Objectives: The objective of this lecture is to understand the development of picosecond laser and to learn the use of picosecond laser in treating melasma. A brief review of melasma pathophysiology and clinical studies using picosecond laser in melasma will be discussed.

Introduction: Melasma is an acquired pigmentary disorder that occurs mainly in women of all racial and ethnic groups, but particularly affects those with Fitzpatrick skin types III–IV. It has a higher incidence in Asians, Hispanic and Mediterranean populations. It has exacerbations by pregnancy, oral contraceptives, UV exposure and thyroid diseases. The most common clinical presentation is mask-like hyperpigmentation of brow, mid cheek, upper lip and chin.

Materials / method: The picosecond laser is a laser device that uses a pulse duration of a trillionth of a second (10-12 sec) to target the chromophore. Picosecond lasers causes predominantly photoacoustic damage rather than photothermal destruction of pigment, thereby minimizes the post inflammatory side effects.

Results: The term laser toning originates from the improvements in skin tone that result from the use of the laser. This is commonly done in Southeast Asia to treat melasma and for brightening effect. It uses a large spot size (6-10mm), low fluence (< 1.6 J/cm2), QS/Pico 1064nm laser with a handpiece held perpendicular to the target with no clinical endpoint. The mechanism is believed to be subcellular selective photothermolysis. Some picosecond lasers have fractionated hand pieces that facilitate tissue remodelling and facial rejuvenation and are used to treat acne scarring, photoageing, and melasma.

Conclusion: The proper parameters to use in the treatment of Asian skin would also be emphasized in this lecture.

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Objectives: These case series highlight the improved efficacy in treating Post Inflammatory Hyperpigmentation (PIH) by utilizing a combined approach of picosecond 1064nm and Cysteamine 5%.

Introduction: Post-Inflammatory Hyperpigmentation (PIH) is a reactive inflammatory hypermelanosis with multiple etiologies ranging from acne vulgaris to insect bites. PIH is challenging to treat, affecting primarily skin colour, particularly in East Asians, as the hyperpigmentation is easily visible against the relatively light-coloured background. Current treatment options are including topical Hydroquinone, Kligman’s formula and chemical peels have been used with variable results, and PIH remain a complex condition to treat.

Materials / method: Ten patients with prolonged Post-Inflammatory Hyperpigmentation treated using a combination of 1064-nm picosecond Laser biweekly and a novel depigmenting agent Cysteamine 5%. Clinical images were taken every two weeks and the treatment was done over the course of 10 weeks.

Results: During the tenth week, 8 patients exhibited pigmentary clearance of 76-100%, with 2 remaining patients exhibited pigmentary clearance of 51-75%. No severe adverse effects were present.

Conclusion: Post Inflammatory Hyperpigmentation (PIH) is commonly found in East Asians, and especially concerning due to very conspicuous localized dark spots over relatively light skin. Current treatment options are not very effective and has considerable adverse effects. The dual modality approach using a combination of 1064-nm picosecond Laser biweekly and novel depigmenting agent Cysteamine 5% present an effective alternative to treating this condition​

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