The effect of combination treatment of the recalcitrant pigmentary disorders with pigmented laser and chemical peeling.

Background: The pigmentary disorders including melasma, freckles, postinflammatory hyperpigmentation, or acquired bilateral nevus of Ota-like macules, etc. are usually resistant to all treatment modalities, and are therefore very frustrating to the patient and clinician.

Objective: The purpose of this study was to demonstrate the effect of the combination treatment of recalcitrant pigmentary disorders with pigmented laser and chemical peeling and to observe any side-effects.

Methods: Twenty-four patients with recalcitrant facial pigmentary disorders were treated with the Q-switched alexandrite laser at fluences of 7.0-8.0 J/cm2 or the pigmented lesion dye laser (PLDL) at fluences of 2.0-2.5 J/cm2, and at the same session, 15-25% trichloroactic acid (TCA) with or without Jessner's solution were used for the chemical peeling. And the results were clinically analyzed.

Results: In the assessment by the patients, 63% of them considered the result as "clear, excellent, or good" in respect to the color and 54% of them assessed that the size of the lesion had cleared more than 50%. In the assessment by a clinician, 67% of the patients were categorized into the grade of clear, excellent, or good. There were no significant complications with this combination method.

Conclusions: The combination treatment with pigmented laser and chemical peeling is effective, safe, and relatively inexpensive treatment modalities in the recalcitrant pigmentary disorders.