature three wavelengths in a single platform: 1064 nm, 532 nm, and 785 nm. It also features the extremely short pulse duration at 300 ps; moreover, it provides selectable durations (300, 375, 450 PS).The shorter picosecond duration is better to acheive a selective photoacoustolysis on particles high peak power but low fluence approaches for melasma treatment.

Introduction: The present data indicate that there may be a size gradient of melanosomes encompassing the global complexion coloration and that the melanosome distribution in keratinocytes of Asian skin is intermediate between that in light Caucasian and dark African/American skin. in Asian skin (1•36 ± 0•15 μm2 × 10−2) . Melanosomes within keratinocytes of Asian skin are distributed as a combination of individual and clustered melanosomes with a proportion of 62•6% vs. 37•4%, respectively. The individual melanosome has larger size compared to cluster melanosomes. Melanosome has stress relaxation time<300PS

Materials / method: We studied retrospectively back on 100 melasma patients with Picoway toning. We selected the melasma patients who have not response to tranxaminic acid (either oral or intralesionl administration) or other laser toning for picoway treatment. Patients received 450ps alone or 450 ps plus 350ps or 450ps plus 300ps laser.

Results: We found most patients have a good satisfaction rates with 450ps in dark brown skin group. For light brown skin group, parameters require 450ps plus 350 or 300ps laser. Certain parameters are required for better results. Mostly are the parameters with low fluences and higher >10 repetition rates. Adding shorter picosecond pulse duration gives long-term improvement >1year.

Conclusion: In summary, Ultrashort picosecond laser give a promising results for the treatment of refractory melasma. The application various ultrashort pulse durations is recommended to get rid of various type and size of melanosomes

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Prasetyadi MAWARDI

Dermatologist

Indonesia

Other author(s) :

The hydroquinon-free bleaching agent for Asian ethnic melasma

Objectives: The purpose of this topic is to provide alternative treatment options for melasma that is often suffered by Asian women, whichlong-term use of hydroquinone will cause ocronosis.. It is the most commonly studied agent for lightening pigment. It inhibits the activity of tyrosinase, the enzyme necessary for melanin biosynthesis. Some non hydroquinone bleaching agents have been developed, such as tretinoin, glucosamine, retinol, retinaldehyde, N-acetyl glucosamine, arbutin, vitamin C, as alternative therapy for melasma

Introduction: Melasma is a common acquired hypermelanosis involving face, which lasts for long period resulting in psychological problems and decreased quality of life. It affects all races but it is more prevalent in those with darker skin types. South East Asian ethnics with melasma have been highly reported. The Asian ethnic becomes an important ethnic group due to their different characteristics, way of life and peculiar habits. It tends to present post-inflammatory hyperpigmentation, melasma, lentigenes, freckles, Ota and Hori nevi. Multiple causative factors have been identified for melasma.

Conclusion: The use of non hydroquinone topical , remain to develope as an alternative therapy for melasma in Asian women, to reduce side effects and adverse events caused by long-term use of hydroquinone.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Seiko KOU

Japan

Other author(s) :

The strategy of the balance of stability in Asian melasma and improvement of skin rejuvenation

Objectives: The primary objective of this study focuses on the control of melasma, which is a functional irregularity of melanocyte among Asian, and rejuvenation of the entire skin layers. This study suggests the strategy of the balance of stability in melasma and improvement of skin rejuvenation.

Introduction: There is a variety of advanced skin rejuvenation devices such as, the pico-second laser, but it is difficult to achieve skin rejuvenation accompanying melasma in Asian patients by short-term treatment by means of a single device alone. It is necessary to select the most appropriate device for the conditions of each patient’s melasma assessed through diagnostic imaging. As a premaise, conservative therapy such as external and internal medicine have already or simultaneously be treated. the strategy of the balance of stability in melasma and improvement of skin rejuvenation will discussed.

Materials / method: There were 493 melasma patients that our facilities followed for over 12 months between August 2008 and May 2019. Oral administration included tranexamic acid,etc.while one of hydroquinone cream,etc was used for external administration.Infusion of highly concentrated Vitamin C could also be applied.Treatment by devices included IPL ,Nano-second, pico-second, long pulse NdYAG Laser, Nano-second Ruby Laser, Plasma, Non-abrasive, abrasive fractional laser, CO2 Laser and electroporation, etc.Customized treatment was designed based on the diagnostic imaging. VISIA-EVOLUTION○R was used for visual e

Results: There were 161 cases of Severe level and 332 cases of Slight level. 85% of the Severe level and 48% of the Sight level were improved. Pico-second Laser showed a higher improvement rate than the conventional treatment cases. There were 12 cases (7%) of “Worsened” from the Severe level, of which 6 cases were not eligible for oral administration of tranexamic acid. On the overall, this long-term clinical case (over 1 year) indicated a balanced result in terms of an improvement of dermis and stability of melasma.

Conclusion: The fundamental approach for photoaging skin with melasma is the conservative treatment by means of oral administration of tranexamic acid. The important point in establishing a long-term stability of melasma during skin rejuvenation is to determine the best selection of Long pulse laser, Nano-second laser, or Pico-second laser, that can be applied each time with least stimulus to the melanocyte. This would be the bases on which the temporal change of pigmentation in melasma should be judged by using image diagnostics.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

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IMCAS Asia 2019 Program

FOCUS ON S030

Melasma

Chairs

Lectures of the session

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IMCAS Asia 2019
Program