Lasers in Surgery and Medicine
Non‐Ablative 1927 nm Fractional Thulium Fiber Laser:
New, Promising Treatment Modality for Riehl's Melanosis
Su Min Kim, MD, 1 Shinwon Hwang, MD, 1 Abdurrahman Almurayshid, MD, 2
Min‐Young Park, MD, 1 and Sang Ho Oh, MD, PhD 1*
1
Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College
of Medicine, Seoul, Korea
2
Department of Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Saudi Arabia
Background and Objectives: The treatment of Riehl's
melanosis, also known as pigmented contact dermatitis, is
highly challenging. Intense pulsed light (IPL) and 1064 nm
Q‐switched Nd:Yag (QS‐Nd:YAG) laser are reported to have
some efficacy. However, no single effective treatment has yet
been identified. In this study, we demonstrated the efficacy
and safety of the non‐ablative 1927 nm fractional thulium
fiber laser (TFL, LASEMD™; Lutronic Corp., Goyang,
Korea) for patients with Riehl's melanosis.
Study Design/Materials and Methods: A retrospective
chart and photographic review of nine patients with
Riehl's melanosis, who had received at least three ses-
sions of TFL treatment, was performed. Before the start of
TFL treatment, combination treatment with a topical
cream containing hydroquinone, low‐fluence QS‐Nd:YAG
laser, pulsed dye laser, and IPL was used with variable
and discouraging effects. Seven patients were treated on
the face and two patients on the neck with three to seven
sessions at 1‐month intervals. Clinical improvement was
assessed using clinical photos taken before and after
every treatment session according to dermal pigmenta-
tion area and severity index (DPASI) and a quartile
grading scale by two blinded dermatologists.
Results: Patients underwent three to seven sessions of
TFL treatment depending on severity of pigmentation.
Of nine patients, six demonstrated a clinical improvement
of 51%–75%, one demonstrated an improvement of
76%–100%, and two showed an improvement of 26%–50%
after treatment. The DPASI was significantly decreased
from 9.55 to 5.25 on average. Melanin index was de-
creased after treatment in two patients whose melanin
index were measured at initial visits. Treatment‐related
adverse events, such as scarring or postinflammatory
hyperpigmentation (PIH), were not observed in all pa-
tients except for transient erythema and swelling.
Conclusions: This report suggests that TFL could be an
alternative and/or additive treatment option for hyper-
pigmentation in intractable Riehl's melanosis and might
be a promising treatment for PIH caused by any reason
including Riehl's melanosis. Lasers Surg. Med. © 2020
Wiley Periodicals LLC
Key words: pigmented allergic contact dermatitis;
Riehl's melanosis; 1927 nm thulium fiber laser
© 2020 Wiley Periodicals LLC
INTRODUCTION
Riehl's melanosis is an acquired macular hyper-
pigmentary disorder characterized by gray‐brown to black
reticulated hyperpigmentation of the face and neck [1].
Histological features include numerous dermal melano-
phages with pigmentary incontinence and may be ac-
companied by lymphohistiocytic infiltration early in the
onset [2]. Although the exact pathogenesis of Riehl's
melanosis is unknown, it has been reported to be asso-
ciated with photoallergic reaction or pigmented contact
dermatitis [3]. As the abrupt onset of hyperpigmentation
can be accompanied by itching and preceding erythema,
patch testing to identify contact allergens is recom-
mended. However, it is common that no allergen shows a
positive reaction even on the patch test.
Patients with Riehl's melanosis may experience loss of
confidence in social life and psychological stress due to the
perceived appearance of dirty, pigmented lesions on ex-
posed areas of the skin. Therefore, patients have a strong
desire for treatment to relieve hyperpigmentation. Var-
ious treatments for Riehl's melanosis such as intense
pulsed light (IPL) and topical bleaching agents have been
tried to date, but a standardized treatment modality is
not available. Topical bleaching agents have a very lim-
ited effect [4], and IPL has been reported to exacerbate
pigmentation in patients who are vulnerable to the risk of
adverse effects by emitting a broad spectrum wavelength.
Therefore, at present, an approach of low‐fluence, such as
a 1064 nm Q‐switched Nd:Yag (QS‐Nd:YAG) laser, is be-
coming popular [5] and is preferably used for various
hyperpigmentary disorders such as postinflammatory
hyperpigmentation (PIH) and melasma despite requiring
many sessions of treatment due to a low chance of side
Conflict of Interest Disclosures: All authors have completed
and submitted the ICMJE Form for Disclosure of Potential
Conflicts of Interest and none were reported.
* Correspondence to: Sang Ho Oh, MD, PhD, Department of
Dermatology and Cutaneous Biology Research Institute, Sev-
erance Hospital, Yonsei University College of Medicine, 50‐1
Yonsei‐ro, Seodaemun‐gu, Seoul 03722, Korea. E‐mail:
oddung93@yuhs.ac
Accepted 12 October 2020
Published online in Wiley Online Library
(wileyonlinelibrary.com).
DOI 10.1002/lsm.23341
2 KIM ET AL.
effects. However, its treatment response is variable de-
pending on patients. The non‐ablative 1927 nm fractional
thulium fiber laser (TFL), which was used for the treat-
ment of Riehl's melanosis in this report, results in high
absorption of water, conferring greater ability to target
superficial layers of the skin such as the epidermis and
papillary dermis without epidermal ablation [6]. There-
fore, we hypothesized that TFL could be applied for the
treatment of Riehl's melanosis, as the histopathologic
findings of Riehl's melanosis are similar to those of PIH,
such as basal pigmentation, melanin incontinence, and
dermal melanophages in the papillary dermis, which is
the main target layer of TFL in the skin. This report
suggests that TFL can be an alternative and/or additive
treatment modality for Riehl's melanosis.
MATERIALS AND METHODS
A total of nine patients (eight women; aged 47–65; Fitz-
patrick skin type III or IV), who were diagnosed with
Riehl's melanosis due to diffuse reticular hyper-
pigmentation of the face and neck after the hair dyeing
event and underwent more than three sessions of TFL
were retrospectively examined to evaluate the safety and
efficacy of TFL for Riehl's melanosis. All information
including clinical images were collected after receiving
patient consent. This study has been approved by the
Institutional Review Board of Severance Hospital (IRB
no.4‐2020‐0049) and was conducted according to the Dec-
laration of Helsinki. The pigmentation was mainly located
on the face for seven patients and the neck for two patients.
Only one patient (Case 5) received a patch test to identify
allergens, but the result was negative. If patients pre-
sented with obvious erythema of the face and neck along
with gray to dark pigmentation on the initial visit (n = 5)
or the skin biopsies showed active inflammatory cell in-
filtration (n = 2, the biopsy was performed in five patients),
oral prednisolone (10 mg per day) was prescribed for 2–8
weeks before the start of laser treatment. All nine patients
showed little improvement with various treatment options
such as bleaching agent with Kligman formula, IPL, low
fluence QS‐Nd:YAG laser, and pulsed dye laser (PDL).
The entire face was completely cleansed using a mild soap
and 70% alcohol before treatment. Topical anesthesia cream
(Enkine™, Kolmar Korea, Sejong, Korea) was applied for
1 hour before the procedure. Treatment with non‐ablative
fractional TFL (LASEMD™; Lutronic Corp., Goyang, Korea)
was performed at monthly intervals. The treatment, with
settings of 5 W for the output power and 10–20 mJ for the
pulse energy with a dynamic and random mode, was deliv-
ered to the face and neck with multiple passes (3–5 passes)
in each session. Patients were instructed to use a mild
cleanser and moisturizer several times daily for the first few
days after each treatment session to promote wound healing
and prevent dryness.
Photographic documentation using identical camera
settings, lighting, and patient positioning were obtained
before each treatment session and every visit for a suc-
cessive treatment. Two blinded dermatologists, who
compared before and after photos in chronological order,
separately conducted clinical assessments. The clinical
response was measured based on a quartile grading scale
(Grade 1, <25%, minimal to no improvement; Grade 2,
26%–50%, moderate improvement; Grade 3, 51%–75%,
marked improvement; and Grade 4, >75%, near‐total
improvement) [7]. To assess the severity of dermal
pigmentation objectively, dermal pigmentation area, and
severity index (DPASI) was evaluated by two blinded
dermatologists [8]. The melanin index from Mexameter®
(Courage+Khazaka electronic, Köln, Germany) was in-
vestigated as an objective measurement for improvement
in two patients (Case 1 and Case 5), whose melanin index
was available at the initial visit. In addition, skin his-
tologies were compared before and after 7‐session treat-
ment in one patient (Case 1). Lastly, the patients were
asked about their overall rates of satisfaction along a
scale of very satisfied, satisfied, slightly satisfied, and
unsatisfied (Table 1).
RESULTS
Nine patients received at least three sessions of TFL
treatment (three to seven sessions every month) de-
pending on its response. After the last treatment of each
patient, the DPASI score decreased from 9.55 to 5.25 on
average. Also, the mean grade of clinical improvement
was 2.89 based on the physician's clinical assessment
using the quartile grading scale (Table 2). Six of nine
patients (67%) demonstrated marked clinical improve-
ment of 51%–75% (Figs. 1A, B, 2A, B), one (11%) showed
significant improvement of 76%–100% (Fig. 3A, B). Two
patients who received treatment for neck lesion showed a
moderate improvement of 26%–50%, which was slightly
lower than those of the patients with a facial lesion.
Moreover, two patients (Case 1 and Case 5) showed a
significant decrease in the melanin index after TFL
treatment (Table 2). The patients' degree of satisfaction
revealed that 8 of 9 patients were very satisfied or sat-
isfied and one was slightly satisfied. And as shown in
Figure 4A, B, the skin histology after the last session re-
vealed a marked decrease in epidermal melanin and
dermal melanophages (Case 1).
The treatment was well tolerated, without the need for
systemic analgesics. Side effects were mild and limited to
transient, mild erythema, which faded away within
3 days.
DISCUSSION
Riehl's melanosis is characterized by diffuse facial hy-
perpigmentation that is especially distributed on the
forehead and the zygomatic and temporal areas. Various
chemicals and natural substances are suggested to be the
causes of Riehl's melanosis. Efforts have been made to
accurately define the relevant entities, but the exact di-
agnosis criteria and the pathogenesis of Riehl's melanosis
are not clear yet.
Based on the unclear pathogenesis of Riehl's melanosis
and the vague disease entity, various methods such as
TABLE 1. Baseline Characteristics and Treatment History Before 1927 nm Fractional Thulium Fiber Laser
Patient
number Age Sex Skin type Region Previous treatment Patch test Skin biopsy Oral steroid administration

1 51 F IV Face IPL 1064 nm Nd:Yag N/A Basal vacuolization upper dermal lymphocytic 4 weeks (PL 5 mg twice
infiltration scattered melanophages daily)
2 52 F III Face Kligman's triple combination N/A Melanin incontinence in the upper dermis 2 weeks (PL 5 mg twice
daily)
3 64 F III Face PDL Pico‐second 1064 nm Nd:Yag N/A N/A 2 weeks (PL 5 mg twice
daily)
4 48 F IV Face Kligman's triple combination PDL N/A Upper dermal melanophages 2 weeks (PL 5 mg twice
1064 nm Nd:Yag daily)
5 55 F III Face Kligman's triple combination Negative Upper dermal melanophages 2 weeks (PL 5 mg twice
daily)
6 47 F III Neck Kligman's triple combination N/A N/A None
7 65 F III Neck 1064 nm Nd:Yag N/A Superficial perivenular lymphocytic infiltration 8 weeks (PL 5 mg twice
with upper dermis daily)
8 49 F III Face Kligman's triple combination N/A N/A N/A
9 44 M III Face Kligman's triple combination N/A N/A 2 weeks (PL 5 mg twice
daily)

IPL, intensive pulsed light; Kligman's triple combination, 4% hydroquinone, 0.05% tretinoin, 0.01% fluocinolone; PDL, pulsed dye laser.

TABLE 2. Treatment Regimens, Parameters and Responses After 1927 nm Fractional Thulium Fiber Laser
Initial Final
Initial Final mexameter mexameter
Patient Treatment Energy DPASI DPASI (melanin (melanin Improvement Patients Adverse
number sessions (mJ) Passes score score index, Rt./Lt.) index, Rt./Lt.) Improvement (%) grade satisfaction event

1 7 20 4 9.4 4.2 321/391 241/241 51‐75 3 Very Mild

FRACTIONAL LASER ON RIEHL'S MELANOSIS

satisfied erythema
2 4 15 5 7.8 3.8 N/A N/A 51‐75 3 Satisfied Mild
erythema
3 4 15 4 8.4 2 N/A N/A 76‐100 4 Very None
satisfied
4 3 20 4 15.3 9.2 N/A N/A 51‐75 3 Satisfied None
5 6 15 4 16 9.3 421/375 222/229 51‐75 3 Satisfied None
6 5 20 4 6.3 5.4 N/A N/A 26‐50 2 Slightly Mild
satisfied erythema
7 7 10 3 4.95 4.05 N/A N/A 26‐50 2 Very None
satisfied
8 3 15 6 7.2 3.5 N/A N/A 51‐75 3 Satisfied None
9 3 15 6 10.6 5.8 N/A N/A 51‐75 3 Satisfied None
3

DPASI, Dermal pigmentation area and severity index.

4 KIM ET AL.

Fig. 1. (A) Case 1: a 51‐year‐old female (upper) before and (lower) after seven sessions of
treatment with the fractional 1927 nm thulium fiber laser. The patient showed marked
(51%–75%) improvement in hyperpigmentation of the face. (B) Magnified photography from
Case 1, which shows the decreased reticular pigmentation on both cheeks (upper: before
treatment, lower; after seven sessions of treatment).

IPL, QS‐Nd:YAG laser, and topical bleaching agents
have been proposed as therapeutic modalities. As a light‐
based treatment modality, IPL, and low/mid fluence
QS‐Nd:YAG laser have been used with evidence of mod-
erate improvement, and repeated treatment sessions were
required for obtaining improvement [9,10]. To date, sev-
eral reports of laser treatment for Riehl's melanosis have
described application of repetitive treatments using low/
mid energy. In our study, four of nine patients previously
received low/mid fluence QS‐Nd:YAG laser treatment
combined with PDL or IPL before introducing treatment
with fractional TFL, but repeated treatment did not result
in sufficient therapeutic response. One previous study
using a low fluence QS‐Nd:YAG laser for Riehl's mela-
nosis suggested that 10–18 treatment sessions were
needed to demonstrate sufficient efficacy [11]. Another
study using a mid fluence QS‐Nd:YAG laser showed
moderate efficacy after above six times of treatment ses-
sions [12]. As this low/mid energy approach requires
several treatment sessions, and current treatment

Fig. 2 . (A) Case 2: a 52‐year‐old female (upper) before and (lower) after four sessions of
treatment with the fractional 1927 nm thulium fiber laser. The patient showed marked
(51%–75%) improvement in hyperpigmentation of the face. (B) Magnified photography from
Case 2, which shows the brightened tone due to decrease of the reticular, slightly yellowish
pigmentation.
 FRACTIONAL LASER ON RIEHL'S MELANOSIS 5

Fig. 3. (A) Case 3: a 64‐year‐old female (upper) before and (lower) after four sessions of treatment
with the fractional 1927 nm thulium fiber laser. The patient showed significant (76%–100%)
improvement in hyperpigmentation of the face. (B) Magnified photography from Case 3, which
shows the decreased reticular pigmentation on both temporal areas. Lentigo‐like
postinflammatory hyperpigmented patches on both cheeks showed faint color.

modalities have limited efficacies, new modalities for
management of Riehl's melanosis are required.
Based on the theory of fractional photothermolysis (FP),
which was first introduced in 2004 [13], a fractional laser
divides the ray of the laser, creating a microscopic column
of thermal injury called a microscopic treatment zone
(MTZ). By producing such a precise column of thermal
injury, it has the advantage of rapid recovery of skin
tissue after laser treatment [13].
Various fractional lasers have been reported to have
efficacy for various acquired pigment diseases including
melasma and PIH [14]. For example, it has been reported
that 1550 nm erbium‐doped fiber laser is a safe and ef-
fective treatment for PIH. Meanwhile, the 1927 nm frac-
tional TFL has a higher absorption coefficient for water
than the 1550 nm wavelength, which allows for more
precise targeting of the epidermis and superficial dermis
without ablation [14,15]. In addition, the maximum pen-
etration depth of TFL is 200 μm, which can more effec-
tively target the melanin pigmentation in dermoepi-
dermal junction through MTZs than a 1550 nm
wavelength with a penetration depth range of

Fig. 4. Histopathologic findings in Case 1 (left) before and (right) after seven sessions of
treatment with the fractional 1927 nm thulium fiber laser. A prominent decrease of
melanophages in the upper dermis is noted (hematoxylin and eosin stain; ×100).
6 KIM ET AL.
1400–1500 nm, which can delay wound healing and more
likely cause PIH. Therefore, Riehl's melanosis, which is
represented by numerous upper dermal melanin par-
ticles, might successfully be treated with the 1927 nm
fractional TFL. Also, similarly to PIH, pigmentation in
Riehl's melanosis is closely associated with inflammation
and injury in the dermoepidermal junction. The shallow
penetration depth of thulium laser minimizes additional
inflammation by targeting mainly epidermal cells, re-
verses the disruption of the dermoepidermal junction
(basement membrane), and induces neocollagenosis and
elastinogenesis in the upper dermis, that is, remodeling of
the pathologic dermis [16]. Therefore, 1927 nm thulium
laser could be also useful for postinflammatory hyper-
pigmentation including Riehl's melanosis, in which mel-
anophages, the main pathology of pigmentation are
mostly located in the upper dermis.
Most studies regarding 1927 nm fractional TFL have
focused on the treatment of melasma and PIH, sug-
gesting it is a safe and effective treatment option
[7,17,18]. In particular, in PIH treatment, whose
pathogenesis and histologic features are similar to
Riehl's melanosis, TFL was reported to show a prom-
ising effect. Lee et al. [19] reported a case in which the
patient experienced marked improvement of PIH after
four sessions of TF with the use of 4% hydroquinone. A
retrospective study that enrolled 61 patients with PIH
showed that the mean percent improvement after
treatment evaluated by the two dermatologists was
43.24%, and treatment sessions ranged from 2 to 5 [16].
Also in our study, a relatively small number of treat-
ment sessions (three to seven sessions) of TFL achieved
considerable clinical improvement (more than 50% in
quartile grading scale) in six of nine patients with
Riehl's melanosis (67.7%), which had shown minimal or
no response to previous treatments. In the aspect of an
objective assessment, melanin index from two patients
whose melanin index was available at their initial visits
showed a marked decrease. Also in histologic evalua-
tion, though the biopsies before and after laser treat-
ment were performed in only one patient (Case 1), a
marked decrease of melanophages in the upper dermis
was evidently observed. However, residual dermal pig-
mentation was still observed although significant re-
duction of pigmentation was achieved by TFL. Despite
the advantage of TFL targeting epidermis and/or upper
dermis with a minimal side effect, the shallow pene-
tration of TFL can be the limitation of the treatment for
Riehl's melanosis if Riehl's melanosis also exhibits
pigmentation in the deeper skin layer and not only in
the superficial layer.
In this study, no patient experienced side effects such as
scarring or PIH. A low possibility of PIH after TFL in
Riehl's melanosis could come from its fractional system,
relatively shallow penetration depth, and intact coagu-
lation zone without ablation. By these pieces of data, in-
cluding efficacy results and safety profile, it can be an-
ticipated that the 1927 nm thulium fiber laser may be a
promising alternative and/or additive treatment modality
to treat Riehl's melanosis, due to the fact that there is no
cure that shows an effect in a relatively short time while
increasing patient satisfaction to date.
CONCLUSIONS
This study, although not randomized or well‐
conditioned but a pilot study with a small number of
patients, is, at least to our knowledge, the first report
regarding the effectiveness and safety of TFL on Riehl's
melanosis. The effectiveness and safety of TFL observed
in this study provide sufficient justification for further
precisely designed clinical trials. The TFL does not di-
rectly target melanin pigments, unlike QS‐Nd:YAG laser
or light‐based devices such as IPL and PDL. Instead, it is
thought that numerous melanin pigments in the der-
moepidermal junction and upper dermis, which are typ-
ical histologic findings of Riehl's melanosis, can be effec-
tively targeted by TFL. In conclusion, the TFL might be
an alternative and/or additive treatment option for in-
tractable pigmentation in Riehl's melanosis and also PIH
caused by any other reasons, although the effects of TFL
on Riehl's melanosis and PIH need to be validated by
well‐controlled, randomized clinical trials.
ACKNOWLEDGMENT
We thank Dr. Won Seok Roh for his help in preparing for
the photographs.
REFERENCES
1. Serrano G, Pujol C, Cuadra J, Gallo S, Aliaga A. Riehl's
melanosis: Pigmented contact dermatitis caused by fra-
grances. J Am Acad Dermatol 1989;21(5 Pt 2):1057–1060.
2. Mikhail M, Sceppa J, Smith BL, Chu P, Marghoob AA. Four
views of areolar melanosis: Clinical appearance, dermoscopy,
confocal microscopy, and histopathology. Dermatol Surg
2008;34(8):1101–1103.
3. Sugai T, Takahashi Y, Takagi T. Pigmented cosmetic der-
matitis and coal tar dyes. Contact Dermatitis 1977;3(5):
249–256.
4. Perez‐Bernal A, Munoz‐Perez MA, Camacho F. Management
of facial hyperpigmentation. Am J Clin Dermatol 2000;
1(5):261–268.
5. Fabi SG, Friedmann DP, Niwa Massaki AB, Goldman MP.
A randomized, split‐face clinical trial of low‐fluence Q‐
switched neodymium‐doped yttrium aluminum garnet
(1,064 nm) laser versus low‐fluence Q‐switched alexandrite
laser (755 nm) for the treatment of facial melasma. Lasers
Surg Med 2014;46(7):531–537.
6. Kwon IH, Bae Y, Yeo UC, et al. Histologic analyses on the
response of the skin to 1,927‐nm fractional thulium fiber
laser treatment. J Cosmet Laser Ther 2018;20(1):12–16.
7. Polder KD, Bruce S. Treatment of melasma using a novel
1,927‐nm fractional thulium fiber laser: A pilot study. Der-
matol Surg 2012;38(2):199–206.
8. Kumaran MS, Dabas G, Vinay K, Parsad D. Reliability as-
sessment and validation of the dermal pigmentation area
and severity index: A new scoring method for acquired
dermal macular hyperpigmentation. J Eur Acad Dermatol
Venereol 2019;33(7):1386–1392.
9. Li YH, Liu J, Chen JZ, et al. A pilot study of intense pulsed
light in the treatment of Riehl's melanosis. Dermatol Surg
2011;37(1):119–122.
10. On HR, Hong WJ, Roh MR. Low‐pulse energy Q‐switched
Nd:YAG laser treatment for hair‐dye‐induced Riehl's mela-
nosis. J Cosmet Laser Ther 2015;17(3):135–138.
 FRACTIONAL LASER ON RIEHL'S MELANOSIS
11. Kwon HH, Ohn J, Suh DH, et al. A pilot study for triple
combination therapy with a low‐fluence 1064 nm Q‐switched
Nd:YAG laser, hydroquinone cream and oral tranexamic acid
for recalcitrant Riehl's melanosis. J Dermatol Treat
2017;28(2):155–159.
12. Cho MY, Roh MR. Successful treatment of Riehl's melanosis
with mid‐fluence Q‐switched Nd:YAG 1064‐nm laser. Lasers
Surg Med 2020;52(8):753–760.
13. Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR.
Fractional photothermolysis: A new concept for cutaneous
remodeling using microscopic patterns of thermal injury.
Lasers Surg Med 2004;34(5):426–438.
14. Dunbar S, Posnick D, Bloom B, Elias C, Zito P, Goldberg DJ.
Energy‐based device treatment of melasma: An update and
review of the literature. J Cosmet Laser Ther 2017;
19(1):2–12.
15. Cho SB, Zheng Z, Kang J‐S, Kim H. Therapeutic efficacy of
1,927‐nm fractionated thulium laser energy and poly-
deoxyribonucleotide on pattern hair loss. Med Lasers
2016;5(1):22–28.
7
16. Bae YC, Rettig S, Weiss E, Bernstein L, Geronemus R.
Treatment of post‐inflammatory hyperpigmentation in
patients with darker skin types using a low energy
1,927 nm non‐ablative fractional laser: A retrospective
photographic review analysis. Lasers Surg Med
2020;52(1):7–12.
17. Kurmuş G, Tatlıparmak A, Aksoy B, Koç E, Aşiran Serdar Z,
Ergin C. Efficacy and safety of 1927 nm fractional Thulium
fiber laser for the treatment of melasma: A retrospective
study of 100 patients. J Cosmet Laser Ther 2019;21(7‐8):
408–411.
18. Niwa Massaki ABM, Eimpunth S, Fabi SG, Guiha I, Groff W,
Fitzpatrick R. Treatment of melasma with the 1,927‐nm
fractional thulium fiber laser: A retrospective analysis of 20
cases with long‐term follow‐up. Lasers Surg Med 2013;
45(2):95–101.
19. Lee SJ, Chung WS, Lee JD, Kim HS. A patient with cupping‐
related post‐inflammatory hyperpigmentation successfully
treated with a 1,927 nm thulium fiber fractional laser.
J Cosmet Laser Ther 2014;16(2):66–68.