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Here, we mainly use Iontophoresis for the delivery of L-Ascorbic Acid phosphate to treat and as an adjunct to other therapies. It has been reported that L-Ascorbic Acid when delivered by Iontophoresis will aid in the treatment of Melasma.

Ascorbic acid inhibits melanin synthesis by reducing dopaquinone, in the tyrosinase reaction which synthesizes melanin from Tyrosine. However, ascorbic acid (Vitamin C) is a strong reductant and so unstable in aqueous solutions as to be reversibly oxidized to dehydroascorbic acid, which is irreversibly decomposed via 2,3-diketogulonic acid into diverse reductions. It is water soluble and hardly penetrates the skin when applied topically.

We use L-Ascorbic acid phosphate ester magnesium salt, which is easily introduces into the skin using Iontophoresis. It has been shown that extracellularly given L-ascorbic acid phosphate can increase the concentration of intracellular ascorbic acid remarkably while extra-cellularly given ascorbic acid itself does not do as much. L-ascorbic acid is converted to ascorbic acid by being dephosphorylated at the cell membrane and concentrated inside the cell as free ascorbic acid. L-ascorbic acid phosphate enriched the intracellular ascorbic acid concentration 90 times higher than the extracellular L-ascorbic acid.

By using L-ascorbic acid Iontophoresis alone or in combination with other procedures. It was shown that it can lighten pigmented skin and remove fine wrinkles, enhance skin’s texture and improve skin’s elasticity. This is because intracellular ascorbic acid stimulates collagen production and cell proliferation.

 
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Case 1

a. Preoperative view of a 45 year old female with melasma which was partly treated with a laser by the previous doctor 2 months before. The site treated with the laser darkened.
b. After 8 Iontophoresis treatments of L-ascorbic acid 2 p-phosphate.

 

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Case 2

a. Preoperative view of a 16 year old female with a persistent Mongolian spot.
b. Three months after an alexandrite laser treatment. Post-irradiation hyperpigmentation was seen.
c. Immediately before the second laser treatment. Nine months were needed to remove the hyperpigmentation with daily application of kojic acid.
d. She received Iontophoresis treatments of L-ascorbic acid 2 –phosphate once a week from 1 month after the second laser treatment. The hyperpigmentation was alleviated 3 months after the second laser treatment.

 
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Case 3

a. Preoperative view of a 38 year old male with tattoos on both eyebrows.
b. Fifty days following a Q-switched Nd:YAG laser treatment.
c. 2 weeks later. He received 3 Iontophoresis treatments during this period. The brownish colour of the lesion lightened which indicated that the lesion had some hyperpigmentation.
d. Three months later. Disappearance of the brownish colour. This indicated that the hyperpigmentation disappeared and is ready for the next laser treatment.

 
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Case 4

a. Preoperative view of a 34 year old female with an acquired bilateral nevus of Ota like macules.
b. Three months after an alexandrite laser treatment. The lesion looked darker with a hyperpigmentation.
c. Seventeen months after the laser treatment. The hyperpigmentation was alleviated with 15 Iontophoresis treatments.

 
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Case 5

a. Preoperative view of a 31 year old female with an acquired bilateral nevus of Ota like macules.
b. Two months after 2 alexandrite laser treatment. The bluish colour of the original macules lightened but the brownish colour of a hyperpigmentation developed.
c. Five months after the third laser treatment. The interval for the laser treatments were 4 to 6 months and Iontophoresis treatment were performed once a week during the intervals. Oral administration of vitamin C, vitamin E, and tranexamic acid and topical whitening agents were given during the entire treatment period.

 
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Case 6

a. Preoperative view of a 47 year old female with an acquired bilateral nevus of Ota like macules.
b. Eighteen months after starting the treatment. Four laser treatments with 3 to 6 month intervals between the treatments, Iontophoresis treatment of L-ascorbic acid 2-phosphate once a week, oral administration of vitamin C, vitamin E, and tranexamic acid and topical whitening agents were given. Besides the lightening of the lesion, removal of fine wrinkles and tightening of the skin were seen.

 
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Case 7

a. Preoperative view of a 58 year old female with an acquired bilateral nevus of Ota like macules.
b. Two year 2 months after starting the treatment. Three laser treatment, Iontophoresis treatment of L-ascobic acid 2-phosphate once a week, oral administration of vitamin C, vitamin E, and tranexamic acid, and topical whitening agents were given. Besides the lightening of the lesion, the patient noticed the removal of fine wrinkles and tightening of the skin.

 
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Case 8

a. A 49 year old female with melasma before the half side test of 1.5% kojic acid on the right half of her face and tranexamic acid ointment on the left half of her face.
b. Three months later. Some lightening was seen on both sides of the face.
c. Eight months later.
d. 10 months later. Both sides of the face lightened to a certain extent. The solar lentigo on the left cheek was treated with a laser.

 
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Case 9

a. A 40 year old female with melasma before the half side test of 1.5% kojic acid on the left half of her face and tranexamic acid ointment on the right half of her face.
b. Two and a half months later. Both sides began to lighten.
c. Eight months later. Both sides of the face were lightened to a certain extent and no significant difference was seen between both sides.

 
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Case 10

a. Left side view of a 60 ear old female with a hypertrophic scar due to a postoperative hematoma after a face lift operation performed in a aesthetic surgery clinic.
b. Iontophoresis treatment of human placenta extract was given twice a week for 10 weeks. The hypertrophic scar became flattened.
c. Right side view of the same patient, before Iontophoresis treatment.
d. Ten weeks after starting the treatment.

 
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Case 11

a. Preoperative view of a 48 year old female with melasma and solar lentigines on the forehead, the left eyebrow, the right cheek and the right lateral canthus.
b. Iontophoresis treatment of L-ascobic acid 2-phosphate was performed once or twice a week for 2 months. The lentigines were treated with a frequency doubled Q-switched Nd: YAG laser. The Melasma almost disappeared but the post-laser irradiation hyperpigmentation was seen.
c. Two years after starting the treatment. The patient continued the Iontophoresis treatment because in addition to its whitening effect, she found that her fine wrinkles diminished and skin tightened.

 
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Case 12

a. Preoperative view of a 50 year old female with melasma.
b. Apparent improvement was not seen after one month of weekly treatments of Iontophoresis with L-ascorbic acid 2-phosphate and twice daily application of kojic acid cream.
c. Some improvement was seen after 3 months of the same treatments.
d. Satisfactory results for both the patient and the doctor were achieved after 4 months of the same treatments.
e. The frequency of the Iontophoresis treatment was diminished to once for 2 weeks. The pigmentation was not worsened and the effect was well maintained for more than 2 months.

 
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Case 13

a. Preoperative view of a 41 year old female with melasma and solar lentigines on the right cheek and the right eyewear.
b. The melasma lightened with weekly Iontophoresis treatment and twice a day application of kojic acid cream for 2 months. The erythema was due to the frequency doubled Q-switched Nd:YAG laser treatment for the lentigines.
c. Six months after starting the treatment. Kojic acid was applied twice a day with weekly Iontophoresis treatment for the first 3 months and without Iontophoresis for the next 3 months.

 
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Case 14

a. Preoperative view of a 40 year old female with melasma.
b. Significant improvement was seen with treatment of oral administration of tranexamic acid, vitamin C, and vitamin E and topical application of kojic acid for 6 months.
c. Melasma disappeared within 8 months of the same treatment.

 
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Case 15

a. Preoperative view of a 35 year old female with melasma and acne.
b. Melasma disappeared and acne diminished within 1 month of the combined treatment of oral administration, topical application, and Iontophoresis of L-ascorbic acid 2-phosphate and Solcoseryl®.

 
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Case  16

a. Preoperative view of a 49 year old female with melasma.
b. Melasma lightened after 11 months with oral, topical, and Iontophoresis treatments.

 
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Case  17

a. Preoperative view of a 50 year old female with melasma
b. Melasma disappeared after 7 months with oral, topical, and Iontophoresis treatments.

 
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Case  18

a. Preoperative view of a 46 year old female with melasma
b. Melasma disappeared after 3 months with oral, topical, and Iontophoresis treatment.

 
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Case  19

a. Preoperative view of a 36 year old female with melasma on the upper lip.
b. Lightning of the lesion was noticed 1 month after starting the treatment. Eight Iontophoresis treatments were performed.
c. Melasma almost disappeared after 10 Iontophoresis treatments within one and a half months.

 
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Case  20

a. Preoperative view of a 48 year old female who suffered Quinke’s edima 1 year before and developed hyperpigmentation on both angles of her mouth. The grayish colour indicated pigmental incontinence.

b. Some lighting of the lesion was noticed 4 months after starting at the treatment. Twenty Iontophoresis treatments of L-ascorbic and 2-phosphate were performed until then.
c. Significant lightening of the lesion was seen after 33 Iontophoresis treatments for 15 months.
d. Two years and 7 months after starting the treatment. Hyperpigmentation disappeared after 42 Iontophoresis treatment.

 
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Case  21

a. Preoperative view of a 24 year old female with hyperpigmented scar on the lower leg developed after an ulceration caused by an insect bite10 years before.
b. Combination of treatment with the frequency doubled Q-switched Nd:YAG laser and Iontophoresis of L-ascorbic acid 2-phosphate was performed. Hyperpigmentation disappeared.

 
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Case  22

a. Preoperative view of a 46 year old female with hyperpigmentation on the nose and upper lip of unknown origin..
b. Three monhs after starting the treatment. Hyperpigmentation was alleviated by Iontophoresis of L-ascorbic acid 2-phosphate 2 to 3 times a week.

 
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Case  23

a. Preoperative view of a 46 year old female with friction melanosis caused by using a coarse towel.
b. Three months after starting the treatment. They hyperpigmentation was alleviated by Iontophoresis of L-ascorbic acid 2-phosphate 2 times a week for 3 months.
c. Two years and 10 months after the final treatment. No recurrence was seen.

 
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Case  24

a. Preoperative view of a 50 year old female with hyperpigmentation caused by a dry ice therapy. The original lesion was small senile lentigines on the right cheek and the right lower eyelid.
b. Two months after starting the treatment. They hyperpigmentation was alleviated by Iontophoresis of L-ascorbic acid 2-phosphate 2 times a week, totalling 10 times.

 
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Case  25

a. Preoperative view of a 23 years old female with hyperpigmentation caused by burn with hot water 1 year before.
b. Three months after starting the treatment. Hyperpigmentation was alleviated by Iontophoresis of L-ascorbic acid 2-phosphate 2 times a week totalling 10 times.

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