Clinicopathologic Efficacy of Copper Bromide Plus/Yellow Laser (578 nm with 511 nm) for Treatment of Melasma in Asian Patients

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. OBJECTIVE To test the efficacy of copper bromide laser in the treatment of Korean women with melasma. MATERIALS AND METHODS Clinical parameters included physician and patient assessment and Melasma Area and Severity Index score. The intensity of pigmentation and erythema was measured using a chromometer. To evaluate histopathologic changes, punch biopsies from melasma were obtained from four patients. Immunohistochemical staining for Melan-A, endothelin 1, CD34, and vascular endothelial growth factor (VEGF) antigen of the melasma lesions was observed. RESULTS Mean MASI score decreased dramatically after treatment. Patients exhibited telangiectatic erythema within the melasma lesion. The values of L* reflecting intensity of pigmentation increased, and the values of a* as the measurement of redness decreased after the treatments. Expression of Melan-A, CD34, endothelin-1, and VEGF decreased after treatment. CONCLUSION The potential application of an antiangiogenetic laser for the treatment of melasma specially accompanied by pronounced telangiectasia in Asian skin is a possible treatment option.