Melasma and Hypopigmentation After Q Switched Laser Treated with Intradermal Injections of Aminoacids and Low Weight Hyaluronic Acid (Sunekos Performa)

Melasma is a common skin condition characterized by symmetrical dark patches, appearing as light to dark brown spots on the face, usually on the forehead and cheek areas, which negatively affect the patient's quality of life. Many laser treatments have been developed to address melasma, with Low Fluence Q-Switched Nd: YAG laser (LFQSNY) being widely used. Some treatment plans recommend a session every 15 days, while others suggest a session every 28 days, but there is currently no agreed-upon frequency for treatment sessions. The LFQSNY appears to be an effective and safe option for treating melasma, though there have been occasional reports of mottled hypopigmentation, which may be linked to the accumulation of high laser energy. Kligman's formula stands as the gold standard for topical treatment of melasma, but its side effects, such as ochronosis from long-term use and irritation, have led many doctors to discontinue its use. We are describing a 48 year old female with Melasma who was treated in another Clinic with LFQSNY laser (10 sessions, one session every 21 days) and topical Kligmans formula nightly. The patient referred that after the 10th session she noticed white round patches in the treated area and and worsening of the melasma, after the physical examination the diagnosis was Melasma and Laser Hypopigmentation, therefore we decided to treat her with intradermal amino acids and low weight hyaluronic acid once a week for 2 weeks and then every 14 days for another 2 sessions, we also prescribed topical formulas. After 3 sessions of the Intradermal Injections and the topical creams the melasma and Hipopigmentation started its resolution. In order to measure the results of the Melasma we used Modified MASI Score as well as Visia (Candfield, USA) equipment for Before and after pictures to measure the response of the Hypopigmentation. The Modified MASI score was initially 9 before treatment, and after completing four sessions and applying the topical formulas, the score decreased to 3.6.