Effect of combination of 1064 nm Q-switched Nd:YAG and fractional carbon dioxide lasers for treating exogenous ochronosis.

We describe three cases of exogenous ochronosis of the malar areas due to long-term application of skin-lightening agents for melasma, effectively treated by combination of Q-switched Nd:YAG and the fractional carbon dioxide lasers. None of these lasers has been reported to be used to effectively treat ochronosis before. The Q-switched Nd:YAG laser is capable of disintegrating dermal ochronotic fibers, thereby facilitating their phagocytosis and elimination via lymphatics. The fractional carbon dioxide laser is believed to assist transepidermal elimination of the onchronotic material. We believe successful treatment of ochronosis is possible when both mechanisms are applied.