Non-Insulated Microneedle Radiofrequency for the Treatment of Hydroquinone-Induced Exogenous Ochronosis: A Case Report and Literature Review

Namthong Wittayabusarakam, Suthinee Rutnin, Natthachat Jurairattanaporn Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Natthachat Jurairattanaporn, Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, Tel +66 2 201 1141, Fax +66 2 201 1211, Email [email protected]: Exogenous ochronosis is a challenging condition that requires multifaceted modalities. This investigation delineates a case of hydroquinone-induced exogenous ochronosis that improved following treatments with a bipolar non-insulated microneedle radiofrequency (MNRF). To report the efficacy and safety of microneedle radiofrequency as a novel treatment for exogenous ochronosis, and to review the role of energy-based devices as treatment options for this condition.Patients and Methods: A 63-year-old patient with a history of long-term application of hydroquinone-containing products for the treatment of melasma gradually developed hyperpigmented lesions on the face, which were later confirmed the diagnosis of exogenous ochronosis by skin biopsy. Three sessions of bipolar non-insulated MNRF with four-week intervals were employed to treat the affected areas. The clinical improvement of the ochronotic lesion was assessed by digital photograph and Trica facial analysis instrumentation.Results: There was a discernible enhancement in exogenous ochronosis and preexisting melasma within one month after the initial session of bipolar non-insulated MNRF. Following three sessions of MNRF, the patient also demonstrated a further diminution of ochronotic substances and a substantial improvement in the overall dermal texture of the treated regions as assessed by the Trica facial analysis system. Adverse effects were mild erythema and edema, which were transient and self-resolving within four to five days. No post-inflammatory hyperpigmentation, hypopigmentation, or prolonged erythema was detected after the intervention.Conclusion: This case of exogenous ochronosis demonstrates the role of bipolar non-insulated MNRF as a viable and safe therapeutic option for the management of hydroquinone-induced exogenous ochronosis.Keywords: ochronosis, melasma, energy-based devices, radiofrequency, microneedle radiofrequency