Efficacy of Low Fluence Q-Switched Nd:YAG Quickly Pulse to Pulse Mode (Q-PTP) 1064nm on Melasma: A Case Report

Melasma is a chronic acquired hypermelanosis of the skin that primarily affects women in Fitzpatrick skin types III-IV. The low-fluence Q-switched Nd:YAG laser has recently become quite popular for treating melasma This case report focuses on the treatment of melasma using low fluence Q-switched Nd:YAG Quickly pulse to pulse mode (Q-PTP) laser on a 43-year-old Fitzpatrick type III Chinese lady with a 10 year history of malar melasma. The patient underwent a total of eight laser treatment sessions at intervals of one to three months. The patient expressed satisfaction with the outcome, as the hyperpigmentation over both cheeks had noticeably diminished after the initial session. Q-switched Nd:YAG Quickly pulse-to-pulse mode (Q-PTP) laser at a wavelength of 1064 nm with low fluence reduced risk of exacerbation of melasma by inhibiting melanocyte activity through subcellular selective photothermolysis. The technique reduces the risk of cell death, inflammation, and damage to the basement membrane. Studies have also shown that laser toning can downregulate melanogenesis and melanogenic stimulators, resulting in the diminished function of melanocytes. Q-PTP uses two sub-pulses with brief intervals to create a larger peak power, lead to pressure changes and vibration of melanin, resulting in lesser pain, skin erythema post treatment and better patient acceptance. In conclusion, low fluence Q-switched Nd:YAG laser (PTP mode) has demonstrated efficacy in the treatment of melasma.