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Melasma has now become a well-known and significant condition within the category of hyperpigmentation. In Japan, the oral treatment for melasma, which is a combination of Vitamin C, Vitamin E, and Tranexamic Acid, has been conventionally used for over 40 years. Nowadays, online medical services exist solely to prescribe these medications regularly. The development of Energy-Based Devices (EBDs) for melasma treatment has been attempted for more than 20 years. The concept of laser toning, once thought to be the solution, has faced criticism due to the significant risk of inducing hypopigmentation and the frequent exacerbation of symptoms during or after treatment cessation.<br/>As new insights into the mechanisms of melasma emerge, it is increasingly understood that photoaging, reactive oxygen species (ROS), and stress play substantial roles in its pathogenesis. In cases of advanced photoaging, the coexistence of solar lentigines and exacerbated ephelides is very common, often addressed only by Q-switched or picosecond lasers. Moreover, severe photoaging can also lead to the occurrence of hypopigmented spots.<br/>In addition to traditional oral treatments and laser therapies, a growing variety of new agents for mesotherapy or percutaneous drug delivery, such as microneedling, have been developed and are now considered viable options for treating melasma. A comprehensive understanding of the fundamental pathology of melasma is essential to tailor individual treatment strategies effectively. This presentation will explore the latest developments in the understanding of melasma and discuss optimal treatment approaches.

AIM: This aim of this study was to evaluate the efficacy and safety of Q swithed 1064 nm Nd:YAG laser to treat melasma and melanosis without combination therapy. Based on the sub-cellular selective photothermolysis hypothesis of Korean Dr. Kin, we try to find the safety and duplicated effictive ways to deal with melasma. To treat melanosis, higher enery laser radiation aimed to kill abnormal melonacyte. PATIENTS AND METHODS: 133 patients' facial halves with bilateral symmetrical melasma have been treated by laser monotherapy since 2008 years. All patients received 24~30 consecutive laser treatment sessions at one-month intervals till the satisfactory result. 6 cases of melanosis have been carried out by same laser system medlite C10 but high energy since 2018 year. The clinical session of melanosis treatment is 8 to 10 months. Reflactance Confocal Micorscopy (RCM)was examined before and after lase. Efficacy was assessed using the RCM and patient’s photos evaluation. We designed laser parameter after previous practice failure of large sport and lower energy method according to the many literature. Our method is setting Q switched Nd:YAG laser 4mm spot size and 4.5J/cm2 of medlite C6 or 4mm spot size and 2.5J/cm2 of Medlite 10 , one evenly scanning over the whole face as a session. That of melanosis is 4mm spots and 4.5J/cm2. RESULTS: ALL melasma patients completed the study. 79 (59.40% ) cases got complete remission, 54 (40.60%) cases got partial remission. Among them 11cases’follow up underwent 12 years, the others underwent 3 years over. No higher pigmentation or hypo-pigmentions / depigmentaion were found. 4/6 of melanosis case got CR, the other 2/6 got PR. The RCM image shown abnormal high density distribution of melanosome was gradually diminished to normal distribution level contrast to normal face area at the end of laser monotherapy. In laser treated melanosis cases, the activated melanocyte were destroyed by Q switched Nd: YAG laser 1064nm. Their melanosome level were become normal. All these cases revealed no skin barrier rebuild process. CONCLUSION: The sub cellular SP was achieved as the melanosome diminished to normal level at melasma cases. Q switched ND:YAG laser at 4mm spot size and 4.5J/cm2 of Medlite C6, or 2,5J/cm2 of Medlite C10, one month session and one scanning technique is safe and effective to treat melasma without side effect. Melanosis is easily treated by Q switched Nd: YAG 1064nm laser.<br/>Key words: Q switched Nd:YAG 1064nm laser, melasma, melanosis, RCM

Q switched lasers in the management of pigmentary conditions in skin of colour<br/><br/>Objectives <br/>To review the efficacy and safety of Q switched lasers in pigmentary conditions in skin of colour <br/>Introduction <br/>The Q-switched Nd:YAG laser is an established modality of treatment for epidermal and dermal pigmented lesions. The dual wavelengths of 1064nm and 532nm are suited for the darker skin tones .Though this laser has become the one of choice for conditions such as nevus of Ota, Hori's nevus and tattoos, its role in the management of melasma and other acquired dermal melanoses is not clear. Despite several studies having been done on the Q-switched Nd:YAG laser in melasma, there is no consensus on the protocol or number of sessions required.<br/>Methods <br/>This presentation reviews the current literature on laser toning in melasma and the role of the Q-switched Nd:YAG laser in stubborn pigmentary disorders such as lichen planus pigmentosus. As the pathology is primarily dermal or mixed epidermal-dermal in these conditions, the longer wavelength of 1064nm is preferred due to its deeper penetration. Generally multiple sessions are needed for successful outcomes. Low fluence Q-switched Nd:YAG laser at 1064nm utilizing the multi-pass technique with a large spot size has been suggested as a modality to treat melasma. Varying degrees of success have been reported but recurrences are common on discontinuing laser therapy. Adverse effects such as mottled hypopigmentation have been reported following laser toning; these can be minimized by using larger spot sizes of 8 to 10mm with longer intervals (2 weeks) between sessions.<br/>Conclusion <br/>Lasers can be used in selected resistant cases of melasma when medical therapy fails or the patient is intolerant to topical medication For melasma, most evidence available is for laser toning (low fluence, multi-pass Q-switched Nd:YAG laser technique).Nevus of Ota and Hori's nevus respond well to Q-switched Nd:YAG laser. Recurrences are very rare upon clearing of the lesion. Lichen planus pigmentosus should be treated only when the condition has stabilized and there is no spread of the disease. Laser can be used in selected cases when activity ceases, and Q-switched Nd:YAG at 1064 nm can help clear the residual hyperpigmentation. However, multiple sittings are necessary.

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