Although low-fluence Q-switched Nd:YAG laser (QSNY) treatment has been shown to be effective in treating melasma, adverse events, including mottled hypopigmentation (MH) and rebound hyperpigmentation (RH) have been reported. A recent study was conducted to compare the effectiveness and safety of combination therapy using low-fluence QSNY and long-pulsed Nd:YAG laser (LPNY) (Dual toning) with lowfluence QSNY monotherapy (QS toning) in Asian patients with melasma. Patients were treated for 10 sessions at oneweek intervals with QSNY (6mm spot); 2.5-3.0 J/cm2 for QS toning (n=177) or 2.1- 2.5 J/cm2 for dual toning (n=183). The dual toning group was immediately treated with LPNY (7mm spot, 15-17 J/cm2). Results were evaluated using the modified Melasma Area and Severity Index (mMASI) score and the physician's global assessment. MH and RH were significantly lower (1.1% vs. 14.1%) and the treatment efficacy was improved (median decrease of mMASI, 3.6 vs. 3.0) in the dual toning group compared with QS toning group. Periorbital melasma showed distinctively high rates of adverse events in QS toning group (23.9% vs. 5.7%), which were significantly reduced in dual toning group (2.9%).

—J Cosmet Laser Ther. 2014 Aug 25:1-24.
[Epub ahead of print]


A recent study found that although childhood facial vitiligo is refractory to treatment, the long-term outcome of this condition is not dismal when treated with conventional vitiligo therapy along with a basic nutritional therapeutic regimen. This study evaluated the long-term outcome of childhood facial vitiligo who were treated with nutritional education, vitamin E (α-tocopherol 100-400 IU/day), folic acid (1-2 mg/ day), and multivitamin intake and antioxidant cosmetics as the mainstay of treatment as well as the conventional therapies including oral, topical, and/or intralesional corticosteroid, topical macrolactam, Excimer laser, and epidermal graft. Medical data and photographs of 111 pediatric facial vitiligo patients who had been followed for more than a year from March 1, 2003 through June 30, 2013 were extracted from a data warehouse of electronic medical records so that photographic evaluation and final visual outcome assessments could be performed. The investigator's assessment found that nine percent of patients demonstrated no improvement regardless of treatment modality versus 91 percent who showed improvement of lesions. Among the latter, 33.3 percent resulted in >75 percent improvement; 18 percent in 50-75 percent improvement; 26.1 percent in 25-50 percent improvement; and 13.5 percent in <25 percent improvement. In the final visual outcome assessment, ‘Looking excellent' was seen in 42.3 percent; ‘looking very good' in 30.6 percent; ‘looking good' in 17.1 percent; ‘looking fair' in 9.0 percent; and ‘looking bad' in 0.9 percent.

—J Eur Acad Dermatol Venereol. 2014 Aug 29.
[Epub ahead of print]


One hundred vitiligo patients aged 18 years and older who were included in a hospital-based study were asked to fill a validated Hindi version of DLQI questionnaire. DLQI scores and interpretation of these scores were recorded separately. Correlation of DLQI Scores with different variables like age, body surface area, duration of disease, and socioeconomic status were studied using Pearson's correlations. Mean DLQI scores were also compared between different groups. The study found that male and female patients were statistically similar in all variables, including age, BSA of the involvement of vitiligo, and DLQI score. DLQI interpretation showed that out of 100 patients with vitiligo, 16 reported no effect of vitiligo on their quality of life and 84 patients reported a small to very large effect on their quality of life. Out of this 84, 37 felt small effects, 21 felt moderate effect, and 26 felt a very large effect on their quality of life. There was no significant difference among the different groups mentioned except very large effect on quality of life seen significantly more in unmarried patients compared to married one.

Researchers concluded that although vitiligo is considered a cosmetic disease without any symptoms, it can carry a significant social stigma, especially in Indian society. “Data interpretation in this study indicates that vitiligo affects QOL in majority of vitiligo patients and such patients require more aggressive and empathic attitude from a dermatologist to cure/improve this so called chronic cosmetic disease,” the study concluded.

—J Clin Diagn Res. 2014 Jun;8(6):YC01-3.