Minocycline induced hyerpigmentation. A comparison of Q-Switched Nd:YAG laser and picosecond alexandrite laser

Background: Minocycline is an effective and commonly used antibiotic in the treatment of rosacea, acne and other inflammatory disorders. However, occasionally its use is limited by the development of hyperpigmentation, with three different subtypes of pigmentation described. Both Q-Switched Nd:YAG and Picosecond Lasers have previously been used for the treatment of minocycline-induced hyperpigmentation, however there is a paucity of studies. We compare the use of Q-Switched Nd:YAG laser (using 1064nm and 532nm) and picosecond alexandrite laser (755nm) in a patient with severe type III minocycline-induced hyperpigmentation over a ten month period, with the purpose of evaluating the efficacy of both treatment modalities.
Case: An 81 year old female patient, was referred for management of severe Type III minocycline hyperpigmentation, following a five year period of low dose minocycline (50mg daily) for the management of rosacea, with a total cumulative dose of >100g. Over a ten month period, the patient was treated with Q-Switched Nd:YAG, laser followed by picosecond alexandrite laser, with her response photographed during her treatment.
Discussion: We observed some response to 5 treatments with Q-Switched Nd:YAG, but a near-complete resolution in the patient's abnormal pigmentation following treatment with four treatments with picosecond alexandrite laser.

Dr. Thomas Barrett