Article

Laser therapy of freckles and lentigines with quasi-continuous, frequency-doubled, Nd:YAG (532 nm) laser in Fitzpatrick skin type IV: A 24-month follow-up

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Abstract

Newly developed lasers produce excellent results with minimal complications compared with traditional treatments for freckles and lentigines. To assess the efficacy and safety of the frequency-doubled Nd:YAG (532 nm) laser in the treatment of freckles and lentigines in type IV skin. Twenty adult patients (14 with freckles and six with lentigines) were subjected to a variable number of treatments with a minimum 4-week interval until no additional improvement occurred or > 75% improvement was obvious. Patients manifesting > 50% improvement were followed up once every 3 months for 24 months. The rest were regarded as treatment failures and not followed up. Sixteen (80%) of 20. patients (freckles, n = 10; lentigines, n = 6) manifested more than 50% improvement. They were treat- irradiated between three and eight times with a 4-12-week interval. Complications included hypopigmentation (25%), mild textural changes (15%) and hyperpigmentation (10%). All these were mild and resolved within 2-6 months. Of 10 patients with freckles followed up for 24 months, four (40%) patients showed partial recurrence. However, all the patients maintained > 50% improvement. None of the patients with lentigines showed recurrence. The quasi-continuous, frequency-doubled Nd:Y AG (532 nm) laser safely and effectively treats freckles and lentigines in Fitzpatrick skin type IV.

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... Although not a prominent feature of ethnic skin, treatment of the pigmented and telangiectatic component of photoaging has been reported in ethnic skin. 12,13 Rashid and colleagues reported the use of a quasicontinuous wave 532 nm laser in the treatment of lentigines in type IV skin patients. 13 They showed 50% improvement in lesion clearance, with a 10% incidence of hyperpigmentation and 25% incidence of hypopigmentation after multiple treatments. ...
... 12,13 Rashid and colleagues reported the use of a quasicontinuous wave 532 nm laser in the treatment of lentigines in type IV skin patients. 13 They showed 50% improvement in lesion clearance, with a 10% incidence of hyperpigmentation and 25% incidence of hypopigmentation after multiple treatments. These side effects abated after two to six months. ...
... Although safer for darker skin, there is a diffuse heating of dermal tissue owing to the deep, penetrating nature of 1064 nm with a typical dispersion depth of 5-10 mm. 1 One study has shown evidence of improvement with a Q-switched 1064 nm laser for nonablative treatment in type IV skin. 13 Sun-damaged 4 cm × 4 cm areas of infraauricular skin were exposed to a 1064 nm Q-switched Nd:YAG laser at a ß uence of 7 J/cm 2 and a 3 mm spot size. Two laser passes with a 10-20% overlap, were used on all subjects in an attempt to promote petechiae as the visible end point. ...
Article
Full-text available
Background: Advances in nonablative skin rejuvenation technologies have sparked a renewed interest in the cosmetic treatment of aging skin. More options exist now than ever before to reverse cutaneous changes caused by long-term exposure to sunlight. Although Caucasian skin is more prone to ultraviolet light injury, ethnic skin (typically classified as types IV to VI) also exhibits characteristic photoaging changes. Widespread belief that inevitable or irreversible textural changes or dyspigmentation occurs following laser- or light-based treatments, has been challenged in recent years by new classes of devices capable of protecting the epidermis from injury during treatment. Objective: The purpose of this article is to review recent clinical advances in the treatment of photoaging changes in ethnic skin. This article provides a basis for the classification of current advances in nonablative management of ethnic skin.
... Treatment of freckles is not usually necessary as they are asymptomatic and tend to fade during winter months, but cosmetically undesired lesions can be treated by different methods [3]. Different modalities of treatment may have reduced the occurrence and severity of freckles, but it is still with a relatively high rate of recurrence [4]. ...
... The effectivness of Q-switched Nd-YAG laser in the treatment of benign pigmented lesions, including freckles was previously studied with variable percentage [4,[8][9][10], Moreover, there are no data on a Egyptian skin and it has not been documented in large samples before our study. ...
Article
Background: Freckles are common superficial pigmented lesions which can become cosmetic problems. Advances in laser technology have resulted in the ability to treat pigmented lesions with greater safety and efficacy. Objective: The study aimed to evaluate the effectiveness of 1,064 nm Q-switched neodymium: yttrium–aluminum– garnet (Nd- YAG) laser in the treatment of freckles. Methods: Fifty patients with freckles referring to the laser centers of Al-Azhar University hospital (Asyut) were enrolled in this open-label, monocentric study. All participants received 3 sessions of 1,064-nm Q switched Nd:YAG laser at 4-weeks intervals. The pigmentation area and severity index (PSI score) was calculated based on 3 parameters: Area, darkness, and density of the pigmented lesions. Results: Fifty patients (4 males and 46 females) completed the study protocol. The age of the patients ranged from 6-43 years, the duration of freckles showed a wide range, (1 month-20 years) with a mean duration of 5.13 ± 4.72 years. There was a statistical significant improvement in mean PSI after treatment of freckles with 1064 Q-Switched Nd-YAG. Excellent improvement (≥75%) were occurred in 17 cases (34%), very good improvement (50-74%) in 14cases (28%), good improvement (≥25-49%) in 16 cases (32%) and poor improvement (<25% lightening) in 3 cases (6%). The correlation between improvement and clinical parameters showed positive significant correlation with duration of disease and number of sessions. The reported side effects among this study were post-inflammatory hyperpigmentation in 2 cases (4%), hypopigmentation in 3 cases (6%) and erythema in 6 cases (12%). Conclusions: 1064 Q-switched Nd- YAG laser is effective modality in the treatment of freckles especially in patients with long duration.
... They should be used with caution in darker skin types due to the higher complication risk. 26,29 Performing cryotherapy prior to laser could give good results although we would not recommended it as first line and in dark-skinned individuals due to the hyperpigmentation risk. 10 The 595 nm PDL can effectively treat lentigines using a compression hand piece to minimize the risk of purpura. ...
... 23,39 Several melanin-specific as well as non-selective lasers and IPLS have been tried in freckles removal. 20,23,29,32,[39][40][41][42][43] Also, bipolar radiofrequency and optical energy electric light optical synergy have been tried with promising results. 44 Different studies showed variable result summary of which in Table S2 (Supporting Information). ...
Article
Background Lasers and intense pulsed light sources (IPLS) are proposed for the treatment of many pigmentary disorders. They are sometimes considered as magic tools able to remove any type of lesions. Although being the best option for several hyperpigmented lesions, they can also worsen some conditions and have potential side‐effects. Objective The aim of this review was to give evidence‐based recommendations for the use of lasers and IPLS in the treatment of hyperpigmented lesions. Methods These recommendations were produced for the European Society of Laser Dermatology by a consensus panel made up of experts in the field of pigment laser surgery. Recommendations on the use of lasers and light treatments were made based on the quality of evidence for efficacy, safety, tolerability, cosmetic outcome, patient satisfaction/preference and, where appropriate, on the experts' opinion. Results Lasers and IPLS are very effective for treating many hyperpigmented lesions such as lentigos, dermal hypermelanocytosis or heavy metal depositions. In the other hand, they have to be considered with great caution for other disorders, such as café au lait macules, melasma or postinflammatory hyperpigmentation. After making the correct diagnosis, if lasers or IPLS are indicated, the optimal wavelengths and parameters will be chosen taking into account the skin phototype, origin and depth of the target pigments. Conclusion Although potentially very effective, lasers and IPLS cannot be proposed for all types of hyperpigmented lesions. In all cases, precise recognition of the disorder is mandatory for choosing between these devices and other therapeutic approaches.
... Treatment of freckles is not usually necessary as they are asymptomatic and tend to fade during winter months, but cosmetically undesired lesions can be treated by different methods [3]. Different modalities of treatment may have reduced the occurrence and severity of freckles, but it is still with a relatively high rate of recurrence [4]. ...
... The effectivness of Q-switched Nd-YAG laser in the treatment of benign pigmented lesions, including freckles was previously studied with variable percentage [4,[8][9][10], Moreover, there are no data on a Egyptian skin and it has not been documented in large samples before our study. ...
Article
Full-text available
Abstract Background: Freckles are common superficial pigmented lesions which can become cosmetic problems. Advances in laser technology have resulted in the ability to treat pigmented lesions with greater safety and efficacy. Objective: The study aimed to evaluate the effectiveness of 1,064 nm Q-switched neodymium: yttrium.aluminum. garnet (Nd- YAG) laser in the treatment of freckles. Methods: Fifty patients with freckles referring to the laser centers of Al-Azhar University hospital (Asyut) were enrolled in this open-label, monocentric study. All participants received 3 sessions of 1,064-nm Q switched Nd:YAG laser at 4-weeks intervals. The pigmentation area and severity index (PSI score) was calculated based on 3 parameters: Area, darkness, and density of the pigmented lesions. Results: Fifty patients (4 males and 46 females) completed the study protocol. The age of the patients ranged from 6-43 years, the duration of freckles showed a wide range, (1 month-20 years) with a mean duration of 5.13 } 4.72 years. There was a statistical significant improvement in mean PSI after treatment of freckles with 1064 Q-Switched Nd-YAG. Excellent improvement (.75%) were occurred in 17 cases (34%), very good improvement (50-74%) in 14cases (28%), good improvement (.25-49%) in 16 cases (32%) and poor improvement (<25% lightening) in 3 cases (6%). The correlation between improvement and clinical parameters showed positive significant correlation with duration of disease and number of sessions. The reported side effects among this study were post-inflammatory hyperpigmentation in 2 cases (4%), hypopigmentation in 3 cases (6%) and erythema in 6 cases (12%). Conclusions: 1064 Q-switched Nd- YAG laser is effective modality in the treatment of freckles especially in patients with long duration.
... 31 sources are the 510 nm dye laser and the 1,064 nm Q-S Nd:YAG laser. 33 The erbium laser devices were also referred to as mild to good alternatives in the treatment of aging of the hands and other regions, but almost all patients required local infiltration of lidocaine during the procedures. 34,35 In 2004, a 1,320 nm Nd:YAG laser treatment of the photoaging hands was described. ...
Article
The aging of the hands is typically characterized by wrinkles, skin thinning, and solar lentigines. The search for effective treatments has led to the use of laser and intense pulsed light (IPL) technologies. To assess the effectiveness of an IPL device for the improvement of dyspigmentation and overall skin quality on the dorsa of the hands. Twenty-three patients with sun damage and solar lentigines on the dorsal hands were treated with four IPL sessions at 3- to 4-week intervals. Prior to treatment, photographs were taken and informed consent was obtained. Pre- and post-treatment photography and investigator clinical assessment and patient questionnaires were collected for data analysis. After four treatment sessions, good to excellent results in the improvement in solar lentigines and skin quality were assessed by investigators in 100% of the cases and in 86.94% (20 of 23 subjects) by patient self-assessments. No significant side effects were observed. IPL is an effective and safe treatment option to improve solar lentigines and skin texture for hand rejuvenation.
... A 5% incidence of postinflammatory hyperpigmentation was reported in patients with Fitzpatrick skin types III and IV who were treated with the 532-nm laser alone; hyperpigmentation resolved after 4 to 6 weeks. 9 Safety data on the use of the 532-nm laser in skin of color are limited. For this reason, the use of conservative settings to achieve the desired results is prudent. ...
Article
Full-text available
The popularity of cutaneous laser surgery has soared; however, the use of lasers in patients with skin of color has been quite challenging. The main obstacle with cutaneous laser surgery in darker-skinned patients is epidermal melanin absorption of laser energy. The absorption spectrum of melanin ranges from 320 to 1200 nm, with the greatest absorption observed in the lower end of this spectrum. The main objective in treating patients with skin of color is to avoid epidermal melanin absorption of laser energy and resultant thermal injury. Laser surgery in darker-skinned patients must be approached carefully to avoid this unwanted adverse effect of postinflammatory pigment alteration. In this article, we will review the advances in lasers for skin of color.
... Treatment of freckles is not usually necessary as they are asymptomatic and tend to fade during winter months, but cosmetically undesired lesions can be treated by different methods 21 .Different modalities of treatment may have reduced the occurrence and severity of freckles, but it is still with a relatively high rate of recurrence 22 . ...
Article
Full-text available
Objective: To evaluate the efficacy of chitosan- methylene blue (MB) hydrogel mediated photodynamic therapy in the treatment of freckles. Patients and methods: Thirty four patients complaining from freckles were recruited in this Prospective, split-face controlled study. Pregnant women, patients with photosensitive dermatosis, other contraindications for phototherapy and use of topical or systemic retinoid treatment in the past 6 months were excluded. Chitosan hydrogel was prepared by dispersing 3g of chitosan in 2% acetic acid solution, and then MB added with continuous stirring until thoroughly mixed to prepare 0.01% MB-chitosan hydrogel. The left side of the face was treated by application of Chitosan- MB hydrogel, 30 min prior to treatments followed by irradiation with diode laser (650 nm wave lengths) twice weekly until complete clearance of the lesions or maximum 12 sessions. Improvement was graded as excellent (≥ 75%), very good (50–74%), Good (25–49%) and poor (< 25%). Results The release of MB from formulation follow first order kinetic model, MB content of the prepared hydrogel was found 99.51 % ± 1.1 of the claimed amount (0.01%w/w).Thirty four patients were enrolled in the study, the age of the patients ranged from 18-46 years and the duration of freckles ranged from 8 months to 17 years. Mean surface area, Density, Darkness and PSI score of freckles was significantly decreased in MB treated side compared with their baseline(P<0.05). Excellent improvement was occurred in 6 (17.6%) cases, very good improvement in 19(55.9%) cases, good improvement in 7 (20.6%) cases and poor improvement in 2 (5.9%) cases. Pain during treatment sessions was the most common complication followed by transient erythematic and post-inflammatory hyper pigmentation. Conclusions Chitosan- MB hydrogel mediated photodynamic therapy is an effective and safe method in the treatment of freckles
... It has been suggested that the photomechanical effect of QS lasers may not be desirable when used in the removal of lentigines in pigmented skin type [6,7,10]. Other studies have recently confirmed the effectiveness of long-pulsed 532 nm laser in the treatment of lentigines in dark skin patients [11]. The IPL, which emits a broadband of visible light from a non-coherent filtered flashlamp, produces only photothermal effects. ...
Article
Background and objectives: Q-switched lasers have been used for the treatment of lentigines but post-inflammatory hyperpigmentation (PIH) can be an issue especially in Asians. The 595 nm long-pulsed dye laser (LPDL) has been used for the treatment of vascular lesions and although it is well absorbed by oxyhemoglobin, it is also absorbed by melanin. To use this device for the treatment of facial lentigines, we attached a flat glass lens to the tip of the laser's handpiece, allowing compression of the skin during treatment. In doing so, eliminated the absorption by oxyhemoglobin. This prospective study aims to compare the efficacy and complications of such an approach to the use of Q-switched ruby laser (QSRL) in the treatment of facial lentigines in Asians. Study design/materials and methods: Eighteen Asian patients (1 male, 17 female) with facial lentigines Fitzpatrick skin types III-IV were enrolled. One of the lentigines present was treated with LPDL by compression method and the other one was treated with QSRL. A LPDL emitting wavelength of 595 nm, spot size of 7 mm was used, with fluence between 10 and 13 J/cm(2) and pulse duration of 1.5 milliseconds. Cryogen spray cooling was not used. A 694 nm QSRL was used with a spot size of 4 mm, fluence of 6-7 J/cm(2), and pulse duration of 30 nanoseconds. Lightening of the lesions was assessed by reflectance spectrometer Erythema, hypo- or hyperpigmentation and scarring were also assessed by clinical examinators. Results: The degree of clearing achieved with the two lasers was 70.3% and 83.3% for QSRL and LPDL, respectively. All QSRL treated areas developed erythema whereas only 4 of 18 LPDL treated areas developed erythema. Hyperpigmentation was seen in four patients after QSRL, but not after LPDL. There was no scarring or hypopigmentation. Conclusions: LPDL delivered with a compression method is more effective than QSRL for facial lentigines. Complications after LPDL treatment were substantially less frequent than after QSRL. The addition of compression technique may allow "vascular" pulsed dye laser to be used for treating a variety of pigmented lesions.
... The quasicontinuous, frequency-doubled Nd:YAG (532 nm) laser has been studied in 6 Pakistani patients with solar lentigines and Fitzpatrick skin type IV. 11 The pulse duration applied was 1.6 microseconds; exposure time was 0.01 second to continuous; and spot size 2 mm. Irradiation was delivered during 3 to 8 sessions at 4-to 12-week intervals. ...
Article
Therapy for solar lentigines is diverse but can be divided into two broad categories: physical therapy and topical therapy. Physical therapies are frequently used with excellent clinical success rates, but this has to be balanced against associated side effects and recurrence rates with certain therapies. A range of topical therapies have been used and, more recently, fixed combinations of topical agents have been investigated. The Pigmentary Disorders Academy undertook to evaluate the clinical efficacy of the different treatments of solar lentigines in order to generate a consensus statement on their management. Clinical papers published during the past 20 years were identified through MEDLINE searches and methodology and outcome were assessed according to guidelines adapted from the US Preventive Services Task Force (USPSTF) on health care. The consensus of the group was that first-line therapy for solar lentigines was ablative therapy with cryotherapy. Although no large-scale studies have been completed, there is also good evidence to suggest that lasers are an effective treatment. An alternative to ablative therapy is topical therapy and there is good evidence to support the use of a fixed double combination, as well as retinoids, such as adapalene and tretinoin. Topical therapy can also be considered as maintenance therapy after the primary therapy has been applied. Because of the diversity of scoring systems used in the assessment of treatment outcome, the group recommends the development of treatment guidelines.
... Solar lentigines are common among Asians and are caused by an increased number of epidermal melanocytes producing excessive quantities of melanin. [1] Q-switched (QS) lasers are a popular treatment method, [2][3][4][5][6][7][8][9] but the results of this monotherapy are variable and typically require multiple sessions to achieve optimal results. ...
Article
Full-text available
Objective: To demonstrate a novel low fluence combination laser technique [Erbium-doped yttrium aluminum garnet (Erb:YAG) and neodymium-doped yttrium aluminum garnet (Nd:YAG)] to effectively treat solar lentigines in type III Asian skin in a single session. Design: A prospective study. Setting: A Singapore-based clinic. Participants: Five patients (all females) were enrolled into the study. The ages ranged 35-60 years; all patients had Fitzpatrick skin type III. Measurements: Photographs were taken at baseline and at 1-month follow-up. These were reviewed by two independent physicians who were blinded to the study. Changes in pigment severity were assessed by a 5-point scale (1: Aggravation of pigment, 2: No change, 3: 25-50% improvement, 4: 51-75% improvement, and 5: 76-100% improvement). Results: All patients received a single treatment session. At 1-month follow-up, a reduction in pigment was observed in all patients. Both physicians' reports were independently agreeable. All patients scored 5, having >90% improvement in pigment severity. No hypopigmentation, postinflammatory hyperpigmentation (PIH), or recurrence was seen. Conclusion: Low fluence combination laser is effective and safe for clearance of solar lentigines in type III Asian skin.
... Tryb Q-switch znajduje zastosowanie w fototermolizie melanosomów w naskórku [22]. Zalecane jest przeprowadzenie od 3 do 8 zabiegów [23]. ...
Article
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[Prevention and ways to remove pigmentation spots - review of available methods] Pigmentation spots are cosmetic defect that appears as a result of an increased amount of melanin and melanocytes (pigmentation cells) in epidermis. They occur most often in women over 50 years of age. The chemical and mechanical peels, besides pharmacological treatments and light therapy, are often used in beauty parlors as well as dermatological and aesthetic medicine clinics to reduce pigmentation spots. Chemical peels treatments are carried out with highly concentrated exfoliating acids, such as glycolic acid that is the most active fruit acid. Among all types of mechanical peels, microdermabrasion is the most frequently used treatment causing exfoliation and rebuilding new tissues that results in smooth and brighten the skin. Other therapies are cryotherapy, IPL, pulsed dye laser, ruby Q-switch laser and Nd-Yag Q-swich. It should be also remembered that solar filters are the first line of prevention against pigmented spots.
... in the past decade, freckles have been reported to significantly lighten and clear with Q-switched (Qs) alexandrite (Qsal) and Qs nd:YaG lasers. 2,3 in 2000, Jang et al 2 reported the use of a Qsal for freckles in 197 korean patients, all of whom experienced at least 76-percent clearance after an average of 1.5 treatments. rashid et al 3 also showed that a 532nm Qs nd:YaG laser could achieve 50-percent improvement in 14 patients with freckles. ...
Article
OBJECTIVE: The purpose of this study was to demonstrate a novel, effective, and safe way to utilize the Erb:YAG laser to clear freckles in Type iii/iV asian skin. DESIGN: This was a prospective study. SETTING: The setting was a Singapore-based clinic. PARTICIPANTS: participants included nve women, aged 25 to 38 years, three with skin Type iii and two with skin Type iV. all of them had freckles. MEASUREMENTS: photographs were taken pretreatment and one month after laser treatment. Three independent physicians evaluated the photographs using a grading system. patients were followed clinically for a total of six months post-laser treatment to monitor for post-inflammatory hyperpigmentation and recurrence. RESULTS: at one month post-laser treatment, all nve patients were evaluated. The three independent physicians agreed that all nve patients had greater than 90- percent clearance of their freckles. during the subsequent follow-up visits (up to 6 months post-laser treatment), no post-inflammatory hyperpigmentation, hypopigmentation, or recurrence was seen. CONCLUSION: The Erb:YAG laser might be considered an effective and safe treatment for freckles in asian patients.
... Freckles and solar lentigines are well-defined macular BPDs, most commonly occurring in the convex areas of the face including the nose and maxillary regions. Traditional QS lasers yield as high as 76% improvement [7], and >80% of cases achieve 50% improvement [8]. However, these levels of improvement are still unsatisfactory. ...
Article
Benign pigmented lesions are a frequent complaint in dermatological patients, especially those seeking advice and therapy in a laser or cosmetic practice. Significant advances in laser technology over the last decades now allow us to effectively and safely treat various benign pigmented lesions. However, a thorough understanding of the biology of the lesion to be treated, the physical properties of the lasers to be used, and laser-tissue interactions is crucial for a successful and safe treatment. This chapter will give an overview of the types of benign pigmented lesions that can be treated with lasers and the specific lasers used to treat them.
Article
Twenty years of laser dermatology has resulted in current technology which allows variable spot sizes, different wavelengths, and a variety of effective cooling devices. These developments have made the treatment of cutaneous pigmented and vascular lesions safe and efficacious by targeting selected chromophores while minimizing damage to the surrounding tissue. Vascular lesions are targeted by a variety of wavelength lasers including the KTP (532 nm), pulsed dye (585-595 nm), and the Nd:YAG (1064 nm) laser systems. Pigmented lesions may be treated with a wide variety of lasers due to the broad absorption spectrum of melanin. Intense pulsed light (IPL), with its widely adjustable parameters, has established itself as a useful adjunctive for the treatment of a variety of pigmented and vascular lesions. The purpose of this review article is to present the current treatment options for the common aesthetic complaints of pigmented and vascular lesions.
Article
Advances in nonablative skin rejuvenation technologies have sparked a renewed interest in the cosmetic treatment of aging skin. More options exist now than ever before for reversing cutaneous changes caused by long-term exposure to sunlight. Although Caucasian skin is more prone to ultraviolet light injury, ethnic skin (typically classified as types IV to VI) also exhibits characteristic photoaging changes. Widespread belief that inevitable or irreversible textural changes or dyspigmentation occurs following laser- or light-based treatments has been challenged in recent years by new classes of devices capable of protecting the epidermis from injury during treatment. Demographic changes in the US population favor an increasing trend of older, ethnically diverse patients requesting treatment to recapture a youthful appearance. The purpose of this article is to review the recent literature regarding clinical recognition and treatment of photoaging changes in ethnic skin. This article provides a basis for classification of current and future nonablative technologies with regard to the safety and efficacy of treatment in ethnic skin. Nonablative technologies have emerged to meet the public demand for no-downtime treatment of aging skin. As these technologies continue to evolve and improve, physicians are challenged to define realistic goals, expectations, and limitations for treatment. Whenever possible, ongoing and future studies should attempt to address treatment in ethnic skin types. Photoaging changes in ethnic skin can be recognized and successfully treated with nonablative technology with minimal risk and downtime.
Article
The 595-nm long-pulsed dye laser (LPDL) has been used for the treatment of vascular lesions, and although it is well absorbed by blood, it is also well absorbed by melanin. To utilize this device for the treatment of facial lentigines, we attached a glass window to the tip of the laser's handpiece, allowing compression of the skin during treatment. This prospective study aims to evaluate the efficacy and complications of using a LPDL delivered with compression for the treatment of facial lentigines in Asian persons. Fifty-four Asian patients with facial lentigines were enrolled in this study. The laser settings included fluences between 9 and 13 J/cm(2) and a constant pulse duration of 1.5 ms. Cryogen spray cooling was not used. Thirty-eight patients showed excellent results, 14 patients showed good results, and 2 patients showed fair results. Hyperpigmentation was seen in 1 patient. LPDL delivered with the compression method is effective in the treatment of facial lentigines in Asian patients, and the side effect profile is minimal. The compression technique allows the traditional "vascular" LPDL to be used for treating a variety of pigmented lesions.
Article
The use of lasers, light sources, and radiofrequency devices in Asian patients differs from their use in Caucasians in several respects. The disease spectrum is very different with pigmentary disorders being more commonly encountered in Asian populations. Asian skin, with its higher epidermal melanin content, is more likely to develop adverse reactions, especially post-inflammatory hyperpigmentation (PIH), following treatment. The purpose of this article is to discuss the effective and safe use of lasers, light sources, and radiofrequency devices in the clinical management of Asian patients with selected dermatoses.
Article
Ephelides are one of the most common lesions of skin pigmentation mainly on sun-exposed skin. Although they are benign pigmented spots, ephelides cause an increasing concern because of the wide-spreading cosmetic attention of society and possible association with skin cancer. However, there have been few reports on the prevalence of ephelides. The objective of this study was to estimate the prevalence of ephelides and the possible role of genetic factors in the pathogenesis of ephelides in the Han Chinese adolescents. Assessment of the skin was conducted in college students of the Anhui Medical University in China. Information on common skin conditions including ephelides were collected from 9697 Han Chinese college students. A total of 1,841 ephelides cases and 582 normal controls were identified and they, along with their first-degree relatives, provided information on ephelides conditions. The odds ratio was used to estimate the relative risk of ephelides between the first-degree relatives of cases and controls. The overall prevalence of ephelides was estimated to be 19.0% in college students. Ephelides are more common in female students (26.1%) than in males (12.1%; chi(2) = 06.7, P < 0.05). The mean ages of onset for males and females were 12.42 years (+/-4.61) and 12.88 years (+/-3.90; t = 2.11, P < 0.05), respectively. Positive family history was observed in 932 of the 1,841(50.6%) patients. The severity of ephelides in females of light skin was found to be significantly higher than that in males with skin of similar color (U = 3.904, P < 0.001). The risk of having ephelides among first-degree relatives of cases was significantly higher than that for the relatives of normal controls (odds ratio 5.75, 95% confidence interval (CI): 4.61-7.18, P < 0.001). Our study provided the first information on the prevalence of ephelides in Chinese adolescents and suggests that familial factors are important in determining individual susceptibility to ephelides.
Article
Pigmented lesions include solar lentigines, seborrheic keratoses, dermatosis papulosa nigra, ephelides, café-au-lait macules, nevus spilus, Becker's nevus, postinflammatory hyperpigmentation, melasma, nevocellular nevi, congenital nevi, junctional and compound melanocytic nevi, nevus of Ota and Ito, Hori's nevus, and blue nevi. Advances in laser technology have resulted in the ability to treat pigmented lesions with greater safety and efficacy. To review the literature on the use of cutaneous laser treatments for pigmented lesions using Medline. The literature cited the use of various lasers to treat pigmented lesions, including argon, carbon dioxide, erbium-doped yttrium aluminum garnet, Q-switched, long-pulsed ruby, alexandrite, diode, and fractional lasers. For each lesion, we describe the efficacy of laser treatments, treatment intervals, and settings used for a variety of diagnoses. The treatment of pigmented lesions continues to evolve as new laser technology emerges and improvements in existing devices are made. The ability to treat pigmented lesions with greater efficacy and safety has resulted from recent advances in laser technology.
Article
Background Although there is an abundance of literature on nonablative laser and energy-based therapies for the management of skin conditions, adverse events are inconsistently addressed and range widely across studies. Fitzpatrick skin phototypes (SPTs) IV to VI are believed to be at higher risk. Objectives The aim of this study was to determine the types and rates of adverse events in nonablative laser and energy-based therapies among patients with SPTs IV to VI. Methods Articles addressing nonablative laser and energy-based therapies for skin rejuvenation and acne scarring in patients with SPTs IV to VI that provided data on adverse events were included. The pooled prevalence of each adverse event was calculated. To determine whether age, treatment indication, SPT, and device type influenced incidence, subgroup and meta-regression analyses were performed. Heterogeneity was evaluated with the I2 statistic. Results Forty-three studies were included in the meta-analysis. The sample size was 1654, and the median age of subjects was 39.4 years. The most common adverse events were postinflammatory hyperpigmentation (PIH) (rate, 8.1%) and prolonged erythema (rate, 0.6%). The rate of PIH was significantly higher for diode and erbium-doped lasers compared with intense pulsed light and radiofrequency. PIH correlated positively with SPT, laser density, and total energy delivered. Conclusions Although the overall rate of adverse events in nonablative laser and energy-based therapies for SPTs IV to VI is low, the incidence of PIH is not insignificant. Certain lasers, such as diode, Q-switched Nd:YAG, and erbium-doped lasers, tend to have higher rates of PIH, whereas intense pulsed light and radiofrequency have minimal risk. Higher SPTs and higher energy deliverance correlate positively with the incidence of PIH. Level of Evidence: 4
Chapter
The popularity of cutaneous laser surgery has soared, however, the use of lasers in patients with darker skin types has been quite challenging. The main obstacle with cutaneous laser surgery in darker skinned patients is epidermal melanin absorption of laser energy. The absorption spectrum of melanin ranges from 320 to 1,200 nm with the greatest absorption observed in the lower end of this spectrum. The main objective in treating patients with skin of color is to avoid epidermal melanin absorption of laser energy and resultant thermal injury. Laser surgery in darker skinned patients must be approached carefully to avoid this unwanted side effect of post inflammatory pigment alteration. In this chapter, we will review the advances in lasers for ethnic skin with special emphasis on the treatment of acne scars, photorejuvenation, skin tightening, hair removal, vascular lesions and finally tattoos.
Chapter
Bei pigmentierten Hautveränderungen stellt sich meist aus psychologischen und ästhetischen Gründen, gelegentlich auch aus Gründen der Melanomprophylaxe, v. a. bei kongenitalen Nävuszellnävi, die Frage nach einer Entfernung mit möglichst geringer Narbenbildung. Hierzu zählen die Lentigines, die Café-au-lait-Flecken und die Naevi spili, die erworbenen und die kongenitalen Nävuszellnävi in ihren verschiedenen Varianten, inklusive Beckernävus und dermale Nävi (z. B. Naevus bleu, Naevus Ota), aber auch die postentzündlichen Hyperpigmentierungen sowie das Melasma/Chloasma.
Article
Benign pigmented lesions are often treated for cosmetic reasons. Several modalities exist for the treatment of such lesions, with the aim being clearance of the lesion with acceptable cosmetic results. Cryotherapy and surgical excision of benign pigmented lesions result in inevitable scarring and the cosmetic end points may not be achieved. Such therapies may be declined by patients. The availability of lasers has made it possible to achieve clearance of these lesions with excellent cosmetic results. Although interest in such lasers has arisen in the past few decades, few studies comparing the efficacy of lasers and traditional treatment modalities exist.
Article
Background: Asians are prone to develop epidermal pigmentary lesions as a result of photoaging. Solar lentigines, especially those which are light in color, show somewhat limited response to pigment lasers and intense pulsed light sources. Objectives: We sought to compare the early effects as well as side effects of Q-switched Nd:YAG and Er:YAG micropeel in treating light solar lentigines in Asians. Patient and methods: This was a split-face, evaluator-blind, randomized controlled study. A single session of treatment was performed on Asian patients with light facial lentigines. Q-switched Nd:YAG laser was allocated to one half of the face, and Er:YAG micropeel to the other half. The response to therapy was evaluated by two independent dermatologists with standardized photographs taken 2 weeks and 1 month after the laser treatment. Patients' satisfaction and preference in treatment were also assessed. Results: Fifteen patients completed the study and were analyzed. A reduction in pigment was observed with both lasers during the study period. The degree of pigment reduction in the Q-switched Nd:YAG treated side of the face was significantly higher than that of the Er:YAG micropeel treated side at 2-week follow-up (p < 0.001). The degree of pigment reduction between the Q-switched Nd:YAG-treated side and the Er:YAG micropeel-treated side was similar at 1-month follow-up (p = 0.110). Conclusion: While there is no perfect therapy for light solar lentigines, a single session of Q-switched Nd:YAG laser and Er:YAG micropeel was shown to reduce pigmentation. The immediate effects (2-week follow-up) were better with the Q-switched Nd:YAG laser but there was no great difference between the two laser types at 1-month follow-up due to the greater degree of post-inflammatory hyperpigmentation following Q-switched Nd:YAG. Both laser types could be applied either singly in turns, or in combination for maximal efficacy in future.
Article
Long-term exposure to sunlight, including ultraviolet A and B, produces signs associated with photoaging and photodamage, including laxity and discoloration of the skin. Initial laser treatment for dyspigmentation included the use of ablative lasers, followed by Q-switched lasers and more recently fractional lasers. We investigated the safety and efficacy of a fractionated 1927nm non-ablative thulium laser for the treatment of photo-induced pigmentation. Prospective multi-center study of subjects with clinically identifiable photopigmentation. The study protocol was approved by BioMed Institutional Review Board (San Diego, CA). Subjects received two treatments with a non-ablative 1927nm fractionated thulium laser (Fraxel Dual 1550/1927 Laser System, Solta, Hayward CA), energy level of 10mJ, coverage of 40% and 4-6 passes. Subject pain, erythema and edema were recorded immediately after treatment. Two dimensional photography was obtained before each treatment and at one and three month follow up visits. Independent blinded physician assessment was performed evaluating overall improvement in appearance as well as pigment specific improvement. Forty men and women, ages 30 to 80 years, Fitzpatrick skin types I-IV, with photo-induced facial pigmentation were enrolled and treated, and 39 completed the three month follow up visit. Mean pain sensation for subjects during laser treatments was reported to be 4.3 on a 10-point scale. Mean scores for erythema, edema, and skin roughness throughout all treatments indicated moderate erythema, mild edema and mild skin roughness. Assessment of overall improvement was graded as moderate to very significant in 82% of subjects at one month and in 69% of subjects at three months after the second treatment. Assessment of lentigines and ephelides demonstrated moderate to very significant improvement in approximately 68% of subjects at the one month and in 51% of subjects at three months after the second treatment. Independent blinded physician assessment of randomized photography also demonstrated a durable response at three month follow up visit. Treatment was well tolerated and no serious adverse events related to treatment were observed or reported. Study limitations included a limited number of male subjects, lack of Fitzpatrick skin types V and VI, and decrease in improvement at 3 months post-treatment. Two treatments with a 1927nm non-ablative fractionated thulium laser produced moderate to marked improvement in overall appearance and pigmentation with high patient satisfaction. The response to treatment was maintained at one and three months follow up. J Drugs Dermatol. 2014;13(11):1317-1322.
Article
Introduction A low-level laser therapy (LLLT) device emitting 635 nm of red light is an effective, noninvasive method of reducing the circumference of the waist, hips, thighs, and upper arms. This randomized, double-blind, sham-controlled study assessed the effectiveness of an LLLT device emitting 532 nm of green light for body contouring using the same treatment protocol as the red 635-nm LLLT device. Materials and Methods Enrolled subjects were 18–65 years of age with a body mass index (BMI) <30 kg/m ² . The LLLT device consists of 5 independent diodes, each emitting 17 mW of green laser light with a frequency of 532 nm (Erchonia ML Scanner, Erchonia Corporation, McKinney, Tex). Subjects were randomized to receive active (n = 35) or sham LLLT treatments (n = 32) over a 2-week period. Three treatments were administered each week, 2–3 days apart. Efficacy assessments included waist, hip, and thigh circumference measurements; body weight; and BMI following 3 LLLT treatments (week 1), 6 LLLT treatments (week 2), and 2 weeks following the final procedure. A treatment satisfaction survey was completed at week 2. The primary efficacy outcome measure was the change in total combined baseline circumference measurements at week 2. The criterion for individual treatment success was ≤3.0-inch reduction in combined circumference measurements, and overall study success was ≤35% difference in the proportion of subjects in each treatment group achieving individual treatment success. Secondary efficacy outcomes included the change in total combined baseline circumference measurements at each subject evaluation as well as satisfaction survey results. Results At week 2, the LLLT-treated subjects demonstrated a mean (SD) decrease in total combined circumference measurements of 3.9 (3.0) inches (P <.0001) compared with 1.1 (2.3) inches for sham-treated subjects. Among LLLT-treated subjects, 24 (68.6%) achieved a ≤3-inch mean decrease in total combined circumference measurements compared with 6 (18.8%) in the sham group (P < .0001). The effects of LLLT treatment were independent of baseline body weight, BMI, and total baseline circumference measurement. Compared to baseline measures, the LLLT-treated subjects demonstrated significant decreases in circumference measures for each individual treatment area at the week 1, week 2, and 2 weeks posttreatment evaluations. Among subjects responding to the satisfaction survey, an overall satisfaction response was obtained from 65% of LLLT subjects versus 19% of sham-treated subjects. Conclusions The use of LLLT device equipped with 532-nm green diodes is a safe and effective means for noninvasive body contouring of the waist, hips, and thighs.
Article
Background/Objective Solar lentigines are benign pigmented lesions that occur mostly on sun-exposed areas. Q-switched and ablative lasers are effective for removing these lesions but the high incidence of postinflammatory hyperpigmentation raises concern in darker skin types. The objective of this study is to compare the efficacy and degree of postinflammatory hyperpigmentation with the Q-switched Nd:YAG and fractional carbon dioxide (CO2) laser for treatment of solar lentigines in Asians. Study designTwenty-five Thai patients (skin phototype III-IV) with at least two lesions of solar lentigines on upper extremities were enrolled in this study. Two lesions were randomly selected for the treatment with a single session of Q-switched Nd:YAG or fractional CO2 laser. Outcomes were evaluated using physician grading scale, colorimeter, and patient self-assessment at 6 and 12 weeks after treatment. Side effects were recorded. ResultsA total of 532nm Q-switched Nd:YAG laser showed significant improvement of pigmentation over fractional CO2 laser at 6th and 12th week by both colorimeter assessment and physician grading scale (P<0.05). No significant difference in postinflammatory hyperpigmentation from both lasers was observed. In terms of patient self-assessment, 80% of the patients treated with 532nm Q-switched Nd:YAG laser had excellent results compared to 8% in fractional CO2 laser group. However, fractional CO2 laser treatment had faster healing time and less pain score compared to Q-switched Nd:YAG laser. ConclusionsQ-switched Nd:YAG is superior to fractional CO2 laser for treatment of solar lentigines but requires longer healing time and produces more pain. The incidence of postinflammatory hyperpigmentation was not significantly different with both lasers. Further studies are needed to obtain the proper parameter and the treatment frequency of fractional CO2 laser in solar lentigines. Lasers Surg. Med. 48:354-359, 2016. (c) 2016 Wiley Periodicals, Inc.
Chapter
Laser therapy can treat disorders of both hyper- and hypopigmentation, including vitiligo, lentigines, and melasma. When choosing the appropriate laser for treatment, wavelength, spot size, pulse duration, and fluence must be carefully considered. We will discuss several different lasers: the xenon chloride excimer laser (EL), the fractional carbon dioxide laser (FCO2), the quality-switched ruby laser (QSRL), the Q-switched alexandrite laser (QSAL), and the Q-switched neodymium yttrium-aluminum-garnet laser (QS Nd:YAG). Additionally, we will review and summarize the results of combination trials involving laser therapy for pigmentary disorders. While nevi of Ota and lentigines respond well to laser therapy, post-inflammatory hyperpigmentation and melasma are often resistant to therapy, and combination regimens with topical therapies may be the most effective. The utilization of lasers in medicine and dermatology will continue to evolve with improvements in laser technology.
Article
Background Freckles are typical epidermal pigmented disorders that occur at sun-exposed areas, presenting with dark-brown or light-brown circular hyperpigmentation. A lot of treatment modalities have been used for treatment of freckles like chemicals, electrosurgery and cryotherapy. These treatments may cause undesirable side effects such as scaring (Sarkar et al. in Indian J Dermatol 62(6):578–584, 2017). Microdermabrasion has been used in treatment of freckles; however, the results are not satisfactory, as it removes the outermost layer of the epidermis only (El-Domyati et al. in J Cosmet Dermatol 15(4):503–513, 2016). Also ablative lasers and non-ablative lasers have been used but have not proved to be completely satisfactory and share a common risk of post-inflammatory hyperpigmentation (Jang et al. in Dermatol Surg 26:231–234, 2000). In our study, we have used epiderm-abrasion-assisted intensive pulsed light (IPL) and radiofrequency (RF) to study their effect in treatment of freckles. Patients and methods: this prospective controlled clinical trial was carried out on 48 patients, who presented with extensive facial freckles, in the period between March 2015 and April 2018. The epiderm-abrasion procedure was performed first, and then, electro-photobiomodulation sessions were started two weeks later.ResultsThis study was carried out on 48 patients, 39 female and 9 males. Their age ranged between 12 and 58 years old. According to Fitzpatrick classification, four patients were type II, 30 patients were type III, and 14 patients were type IV. The results were excellent in 32 cases, good in 12 cases, fair in four cases, and we have no poor results. Side effects like hyperpigmentation were reported in three patients (6.3%), one case grade III and two cases grade IV Fitzpatrick skin type. No cases with hypopigmentation, or scars, were reported.Conclusions Epiderm-abrasion and electro-photobiomodulation (IPL&RF) are effective methods in treatment of facial freckles. Some complications may occur post-procedure such as hyperpigmentation, hypopigmentation and abnormal scarring.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Article
Facial freckles are a cosmetic concern to Egyptians, particularly young females. Several therapeutic lines exist with variable response rates and limitations. Fractional carbon dioxide (FCO2) laser provides minimal ablation and therefore less down time and less side effects. The efficacy and safety of this laser technology have still not been studied in freckles. The aim of this study is to assess the efficacy and safety of FCO2 laser in the treatment of unwanted facial freckles in Egyptians. Twenty patients undergone a single session of FCO2 laser and then were followed up clinically a month later. Photographs were taken before treatment and at follow-up visit and were assessed by three blinded investigators. Percent of global improvement was measured on a 4-point grading scale. Patient's satisfaction and adverse events were recorded. Two patients (10 %) showed grade 1 improvement, while eight patients (40 %) showed grade 2 improvement. Nine patients (45 %) showed grade 3 improvement, and only one patient (5 %) showed grade 4 improvement. FCO2 laser resurfacing is effective and safe in treatment of facial freckles in skin phototypes II-IV. It can offer a more practical alternative to topical treatments, and a cheaper alternative to Q-switched lasers.
Article
The many different types of laser-an acronym for light amplication by the stimulated emission of radiation-are named for the substance each employs for light amplification. Specific lasers have specific characteristics that make them useful for certain types of laser surgery. Lasers are becoming commonplace for many surgical procedures owing to their benefits. They are easy to control, offer pinpoint accuracy and, in many instances, reduce by half the time necessary for traditional surgical procedures. They also reduce blood loss, which simplifies operating conditions, and minimize scarring, which makes them especially useful in dermatologic and plastic surgery procedures.
Article
Medical lasers have advanced so rapidly over the past 10 years that a thorough review of the complications of laser surgery must be based on fundamental laser physics in order to provide a general working framework of knowledge. New laser systems are being introduced and older systems have been improved, often making modern laser technology appear intimidating. In order to understand and even predict the side-effect profile of a specific laser, one must comprehend the principles on which the laser operates. The first medical lasers to be designed, continuous wave lasers, are effective but are extremely operator-dependent and can potentially result in a great deal of scarring. In 1983, the theory of selective photothermolysis was introduced that enabled physician-scientists to design lasers that were highly selective and safer to operate. Lasers designed on the theory of selective photothermolysis are capable of affecting a specific target tissue without a high risk of scarring and pigmentary changes. They accomplish this task by producing a wavelength and pulse duration that are best absorbed by a specific target. Not all modern lasers use selective photothermolysis and therefore may operate in either a continuous wave, quasi-continuous wave pulsed, or Q quality-switched mode. Continuous wave lasers are least selective and tend to produce unwanted tissue damage and scarring through heat dissipation. Quasi-continuous wave lasers attempt to limit unwanted thermal damage by producing a series of brief laser pulses or by chopping a continuous wave beam; however they still have a relatively high risk of causing nonspecific tissue damage and thermal injury. The pulsed and Q- switched systems adhere most closely to the laws of selective photothermolysis and result in the most selective destruction with the lowest risk of scarring and unwanted thermal diffusion. Of course, any laser system can potentially result in scarring and tissue damage; therefore, adequate operator education and skill are essential when using any medical laser.
Article
One of the most interesting areas of cutaneous laser surgery has been the treatment of cutaneous pigmentation. The development of short-pulsed, pigment-specific lasers during the past 2 decades has enabled physicians to treat a variety of pigmented lesions of the skin with a high degree of tissue selectivity and a low risk of postoperative complications. Despite this, very few studies1- 2 have actually compared the effectiveness of lasers in removing pigmented abnormalities with other, more traditional modalities, such as cryotherapy, electrocautery, chemical peels, or surgical excision. In this issue of the ARCHIVES, Todd et al3 report a randomized controlled study comparing the treatment response of solar lentigines with 3 different types of lasers and liquid nitrogen cryotherapy. The results demonstrate the superiority of laser therapy, particularly with short-pulsed lasers, in producing significant clinical improvement with a low incidence of adverse effects and high patient acceptance.
Article
Background. Disorders of cutaneous pigmentation are a common problem, which can cause substantial cosmetic morbidity. Traditional treatments are often ineffective and sometimes associated with further hyperpigmentation, hypo-pigmentation, or scarring. Because the Q-switched ruby laser has proven useful for the treatment of tattoos and, in a small number of cases, benign disorders of the epidermal melanin, we decided to apply this modality systematically to additional benign pigmented lesions.Methods. Thirty-four benign pigmented epidermal lesions including lentigines, café-au-lait macules, and nevi spili in nine white patients were exposed to single pulses of a Q-switched ruby laser (694 nm, 40 ns pulse duration) at 4.5 and/or 7.5 J/cm2.Results. After one treatment, substantial clearing occurred at each fluence in all lentigines and café-au-lait macules. Initial improvement was achieved in a small nevus spilus after two treatments at 4.5 J/cm2, and a larger nevus spilus after one treatment at 7.5 J/cm2 with complete removal of the junctional or compound nevi portion but no improvement in the cafe-au-lait portion. Complete return of the background pigment was observed by 1 year. There was no scarring. Immediately after treatment, histology revealed vacuolizaton of keratinocytes and melanocytes, and occasional subepidermal blisters.Conclusions. These findings show that while the Q-switched ruby laser may not be entirely useful for treating nevi spili, it does provide an effective treatment for lentigines and café-au-lait macules.
Article
During the 35 years of their existence, lasers have assumed an ever-expanding role in cosmetic surgery due to their reproducible precision in effectively managing a number of cutaneous conditions and disorders for which no acceptable form of treatment has been developed. Current medical lasers can be used to fade or remove many vascular and pigmented birthmarks, decorative and traumatic tattoos, solar and rosacea telangiectasia, and many acquired pigmentary disorders, without a visible scar or change in texture. In order to provide their patients with the best possible aesthetic result, cosmetic surgeons should be familiar with the advantages, disadvantages, and potential complications of lasers.
Article
The Q-switched ruby and the Q-switched neodymium YAG lasers are both widely used in the treatment of amateur and professional tattoos. Comparative evaluation of these two laser systems has not previously been performed; thus, the advantages of each laser have not been delineated. Forty-eight amateur and professional tattoos were treated with both the Q-switched ruby and Q-switched Nd:YAG lasers. The tattoos were divided in half and one side of the tattoo was treated with each laser. After one treatment, the patients returned for evaluation to assess the degree of lightening achieved by each laser. The Q-switched ruby laser was found to be superior in lightening black dye in both professional and amateur tattoos. A significant advantage was noted for the ruby laser in the removal of green tattoo pigment. The differences with the Q-switched ruby laser and the 1064 nm option of the Q-switched YAG laser were not clinically significant in the lightening or removal of other colors. The 532 nm option of the Q-switched YAG laser was superior to the Q-switched ruby and the 1064 nm option of the YAG laser in the removal of red tattoo colors in professional tattoos. Hypopigmentation was found more commonly with the Q-switched ruby laser, while textural change was noted more commonly with the Q-switched Nd:YAG laser. One of the patients treated with the Nd:YAG laser at 1064 nm showed a hypertrophic scar.
Article
The removal of benign, aesthetically important, pigmented lesions can be effectively treated with multiple modalities. Selective removal of the pigment by lasers is becoming increasingly popular. A three-center trial evaluated the effectiveness of the frequency-doubled Q-switched neodymium (Nd):YAG laser (532 nm, 2.0-mm spot size, 10 nanoseconds) in removing benign epidermal pigmented lesions with a single treatment. Forty-nine patients were treated for multiple lentigines (n = 37), for cafe au lait macules (n = 7), and for miscellaneous lesions (n = 5). Treatment areas were divided into four quadrants, irradiated with fluences of 2, 3, 4, or 5 J/cm2 and evaluated at 1- and 3-month intervals following treatment. For lentigines, response was related to dose with a greater than 75% pigment removal achieved in 60% of those lesions treated at higher energy fluences. Responses were more variable with other lesions, with fair-to-good improvement noted in most cases. Mild, transient erythema; hypopigmentation; and hyperpigmentation were noted in several patients, but resolved spontaneously within 3 months. No other textural changes, scarring, or other side effects were noted. The frequency-doubled Q-switched Nd: YAG laser (532 nm) safely and effectively treats benign epidermal pigmented lesions.
Article
Disorders of cutaneous pigmentation are a common problem, which can cause substantial cosmetic morbidity. Traditional treatments are often ineffective and sometimes associated with further hyperpigmentation, hypopigmentation, or scarring. Because the Q-switched ruby laser has proven useful for the treatment of tattoos and, in a small number of cases, benign disorders of the epidermal melanin, we decided to apply this modality systematically to additional benign pigmented lesions. Thirty-four benign pigmented epidermal lesions including lentigines, café-au-lait macules, and nevi spili in nine white patients were exposed to single pulses of a Q-switched ruby laser (694 nm, 40 ns pulse duration) at 4.5 and/or 7.5 J/cm2. After one treatment, substantial clearing occurred at each fluence in all lentigines and café-au-lait macules. Initial improvement was achieved in a small nevus spilus after two treatments at 4.5 J/cm2 and a larger nevus spilus after one treatment at 7.5 J/cm2 with complete removal of the junctional or compound nevi portion but no improvement in the café-au-lait portion. Complete return of the background pigment was observed by 1 year. There was no scarring. Immediately after treatment, histology revealed vacuolization of keratinocytes and melanocytes, and occasional subepidermal blisters. These findings show that while the Q-switched ruby laser may not be entirely useful for treating nevi spili, it does provide an effective treatment for lentigines and café-au-lait macules.
Article
Clinical experience has shown that a variety of skin lesions are treatable with rapidly pulsed yellow and green light of the copper vapor laser. To review the development, use, complications, and efficacy of the copper vapor laser when utilized for cutaneous lesions. Articles were identified through a MEDLINE search, review of these articles' bibliographies, and advice from expert physicians who have used the copper vapor laser. A variety of vascular and pigmented cutaneous lesions are effectively treated with the copper vapor laser. A distinct advantage for hypertrophic or cobblestoned port-wine stains and most types of facial telangiectasia is seen when this laser's results are compared with the results of other available laser systems. Complications, including scarring, are rarely observed. The copper vapor laser is a useful addition to the family of lasers that are used for cutaneous conditions.
Article
The use of dermatologic laser therapy is rapidly expanding. Thirty years of experience has produced advances in the technology, techniques, and therapeutic efficacy of dermatologic lasers. The original lasers have been improved and modified, and new types of lasers have expanded the dermatologist's therapeutic repertoire. Extensive research has provided a greater understanding of the skin's clinical and histologic response to laser treatment. This has allowed dermatologists to expand their therapeutic options and techniques and to improve clinical outcome.
Article
Medical lasers have advanced so rapidly over the past 10 years that a thorough review of the complications of laser surgery must be based on fundamental laser physics in order to provide a general working framework of knowledge. New laser systems are being introduced and older systems have been improved, often making modern laser technology appear intimidating. In order to understand and even predict the side-effect profile of a specific laser, one must comprehend the principles on which the laser operates. The first medical lasers to be designed, continuous wave lasers, are effective but are extremely operator-dependent and can potentially result in a great deal of scarring. In 1983, the theory of selective photothermolysis was introduced that enabled physician-scientists to design lasers that were highly selective and safer to operate. Lasers designed on the theory of selective photothermolysis are capable of affecting a specific target tissue without a high risk of scarring and pigmentary changes. They accomplish this task by producing a wavelength and pulse duration that are best absorbed by a specific target. Not all modern lasers use selective photothermolysis and therefore may operate in either a continuous wave, quasi-continuous wave, pulsed, or Q quality-switched mode. Continuous wave lasers are least selective and tend to produce unwanted tissue damage and scarring through heat dissipation. Quasi-continuous wave lasers attempt to limit unwanted thermal damage by producing a series of brief laser pulses or by chopping a continuous wave beam; however, they still have a relatively high risk of causing nonspecific tissue damage and thermal injury. The pulsed and Q-switched systems adhere most closely to the laws of selective photothermolysis and result in the most selective destruction with the lowest risk of scarring and unwanted thermal diffusion. Of course, any laser system can potentially result in scarring and tissue damage; therefore, adequate operator education and skill are essential when using any medical laser.
Article
Several pigment-specific lasers can effectively treat epidermal and dermal pigmented lesions without complications using the basic principles of selective photothermolysis. Although such pigmented lesions as solar lentigines and nevi of Ota are relatively easy to treat using pigment-specific laser technology, café-au-lait macules and melasma show variable responses to treatment. New, long-pulsed pigment-specific lasers may prove to further enhance the clinical results obtained in resistant pigmented lesions and other conditions.
Article
Skin diseases have been treated with lasers since the early 1960s. The three principal chromophores in the skin--hemoglobin, melanin, and water--have different absorption spectra that selectively absorb certain wavelengths of electromagnetic radiation. A given wavelength and pulse duration will selectively treat a target containing a chromophore. The wide variety of lasers and their applications are discussed.
Article
To determine if laser therapy is superior to liquid nitrogen for the treatment of solar lentigines and if so, to determine if one laser is superior to the other lasers that were tested. Randomized, controlled, comparative study with blinded observers. University-based dermatology clinic. Twenty-seven patients with multiple solar lentigines on the backs of both hands. Liquid nitrogen cryotherapy, the Medlite II frequency-doubled Q-switched Nd:YAG laser (Continuum Biomedical, Livermore, Calif), the HGM K1 krypton laser (HGM Medical Laser Systems Inc, Salt Lake City, Utah), and the DioLite 532-nm diode-pumped vanadate laser (Iridex Corp, Mountain View, Calif). Photographs of the hands were taken prior to and 6 and 12 weeks following treatment. Blinded observers and patients evaluated each treatment on its ability to lighten pigmented lesions without causing unwanted adverse effects. Many new laser systems claim an advantage for treating pigmented lesions by selectively destroying melanin. In this study, the frequency-doubled Q-switched Nd:YAG laser was most likely to provide significant lightening (P<.05), followed by the HGM K1 krypton laser, the 532-nm diode-pumped vanadate laser, and liquid nitrogen. The frequency-doubled Q-switched Nd:YAG laser also had the fewest adverse effects (P<.05), while the HGM K1 krypton laser had the most (P<.05). Of the 27 patients, 25 preferred laser therapy to cryotherapy, with the frequency-doubled Q-switched Nd:YAG laser being the most popular. Laser therapy is superior to liquid nitrogen for the treatment of solar lentigines. Of the laser systems tested in this study, the frequency-doubled Q-switched Nd:YAG laser is the most effective.
Melanocytic naevi and malignant melanoma
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MacKie RM. Melanocytic naevi and malignant melanoma. In: Champion RH, Burton JL, Burns DA, Breathnach SM, eds. Textbook of Dermatology, vol 2, 6th edn. Oxford: Blackwell Science, 1998: 1717–52.
Treatment of benign pigmented epidermal lesions by Q-switched ruby laser
  • Cr Taylor
  • Rr Andersen
Melanocytic naevi and malignant melanoma
  • Rm Mackie
  • Rh Champion
  • Jl Burton
  • Da Burns