Fractional lasers have emerged as a significant option in the treatment of various skin conditions, including melasma, a chronic skin disorder characterized by hyperpigmented patches. While fractional lasers were first approved for use in melasma treatment around 2006 with the Fraxel 1550 wavelength, their effectiveness has been debated among doctors. This article seeks to shed light on the appropriate use of fractional lasers, particularly for melasma, including their benefits, limitations, and optimal applications.
Since their initial approval, the perception of fractional lasers has evolved. While the Fraxel 1550 wavelength was thought to be a viable solution for primary melasma, clinical experience has demonstrated that this approach does not yield satisfactory results. In fact, in many cases, fractional laser treatment can exacerbate the condition, leading to increased pigmentation. Given this backdrop, it is essential to analyze the current status of fractional lasers and their potential efficacy for treating melasma.
Recent findings suggest that certain wavelengths, particularly the 1927 thulium laser, hold promise in treating melasma effectively. However, the key to success lies in the specifics of treatment settings and patient characteristics. Low energy settings, typically ranging from two to five millijoules, combined with a moderate density of 10 to 20 percent, are essential to minimize the risk of side effects. Treatments performed at these low energy levels may induce only mild redness, with slight peeling lasting a few days, making them a comparatively safer choice for individuals suffering from melasma.
Despite advancements in laser technology, one of the significant challenges associated with fractional lasers—such as CO2 and erbium glass lasers—remains the heat they generate during the treatment process. Heat can worsen melasma, leading practitioners to exercise caution when considering these treatments. As a result, many doctors remain reluctant to utilize fractional lasers, instead opting for alternative approaches when treating cases of melasma.
However, there are specific scenarios where fractional lasers may be employed. For patients who have melasma that has not responded to conventional topical therapies, deeper wavelengths like 1550, 1540, or 1570 may be explored. This method aims to penetrate deeper into the dermal layer to exfoliate persistent pigmentation. Furthermore, once a patient’s melasma has stabilized or is in a state of remission, fractional lasers can be beneficial for repairing underlying skin structures, specifically targeting senescent fibroblasts.
The rationale for using fractional lasers extends beyond pigmentation; these lasers can help restore the dermal architecture by stimulating collagen production and modulating the behavior of fibroblasts. This collagen synthesis strengthens the skin and balances the cell communication pathways critical in pigmentation disorders. Understanding how fibroblasts interact with melanocytes—the cells responsible for pigment production—can provide insight into more effective treatment outcomes.
In summary, fractional lasers represent an exciting option in the doctor’s toolkit, particularly for managing conditions beyond melasma. For optimal results, it is crucial to select the right patient candidates and utilize appropriate wavelengths and settings. Skin types one and two generally see good results, but darker skin types may require additional sessions to achieve similar outcomes.