Use of the Q-Switched 755-nm Alexandrite Laser to Treat Recalcitrant Pigment after Depigmentation Therapy for Vitiligo

BACKGROUND: In patients with extensive vitiligo, depigmentation therapy is often preferred over attempts to restore skin color. Bleaching creams sometimes fail to permanently depigment the skin, leaving disfiguring pigmented patches. This recalcitrant pigmentation may be treated with Q-switched laser technology. OBJECTIVE: The objective was use the Q-switched alexandrite laser to treat recalcitrant pigmentation after unsuccessful attempts at total-body depigmentation for vitiligo. METHODS: We have attempted to destroy the remaining melanin pigmentation in a 68-year-old woman with vitiligo by using selective photothermolysis from a Q-switched alexandrite laser. RESULTS: Excellent results were achieved after 10 treatment sessions, with no recurrence of pigment after 1 year of follow-up. CONCLUSION: The Q-switched alexandrite laser was used successfully and safely in a vitiligo patient with recalcitrant pigmentation after unsuccessful depigmentation therapy and may prove useful in other such cases.     

Treatment of an Amalgam Tattoo with a Q-Switched Alexandrite (755 nm) Laser

BACKGROUND: Amalgam tattoos result from deposition of metallic particles (eg, silver, mercury, copper, zinc, and tin) into the oral mucosa. Their clinical and histologic appearance is similar to that of decorative tattoos. OBJECTIVE: To describe the successful use of a Q-switched alexandrite laser for removal of an amalgam tattoo. MATERIALS AND METHODS: An amalgam tattoo on the buccal mucosa and gingiva was treated with a QS 755 nm alexandrite laser. Three treatments were delivered at 8-week time intervals (average fluence = 6.8 J/cm2). RESULTS: Significant lightening of the tattoo was achieved after each of the three treatments without adverse sequelae. CONCLUSION: Q-switched alexandrite laser irradiation can safely and effectively eradicate amalgam tattoos.     

Treatment of Exogenous Ochronosis With a Q-Switched Alexandrite (755 nm) Laser

Background. Exogenous ochronosis is a cutaneous disorder characterized by blue-black or slate-gray hyperpigmentation resulting from the prolonged use of certain topical agents, most commonly hydroquinones. It is notoriously difficult to treat.
Objective. To report the effectiveness of a quality-switched (QS) 755-nm alexandrite laser in treating hydroquinone-induced exogenous ochronosis.
Methods. Hydroquinone-induced exogenous ochronosis in two patients was treated with a QS alexandrite laser. The first patient received six treatments (average fluence=7.8 J/cm²) at 2-month intervals. The second patient received four treatments (average fluence=6.9 J/cm²) at 4-month intervals. Biopsies of lesional skin were obtained before and after laser treatment for histologic evaluation.
Results. Significant lightening of the pigmented skin areas was achieved in both patients without scarring or textural changes. Decreased dermal pigmentation was observed on histologic examination of treated skin specimens.
Conclusion. The QS alexandrite laser can effectively treat exogenous ochronosis without untoward side effects.     

Laser Hair Removal: Long-Term Results with a 755 nm Alexandrite Laser

BACKGROUND: Hypertrichosis is a common problem for which laser hair removal is becoming the treatment of choice. Optimal wavelength, pulse duration, spot size, fluence, and skin cooling parameters for various skin types have not yet been firmly established. OBJECTIVE: To evaluate the long-term efficacy and safety of a 3-msec 755 nm alexandrite laser equipped with a cryogen cooling device for patients with Fitzpatrick skin types I-V. METHODS: Eighty-nine untanned patients with skin types I-V underwent a total of 492 treatments of laser hair removal over a 15-month period. Each patient in the study underwent a minimum of three treatment sessions spaced 4-6 weeks apart (mean treatments 5.6). Retrospective chart review and patient interviews were used to establish hair reduction results. Treatment sites included the axillae, bikini, extremities, face, and trunk. A 3-msec pulse width, 755 nm alexandrite laser equipped with a cryogen spray cooling device was used in this study. Spot sizes of 10-15 mm were used. A spot size of 10 mm was used for fluences greater than 40 J/cm(2), a spot size of 12 mm was used for fluences of 35-40 J/cm(2), and spot sizes of 12 and 15 mm were used for fluences less than 30 J/cm(2). Fluences ranging from 20 to 50 J/cm(2) (mean fluence 36 J/cm(2)) were used. RESULTS: The patients had a mean 74% hair reduction. Skin type I patients had an average of 78.5% hair reduction using a mean fluence of 40 J/cm(2) (35-50 J/cm(2)) and a 10-12 mm spot size (12 mm in more than 95% of treatments). Skin type II patients had a mean 74.3% hair reduction using a mean fluence of 38 J/cm(2) (30-40 J/cm2) and a 12-15 mm spot size. Skin type III patients had a mean 73.4% hair reduction using a mean fluence of 37 J/cm(2) (25-40 J/cm(2)) and a 12-15 mm spot size. Skin type IV patients had a mean 71.0% hair reduction using a mean fluence of 31 J/cm2 (25-35 J/cm(2)) and a 12-15 mm spot size. A patient with skin type V had a 60% hair reduction using a mean fluence of 23 J/cm(2) (20-25 J/cm(2)) and a 12-15 mm spot size. The efficiency of hair removal directly correlates significantly with the fluence used. Rare side effects included transient postinflammatory hyperpigmentation (n = 9; 10%), burn with blisters (n = 1; 1%), and postinflammatory hypopigmentation (n = 2; 2%). All complications resolved without permanent scarring. CONCLUSION: The 3-msec cryogen cooling-equipped alexandrite laser can safely and effectively achieve long-term hair removal in patients with skin types I-V. The best results are achieved in untanned patients with skin types I-IV.     

Q-Switched Ruby Laser Treatment for Postsclerotherapy Hyperpigmentation

BACKGROUND: One of the most common adverse sequelae of sclerotherapy is cutaneous hyperpigmentation. OBJECTIVE: We used the Q-switched ruby laser to treat postsclerotherapy hyperpigmentation. METHODS: Eight patients developed pigmentation lasting more than 1 year (1-2 years on average) after sclerotherapy treatment for reticular and telangiectatic veins in the legs ranging in size from 0.2 to 4 mm in diameter. All patients were treated with a Q-switched ruby laser at 694 nm, 4 mm beam size, and fluence range of 5.6-10.5 J/cm2. RESULTS: Ninety-two percent of lesions lightened after treatment. There was significant (75-100%) resolution of hyperpigmentation in 58% of treated areas, 25% improvement in 33% of treated areas, and no improvement in the remaining areas. CONCLUSION: Our impression is that given a choice of lasers, the Q-switched ruby laser provides the greatest efficacy for treating postsclerotherapy hyperpigmentation.     

Treatment of Widespread Segmental Nevus Spilus by Q-Switched Alexandrite Laser (755 nm, 100 nsec)

BACKGROUND: Widespread unilateral nevus spilus causes important cosmetic and psychological disturbances, and only a few therapeutic options can guarantee good functional and cosmetic results. OBJECTIVE: To evaluate the clinical response of a patient with widespread segmental nevus spilus to Q-switched (QS) alexandrite laser. METHODS: The treatment was QS alexandrite laser (755 nm, 100 nsec) with a mean fluence of 7.28 +/- 0.37 J/cm2 using a single-impact technique at 10 +/- 8.47-week intervals. RESULTS: Fifty percent clearance of the facial portion of the lesion was observed after 16 treatment sessions with QS alexandrite laser. CONCLUSION: QS alexandrite laser is suitable for removal of widespread segmental nevus spilus.     

Comparing 18- Versus 12-mm Spot Size in Hair Removal Using a Gentlease 755-nm Alexandrite Laser

Background. Laser epilation is based on the principle of selective photothermolysis, absorption of laser energy by the target chromophore melanin. It is claimed that larger spot sizes may be more effective for hair removal at identical fluences.
Objective. To compare the efficacy of 18- vs. 12-mm spot size in hair removal using a Gentlelase Alexandrite laser from Candela Corporation (Boston, MA).
Methods. In this double-blind, randomized control trial, patients underwent laser-assisted hair removal on the axillary region. Regions were randomly selected and treated with either an 18- or a 12-mm spot size. Three treatments at 6-week intervals with a 755-nm Gentlelase Alexandrite laser (Candela Corp., Canton, MA) at a fluence of 16 J/cm² with cooling and delay times of 60 ms. Hair counts were taken before each treatment session and compared. The mean percentage hair reduction and student's paired t -test were used to compare 18 versus 12 mm versus control sites at each visit and compared it with the baseline hair count.
Results. There was a 10.3% difference in mean reduction favoring the 18-mm spot size treated area at the 6-month follow-up.
Conclusion. Our results indicate that a larger spot size appears to be more effective for laser assisted hair removal.     

Successful Removal of Freckles in Asian Skin with a Q-Switched Alexandrite Laser

BACKGROUND.: Although freckles are light-brown macules most frequently observed in individuals with red or blond hair and blue or gray eyes, freckles are common to Asian people, including Koreans. Treatment may be requested on cosmetic grounds. OBJECTIVE.: The objective of this study was to determine the effectiveness of the Q-switched alexandrite laser (wavelength 755 nm; pulse width 100 nsec) in treating the 197 cases of Asian skin with freckles and to observe any side effects such as pigmentary changes or scarring. METHODS.: One hundred ninety-seven patients with freckles were treated with the Q-switched alexandrite laser at 8-week intervals and clinically analyzed. RESULTS.: More than 76% removal of freckles required an average of 1.5 treatment sessions with 7.0 J/cm2. No scarring, long-standing pigmentary changes, or textural changes were seen in laser-irradiated skin. CONCLUSION.: The Q-switched alexandrite laser is a safe and highly effective modality for removing freckles without scarring or permanent pigmentary changes in Asian skin.     

Combined Ultrapulse CO2 Laser and Q-Switched Alexandrite Laser Compared with Q-Switched Alexandrite Laser Alone for Refractory Melasma: Split-Face Design

BACKGROUND. : Melasma is common and can cause major psychological impact. To date, the mainstay of treatment, including various hypopigmenting agents and chemical peels, is ineffective and can cause adverse effects. Laser is a new approach and is yet to be explored for its efficacy and safety. OBJECTIVE. : To compare combined Ultrapulse CO2 laser and Q-switched alexandrite laser (QSAL) with QSAL alone in the treatment of refractory melasma. METHODS. : Six Thai females were treated with combined Ultrapulse CO2 laser and QSAL on one side of the face and QSAL alone on the other side. The outcome was evaluated periodically for up to 6 months using the modified Melasma Area and Severity Index score and the modified Melasma Area and Melanin Index score. RESULTS. : The side with combination treatment had a statistically significant reduction of both scores. On the QSAL side, the score reduction was not significant. Two cases developed severe postinflammatory hyperpigmentation and were effectively treated with bleaching agents. Transient hypopigmentation and contact dermatitis were observed with the combination treatment side. CONCLUSIONS. : Combined Ultrapulse CO2 laser and QSAL showed a better result than QSAL alone but was associated with more frequent adverse effects. Long-term follow-up and a larger number of cases are required to determine its efficacy and safety for refractory melasma.     

Temporary Tattooing Followed by Q-Switched Alexandrite Laser for Treatment of Syringomas

BACKGROUND: Syringomas usually develop in women as multiple skin-colored papules primarily seen on the periocular regions and cheeks. They can cause cosmetic problems and lead to poor self-esteem. Though several treatment modalities have been established, such as excision, electro/cryosurgery, chemical peeling, and CO2 laser surgery, none of them are satisfactory due to their limitations and side effects, for example, pain, prolonged healing time, postoperative erythema/pigmentary changes, and scarring. OBJECTIVE: The objective of this study was to develop a new treatment method for syringoma and to minimize the side effects through selective destruction of the tumor. METHODS: Six patients with multiple periorbital syringomas were enrolled in this study. The surface epithelium of the syringomas was vaporized by CO2 laser, and black ink was introduced in order to allow penetration to the dermis using iontophoresis. Subsequently the artificial tattoos were removed by Q-switched alexandrite laser. The results were evaluated clinically by both physicians and patients at 1, 2, 4, and 8 weeks after treatment. RESULTS: The majority of syringoma in the six patients disappeared by the first follow-up 1 week after treatment. There were no cases of prolonged erythema persisting beyond 2 weeks. Additional treatment was repeated in the same manner in order to remove the remaining syringomas in one patient. There were no recurrences during the 8-week follow-up period. CONCLUSION: Our new treatment was safer, less painful, nonscarring, and there was a quicker recovery period and less of a burden to repeat treatment when necessary.     

Analysis of 602 Chinese Cases of Nevus of Ota and the Treatment Results Treated by Q-Switched Alexandrite Laser

BACKGROUND: Nevus of Ota is a congenital or acquired pigmentary disorder of the skin and mucous membranes, which are areas innervated by the first and second branches of the trigeminal nerve. Nevus of Ota is very common in Asia. Nevus of Ota was effectively treated with Q-switched alexandrite (755 nm) laser, but no detailed report existed on many Chinese cases treated with Q-switched alexandrite laser. OBJECTIVE: The objective was to gauge clinical and treatment data and material statistics for 602 cases of nevus of Ota and analyze its pathogenic mechanism and therapeutic results. METHODS: A total of 602 cases of clinical data on nevus of Ota were collected by means of clinical registration, photo verification, and telephone inquiry or correspondence. CONCLUSIONS: There are some differences in sex, age, and local regions in nevus of Ota. Nevus of Ota can combine with other diseases. The treatment of Nevus of Ota by a Q-switched alexandrite laser is safe and effective. Additional treatment will achieve good results. The results correlate to the eyelids and Tanino's classification.     

Recurrent Pigmented Macules after Q-Switched Alexandrite Laser Treatment of Congenital Melanocytic Nevus

BACKGROUND: Q-switch-mode laser treatment of congenital nevi does not result in complete histological clearance, and many patients have partial repigmentation within several months. In addition, the number of recurrent pigmented macules (RPMs) may increase, a major drawback to good cosmetic results. While the mechanism of recurrence is not known. OBJECTIVE: To help elucidate the mechanism of RPM development, we evaluated the expression of TNF-alpha and E-cadherin on RPM after treatment of congenital nevi with a Q-switched alexandrite laser (QSAL). METHODS: Thirteen Korean subjects with congenital nevi received QSAL treatment at intervals ranging from 2 to 6 months (mean, 4.5 treatments). Two-millimeter punch biopsy specimens were obtained at their first visit and from RPMs 3-6 months after the last treatment. Expression of E-cadherin and TNF-alpha were determined histochemically in the original nevi and RPM. In addition, one RPM was examined by electron microscopy. RESULTS: Reduced pigmentation in the treated areas was seen in all cases, but partial repigmentaion was seen as black spots within 6 months after the last QSAL treatment. Compared to the original nevi, the RPMs had increased numbers of melanocytes in the epidermis and reduced nevomelanocytic nests in the dermis. The expression of TNF-alpha and E-cadherin was downregulated in the RPMs compared to the original nevi. Electron microscopy confirmed the increase in melanocytes in the epidermis of RPMs. CONCLUSION: Our findings suggest that the down-regulation of E-cadherin and TNF-alpha may induce the proliferation of melanocytes, resulting in the formation of RPMs.     

Q-Switched Alexandrite Laser Therapy for Pigmentation of the Lips Owing to Laugier-Hunziker Syndrome

BACKGROUND: Laugier-Hunziker (LH) syndrome is a rare benign condition in which hyperpigmentation of the lips and buccal mucosa occurs with no systemic associations. OBJECTIVE: We report the response to treatment with the Q-switched alexandrite laser (QSAL) because there are few reports on therapy for LH syndrome. METHODS: The QSAL was used for pigmentation of the lips in a 63-year-old woman with LH syndrome. Laser irradiation was done at 5.0 J/cm2 with a 3 mm spot size. RESULTS: There was 100% clearance of pigmentation of the lips with a single laser treatment, and recurrence was not observed after 6 months. CONCLUSION: The QSAL is very effective for pigmentation owing to LH syndrome.     

Refractory Postinflammatory Hyperpigmentation Treated Fractional CO2 Laser

Objective: Postinflammatory hyperpigmentation is a reactive hypermelanosis of the skin that occurs as a consequence of an inflammatory process, such as acne, eczema, drug reactions, burns, chemical peelings, and laser applications. Although topical agents remain to be the first-line treatment of postinflammatory hyperpigmentation, treatment of recalcitrant cases is challenging. The Q-switched ruby laser, the low-dose Q-switched neodymium-doped yttrium aluminum garnet laser, and the fractional 1550nm erbium-doped fiber laser have been reported to improve postinflammatory hyperpigmentation. Design/setting/participants: The authors present a case of refractory postinflammatory hyperpigmentation successfully treated with two sessions of fractional CO₂ laser in a 24-year-old woman with Fitzpatrick skin type III. Results: After two treatment sessions with a one-month interval, the lesion totally cleared without any complications. Conclusion: Although many laser systems, including fractional CO₂ lasers, can cause postinflammatory hyperpigmentation, they also can be very efficacious tools by using conservative laser settings and by providing appropriate post-treatment care in recalcitrant postinflammatory hyperpigmentation treatment.Postinflammatory hyperpigmentation (PIH) is a reactive hypermelanosis of the skin. It appears as asymptomatic macules or patches that may be different in size and distribution depending on the causative pathology. Characteristically, it occurs as a consequence of an inflammatory process, such as acne, eczema, drug reactions, burns, chemical peelings, and laser applications. Increased amounts of arachidonic acid metabolites, cytokines, inflammatory mediators, and histamine in the inflammatory process may stimulate the melanocytes causing an increase in the melanin synthesis and transfer of pigment to the surrounding keratinocytes. In PIH, there is either excess melanin production or an abnormal distribution of melanin pigment deposited in the epidermis and/or dermis.1Treatment of PIH consists of a variety of medications and procedures. These include topical bleaching agents, such as hydroquinone, azelaic acid, kojic acid, retinoids, vitamin C, chemical peels, laser therapy, and sunscreens.1,2 The Q-switched ruby laser, the low-dose Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, and the fractional 1550nm erbium-doped fiber laser have been reported to improve PIH.1-4 Here, the authors present a case of refractory PIH treated with fractional CO₂ laser.     

Areolar Cosmetic Tattoo Ink Darkening: A Complication of Q-Switched Alexandrite Laser Treatment

BACKGROUND AND OBJECTIVE: Medical tattooing of the areola is widely performed in Korea. However, cosmetic tattoos containing flesh-tone, purple-red, and yellow dyes are sometimes resistant to Q-switched laser and may even become darker. METHOD: Two Korean women in their 30s who had a mastectomy got light brown to red areolar medical tattoos but they were not satisfied with the shape and size of the tattoos. They underwent Q-switched alexandrite laser treatment with a 3 mm collimated beam at fluences of 7.5-8 J/cm2 in order to trim the irregular contour and reduce the diameter of the tattoos. RESULTS: Within 5 minutes a dark gray to black discoloration of the treated area was evident and remained dark for 6 weeks. Improvement was not noted after two further Q-switched Nd:YAG laser treatments. CONCLUSION: Medical areolar tattoos should be approached with extra caution when attempting their removal with high-energy pulsed lasers such as Q-switched alexandrite laser and a small test site should be performed prior to treatment.     

755nm翠绿宝石激光联合800nm半导体激光治疗腰骶部多毛疗效分析

目的:回顾性分析755nm翠绿宝石激光联合800nm半导体激光治疗腰骶部多毛的临床疗效和安全性。方法:收集笔者医院2017年1月1日-2018年6月30日收治的100例腰骶部多毛患者病例资料,其中50例患者为单纯755nm翠绿宝石激光治疗;50例患者为755nm翠绿宝石激光联合800nm半导体激光治疗。分析两组患者的治疗效果、不良反应发生情况及对治疗效果的满意度。结果:相较于单纯755nm激光治疗,755nm翠绿宝石激光联合800nm半导体激光脱毛的有效率和治愈率显著高于755nm治疗组,两组比较有统计学意义(P<0.05);组间的VAS(视觉模拟评分法)疼痛评分比较,差异无统计学意义(P>0.05),但联合治疗组发生疼痛的次数显著低于单一治疗组(P<0.05);单纯治疗组出现2例色素沉着斑,联合治疗组无色素沉着斑出现,两组比较差异无统计学意义(P>0.05),两组均未出现色素减退斑及瘢痕;联合治疗组患者的总满意率显著高于单一治疗组(P<0.05)。结论:755nm翠绿宝石激光联合800nm半导体激光治疗腰骶部多毛临床疗效明显,安全性良好,疼痛感轻,值得广泛应用。     

Sebaceous Hyperplasia Treated With a 1450-nm Diode Laser

Background. Sebaceous hyperplasia is a benign proliferation of the sebaceous gland. Previous treatment options have included isotretinoin, destructive modalities, and pulsed-dye laser.
Objective. To evaluate the efficacy of a 1450-nm diode laser for the treatment of sebaceous hyperplasia.
Methods. Ten patients with sebaceous hyperplasia were treated one to five times with a 1450-nm diode laser. Fluences of 16 to 17 J/cm² were used, with cooling durations of 40 to 50 ms. Patients and physicians evaluated treated lesions for improvement. Measured areas of treated lesions were also recorded.
Results. In most cases, patients and physicians rated improvement as "very good" or better. After two to three treatments, 84% of lesions shrunk greater than 50%, and 70% shrunk greater than 75%. Adverse effects were unusual; one atrophic scar and one case of transient hyperpigmentation were observed.
Conclusion. The 1450-nm diode laser is effective and safe for the treatment of sebaceous hyperplasia.     

Combination Treatment of Melasma with Pulsed CO2 Laser Followed by Q-Switched Alexandrite Laser: A Pilot Study

BACKGROUND: Melasma is very difficult to treat and often refractory to treatment with topical creams and pigmented-lesion lasers. OBJECTIVE: Pulsed CO2 laser alone is compared with the combination of pulsed CO2 laser followed by Q-switched alexandrite laser in the treatment of dermal-type melasma. This combination is proposed to be effective by first destroying the abnormal melanocytes with the pulsed CO2 laser and then selectively eliminating the dermal melanin with the alexandrite laser. METHODS: Four patients were randomly chosen for each treatment arm. There were multiple follow-up visits for examination by an objective blinded investigator. RESULTS: All patients in the combination laser group showed complete resolution, and two patients in the CO2 laser only group had peripheral hyperpigmentation in the long-term follow-up evaluation. CONCLUSION: These laser therapies are safe, as there was no scarring and no infection. The combination laser therapy was highly effective in removing the hyperpigmentation and all patients in this group showed complete resolution without any peripheral hyperpigmentation.