Cutaneous Hyperpigmentation Following Venous Sclerotherapy Treated with Deferoxamine Mesylate

BACKGROUND: Cutaneous hyperpigmentation after venous sclerotherapy is an adverse sequelae of difficult management. OBJECTIVE: To evaluate the degree of depigmentation with the use of deferoxamine mesylate (DM) in patients with postsclerotherapy hyperpigmentation treated with polydocanol (POL) for telangiectasias and reticular veins (0.2-5 mm diameter) and varicose veins (5-8 mm diameter). METHODS: The experimental group of 36 female patients (mean age 37 years) was divided in two groups. Group I consisted of 30 patients who were treated with POL at 0.25-0.50% concentration for telangiectasias and reticular veins. Group II consisted of six patients with prolonged postsclerotherapy hyperpigmentation (more than 6 months after treatment) in varicose veins that had been treated with POL at 1.5% concentration each week. Groups I and II were injected with DM 500 mg subcutaneously once a week until 81-100% depigmentation was reached. In group I, DM was injected at the time of sclerotherapy. These groups were compared to their respective control groups with similar conditions but allowing spontaneous depigmentation without DM. Evaluation was undertaken clinically and photographically, and the number of days required to reach the desired depigmentation of 81-100% was determined. RESULTS: When DM was used, depigmentation of 81-100% was observed in group I at 27 days, and for group II in 46 days. In each control group, similar depigmentation was seen at 150 +/- 19 and 255 +/- 11 days, respectively. Comparing results, there was a reduction in the time to depigmentation of 82% for each group (P <.0001). CONCLUSION: The weekly subcutaneous administration of DM 500 mg reduces the time to depigmentation by 82% in patients with postsclerotherapy cutaneous hyperpigmentation treated for telangiectasias and reticular veins and prolonged postsclerotherapy hyperpigmentation in varicose veins. In this study we could not explain why such variability exists in the length of time to spontaneous depigmentation.     

Q-switched ruby versus long-pulsed dye laser delivered with compression for treatment of facial lentigines in Asians

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.     

Minocycline-induced hyperpigmentation of the tongue: successful treatment with the Q-switched ruby laser.

BACKGROUND: Minocycline-induced hyperpigmentation (MIH) is a benign condition that may persist for years despite abrogation of therapy. The Q-switched ruby laser (QSRL) has been successful in removing such lesions from the skin. To date there is no documentation of QSRL or any laser being used to treat lingual hyperpigmentation associated with minocycline therapy. OBJECTIVE: Long-term follow-up results are reported for the use of QSRL to treat lingual hyperpigmentation. The literature is reviewed comparing the use of different laser systems on MIH. METHODS: A 26-year-old woman with pigment changes of the tongue and buccal mucosa due to long-term minocycline therapy was treated with four consecutive sessions with QSRL (694 nm, 20-nsec pulse duration, and 6.5 mm spot size) at 3.6-4.0 J/cm2. RESULTS: A 90% resolution was achieved after three treatments. After the final treatment the lesions were completely gone. There were no side effects reported. No new pigment was detected at follow-up. CONCLUSION: Treatment with the QSRL is a safe and effective strategy for treating hyperpigmentation of the tongue associated with minocycline therapy.     

非剥脱性Q开关Nd：YAG 1 064 nm激光对黄褐斑的治疗效果

目的 观察非剥脱性Q开关Nd：YAG 1 064 nm激光对黄褐斑的治疗效果.方法 应用Q开关Nd：YAG 1 064 nm激光对23例黄褐斑患者进行治疗,其光斑直径6 mm,脉宽5～7 ns,频率10 Hz,能量密度1.8～2.0 J/cm2.一般需8～10次治疗,每次治疗间隔1周.结果 23例经8～10次治疗后,黄褐斑明显淡化或消失,局部出现轻度充血,无水泡和结痂形成,基本治愈率达52.17%.5例出现眼睑紫癜,3 d后自行消退,无色素沉着及瘢痕发生.术后随访6个月以上,其中7例（占30.4%）出现复发,继续治疗仍然有效.结论 非剥脱性Q开关Nd：YAG 1 064 nm激光治疗黄褐斑虽有复发,仍不失为一种比较可行的治疗方法 ,有一定效果,操作简单、安全,不影响患者的工作和生活.     

非剥脱性Q开关Nd:YAG 1 064 nm激光对黄褐斑的治疗效果

目的 观察非剥脱性Q开关Nd:YAG 1 064 nm激光对黄褐斑的治疗效果.方法 应用Q开关Nd:YAG 1 064 nm激光对23例黄褐斑患者进行治疗,其光斑直径6 mm,脉宽5～7 ns,频率10 Hz,能量密度1.8～2.0 J/cm2.一般需8～10次治疗,每次治疗间隔1周.结果 23例经8～10次治疗后,黄褐斑明显淡化或消失,局部出现轻度充血,无水泡和结痂形成,基本治愈率达52.17%.5例出现眼睑紫癜,3 d后自行消退,无色素沉着及瘢痕发生.术后随访6个月以上,其中7例(占30.4%)出现复发,继续治疗仍然有效.结论 非剥脱性Q开关Nd:YAG 1 064 nm激光治疗黄褐斑虽有复发,仍不失为一种比较可行的治疗方法 ,有一定效果,操作简单、安全,不影响患者的工作和生活.     

非剥脱性Q开关Nd:YAG 1 064 nm激光对黄褐斑的治疗效果

目的 观察非剥脱性Q开关Nd:YAG 1 064 nm激光对黄褐斑的治疗效果.方法 应用Q开关Nd:YAG 1 064 nm激光对23例黄褐斑患者进行治疗,其光斑直径6 mm,脉宽5～7 ns,频率10 Hz,能量密度1.8～2.0 J/cm2.一般需8～10次治疗,每次治疗间隔1周.结果 23例经8～10次治疗后,黄褐斑明显淡化或消失,局部出现轻度充血,无水泡和结痂形成,基本治愈率达52.17%.5例出现眼睑紫癜,3 d后自行消退,无色素沉着及瘢痕发生.术后随访6个月以上,其中7例(占30.4%)出现复发,继续治疗仍然有效.结论 非剥脱性Q开关Nd:YAG 1 064 nm激光治疗黄褐斑虽有复发,仍不失为一种比较可行的治疗方法 ,有一定效果,操作简单、安全,不影响患者的工作和生活.     

Long-Term Follow-Up in Treatment of Solar Lentigo and Café-au-Lait Macules with Q-Switched Ruby Laser

A Q-switched ruby laser was used for treatment of 10 patients with solar lentigo and 12 patients with café-au-lait macules. In this study, the lesions were treated with the laser at a rate of 6 J/cm². The patients were observed for 10–21 months with an average of 13.8 months after the final session. Solar lentigos were treated once or twice, and the response rate was 70%. Café-au-lait macules were treated one to six times, and the response rate was 33%. Side effects, such as hyperpigmentation and scar formation, were rarely seen. Therefore, Q-switched ruby laser treatment is an effective treatment for epidermal pigmented lesions; however, in patients with café-au-lait macules, the responses to the treatment varied, and a repigmentation was seen in 50% of these patients. Thus, long-term follow-up is required for patients with café-au-lait macules.     

Q-Switched Ruby Laser Therapy of Acquired Bilateral Nevus of Ota-like Macules

BACKGROUND: Acquired bilateral nevus of Ota-like macules (ABNLM), also called nevus fuscoceruleus zygomaticus or nevus of Hori, is a relatively common disease in Asia. It is refractory to all medical treatment. OBJECTIVE: To present the first report on the use of Q-switched ruby laser to treat ABNLM. METHODS: One hundred and forty female patients, ages 19-62 years (mean 39 years), were included in the study. The laser fluence employed was 7-10 J/cm2, at a repetition rate of 1 Hz, and with a spot size of 2-4 mm. The number of treatment sessions ranged from 1 to 6 (mean 2.3). RESULTS: Nine patients were lost to follow-up before complete clearance of the lesions, while in the remaining 131 patients complete clearance was obtained. The only complication was a long-term hypopigmentation, observed in three patients. There was no recurrence at 6 months- 4.3 years (mean 2.5 years) of follow-up. CONCLUSION: Q-switched ruby laser is an effective and less invasive tool to eradicate ABNLM.     

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.     

Q-switched Nd:YAG laser treatment for acquired bilateral nevus of ota-like maculae: a long-term follow-up

BACKGROUND AND OBJECTIVE: Acquired bilateral nevus of Ota-like maculae (ABNLM) is not an uncommon dermal melanosis in Asian people. It is known for its recalcitrance to conventional treatment. We proposed Q-switched Nd:YAG laser for the treatment of this entity. STUDY DESIGN/PATIENTS AND METHODS: Seventy female patients with ABNLM, who were 25-40 years old (mean, 37 years), were included in a prospective clinical study. Q-switched Nd:YAG laser at fluence of 8-10 J/cm(2), spot size 2 or 4 mm, and a repetition rate of 10 Hz was used to treat the lesions. RESULTS: Two patients were lost to follow-up. In the remaining 68 cases, all lesions attained a 100% clearance after two to five treatment sessions (mean, 2.8 sessions). The results had persisted at 3-4 years follow-up (mean, 42 months). Temporary hyperpigmentation was found in 50% of patients; there was no scarring or changing of skin texture. CONCLUSION: Q-switched Nd:YAG laser is a safe and effective noninvasive alternative treatment for ABNLM.     

Comparison of the 595 nm Long-Pulse (1.5 msec) and Ultralong-Pulse (4 msec) Lasers in the Treatment of Leg Veins

BACKGROUND: Although several lasers and light sources are now available for vascular lesions, treatment of leg veins has not been very satisfactory. Lengthening the pulse width should theoretically result in improved response rates. OBJECTIVE: This study compared the efficacy and safety of 595 nm pulsed lasers at 1.5 msec and 4 msec in treating leg veins. METHODS: For group A, 27 healthy adult volunteers with leg veins measuring less than 1 mm in diameter were treated with a 2 mm x 7 mm elliptical handpiece. Each patient had three areas treated. The first two areas were treated with the 4 msec pulsed dye laser with fluences of 16 and 20 J/cm2, while the last area was treated with a 1.5 msec pulsed dye laser at fluences ranging from 14 to 16 J/cm2. For group B, 13 subjects were treated. Areas 1 and 2 were treated with the 4 msec pulsed dye laser using a 3 mm x 5 mm and 5 mm handpiece, respectively, while the third site was treated with a 1.5 msec laser using a 3 mm x 5 mm handpiece. Fluences ranging from 14 to 16 J/cm2 were used. Clinical evaluations were performed and photographs taken at 4-8 week intervals. RESULTS: Neither laser regularly induced satisfactory diminution or disappearance of these vessels after one treatment. In group A, more than 50% of patients had little to no improvement, while in group B little to no improvement was observed in 33% of patients following a single treatment. Although there was no significant difference in outcomes between the test sites, the 4 msec PDL with a 3 mm x 5 mm spot size appeared to be most effective. Transient hyperpigmentation was common following either treatment, while hypopigmentation was seen in group B subjects. No scarring was noted. CONCLUSION: Both the 4 and 1.5 msec flashlamp-pumped pulsed dye lasers were ineffective in treating leg telangiectasia following a single treatment.     

Comparison and sequential study of long pulsed Nd:YAG 1,064 nm laser and sclerotherapy in leg telangiectasias treatment

BACKGROUND AND OBJECTIVES: Millisecond pulsed 1,064 nm Nd:YAG lasers have been developed for the treatment of leg telangiectasias. To date there have been very few side by side comparison studies of laser versus the gold standard sclerotherapy in treating small leg veins. This study aims to compare a long pulsed Nd:YAG laser with contact cooling to sclerotherapy for treating small diameter leg telangiectasias by evaluating objective and subjective clinical effects. STUDY DESIGN/PATIENTS AND METHODS: Fourteen patients were selected with leg telangiectasias ranging from 0.5 to 2 mm at four comparable sites. One site was treated with long pulsed Nd:YAG alone, the second received sclerotherapy alone, the third laser then sclerotherapy, and the last one sclerotherapy then laser. The patients were followed up at 3 months after the last treatment. Photographs were taken pre-operatively and at 3 months after the last session. They were used for objective and comparative analysis. Statistical analysis was performed using Friedman's test controlling for subject. RESULTS: Improvement was tabulated from the photographic assessment on an improvement scale from 0 (no change) to 4 (greater than 75% clearing). There were clinical improvements in the laser group than sclerotherapy without statistical significance. Side effects were minimal and included hyperpigmentation. CONCLUSIONS: This pilot study demonstrates that the Smartepil LS long pulse Nd:YAG 1,064 nm laser can yield results similar to sclerotherapy in the treatment of small leg telangiectasias. Combination of both methods could increase response to treatment.     

Microthrombectomy reduces postsclerotherapy pigmentation: multicenter randomized trial

OBJECTIVE: Postsclerotherapy pigmentation occurs in nearly 30% of patients. Hemosiderin, from degradation of the venous thrombus, is the possible cause. The hypothesis that early removal of the thrombus may eliminate or decrease the incidence of pigmentation has not been proved or documented. The objective of this study was to investigate the effects of early microthrombectomy on incidence of postsclerotherapy pigmentation. MATERIAL AND METHODS: This multicenter, randomized, controlled study involved 101 patients with varicose veins (100 women, 1 man; mean age, 46 years [range, 25-68 years]). Patients were divided into two groups, with veins 1 mm or less in diameter (group 1, n = 50) or veins 3 mm or less in diameter (group 2, n = 51). Group 1 was treated with Sotradecol (STD) 0.25%, and group 2 with STD 0.50%. In each patient, an area of varicosities was selected and divided into halves. One half was randomized to microthrombectomy and the other half served as control. Microthrombectomy was performed 1 to 3 weeks after treatment in the randomized half. Standard photographs were obtained before and 16 weeks after treatment, and were evaluated by three independent reviewers who were blinded to treatment assignments. Each reviewer received an identical set of pretreatment and posttreatment 10 x 15-cm color photographs of the study area, and completed a scoring sheet. Average of the scores was used to evaluate primary (pigmentation) and secondary (overall clinical improvement) end points. The paired t test and chi-square test were used for statistical analysis. RESULTS: In group 1, microthrombectomized areas had statistically significant less pigmentation (P =.0047) and better overall clinical improvement scores (P =.0002) compared with the control side. In group 2 there was no significant difference between the two areas, but patients reported significant relief of pain and inflammation associated with postsclerotherapy thrombophlebitis. CONCLUSION: In veins 1 mm or smaller, microthrombectomy reduced pigmentation and improved overall clinical results. In veins 3 mm or smaller, statistical significance was not achieved, but thrombectomy resulted in faster resolution of the postsclerotherapy pain and inflammation. On the basis of these results, microthrombectomy after sclerotherapy is recommended.     

Comparative Trial Between Sodium Tetradecyl Sulfate and Glycerin in the Treatment of Telangiectatic Leg Veins

BACKGROUND: Thirteen patients were treated with either sodium tetradecyl sulfate (STS) or glycerin to compare the efficacy and adverse sequelae of each agent. OBJECTIVE: To determine the relative safety and efficacy of two sclerosant solutions. METHODS: Each patient's leg veins that were from 0.2 to 0.4 mm in diameter and that did not have incompetence from the saphenofemoral junction and whose feeding reticular veins had been already treated in a prior sclerotherapy session were randomly treated with either 0.25% STS or 72% glycerin solution. Patients were evaluated from 2 to 6 months postsclerotherapy for overall clinical improvement and incidence of adverse sequelae. RESULTS: Glycerin was comparable to STS in discomfort of injection but demonstrated a significant decrease in bruising, swelling, and postprocedural hyperpigmentation. Glycerin also demonstrated a better, more rapid clearance of treated telangiectasias. CONCLUSIONS: Seventy-two percent glycerin is a safe and effective sclerosant with fewer side effects and more rapid clearance of telangiectatic leg veins than STS.     

Treatment of Facial Skin Using Combinations of CO2, Q-Switched Alexandrite, Flashlamp-Pumped Pulsed Dye, and Er:YAG Lasers in the Same Treatment Session

BACKGROUND: Many patients who seek facial CO2 laser resurfacing for improvement of photodamage are also concerned with "dark circles" under their eyes (periorbital hyperpigmentation) and/or telangiectasia as well as various types of deep scars on their faces. CO2 laser resurfacing alone provides limited improvement for these problems. OBJECTIVE: The purpose of this study was to demonstrate the conjunctive therapeutic effects of the CO2, Q-switched alexandrite, Er:YAG, and/or flashlamp-pumped pulsed dye lasers on facial skin treatments. METHOD: Thirty patients who underwent CO2 laser resurfacing were treated with additional lasers specific for their cosmetic concerns. Twenty patients with facial telangiectasias were treated with the pulsed dye laser immediately prior to CO2 laser resurfacing. Eleven patients with periorbital hyperpigmentation were treated with the Q-switched alexandrite laser immediately following use of the pulsed CO2 laser. Eight patients having sharply defined acne scars were treated with the Er:YAG laser following use of the CO2 laser. All patients had peripheral feathering performed with the Er:YAG laser. Nine patients were treated with all four lasers. RESULTS: In addition to significant improvement of the wrinkle scores from the CO2 laser resurfacing, patients had 75-100% clearing of the periorbital hyperpigmentation. All patients with facial telangiectasia showed virtually 100% improvement. All deep wrinkles and sharply defined scars responded with combined CO2/Er:YAG laser better than with CO2 laser resurfacing alone. All feathering was more uniform, with a more subtle transition to nontreated skin. There were no complications that could be attributed to the simultaneous use of multiple lasers. CONCLUSIONS: For patients who present with multiple cosmetic complaints, combined treatment using appropriate lasers offers excellent therapeutic outcome.     

Combined use of intense pulsed light and Q-switched ruby laser for complex dyspigmentation among Asian patients

BACKGROUND: Dyspigmentation is a common cosmetic concern among Asians. Many individuals exhibit mixed pigmentary entities including melasma, flat/small seborrheic keratoses, ephelides, solar lentigines and acquired bilateral nevus-of-Ota-like macules (ABNOM). We term this phenomenon complex dyspigmentation (CD) and suggest that a combination strategy may be more efficacious than any singular modality. OBJECTIVE: To determine the effectiveness of combined intense-pulsed light (IPL) for global photorejuvenation along with Q-switched ruby laser (QSRL) for targeted pigment dissolution. STUDY DESIGN/MATERIALS AND METHODS: Twenty-five Korean women with CD (defined as >2 types of facial pigmentary disorders) were initially treated with IPL followed by repeat treatments every 3-4 weeks as needed. The QSRL treatments, set at low fluence, were added either during the same session or within 1 week of the IPL treatment. Improvement was assessed by the patient, the treating physician and a blinded evaluation of pre- and post-treatment photographs. RESULTS: Using a 4-point scale (1 = poor, 2 = fair, 3 = good, 4 = excellent), 19/25 patients (76%) reporting good-to-excellent response (score "3" or "4"). Two independent physician assessment revealed that 15/25 patients (60%) showed 76-100% improvement while 19/25 patients (76%) showed at least 50% improvement. Side-effects were minimal: 3 patients had transient post-inflammatory hyperpigmentation (12%) and 1 patient (4%) had linear hypopigmentation. CONCLUSIONS: Combination treatment with IPL and QSRL is an effective and safe treatment for CD among Asian patients.     

Comparative pilot study evaluating the treatment of leg veins with a long pulse ND:YAG laser and sclerotherapy

BACKGROUND AND OBJECTIVE: To date there have been very few side by side comparison studies of laser versus sclerotherapy in treating small leg veins. This study compares a long pulsed Nd:YAG laser with contact cooling to sclerotherapy for treating small diameter leg veins by evaluating objective and subjective clinical effects. STUDY DESIGN/MATERIALS AND METHODS: Twenty patients were selected with leg veins ranging from 0.25 to 3 mm at two comparable sites. One site was treated with long pulsed Nd:YAG laser and the other received sotradecol sclerotherapy. The patients followed up at 8 weeks for another possible laser retreatment and 3 months following the last treatment. Photographs were taken pre- and post-operatively and at each follow-up visit and used for objective comparative analysis. The patients also completed a Quality of Life survey. RESULTS: Improvement was tabulated from the photographic assessment on an improvement scale from 0 (no change)-4 (greater than 75% clearing). The laser treated areas averaged 2.50 and sclerotherapy treated sites averaged 2.30. Patient surveys show 35% preferred laser and 45% choose sclerotherapy. CONCLUSION: This pilot study demonstrates that the Lyra Long Pulse Nd:YAG laser can yield results similar to sclerotherapy in the treatment of small leg veins.     

Successful treatment of treatment-resistant laser-induced pigment darkening of a cosmetic tattoo

BACKGROUND AND OBJECTIVE: Cosmetic tattoo removal has a reported risk of immediate pigment darkening when treated with a high energy, nanosecond pulsed-laser system. Surgical treatment options for this reaction are limited and carry significant risk of scarring and permanent pigment alterations. This report describes the response of a resistant Q-switched ruby laser-induced cosmetic tattoo ink darkening to multiple treatments with the Q-switched alexandrite laser and Q-switch Nd:YAG laser and textural improvement with the UltraPulse CO(2) laser. STUDY DESIGN/MATERIALS AND METHODS: A woman with Q-switched ruby laser-induced pigment darkening of a cosmetic tattoo of the upper lip resistant to four further treatments with the ruby laser and two chemical peels received a total of 26 treatments with the Q-switched alexandrite and Nd:YAG lasers and a single treatment with the UltraPulse CO(2) laser, most treatments being done at monthly intervals. RESULTS: Treatment of the affected areas with the Q-switched alexandrite and Nd:YAG lasers resulted in complete clearing of the pigment without scarring, but revealed some preexisting textural changes. Use of the UltraPulse CO(2) laser smoothed the surface irregularities. CONCLUSION: The Q-switched pigment lasers are a useful modality for treating this pigment darkening reaction. As in this case, multiple treatment sessions with the laser may be necessary but the pigment can be expected to clear eventually without scarring. Any textural changes may be blended with the UltraPulse CO(2) laser with further improvement.     

Use of Onion Extract, Heparin, Allantoin Gel in Prevention of Scarring in Chinese Patients Having Laser Removal of Tattoos: A Prospective Randomized Controlled Trial

BACKGROUND: With rapid advancement in cutaneous laser therapy, Q-switched lasers have become the standard treatment for tattoo removal. The longer wavelength Q-switched Nd:YAG laser is used when removing tattoos in darker skin patients to avoid scarring and permanent pigment changes. Nevertheless, the local experience revealed that nearly 25% of the Chinese patients developed scarring. Meanwhile, multiple clinical studies have shown that Contractubex gel (Merz Pharma, Frankfurt, Germany) was effective in the treatment and prevention of hypertrophic scars and keloids. OBJECTIVE: To evaluate the efficacy of Contractubex gel in the prevention of scarring after laser removal of tattoos in Chinese patients. METHODS: A total of 120 Chinese patients with 144 professional blue-black tattoos were recruited into the study. They were randomly assigned into the Contractubex group or the control group. All patients were treated with a QS 1,064-nm Nd:YAG laser using a 3-mm spot size, a 10-Hz repeat rate, a pulse duration of 6 nanoseconds, and fluences that ranged from 3.6 to 4.8 J/cm2 (mean fluence, 4.2 J/cm2). The treated areas were assessed 3 months after the last treatments for clinical clearance and complications. RESULTS: Fifty-two patients with 61 tattoos in the Contractubex group were able to achieve a mean clearing rate of 82.3+/-11.6%. There were 7 tattoos in 7 patients that developed scarring, 4 patients had permanent hypopigmentation, and 3 patients had transient hyperpigmentation. In contrast, 55 patients with 68 tattoos in the control group had a mean clearing rate of 80.4+/-11.3%. Among them, 16 tattoos in 14 patients developed scarring, 4 patients had permanent hypopigmentation, and 5 patients had transient hyperpigmentation. Although there was no significant difference in age, sex, fluence, treatment session, and clinical clearance between the two groups, the Contractubex group had a statistically significantly lower rate of scarring than the control group (p<.05). CONCLUSION: Contractubex gel is effective in scar prevention in Chinese patients having laser removal of tattoos.