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

Kateryn Michelle Perez Willis

doi:doi:10.11648/j.ijcd.20250801.17

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

Kateryn Michelle Perez Willis^*

Published in International Journal of Clinical Dermatology (Volume 8, Issue 1)

Received: 16 May 2025 Accepted: 28 May 2025 Published: 26 June 2025

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Abstract

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 10^th 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.

Published in	International Journal of Clinical Dermatology (Volume 8, Issue 1)
DOI	10.11648/j.ijcd.20250801.17
Page(s)	40-43
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Melasma, Laser, Hypopigmentation, Ochronosis

References

[1]	Lee YS, Lee YJ, Lee JM, Han TY, Lee JH, Choi JE. The Low-Fluence Q-Switched Nd: YAG Laser Treatment for Melasma: A Systematic Review. Medicina (Kaunas). 2022 Jul 14; 58(7): 936. https://doi.org/10.3390/medicina58070936
[2]	Feng J, Shen S, Song X, Xiang W. Efficacy and safety of picosecond laser for the treatment of melasma: a systematic review and meta-analysis. Lasers Med Sci. 2023 Mar 10; 38(1): 84. https://doi.org/10.1007/s10103-023-03744-y
[3]	Aurangabadkar SJ. Optimizing Q-switched lasers for melasma and acquired dermal melanoses. Indian J Dermatol Venereol Leprol. 2019 Jan-Feb; 85(1): 10-17. https://doi.org/10.4103/ijdvl.IJDVL_1086_16
[4]	Sofen B, Prado G, Emer J. Melasma and Post Inflammatory Hyperpigmentation: Management Update and Expert Opinion. Skin Therapy Lett. 2016 Jan; 21(1): 1-7.
[5]	Mahajan VK, Patil A, Blicharz L, Kassir M, Konnikov N, Gold MH, Goldman MP, Galadari H, Goldust M. Medical therapies for melasma. J Cosmet Dermatol. 2022 Sep; 21(9): 3707-3728. https://doi.org/10.1111/jocd.15242
[6]	Shenoy A, Madan R. Post-Inflammatory Hyperpigmentation: A Review of Treatment Strategies. J Drugs Dermatol. 2020 Aug 1; 19(8): 763-768. https://doi.org/10.36849/JDD.2020.4887
[7]	Mysore V, Anitha B, Hosthota A. Successful treatment of laser induced hypopigmentation with narrowband ultraviolet B targeted phototherapy. J Cutan Aesthet Surg. 2013 Apr; 6(2): 117-9. https://doi.org/10.4103/0974-2077.112677
[8]	Baugh, Erica G. BA; Anagu, Olive BS; Kelly, Kristen M. MD*,†. Laser Treatment of Hypopigmentation in Scars: A Review. Dermatologic Surgery 48(2): p 201-206, February 2022. \| https://doi.org/10.1097/DSS.0000000000003330
[9]	Zhang X, Chen Y, Yang H, Ding H, Cai P, Ge Y, Zheng H, Sun X, Yang Y, Li X, Lin T. Plasma Metabolomics Indicates Potential Biomarkers and Abnormal Metabolic Pathways in Female Melasma Patients. Ann Dermatol. 2024 Oct; 36(5): 300-309. https://doi.org/10.5021/ad.23.141
[10]	Pimentel B, Palmeiro A, Castro C, Silva L, Catorze MG, João AL. Use of Picosecond Laser for Melasma Treatment: A Narrative Review. Photobiomodul Photomed Laser Surg. 2023 Dec; 41(12): 674-682. https://doi.org/10.1089/photob.2023.0096
[11]	Liu Z. Treatment of Melasma With Q-Switched Laser in Combination With Tranexamic Acid. Dermatol Res Pract. 2025 Feb 5; 2025: 1883760. https://doi.org/10.1155/drp/1883760
[12]	Jiryis B, Toledano O, Avitan-Hersh E, Khamaysi Z. Management of Melasma: Laser and Other Therapies-Review Study. J Clin Med. 2024 Mar 3; 13(5): 1468. https://doi.org/10.3390/jcm13051468
[13]	Wu W, Su Q, Zhang Y, Du Y, Hu Y, Wang F. Novel 532-nm Q-switched Nd: YAG laser for the treatment of melasma and rejuvenation: a prospective, randomized controlled comparison with 1,064-nm Q-switched Nd: YAG laser. Int J Dermatol. 2024 Sep; 63(9): 1242-1251. https://doi.org/10.1111/ijd.17091

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APA Style

Willis, K. M. P. (2025). Melasma and Hypopigmentation After Q Switched Laser Treated with Intradermal Injections of Aminoacids and Low Weight Hyaluronic Acid (Sunekos Performa). International Journal of Clinical Dermatology, 8(1), 40-43. https://doi.org/10.11648/j.ijcd.20250801.17

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ACS Style

Willis, K. M. P. Melasma and Hypopigmentation After Q Switched Laser Treated with Intradermal Injections of Aminoacids and Low Weight Hyaluronic Acid (Sunekos Performa). Int. J. Clin. Dermatol. 2025, 8(1), 40-43. doi: 10.11648/j.ijcd.20250801.17

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AMA Style

Willis KMP. Melasma and Hypopigmentation After Q Switched Laser Treated with Intradermal Injections of Aminoacids and Low Weight Hyaluronic Acid (Sunekos Performa). Int J Clin Dermatol. 2025;8(1):40-43. doi: 10.11648/j.ijcd.20250801.17

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@article{10.11648/j.ijcd.20250801.17,
  author = {Kateryn Michelle Perez Willis},
  title = {Melasma and Hypopigmentation After Q Switched Laser Treated with Intradermal Injections of Aminoacids and Low Weight Hyaluronic Acid (Sunekos Performa)},
  journal = {International Journal of Clinical Dermatology},
  volume = {8},
  number = {1},
  pages = {40-43},
  doi = {10.11648/j.ijcd.20250801.17},
  url = {https://doi.org/10.11648/j.ijcd.20250801.17},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcd.20250801.17},
  abstract = {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.},
 year = {2025}
}

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TY  - JOUR
T1  - Melasma and Hypopigmentation After Q Switched Laser Treated with Intradermal Injections of Aminoacids and Low Weight Hyaluronic Acid (Sunekos Performa)
AU  - Kateryn Michelle Perez Willis
Y1  - 2025/06/26
PY  - 2025
N1  - https://doi.org/10.11648/j.ijcd.20250801.17
DO  - 10.11648/j.ijcd.20250801.17
T2  - International Journal of Clinical Dermatology
JF  - International Journal of Clinical Dermatology
JO  - International Journal of Clinical Dermatology
SP  - 40
EP  - 43
PB  - Science Publishing Group
SN  - 2995-1305
UR  - https://doi.org/10.11648/j.ijcd.20250801.17
AB  - 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.
VL  - 8
IS  - 1
ER  -

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Author Information

Kateryn Michelle Perez Willis

Derma Laser KPW Department of Dermatology, Derma Laser KPW Medical Center, Lima, Peru

Contact Email

http://orcid.org/0009-0003-5810-7329

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Plain Text BibTeX RIS

APA Style

Willis, K. M. P. (2025). Melasma and Hypopigmentation After Q Switched Laser Treated with Intradermal Injections of Aminoacids and Low Weight Hyaluronic Acid (Sunekos Performa). International Journal of Clinical Dermatology, 8(1), 40-43. https://doi.org/10.11648/j.ijcd.20250801.17

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ACS Style

Willis, K. M. P. Melasma and Hypopigmentation After Q Switched Laser Treated with Intradermal Injections of Aminoacids and Low Weight Hyaluronic Acid (Sunekos Performa). Int. J. Clin. Dermatol. 2025, 8(1), 40-43. doi: 10.11648/j.ijcd.20250801.17

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AMA Style

Willis KMP. Melasma and Hypopigmentation After Q Switched Laser Treated with Intradermal Injections of Aminoacids and Low Weight Hyaluronic Acid (Sunekos Performa). Int J Clin Dermatol. 2025;8(1):40-43. doi: 10.11648/j.ijcd.20250801.17

Copy | Download

@article{10.11648/j.ijcd.20250801.17,
  author = {Kateryn Michelle Perez Willis},
  title = {Melasma and Hypopigmentation After Q Switched Laser Treated with Intradermal Injections of Aminoacids and Low Weight Hyaluronic Acid (Sunekos Performa)},
  journal = {International Journal of Clinical Dermatology},
  volume = {8},
  number = {1},
  pages = {40-43},
  doi = {10.11648/j.ijcd.20250801.17},
  url = {https://doi.org/10.11648/j.ijcd.20250801.17},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcd.20250801.17},
  abstract = {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.},
 year = {2025}
}

Copy | Download

TY  - JOUR
T1  - Melasma and Hypopigmentation After Q Switched Laser Treated with Intradermal Injections of Aminoacids and Low Weight Hyaluronic Acid (Sunekos Performa)
AU  - Kateryn Michelle Perez Willis
Y1  - 2025/06/26
PY  - 2025
N1  - https://doi.org/10.11648/j.ijcd.20250801.17
DO  - 10.11648/j.ijcd.20250801.17
T2  - International Journal of Clinical Dermatology
JF  - International Journal of Clinical Dermatology
JO  - International Journal of Clinical Dermatology
SP  - 40
EP  - 43
PB  - Science Publishing Group
SN  - 2995-1305
UR  - https://doi.org/10.11648/j.ijcd.20250801.17
AB  - 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.
VL  - 8
IS  - 1
ER  -

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