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Managing melasma with light consists of applying different laser/LED wavelengths (colors) acting on all signaling pathways of melanin formation in the skin. Then Amber led light acts: stimulating the degradation on superficial to deep melanin on skin; stimulate melanin autophagy; generate local vasoconstriction decreased vascularization; as well as modulating the inflammatory process; main responsible for the “rebound effect”; increases of spots after treatment [22-27]. Also the Red light decrease the melanogenesis process since that decreases the tyrosinase enzyme activity as well as contributes to modulating the aging on dermis, induced by sun (photoaged skin), that have impaction on several inflammatory mediators such as endothelin-1, stem cell factor, c-kit, GM-CSF, iNOS, and VEGF, besides having a greater number of inflammatory cells and vessels, have been described as more highly expressed in skin with melasma, when compared to normal adjacent skin. The red light has a greater influence on dermis structuration stimulating proliferation of fibroblast that increases collagen and other proteins on dermis layers modulating also the inflammatory response of damaged skin [28-30]. Blue LED light in low fluences acts also decreasing the pigmentation by different mechanism as: inhibits melanin synthesis, promoting degradation on superficial melanin and also improves of the hydration of skin optimizing the reversion of aging on skin [31,32]. The infrared light acts modulating also de inflammatory response corroborating to melasma treatment. The Microneedling technique is a promising technique for transdermal drug delivery and on melasma treatment acts optimizing the permeation of cosmetic actives on skin and also improves the liberation of growth factors decreasing the aging process [33]. The aim of this study is to demonstrate that the management of melasma proposed in the melan reduxx program is possible by associating different treatment strategies as: (1) application of Low level light professional therapy, using laser or LED, on different visible light wavelengths, (2) professional cosmetics, including chemical and photoactived peels and (3) topical and oral cosmetics (nutraceuticals) for home care aplications. So, it is possible to perform the Photodynamic Cosmetic Therapy on melasma treatment using chemical and photoactived peels on aesthetical procedures with safety and effectivity associating visible light and a lot of cosmetology. Materials and Methods Equipment The laser and LED light treatment was done using commercial equipment called Venus (MM Optics - São Carlos-Brazil). The equipment shows red and infrared laser light on 630 nm and 850 nm respectively and blue and Ambar LED light on 450 nm and 590 nm. In Figure 1 the irradiation procedure at skin can be observed using different wavelengths and in the Figure 2 we can observe the melasma diagnosis. 2020 Vol.6 No.3:10 with age from 30 to 40 years old, healthy (without any concomitant disease), skin phototype III and IV, with melasma on face, characterized by elevated pigmentation. The volunteers were clarified about the study and read and signed the informed consent, authorizing the accomplishment of the procedures. The patients report years of problems with many tries with conventional therapy without satisfactory results. Melan Redux Program - Melasma management The melan reduxx program; on melasma management is possible by associating different treatment strategies as: professional procedures on clinical using low level light professional therapy, with laser and LEDs, in different visible light wavelengths in the presence of chemical and photoactivated peels (professional cosmetics products) as well as home care procedures using topical and oral cosmetics products. The management of melasma can be realized from 3 to 4 months until 5 months, decreasing the skin pigmentation gradually. The professional treatment using chemical and photoactivated peels is proposed to be performed from 5 to 15 sessions with intervals from fifteen to thirty days enter sessions. However the spots on skin beginning decrease with one month after melan reduxx program initiation. This program can be used on epidermal Figure 1 Photobiomodulation professional session on Melasma management. The equipment used on study is called Venus (MMOptics – São Carlos- Brazil). Volunteers A B The case report for melasma was carried with female volunteers Figure 2 Melasma diagnosis using commercial equipment called EVINCE (MMOptics – São Carlos- Brazil). © Under License of Creative Commons Attribution 3.0 License 3 called Venus (MMOp�cs – São Carlos- Brazil). Journal of Aesthetic & Reconstructive Surgery ISSN 2472-1905PDF Image | Photodynamic Cosmetic Therapy on Melasma Management
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