Treatment of Minocycline Induced Hyperpigmentation with Fraxel? (photo)

I've undergone several Fraxel Dual treatments to treat minocycline hyperpigmentation but have seen little improvement. It's very depressing. I've read a few articles describing resolution of minocycline pigmentation using q-switched ruby or alexandrite lasers, but in all cases the patients have blue-grey pigmentation- I would describe mine to be mottled, spotty and brown, not blue-grey. Will wither laser be as effective in my case? I'd like opinions before spending more time and $. Many thanks.

Doctor Answers 3

Laser for pigmentation

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I would recommend that you do a test treatment with a Q-switched laser to a small area to see how you do.  I would typically start with Q-switched 1064 nm Nd:YAG laser which has the deepest penetration into the skin.  Q-switched alexandrite or ruby could also be used.  I would start with lower fluence or energy and raise the energy over time with repeat treatments if the treatment is helping.

Minocycline induce pigmentation

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Although your photo is blurry, at first glance that does not look like typical minocycline induced pigmentation. Minocycline does not commonly casuse hyperpigmentation which is a brown color, unless you have a sunburn type reaction to it and then turn brown (post-inflammatory hyperpigmetnation). Minocycline typically casues a slate blue pigmentation and this is usually a problem when used long term.   The slate blue color is classic and I dont see that.  If you have brown hyperpigmentation from an allergic reaction to Minocycline, sun damage, melasma, etc,  the treatments are aimed at the melanin in the skin.  If you have Minocycline induced pigmentation the treatments are aimed at the deposition of minocycline pigments in the skin.  Two very different animals.  If your dermatologist is not sure, a tiny punch biospy can make the diagnosis.  He or she should also address other possible triggers for hyperpigmentation (hormones, etc).  Best to you.

Jacqueline Calkin, MD
Sacramento Dermatologic Surgeon

Try Q Switch instead.

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Minocycline induced hyperpigmentation does not respond to Fraxel because the pigment particles are deposited rather deep. The Fraxel laser is not a pigment laser. I have had success treating minocycline induced hyperpigmentation with the Q Switch Laser.

Cameron Rokhsar, MD, FAAD
New York Dermatologic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.