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Laser and light therapy for cutaneous hyperpigmentation

Andrei Metelitsa, MD, FRCPC
Thomas Rohrer, MD
Kenneth A Arndt, MD
Section Editor
Jeffrey S Dover, MD, FRCPC
Deputy Editor
Abena O Ofori, MD


Lasers and intense pulsed light are useful for the treatment of a wide variety of disorders characterized by the presence of cutaneous hyperpigmentation. The mechanisms by which these therapies improve hyperpigmentation include photothermal, photomechanical, and ablative effects.

Thorough knowledge of the principles that govern the interaction between light and skin is essential for the successful and safe clinical application of lasers and intense pulsed light. Knowledge of the lesion type and lesional histopathologic characteristics are critical for the selection of an appropriate light-based therapy.

The principles of laser and intense pulsed light therapy for hyperpigmented skin lesions, the lasers used for this indication, and the therapeutic options for select disorders of hyperpigmentation will be discussed here. The general principles of medical lasers and more information on the principles of treatment of cutaneous lesions with laser and intense pulsed light are reviewed elsewhere. (See "Basic principles of medical lasers" and "Principles of laser and intense pulsed light for cutaneous lesions".)


The use of laser and intense pulsed light therapy for cutaneous hyperpigmentation is based upon the clinical application of the theory of selective photothermolysis, a theory that describes the mechanism by which light can be used to exert specific effects on the skin [1]. (See "Principles of laser and intense pulsed light for cutaneous lesions", section on 'Selective photothermolysis'.)

The basic principles of selective photothermolysis are as follows [1]:

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Literature review current through: Nov 2017. | This topic last updated: Aug 04, 2017.
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  1. Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science 1983; 220:524.
  2. Haimovic A, Brauer JA, Cindy Bae YS, Geronemus RG. Safety of a picosecond laser with diffractive lens array (DLA) in the treatment of Fitzpatrick skin types IV to VI: A retrospective review. J Am Acad Dermatol 2016; 74:931.
  3. Khetarpal S, Desai S, Kruter L, et al. Picosecond laser with specialized optic for facial rejuvenation using a compressed treatment interval. Lasers Surg Med 2016; 48:723.
  4. Hantash BM, Bedi VP, Sudireddy V, et al. Laser-induced transepidermal elimination of dermal content by fractional photothermolysis. J Biomed Opt 2006; 11:041115.
  5. Trotter MJ, Tron VA, Hollingdale J, Rivers JK. Localized chrysiasis induced by laser therapy. Arch Dermatol 1995; 131:1411.
  6. Polder KD, Landau JM, Vergilis-Kalner IJ, et al. Laser eradication of pigmented lesions: a review. Dermatol Surg 2011; 37:572.
  7. Polder KD, Harrison A, Eubanks LE, Bruce S. 1,927-nm fractional thulium fiber laser for the treatment of nonfacial photodamage: a pilot study. Dermatol Surg 2011; 37:342.
  8. Todd MM, Rallis TM, Gerwels JW, Hata TR. A comparison of 3 lasers and liquid nitrogen in the treatment of solar lentigines: a randomized, controlled, comparative trial. Arch Dermatol 2000; 136:841.
  9. Taylor CR, Anderson RR. Treatment of benign pigmented epidermal lesions by Q-switched ruby laser. Int J Dermatol 1993; 32:908.
  10. Kagami S, Asahina A, Watanabe R, et al. Treatment of 153 Japanese patients with Q-switched alexandrite laser. Lasers Med Sci 2007; 22:159.
  11. Sadighha A, Saatee S, Muhaghegh-Zahed G. Efficacy and adverse effects of Q-switched ruby laser on solar lentigines: a prospective study of 91 patients with Fitzpatrick skin type II, III, and IV. Dermatol Surg 2008; 34:1465.
  12. Suh DH, Han KH, Chung JH. The use of Q-switched Nd:YAG laser in the treatment of superficial pigmented lesions in Koreans. J Dermatolog Treat 2001; 12:91.
  13. Rosenbach A, Lee SJ, Johr RH. Treatment of medium-brown solar lentigines using an alexandrite laser designed for hair reduction. Arch Dermatol 2002; 138:547.
  14. Kilmer SL, Wheeland RG, Goldberg DJ, Anderson RR. Treatment of epidermal pigmented lesions with the frequency-doubled Q-switched Nd:YAG laser. A controlled, single-impact, dose-response, multicenter trial. Arch Dermatol 1994; 130:1515.
  15. Galeckas KJ, Collins M, Ross EV, Uebelhoer NS. Split-face treatment of facial dyschromia: pulsed dye laser with a compression handpiece versus intense pulsed light. Dermatol Surg 2008; 34:672.
  16. Konishi N, Kawada A, Kawara S, et al. Clinical effectiveness of a novel intense pulsed light source on facial pigmentary lesions. Arch Dermatol Res 2008; 300 Suppl 1:S65.
  17. Kawada A, Shiraishi H, Asai M, et al. Clinical improvement of solar lentigines and ephelides with an intense pulsed light source. Dermatol Surg 2002; 28:504.
  18. Kawada A, Asai M, Kameyama H, et al. Videomicroscopic and histopathological investigation of intense pulsed light therapy for solar lentigines. J Dermatol Sci 2002; 29:91.
  19. Kono T, Manstein D, Chan HH, et al. Q-switched ruby versus long-pulsed dye laser delivered with compression for treatment of facial lentigines in Asians. Lasers Surg Med 2006; 38:94.
  20. Kono T, Groff WF, Sakurai H, et al. Comparison study of intense pulsed light versus a long-pulse pulsed dye laser in the treatment of facial skin rejuvenation. Ann Plast Surg 2007; 59:479.
  21. Kono T, Chan HH, Groff WF, et al. Long-pulse pulsed dye laser delivered with compression for treatment of facial lentigines. Dermatol Surg 2007; 33:945.
  22. Kauvar AN, Rosen N, Khrom T. A newly modified 595-nm pulsed dye laser with compression handpiece for the treatment of photodamaged skin. Lasers Surg Med 2006; 38:808.
  23. Galeckas KJ, Ross EV, Uebelhoer NS. A pulsed dye laser with a 10-mm beam diameter and a pigmented lesion window for purpura-free photorejuvenation. Dermatol Surg 2008; 34:308.
  24. Wanner M, Tanzi EL, Alster TS. Fractional photothermolysis: treatment of facial and nonfacial cutaneous photodamage with a 1,550-nm erbium-doped fiber laser. Dermatol Surg 2007; 33:23.
  25. Sherling M, Friedman PM, Adrian R, et al. Consensus recommendations on the use of an erbium-doped 1,550-nm fractionated laser and its applications in dermatologic laser surgery. Dermatol Surg 2010; 36:461.
  26. Tse Y, Levine VJ, McClain SA, Ashinoff R. The removal of cutaneous pigmented lesions with the Q-switched ruby laser and the Q-switched neodymium: yttrium-aluminum-garnet laser. A comparative study. J Dermatol Surg Oncol 1994; 20:795.
  27. Wang Y, Qian H, Lu Z. Treatment of café au lait macules in Chinese patients with a Q-switched 755-nm alexandrite laser. J Dermatolog Treat 2012; 23:431.
  28. Shimbashi T, Kamide R, Hashimoto T. Long-term follow-up in treatment of solar lentigo and café-au-lait macules with Q-switched ruby laser. Aesthetic Plast Surg 1997; 21:445.
  29. Kim HR, Ha JM, Park MS, et al. A low-fluence 1064-nm Q-switched neodymium-doped yttrium aluminium garnet laser for the treatment of café-au-lait macules. J Am Acad Dermatol 2015; 73:477.
  30. Alora MB, Arndt KA. Treatment of a café-au-lait macule with the erbium:YAG laser. J Am Acad Dermatol 2001; 45:566.
  31. Choi JE, Kim JW, Seo SH, et al. Treatment of Becker's nevi with a long-pulse alexandrite laser. Dermatol Surg 2009; 35:1105.
  32. Nanni CA, Alster TS. Treatment of a Becker's nevus using a 694-nm long-pulsed ruby laser. Dermatol Surg 1998; 24:1032.
  33. Trelles MA, Allones I, Moreno-Arias GA, Vélez M. Becker's naevus: a comparative study between erbium: YAG and Q-switched neodymium:YAG; clinical and histopathological findings. Br J Dermatol 2005; 152:308.
  34. Meesters AA, Wind BS, Kroon MW, et al. Ablative fractional laser therapy as treatment for Becker nevus: a randomized controlled pilot study. J Am Acad Dermatol 2011; 65:1173.
  35. Glaich AS, Goldberg LH, Dai T, et al. Fractional resurfacing: a new therapeutic modality for Becker's nevus. Arch Dermatol 2007; 143:1488.
  36. Jang KA, Chung EC, Choi JH, et al. Successful removal of freckles in Asian skin with a Q-switched alexandrite laser. Dermatol Surg 2000; 26:231.
  37. Rashid T, Hussain I, Haider M, Haroon TS. Laser therapy of freckles and lentigines with quasi-continuous, frequency-doubled, Nd:YAG (532 nm) laser in Fitzpatrick skin type IV: a 24-month follow-up. J Cosmet Laser Ther 2002; 4:81.
  38. Imayama S, Ueda S. Long- and short-term histological observations of congenital nevi treated with the normal-mode ruby laser. Arch Dermatol 1999; 135:1211.
  39. Vibhagool C, Byers HR, Grevelink JM. Treatment of small nevomelanocytic nevi with a Q-switched ruby laser. J Am Acad Dermatol 1997; 36:738.
  40. Rosenbach A, Williams CM, Alster TS. Comparison of the Q-switched alexandrite (755 nm) and Q-switched Nd:YAG (1064 nm) lasers in the treatment of benign melanocytic nevi. Dermatol Surg 1997; 23:239.
  41. Duke D, Byers HR, Sober AJ, et al. Treatment of benign and atypical nevi with the normal-mode ruby laser and the Q-switched ruby laser: clinical improvement but failure to completely eliminate nevomelanocytes. Arch Dermatol 1999; 135:290.
  42. Grevelink JM, van Leeuwen RL, Anderson RR, Byers HR. Clinical and histological responses of congenital melanocytic nevi after single treatment with Q-switched lasers. Arch Dermatol 1997; 133:349.
  43. Waldorf HA, Kauvar AN, Geronemus RG. Treatment of small and medium congenital nevi with the Q-switched ruby laser. Arch Dermatol 1996; 132:301.
  44. Kishi K, Okabe K, Ninomiya R, et al. Early serial Q-switched ruby laser therapy for medium-sized to giant congenital melanocytic naevi. Br J Dermatol 2009; 161:345.
  45. August PJ, Ferguson JE, Madan V. A study of the efficacy of carbon dioxide and pigment-specific lasers in the treatment of medium-sized congenital melanocytic naevi. Br J Dermatol 2011; 164:1037.
  46. Ueda S, Imayama S. Normal-mode ruby laser for treating congenital nevi. Arch Dermatol 1997; 133:355.
  47. Kono T, Erçöçen AR, Chan HH, et al. Effectiveness of the normal-mode ruby laser and the combined (normal-mode plus q-switched) ruby laser in the treatment of congenital melanocytic nevi: a comparative study. Ann Plast Surg 2002; 49:476.
  48. Horner BM, El-Muttardi NS, Mayou BJ. Treatment of congenital melanocytic naevi with CO2 laser. Ann Plast Surg 2005; 55:276.
  49. Kono T, Chan HH, Erçöçen AR, et al. Use of Q-switched ruby laser in the treatment of nevus of ota in different age groups. Lasers Surg Med 2003; 32:391.
  50. Watanabe S, Takahashi H. Treatment of nevus of Ota with the Q-switched ruby laser. N Engl J Med 1994; 331:1745.
  51. Jerdan K, Hsu JT, Schnurstein E. Successful treatment of Ota nevus with the 532-nm solid-state picosecond laser. Cutis 2017; 99:E29.
  52. Chan JC, Shek SY, Kono T, et al. A retrospective analysis on the management of pigmented lesions using a picosecond 755-nm alexandrite laser in Asians. Lasers Surg Med 2016; 48:23.
  53. Chang CJ, Kou CS. Comparing the effectiveness of Q-switched Ruby laser treatment with that of Q-switched Nd:YAG laser for oculodermal melanosis (Nevus of Ota). J Plast Reconstr Aesthet Surg 2011; 64:339.
  54. Chan HH, Ying SY, Ho WS, et al. An in vivo trial comparing the clinical efficacy and complications of Q-switched 755 nm alexandrite and Q-switched 1064 nm Nd:YAG lasers in the treatment of nevus of Ota. Dermatol Surg 2000; 26:919.
  55. Chan HH, King WW, Chan ES, et al. In vivo trial comparing patients' tolerance of Q-switched Alexandrite (QS Alex) and Q-switched neodymium:yttrium-aluminum-garnet (QS Nd:YAG) lasers in the treatment of nevus of Ota. Lasers Surg Med 1999; 24:24.
  56. Chan HH, Leung RS, Ying SY, et al. Recurrence of nevus of Ota after successful treatment with Q-switched lasers. Arch Dermatol 2000; 136:1175.
  57. Kouba DJ, Fincher EF, Moy RL. Nevus of Ota successfully treated by fractional photothermolysis using a fractionated 1440-nm Nd:YAG laser. Arch Dermatol 2008; 144:156.
  58. Katz TM, Goldberg LH, Firoz BF, Friedman PM. Fractional photothermolysis for the treatment of postinflammatory hyperpigmentation. Dermatol Surg 2009; 35:1844.
  59. Rokhsar CK, Ciocon DH. Fractional photothermolysis for the treatment of postinflammatory hyperpigmentation after carbon dioxide laser resurfacing. Dermatol Surg 2009; 35:535.
  60. Schmitt L, Raulin C, Karsai S. [Fractional photothermolysis. Treatment of post-inflammatory hyperpigmentation following meadow grass dermatitis]. Hautarzt 2009; 60:573.
  61. Kroon MW, Wind BS, Meesters AA, et al. Non-ablative 1550 nm fractional laser therapy not effective for erythema dyschromicum perstans and postinflammatory hyperpigmentation: a pilot study. J Dermatolog Treat 2012; 23:339.
  62. Kim S, Cho KH. Treatment of facial postinflammatory hyperpigmentation with facial acne in Asian patients using a Q-switched neodymium-doped yttrium aluminum garnet laser. Dermatol Surg 2010; 36:1374.
  63. Taylor CR, Anderson RR. Ineffective treatment of refractory melasma and postinflammatory hyperpigmentation by Q-switched ruby laser. J Dermatol Surg Oncol 1994; 20:592.
  64. Cho SB, Kim JS, Kim MJ. Melasma treatment in Korean women using a 1064-nm Q-switched Nd:YAG laser with low pulse energy. Clin Exp Dermatol 2009; 34:e847.
  65. Chan NP, Ho SG, Shek SY, et al. A case series of facial depigmentation associated with low fluence Q-switched 1,064 nm Nd:YAG laser for skin rejuvenation and melasma. Lasers Surg Med 2010; 42:712.
  66. Jeong SY, Shin JB, Yeo UC, et al. Low-fluence Q-switched neodymium-doped yttrium aluminum garnet laser for melasma with pre- or post-treatment triple combination cream. Dermatol Surg 2010; 36:909.
  67. Lee HS, Won CH, Lee DH, et al. Treatment of melasma in Asian skin using a fractional 1,550-nm laser: an open clinical study. Dermatol Surg 2009; 35:1499.
  68. Wind BS, Kroon MW, Meesters AA, et al. Non-ablative 1,550 nm fractional laser therapy versus triple topical therapy for the treatment of melasma: a randomized controlled split-face study. Lasers Surg Med 2010; 42:607.
  69. Karsai S, Fischer T, Pohl L, et al. Is non-ablative 1550-nm fractional photothermolysis an effective modality to treat melasma? Results from a prospective controlled single-blinded trial in 51 patients. J Eur Acad Dermatol Venereol 2012; 26:470.
  70. Katz TM, Glaich AS, Goldberg LH, et al. Treatment of melasma using fractional photothermolysis: a report of eight cases with long-term follow-up. Dermatol Surg 2010; 36:1273.
  71. Naito SK. Fractional photothermolysis treatment for resistant melasma in Chinese females. J Cosmet Laser Ther 2007; 9:161.
  72. Trelles MA, Velez M, Gold MH. The treatment of melasma with topical creams alone, CO2 fractional ablative resurfacing alone, or a combination of the two: a comparative study. J Drugs Dermatol 2010; 9:315.
  73. Brauer J, Geronemus RG, Correa LM, et al. #5 Novel low energy low density non-ablative fractional treatment of melasma and postinflammatory hyperpigmentation. Lasers Surg Med 2013; 45 (S25):2.
  74. Brauer JA, Alabdulrazzaq H, Bae YS, Geronemus RG. Evaluation of a Low Energy, Low Density, Non-Ablative Fractional 1927 nm Wavelength Laser for Facial Skin Resurfacing. J Drugs Dermatol 2015; 14:1262.
  75. Wang CC, Hui CY, Sue YM, et al. Intense pulsed light for the treatment of refractory melasma in Asian persons. Dermatol Surg 2004; 30:1196.
  76. Zoccali G, Piccolo D, Allegra P, Giuliani M. Melasma treated with intense pulsed light. Aesthetic Plast Surg 2010; 34:486.
  77. Goldman MP, Gold MH, Palm MD, et al. Sequential treatment with triple combination cream and intense pulsed light is more efficacious than sequential treatment with an inactive (control) cream and intense pulsed light in patients with moderate to severe melasma. Dermatol Surg 2011; 37:224.
  78. Li YH, Chen JZ, Wei HC, et al. Efficacy and safety of intense pulsed light in treatment of melasma in Chinese patients. Dermatol Surg 2008; 34:693.
  79. Manaloto RM, Alster T. Erbium:YAG laser resurfacing for refractory melasma. Dermatol Surg 1999; 25:121.
  80. Nouri K, Bowes L, Chartier T, et al. Combination treatment of melasma with pulsed CO2 laser followed by Q-switched alexandrite laser: a pilot study. Dermatol Surg 1999; 25:494.
  81. Wanitphakdeedecha R, Manuskiatti W, Siriphukpong S, Chen TM. Treatment of melasma using variable square pulse Er:YAG laser resurfacing. Dermatol Surg 2009; 35:475.
  82. Gupta AK, Gover MD, Nouri K, Taylor S. The treatment of melasma: a review of clinical trials. J Am Acad Dermatol 2006; 55:1048.
  83. Basler RS. Minocycline-related hyperpigmentation. Arch Dermatol 1985; 121:606.
  84. Wasel NR, Schloss EH, Lin AN. Minocycline-induced cutaneous pigmentation. J Cutan Med Surg 1998; 3:105.
  85. Tsao H, Busam K, Barnhill RL, Dover JS. Treatment of minocycline-induced hyperpigmentation with the Q-switched ruby laser. Arch Dermatol 1996; 132:1250.
  86. Wilde JL, English JC 3rd, Finley EM. Minocycline-induced hyperpigmentation. Treatment with the neodymium:YAG laser. Arch Dermatol 1997; 133:1344.
  87. Wood B, Munro CS, Bilsland D. Treatment of minocycline-induced pigmentation with the neodymium-Yag laser. Br J Dermatol 1998; 139:562.
  88. Collins P, Cotterill JA. Minocycline-induced pigmentation resolves after treatment with the Q-switched ruby laser. Br J Dermatol 1996; 135:317.
  89. Alster TS, Gupta SN. Minocycline-induced hyperpigmentation treated with a 755-nm Q-switched alexandrite laser. Dermatol Surg 2004; 30:1201.
  90. Green D, Friedman KJ. Treatment of minocycline-induced cutaneous pigmentation with the Q-switched Alexandrite laser and a review of the literature. J Am Acad Dermatol 2001; 44:342.
  91. Greve B, Schönermark MP, Raulin C. Minocycline-induced hyperpigmentation: treatment with the Q-switched Nd:YAG laser. Lasers Surg Med 1998; 22:223.
  92. Knoell KA, Milgraum SS, Kutenplon M. Q-switched ruby laser treatment of minocycline-induced cutaneous hyperpigmentation. Arch Dermatol 1996; 132:1251.
  93. Izikson L, Anderson RR. Resolution of blue minocycline pigmentation of the face after fractional photothermolysis. Lasers Surg Med 2008; 40:399.
  94. Orringer JS, Lowe L, Cha KB. Treatment of imipramine-induced dyspigmentation with Q-switched alexandrite laser therapy. Dermatol Surg 2010; 36:1469.
  95. Atkin DH, Fitzpatrick RE. Laser treatment of imipramine-induced hyperpigmentation. J Am Acad Dermatol 2000; 43:77.
  96. Izikson L, Anderson RR. Delayed darkening of imipramine-induced hyperpigmentation after treatment with a Q-switched Nd:YAG laser followed by a Q-switched ruby laser. Dermatol Surg 2009; 35:527.
  97. Kramer KE, Lopez A, Stefanato CM, Phillips TJ. Exogenous ochronosis. J Am Acad Dermatol 2000; 42:869.
  98. Bellew SG, Alster TS. Treatment of exogenous ochronosis with a Q-switched alexandrite (755 nm) laser. Dermatol Surg 2004; 30:555.
  99. Karrer S, Hohenleutner U, Szeimies RM, Landthaler M. Amiodarone-induced pigmentation resolves after treatment with the Q-switched ruby laser. Arch Dermatol 1999; 135:251.
  100. Wiper A, Roberts DH, Schmitt M. Amiodarone-induced skin pigmentation: Q-switched laser therapy, an effective treatment option. Heart 2007; 93:15.