Combined use of intense pulsed light and Q-switched ruby laser for complex dyspigmentation among Asian patients

BACKGROUND: Dyspigmentation is a common cosmetic concern among Asians. Many individuals exhibit mixed pigmentary entities including melasma, flat/small seborrheic keratoses, ephelides, solar lentigines and acquired bilateral nevus-of-Ota-like macules (ABNOM). We term this phenomenon complex dyspigmentation (CD) and suggest that a combination strategy may be more efficacious than any singular modality. OBJECTIVE: To determine the effectiveness of combined intense-pulsed light (IPL) for global photorejuvenation along with Q-switched ruby laser (QSRL) for targeted pigment dissolution. STUDY DESIGN/MATERIALS AND METHODS: Twenty-five Korean women with CD (defined as >2 types of facial pigmentary disorders) were initially treated with IPL followed by repeat treatments every 3-4 weeks as needed. The QSRL treatments, set at low fluence, were added either during the same session or within 1 week of the IPL treatment. Improvement was assessed by the patient, the treating physician and a blinded evaluation of pre- and post-treatment photographs. RESULTS: Using a 4-point scale (1 = poor, 2 = fair, 3 = good, 4 = excellent), 19/25 patients (76%) reporting good-to-excellent response (score "3" or "4"). Two independent physician assessment revealed that 15/25 patients (60%) showed 76-100% improvement while 19/25 patients (76%) showed at least 50% improvement. Side-effects were minimal: 3 patients had transient post-inflammatory hyperpigmentation (12%) and 1 patient (4%) had linear hypopigmentation. CONCLUSIONS: Combination treatment with IPL and QSRL is an effective and safe treatment for CD among Asian patients.