Objectives: The aim was to review experience using combined approach in the treatment of post inflammatory hyperpigmentation in acne patients with 1,064-nm Q-switched NDYG laser assisted with topically applied carbon suspension and superficial chemical peels.
Introduction: Acne is one of the most common inflammatory skin disorders. Patients with skin of color often worry more about post inflammatory hyperpigmentation and scarring than acne itself. Acne-PIH has negative impact on patients’ quality of life. Early intervention and aggressive acne treatment are important in patients with dark skin to treat as well as prevent acne-related PIH. Dermal hyperpigmentation can take years to fade to normal, while the epidermal variant can take up to 6-9 months. Very few therapeutic modalities have proved to be really efficacious in this condition.
Materials / method: Patients were treated with 1,064-nm QSNY laser and superficial chemical peel in the same session. Carbon suspension has been used which is an oil base carbon and the device used is Spectra from Lutronic. Total of 3 passes has been delivered, we start with Quasi-long pulse mode (300 micro sec) known as spectra mode to heat the carbon and then use the 5ns Q-switched mode (1064nm) to blast of the carbon, followed by chemical peel [ mandelic, glyco k, or retinol peel ] in the same session. Photographs were reviewed to determine the efficacy. Adverse effects were noted.
Results: The dual mode of the quasi-long pulse and Q-switched Nd:YAG laser treatment assisted with a topically applied carbon suspension acted quickly, and was effective for treating post inflammatory hyperpigmentation in acne lesions.1064nm being longer wavelength penetrates deeper, thus leading to less paradoxical PIH. Chemical peels when combined with lasers optimize outcomes and enhanced patient satisfaction. The sessions were well tolerated and no serious side effects were observed. Patients noticed significant reduction in pigmentation was faster with fewer sessions.
Conclusion: Management of long-lasting PIH due to acne is a psychological and cosmetic morbidity and it remains a challenge, especially in dark-skinned individuals. Although many treatment options are available for PIH, it takes months to resolve, even with an adequate therapy. The advantages of combining the dual mode of the quasi-long pulse and Q-switched Nd:YAG laser treatment assisted with a topically applied carbon suspension and chemical peel may provide a novel approach that is safe and effective for acne PIH.
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