Journal of Cutaneous and Aesthetic Surgery
Print this page
Email this page
Small font size
Default font size
Increase font size
Home About us Current issue Archives Instructions Submission Subscribe Editorial Board Partners Contact e-Alerts Login 


 
   Table of Contents     
LETTER  
Year : 2014  |  Volume : 7  |  Issue : 1  |  Page : 56-57
Novel method of treatment of post-Q-switched Nd-YAG laser depigmentation with trichloroacetic acid: A report of two cases


1 Dermatology Cutis, Academy of Cutaneous Sciences, Bangalore, Karnataka, India
2 FRGUHS (Dermatosurgery) Cutis, Academy of Cutaneous Sciences, Bangalore, Karnataka, India

Click here for correspondence address and email

Date of Web Publication2-Apr-2014
 

How to cite this article:
Chandrashekar BS, Sriram R, Madura C. Novel method of treatment of post-Q-switched Nd-YAG laser depigmentation with trichloroacetic acid: A report of two cases. J Cutan Aesthet Surg 2014;7:56-7

How to cite this URL:
Chandrashekar BS, Sriram R, Madura C. Novel method of treatment of post-Q-switched Nd-YAG laser depigmentation with trichloroacetic acid: A report of two cases. J Cutan Aesthet Surg [serial online] 2014 [cited 2019 Jul 22];7:56-7. Available from: http://www.jcasonline.com/text.asp?2014/7/1/56/129983


Sir,

Q-Switched Nd-YAG laser (SPECTRA: LUTRONIC) has revolutionised the treatment of pigmentary lesions, which otherwise do not respond to medical line of treatment. In spite of its versatile applications, there is often a fear of post-inflammatory depigmentation (PID) especially in Fitzpatrick skin types 3-6. We would like to share our experience of treating two cases of post-Q-switched Nd-YAG laser depigmentation with 65% trichloroacetic acid (TCA) with complete re-pigmentation.

A 27-year-old male patient was started on Q-switched 1064 nm-Nd YAG laser for Nevus of Ota with energy of 6-8.6 J and 3-6 mm spot size. The laser therapy was continued with an interval of 6 weeks between each session. After 15 sessions, the patient developed PID [Figure 1]a. Patient was initially treated with excimer laser for 10-15 sessions with no re-pigmentation. He was then treated with 65% TCA. Degreasing with soap and water was done, all depigmented macules were marked within 1 cm 2 area and 65% TCA was applied using toothpick. Frosting was seen in 10-15 s. It was done in five sessions in divided areas. Sunscreen was advised. Complete re-pigmentation was seen in 2-4 weeks [Figure 1]b. The patient is currently under follow up and re-pigmentation is maintained even after 6 months [Figure 1]c. We came across yet another case of post-Nd-YAG depigmentation in a 17-year-old female treated for facial rejuvenation and skin lightening with energy of 1.6-2 J, 8 mm spot size and three passes for 10 sessions. After second session she developed PID [Figure 2]a. She was treated with 65% TCA and the procedure was carried out similarly. Few areas of complete re-pigmentation and crusting were seen in 2 weeks [Figure 2]b. The re-pigmentation is maintained even after 3 months [Figure 2]c.
Figure 1: (a) Patient with Nevus of Ota with mottled depigmentation following 15 sessions of Q-switched Nd YAG laser (b) Complete repigmentation following treatment with 65% trichloroacetic acid after 4 weeks (c) Complete repigmentation persistant at 6 months

Click here to view
Figure 2: (a) Patient treated for facial rejuvenation showing mottled depigmenattion following 2 sessions of Q-switched Nd YAG laser (b) Few areas of crusting and complete repigmentation following treatment with 65% trichloroacetic acid after 2 weeks (c) Complete repigmentation persistant at 3 months

Click here to view


While some of the hyperpigmented lesions such as melasma and post-inflammatory hyperpigmentation have no satisfactory medical management; other lesions like Nevus of Ota do not respond to medical management at all. The past decade has developed new systems that are more effective in treating pigmentary lesions such as Q-switched lasers. [1]

Transient complications include immediate erythema, physical urticaria, acneiform eruption, petechiae, whitening of fine hair and rebound hyperpigmentation. Complications, which need stopping the laser therapy, include mottled hypo- and hyperpigmentation, leukoderma, severe urticaria, severe acneiform eruption and herpes simplex activation. [2] It is often stated that PID is difficult to treat and may persist for weeks to months or years. It requires cessation of treatment for a period of 2-3 months, which may be treated with phototherapy. [3] However, the exact incidence of PID as a side effect is not known.

Post-inflammatory hyperpigmentation is a very common complication with TCA in patients with skin type 3-6. [4] We used TCA to treat depigmentation as it is well known to produce side effect of hyperpigmentation. TCA is simple, cost effective and can produce cosmetically acceptable results when complications such as mottled depigmentation are encountered. Hence by these simple techniques of handling the complications, use of Q-switched lasers can be encouraged.

 
   References Top

1.Aurangabadkar S. Laser for Pigmented lesions and tattoos. In: Mysore Venkatram. Textbook on Cutaneous and Aesthetic surgery: Lasers for pigmented lesions and tattoos, 1 st ed. New Delhi: Jaypee; 2012. p. 799-810.  Back to cited text no. 1
    
2.Goel A. Clinical applications of Q-switched NdYAG laser. Indian J Dermatol Venereol Leprol 2008;74:682-6.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.Aurangabadkar S, Mysore V. Standard guidelines of care: Lasers for tattoos and pigmented lesions. Indian J Dermatol Venereol Leprol 2009;75:111-26.  Back to cited text no. 3
  Medknow Journal  
4.Tca-Khunger N. Trichloroacetic acid. Step by Step Chemical Peels. 1 st ed. New Delhi: Jaypee Medical Publishers; 2009. p. 90-110.  Back to cited text no. 4
    

Top
Correspondence Address:
Byalakere Shivanna Chandrashekar
Dermatology Cutis, Academy of Cutaneous Sciences, Bangalore, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2077.129983

Rights and Permissions


    Figures

  [Figure 1], [Figure 2]



 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures

 Article Access Statistics
    Viewed1552    
    Printed33    
    Emailed0    
    PDF Downloaded188    
    Comments [Add]    

Recommend this journal