Combining Treatment of Basic Protocol for Melasma with Yellow Light Diode Laser 577 nm

Wulan Yuwita, Rosalin Naomi Harsono

Bandung Skin Centre
Bandung, West Java, Indonesia

Background: Melasma is a common pigmentary disorder in Asians. Although the pathogenesis of

melasma is not yet fully understood, there are several hypotheses supporting angiogenetic factors
related to some types of melasma. Yellow light diode laser which emits 577 nm may has effect on
dermal vasculature and may be of benefit in the treatment of melasma. In these case, we treated three
patients with melasma on the face with combination of trichloracetic acid (TCA) TCA 20% peels,
topical kligman modification, with/without oral tranexamic acid, and yellow light diode laser 577 nm.
Two patient achieved satisfactory results without complications or post-laser hypo/hyperpigmentations.

Observation: We treated three patient with combining treatment : kligman modification, TCA 20%
peels, with/without oral tranexamic acid, and yellow light diode laser 577 nm. The patient was using
kligman modification (as a priming) for one month, and then we treated with TCA 20% peels. Only in
first case we gave oral tranexamic acid. After two month using kligman modification, we treated with
yellow light diode laser 577 nm. Four treatment sessions were performed with a 1 month interval in
first and third cases, but only two treatment sessions were performed in second case because of the
significant improvement. The lesions in first and second cases were remarkably improved without
bruising or any other noticeable side effects. MASI score was significantly improved from 35.2 to 4.6
and 16.2 to 1.2, but only slightly improved in third case (MASI score from 18.3 to 11.4).

Key message: Yellow light diode laser 577 nm is effective for angiogenetic factors related to some
types of melasma, because it target mostly in hemoglobin with less absorbtion in melanin. The results
from these case reports were different because of the characteristic of melasma; which in first and
second case were pronounced telangiectatic (angiogenetic) factors related to some types of melasma.