Hand rejuvenation using intense pulsed light

BACKGROUND: 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. OBJECTIVE: To assess the effectiveness of an IPL device for the improvement of dyspigmentation and overall skin quality on the dorsa of the hands. METHODS: 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. RESULTS: 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. CONCLUSION: IPL is an effective and safe treatment option to improve solar lentigines and skin texture for hand rejuvenation.     

Comparison of trichloroacetic acid solution and cryosurgery in the treatment of solar lentigines

Background Solar lentigines are benign keratinocytic proliferations resulting from prolonged and cumulative sun exposure. The newer photoselective lasers have become the mainstay of treatment. However, cryosurgery and trichloroacetic acid (TCA) solution are cost‐effective alternatives in the treatment of solar lentigines. Methods Twenty‐five patients with multiple solar lentigines over the dorsa of their hands were included. Each hand was treated randomly with either 30% TCA solution or liquid nitrogen spray. The efficacy of treatment was evaluated at 8 weeks. Results Cryosurgery was more likely to produce significant lightening of the lentigines than 30% TCA solution (P < 0.05) but was more painful and took longer to heal. Conclusion Cryosurgery was found to be superior to TCA 30% solution in the treatment of solar lentigines. This study demonstrates that old‐fashioned treatments for solar lentigines are still excellent and cost‐effective therapeutic choices.     

Efficacy and safety of cryotherapy vs. trichloroacetic acid in the treatment of solar lentigo

Background Solar lentigines are common sun‐induced benign melanocytic proliferation that presents a significant cosmetic worrying for many middle‐aged and elderly patients. Although the newer photoselective lasers have become the mainstay of treatment, cryotherapy and trichloroacetic acid (TCA) solution are inexpensive alternatives in the treatment of solar lentigines. The purpose of this study was to assess the efficacy of cryotherapy compared with TCA 33% on solar lentigines of the back of the hands (SLBH) in patients presenting to dermatologic clinic of our hospital. Methods Each hand of 25 women with SLBH was treated randomly with either cryotherapy or TCA 33% solution. Photographs of the hands were taken prior to and 2 months following the treatment. The response and side‐ effect rate were compared. Results Cryotherapy was more likely to produce substantial lightening of the solar lentigines than TCA 33% solution (P = 0.025) but more painful and took more time to heal. Post‐inflammatory hyperpigmentation (PIH) was almost equal in two types of treatment (P > 0.05). Statistically, the better results were seen in fairer Fitzpatrick's skin types (P = 0.00). Conclusion Cryotherapy shows better results than TCA 33% solution in the treatment of SLBH particularly in lower Fitzpatrick skin types. PIH is the major complication of each type of treatments particularly in darker Fitzpatrick skin types. Generally, the major criterion for treatment of SLBH with cryotherapy or TCA is Fitzpatrick's skin type of patients.     

Clinical effectiveness of a novel intense pulsed light source on facial pigmentary lesions

Intense pulsed light (IPL) therapy improves various clinical symptoms of photoaging skin. In this study we have investigated clinical effects of a novel IPL, Lumenis One (LUMENIS, Tokyo) on facial pigmentary lesions in 18 Japanese female patients. Measurement was performed after 3-5 treatments. IPL showed marked and slight improvements in 28 and 39%, respectively. The data of melanin index demonstrated the improvement after IPL therapy. These results indicated that IPL therapy using Lumenis One may be useful to treat solar lentigines and ephelides on the face.     

新型强脉冲光治疗日光性雀斑样痣的体会

目的 观察新型强脉冲光（intense pulsed light, IPL）治疗日光性雀斑样痣的临床疗效。方法 应用新型IPL治疗173例日光性雀斑样痣患者,其中小斑型（皮损直径≤1 cm）113例,大斑型（皮损直径 ＞ 1 cm） 21例,小斑型 + 大斑型（混合型）39例。每3周治疗1次,4次为1疗程。每次治疗前皮损照相以评估治疗效果。采用5级分类法来统计改善率情况。同时评定医生和患者的主观满意程度。结果 应用新型IPL治疗4次后,总有效率为92.49%（160例）,其中74例（42.77%）日光性雀斑样痣临床改善率达76% ~ 100%。小斑型、大斑型、混合型总有效率分别为94.69%（107例）、85.71%（18例）、89.74%（35例）,各型间总有效率差异无统计学意义（P值均 ＞ 0.05）;超过57例（50%）小斑型患者达到76％ ～ 100％临床改善率。173例患者中,医生满意率为95.38%（165例）,患者满意率为91.91%（159例）,两者差异无统计学意义（χ2 = 1.75,P ＞ 0.05）。结论 新型IPL治疗日光性雀斑样痣疗效显著。     

Clinical effectiveness of a novel intense pulsed light source on facial pigmentary lesions

Intense pulsed light (IPL) therapy improves various clinical symptoms of photoaging skin. In this study we have investigated clinical effects of a novel IPL, Lumenis One? (LUMENIS, Tokyo) on facial pigmentary lesions in 18 Japanese female patients. Measurement was performed after 3–5 treatments. IPL showed marked and slight improvements in 28 and 39%, respectively. The data of melanin index demonstrated the improvement after IPL therapy. These results indicated that IPL therapy using Lumenis One may be useful to treat solar lentigines and ephelides on the face.     

A randomized,double‐blind,vehicle‐controlled study of a preparation containing undecylenoyl phenylalanine 2% in the treatment of solar lentigines

Background. Solar lentigines are common, benign, cosmetically disfiguring lesions. Available physical treatments are effective, but they are costly and carry risks of side‐effects. Objective. To evaluate the efficacy and safety of a preparation containing undecylenoyl phenylalanine 2% in the topical treatment of solar lentigines. Methods. In total, 36 patients with solar lentigines of the hands were randomly assigned to apply the active preparation on one side and the vehicle alone on the other side, twice daily for 12 weeks. Patients were evaluated monthly for efficacy and safety. Results. In all, 30 patients (28 women and 2 men; age range 47–75 years) completed the study. The duration of lesions ranged from 8 months to > 10 years. All patients responded partially on the side of the active treatment. Of the partial responders, 19 (63.3%) had moderate improvement and 11 (36.6%) had marked improvement. Improvement was evident from the first follow‐up visit. On the side of the vehicle, 26 remained stable (86.6%) and 4 (13.3%) had partial improvement. There was a significant difference (P < 0.01) in efficacy of the active preparation vs. the vehicle. Using patient assessment ratings, 80% were ‘much more satisfied/more satisfied’ with the result. The reported side‐effects were minor and included erythema and itching or burning on the side of active treatment. Conclusions. Undecylenoyl phenylalanine 2% is a novel depigmenting agent, which possibly acts as an α‐melanocyte‐stimulating hormone antagonist, thus inhibiting melaninogenesis. It achieved a significant lightening of the lesions with minimal side‐effects. Most patients were satisfied with the improvement. Undecylenoyl phenylalanine 2% may represent a safe, effective and inexpensive therapeutic alternative for solar lentigines.     

A comparative study of focal medium-depth chemical peel versus cryosurgery for the treatment of solar lentigo

Recently, focal chemical peels with trichloroacetic acid (TCA) have been introduced for the treatment of pigmentary disorders to minimize the side effects such as pain or scarring associated with medium-to-deep chemical peeling. This is a controlled, prospective study to compare the efficacy of a focal medium-depth chemical peel regimen using 70% glycolic acid and 35% TCA with cryosurgery, in the treatment of solar lentigines of the hands. Twenty-five patients were treated with either focal medium-depth chemical peel or cryosurgery, which was randomly assigned to the left or right hand. Clinical improvement was graded by the three blinded investigators 2-months after the treatment. In the focal medium-depth chemical peel treated side, clearing was achieved in four out of 23 patients (17.4%) compared with five out of 23 patients (21.7%) in the cryosurgery treated side. Statistically, the difference between the clinical improvement of solar lentigines with chemical peel and cryosurgery was not significant, according to chi-square test (p = 0.940). However, we suggest that treatment of the solar lentigines with a focal medium-depth chemical peel may be clinically superior to treatment with cryosurgery, due to the paucity of side effects, such as hypopigmentation and pain, associated with the chemical peel regimen.     

A comparison of 3 lasers and liquid nitrogen in the treatment of solar lentigines: a randomized, controlled, comparative trial

OBJECTIVE: 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. DESIGN: Randomized, controlled, comparative study with blinded observers. SETTING: University-based dermatology clinic. PARTICIPANTS: Twenty-seven patients with multiple solar lentigines on the backs of both hands. INTERVENTIONS: 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). MAIN OUTCOME MEASURES: 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. RESULTS: 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. CONCLUSIONS: 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.     

Intense pulsed light therapy for superficial pigmented lesions evaluated by reflectance-mode confocal microscopy and optical coherence tomography

Intense pulsed light (IPL) therapy is reported to be effective for pigment removal from pigmented lesions. However, the dynamic mechanism of pigment removal by IPL therapy is not completely understood. We investigated the mechanism of IPL therapy for the removal of pigmented skin lesions through non-invasive observation of the epidermis. Subjects with solar lentigines on the face were treated with three sessions of IPL therapy. The solar lentigines were observed on consecutive days after the treatments using reflectance-mode confocal microscopy (RCM) and optical coherence tomography (OCT). In addition, desquamated microcrusts that formed after the treatment were investigated by transmission electron microscopy (TEM). The images of RCM and OCT showed that the melanosomes in the epidermal basal layer rapidly migrated to the skin surface. The TEM images of the extruded microcrusts revealed numerous melanosomes together with cell debris. It was also found that the IPL irradiated melanocytes in the lesions seemed to be left intact and resumed their high activity after treatment. We conclude that IPL therapy effectively removed the dense melanosomes in the epidermal-basal layer. However, additional application of suppressive drugs such as hydroquinone or Q-switched laser irradiation is necessary to suppress the remaining active melanocytes.     

Reduction of pain and side effects in the treatment of solar lentigines with pneumatic skin flattening (PSF).

BACKGROUND: Energy densities utilized in the treatment of pigmented lesions such as solar lentigines with intense pulsed light systems are often limited by pain and post-treatment erythema and edema. The sensation of pain associated with the treatment is immediate and acute. Application of topical anesthesia is time-consuming, with only very moderate pain relief. OBJECTIVE: (a) To test pain reduction as well as the reduction of post-treatment erythema and edema when using pneumatic skin flattening (PSF). This new technology utilizes an evacuation chamber to generate skin compression and activates tactile neural receptors in the skin. The result is an afferent inhibition of pain transmission in the dorsal horn (the 'gate theory'). (b) To test the efficacy of PSF. METHODS: Twenty patients were treated for solar lentigines. The patients were treated by three different IPLs. The evaluation of acute pain and post-treatment erythema and edema was performed on all 20 patients: one to three sites per patient treated with PSF and the same number of control sites without PSF. Identical energies and IPL were applied to both sites on each patient. The pain evaluation was performed on a 10-level scale modified McGill Pain Questionnaire. The clinical response to treatment was also evaluated. RESULTS: All 20 patients completed the study and preferred the PSF treatment side over the non-PSF side. Substantial pain reduction was observed in 19/20 patients (95%). The average reduction of pain was by two levels, from very painful to very mild pain. Erythema reductions were observed on 14/18 (77%) patients and edema reduction on 8/9 (88%) patients. Treatment efficacy on PSF sites was identical to that of non-PSF sites. CONCLUSION: The pneumatic skin flattening (PSF) technology considerably reduces pain, erythema and edema in the treatment of solar lentigines by IPLs. Treatment efficacy is preserved. The enhanced safety of PSF enables the increase of energy density and the acceleration of results.     

A retrospective study of the efficacy of intense pulsed light for the treatment of dermatologic disorders presenting to a cosmetic skin clinic

Background One hundred seven patients presenting to a cosmetic skin clinic were treated with intense pulsed light (IPL) over a 12‐month period. The main categories of patients offered treatment were those with vascular problems such as rosacea, facial telangiectasia, and spider nevi; pigmentation disorders such as solar damage, lentigines, and hyperpigmentation; and assorted problems such as scarring and poikiloderma. Methods Each patient who entered into the study had the full medical history taken and a dermatologic assessment. Polaroid photographs were taken and the images used for comparison before and after treatment. Outcomes were assessed by physicians’ global assessment and a patients’ postal questionnaire. Patients were treated with a Lumina IPL (Lynton Lasers Ltd) using a multiple pulsing facility with variable interpulse spacing, incorporating a 585‐nm head. Fluence levels varied between 10 and 40 J/cm², although the average fluence over all patients was 25 J/cm². The delay was set between 10 and 30 ms and two to four pulses were used. Results Excellent results were seen in 80% of patients treated. There was a high patient satisfaction rate and low prevalence of side effects. Conclusions IPL has been shown to provide a safe and effective noninvasive treatment for a wide range of dermatologic disorders and is suitable for wider use in primary care.     

The combination of 2% 4-hydroxyanisole (mequinol) and 0.01% tretinoin effectively improves the appearance of solar lentigines in ethnic groups

While the efficacy and safety of topical 4-hydroxyanisole (mequinol) 2%/tretinoin 0.01% therapy has been established in Caucasian populations, those with skin types I-II, little research has focused on individuals with darker skin types. The purpose of this open-label study was to evaluate the efficacy and safety of mequinol 2%/tretinoin 0.01% solution in the treatment of solar lentigines in Asian, Latin/Hispanic, and African American ethnic groups with skin types II-V. Subjects were required to have >or= 10 solar lentigines on the dorsal forearms/hands and >or= 3 on the face. One lesion was designated the target lesion, however, all lesions were treated. Patients were treated with topical mequinol 2%/tretinoin 0.01% and clinically evaluated at 4, 8, 12, 16, 20, and 24 weeks as well as 4 weeks following treatment cessation. At each visit, lesions were evaluated using Target and Overall Lesion Pigmentation Index scores ranging from 0 (lightest) to 8 (darkest), where 4 indicated equal pigment with surrounding skin. Efficacy was determined based on pigmentation index scores, and safety was assessed using laboratory monitoring and adverse event (AE) reporting. Over 80% of the 259 subjects completing this study responded to mequinol 2%/tretinoin 0.01% therapy, with a majority of subjects maintaining clinical benefit at 4 weeks post-treatment. Most AEs reported were tolerable and overall mequinol 2%/tretinoin 0.01% therapy had a favorable benefit-to-risk ratio. This study therefore supports the theory that topical mequinol 2%/tretinoin 0.01% is an effective and safe treatment of solar lentigines in ethnic populations, and in those with dark skin types.     

Complete regression of a melanocytic nevus under intense pulsed light therapy for axillary hair removal in a cosmetic center

Intense pulsed light (IPL) therapy using noncoherent broad-spectrum light has been reported to be effective for hair removal, and also for treating superficial pigmented lesions like ephelides and solar lentigines. We report complete regression of a pigmented melanocytic nevus, histologically confirmed, after hair removal treatment with IPL. The use of lasers and IPL is a common procedure used by dermatologists and even other professions for the treatment of cosmetically troubling skin conditions. The main advantage of such treatment is a reduction of surgical scars, thus producing a favorable cosmetic outcome, but a major limitation is that histopathologic diagnosis is not usually obtained prior to treatment. Such devices should be carefully used in patients with potentially dangerous melanocytic lesions. We also review the recent literature regarding inadequate treatment of melanocytic lesions with lasers.     

Assessment of adapalene gel for the treatment of actinic keratoses and lentigines: a randomized trial

BACKGROUND: Adapalene is a synthetic retinoid with an established clinical efficacy against acne and good local tolerability. Its effectiveness in the treatment of photodamaged skin has not been studied. OBJECTIVE: We sought to determine the safety and efficacy of adapalene gel in the treatment of actinic keratoses and solar lentigines. METHODS: In a prospective, 2-center, randomized, controlled, investigator-masked, parallel-group study, 90 patients with actinic keratoses and solar lentigines were treated daily with either adapalene gel (0.1% or 0.3%) or its vehicle gel for 4 weeks, followed by twice-daily applications, if tolerated, for up to 9 months. RESULTS: Of the 90 Caucasian patients (69 male, 21 female; mean age 63.1 years) who were enrolled into the study, 83 patients completed 9 months of treatment. With adapalene gel 0.1% and 0.3%, the mean number of actinic keratoses was reduced by 0.5 +/- 0.9 (mean +/- SE) and 2.5 +/- 0.9, respectively. Whereas, with the vehicle gel, there was an increase of 1.5 +/- 1.3 (P <.05). After 1 month of treatment, the patients who received adapalene had significant lightening of solar lentigines as compared with the patients who were treated with vehicle gel (P <.05). After 9 months, 57% and 59% of the patients had lighter lesions in the adapalene 0.1% and 0.3% groups, respectively, in comparison with only 36% in the vehicle group (P <.05). Histologic evaluations revealed improved cellular atypia and reduced epidermal melanin in adapalene-, as compared with vehicle-treated group. The differences, however, were not statistically significant. A retrospective evaluation of paired clinical photographs (before and after 9-month treatment) by 2 dermatologists who were treatment-blinded revealed significant improvement in wrinkles and other clinical features of photoaged skin with adapalene as compared with its vehicle. CONCLUSION: Adapalene gel 0.1% and 0.3% were well tolerated and improved actinic keratoses, solar lentigines, and other features of photodamaged skin.     

Reduction of pain and side effects in the treatment of solar lentigines with pneumatic skin flattening (PSF)

Background: Energy densities utilized in the treatment of pigmented lesions such as solar lentigines with intense pulsed light systems are often limited by pain and post‐treatment erythema and edema. The sensation of pain associated with the treatment is immediate and acute. Application of topical anesthesia is time‐consuming, with only very moderate pain relief. Objective: (a) To test pain reduction as well as the reduction of post‐treatment erythema and edema when using pneumatic skin flattening (PSF). This new technology utilizes an evacuation chamber to generate skin compression and activates tactile neural receptors in the skin. The result is an afferent inhibition of pain transmission in the dorsal horn (the ‘gate theory’). (b) To test the efficacy of PSF. Methods: Twenty patients were treated for solar lentigines. The patients were treated by three different IPLs. The evaluation of acute pain and post‐treatment erythema and edema was performed on all 20 patients: one to three sites per patient treated with PSF and the same number of control sites without PSF. Identical energies and IPL were applied to both sites on each patient. The pain evaluation was performed on a 10‐level scale modified McGill Pain Questionnaire. The clinical response to treatment was also evaluated. Results: All 20 patients completed the study and preferred the PSF treatment side over the non‐PSF side. Substantial pain reduction was observed in 19/20 patients (95%). The average reduction of pain was by two levels, from very painful to very mild pain. Erythema reductions were observed on 14/18 (77%) patients and edema reduction on 8/9 (88%) patients. Treatment efficacy on PSF sites was identical to that of non‐PSF sites. Conclusion: The pneumatic skin flattening (PSF) technology considerably reduces pain, erythema and edema in the treatment of solar lentigines by IPLs. Treatment efficacy is preserved. The enhanced safety of PSF enables the increase of energy density and the acceleration of results.     

Efficacy and safety of long-pulse pulsed dye laser delivered with compression versus cryotherapy for treatment of solar lentigines

Background:

Although cryotherapy is still the first-line therapy for solar lentigines, because of the side effects such as post-inflammatory hyperpigmentation (PIH), especially in patients with darker skin types, pigment-specific lasers should be considered as a therapy for initial treatment.

Aim:

The aim of this study is to evaluate the efficacy and safety of cryotherapy compared with 595-nm pulsed dye laser (PDL) with cutaneous compression in the treatment of solar lentigines.

Materials and Methods:

Twenty-two patients (skin type II–IV) with facial or hand lentigines participated in this study. Lesions of one side of the face or each hand were randomly assigned and treated with either cryotherapy or PDL. Treatments were performed with radiant exposures of 10 J/cm² , 7-mm spot size and 1.5 ms pulse duration with no epidermal cooling. Photographs were taken before treatment and 1-month later. The response rate and side effects were compared.

Results:

PDL was more likely to produce substantial lightening of the solar lentigines than cryotherapy, especially in skin type III and IV (n = 8, n = 9; P < 0.05), but might be no difference in type II (n = 5; P > 0.05). PIH was seen only in cryotherapy group. PDL group had only minimal erythema. No purpura was observed.

Conclusion:

PDL with compression is superior to cryotherapy in the treatment of solar lentigines in darker skin types.     

Skin cancer in a Queensland population

In the present study we have estimated the current prevalence of actinic skin disease in young and middle-aged adults in Queensland, Australia by surveying a representative community. It was found that 4.6% of persons aged 20 to 69 years had skin cancer, mostly basal cell carcinoma, and 40% had solar keratoses. The age distribution and site distribution of actinic lesions in this population were not as classically described; persons below age 40 years exhibited substantial sun-related skin damage, and a large proportion of actinic lesions occurred on sites other than the head, backs, of hands, or forearms. Allowing for age and sex, the strongest risk factors for skin cancer and solar keratoses were fair skin, as assessed by a dermatologist, and clinical signs of solar damage such as solar lentigines, facial telangiectasia, and actinic elastosis of the neck. Associations with self-reported tendencies toward sunburn, frequent painful sunburns, occupational sun exposure, and a previous history of skin cancer were confirmed.     

A Split-Face,Single-Blinded,Randomized Controlled Comparison of 532 nm Picosecond Neodymium-Doped Yttrium Aluminum Garnet Laser versus 532 nm Q-Switched Neodymium-Doped Yttrium Aluminum Garnet Laser in the Treatment of Solar Lentigines

BackgroundSolar lentigines are the most common form of benign epidermal pigmentation and one of the major cosmetic concerns in Korea. A 532 nm Q-switched neodymium: yttrium-aluminum-garnet (QSND) laser is typically used for the treatment, but the occurrence of post-inflammatory hyperpigmentation (PIH) is not rare. Recently, the use of picosecond (PS) lasers has emerged in pursuit of better outcomes.ObjectiveTo objectively compare the efficacy and safety of 532 nm PS and QSND lasers for the treatment of solar lentigines.MethodsTwenty patients with solar lentigines were enrolled in a prospective, randomized split-face, single-blind study. One side of each face was treated using a 532 nm PS laser, and the other side using a 532 nm QSND laser. After one treatment, all patients were followed up for evaluation after 2, 4, 8, and 12 weeks. The clinical clearance was assessed by three blinded dermatologists using a 5-point quartile improvement scale (QIS). Subjective satisfaction, development of PIH, pain scale during treatment, and adverse problems were also recorded.ResultsClinical clearance measured by QIS showed that the PS laser was more effective than the QSND laser. Subjective satisfaction and pain scale did not significantly differ between the two groups. The incidence of PIH was 5% in sides treated with the PS laser, and 30% with the QSND laser.ConclusionBoth 532 nm PS laser and QSND laser were effective for the treatment of solar lentigines, but the PS laser was more effective with less PIH development.     

Two patterns of solar lentigines: A histopathological analysis of 40 Japanese women

Solar lentigines are common acquired pigmented lesions on sun-exposed skin. Their histopathological features have been reported as large numbers of melanocytes at the base of clubbed and budding rete ridges. In this study, biopsies were taken from facial solar lentigines in 40 Japanese women, and the sections were stained using hematoxylin-eosin, Fontana-Masson, and immunostained for melanocytes and Langerhans cells in order to verify the histological patterns of Japanese patients. We characterized the histopathological features of solar lentigines on the face and identified two patterns: one pattern (20/40 cases) demonstrated a flattened epidermis with basal melanosis, and the other pattern (20/40 cases) showed epidermal hyperplasia with elongated rete ridges composed of deeply pigmented basaloid cells. We termed the former pattern the "flattened epidermis" group, and the latter the "budding" group, respectively. The flattened epidermis group showed a significantly thinner epidermis, more severe solar elastosis and fewer Langerhans cells in the epidermis as compared with the budding group. We concluded that more severely sun-damaged solar lentigines might show the changes observed in the flattened epidermis group. Langerhans cells in the epidermis of solar lentigines might play a role in the remission of postinflammatory pigmentation due to aesthetic treatment.