Fraxel dual or Q-switched Nd:YAG for unresolved PIH?

Question

I am a skin type 4 and have a patch of pigmented skin on my face, present for around 7 years, caused by a rash which I picked at. I have tried hydroquinone based creams before which only helped a little. I have been given 2 laser options by different people; the fraxel dual and low-fluence Q-switched Nd:YAG. I am not sure which I should try first so would be grateful if I could get some opinions on which of the 2 lasers, or any other for that matter, would work best. Thank you for your time

Phillip Bekhor, MBBS, FACD · Answer

The treatment of cream resistant PIH is challenging with a high risk of aggressive treatments worsening the situation.In answer to your question, I would suggest that you start with the safest of the options, namely low fluence QS Yag 1064nm.  This will take a number of visits but has been extensively used around the world and appears to be very safe.  It may require 5-10 sessions before you see any improvement and is used in conjunction with your fading creams.

Michele S. Green, MD · Answer

Fraxel generally works very well on pigmentation from the sun.  A photo would be helpful to evaluate your skin type and coloring.  Post-inflammatory hyperpigmentation may not respond well to the Fraxel with your skin type. I would recommend chemical peels or the Q-switched Yag for this area.  For the best results please consult a board certified dermatologist with experince with these lasers.

Fraxel dual or Q-switched Nd:YAG for unresolved PIH?

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