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.     

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开关翠绿宝石激光和强脉冲光治疗面部雀斑的疗效和安全性

目的 比较Q开关翠绿宝石激光(Q-switched Alexandrite Laser,QSAL)和OPT(Optimal Pulse Technology)强脉冲光治疗面部雀斑的临床疗效和安全性. 方法 将100例单纯面部雀斑患者随机分为QSAL组50例,OPT组50例.QSAL组以Q755nm激光仪治疗1次,OPT组以OPT治疗2次,每次间隔4周.治疗结束后第4、12、24周判定临床疗效,第4周统计PIH发生率以判定安全性,24周进行满意度评价. 结果 QSAL组患者治疗后第4周,治愈率82％,显效率14％,进步为4％;治疗后第12周,治愈率84％,显效率14％,进步为2％;治疗后第24周,治愈率86％,显效率14％.OPT组治疗1次后第4周治愈率30％,显效率60％,进步为10％;经过2次OPT治疗后第12周治愈率70％,显效率24％,进步为6％;2次治疗后第24周治愈率70％,显效率24％,进步为6％.患者对治疗的满意度评价,QSAL组非常满意率和满意率分别为78％和20％,轻度满意率2％.OPT组非常满意率和满意率分别为80％和20％.QSAL组有2例患者于术后2～4周开始患处出现炎症后色素沉着(Postinflammatory Hyperpigmentation,PIH),占总例数的4％,于6～24个月内消退;OPT组无PIH的病例出现. 结论 Q开关翠绿宝石激光和强脉冲光(OPT)均能很好地治疗雀斑,QSAL组激光治疗效果优于OPT组,而OPT的安全性优于QSAL.     

Minocycline-Induced Hyperpigmentation Treated with a 755-nm Q-Switched Alexandrite Laser

BACKGROUND: Cutaneous pigmentation associated with minocycline therapy is an unusual adverse effect for which few successful treatments have been described. The pigment changes may persist for years, despite cessation of therapy, and is often cosmetically disfiguring, causing significant embarrassment and psychological depression in those affected. Few safe and effective treatments have been described in the past; however, recent pigment-specific laser technology has shown promise in the treatment of this condition. OBJECTIVE: The objective was to describe a series of patients with minocycline-induced hyperpigmentation who were successfully treated with a 755-nm Q-switched alexandrite laser. METHODS: Six patients with minocycline-induced hyperpigmentation on the face or legs were treated with a Q-switched alexandrite laser on a bimonthly basis until pigmentation was eradicated. RESULTS: Cutaneous pigmentation resolved completely in all patients in an average of four laser sessions. Side effects were limited to transient purpura and mild desquamation without scarring or dyspigmentation. CONCLUSION: Minocycline-induced cutaneous pigmentation can be effectively cleared without risk of adverse sequelae by Q-switched alexandrite (755-nm) laser irradiation.     

Efficacy and Safety of Q-switched Double-frequency 532-nm Neodymium-doped Yttrium Aluminum Garnet Laser in the Treatment of Lip Hyperpigmentation: A Pilot Study

BackgroundLip hyperpigmentation is a common cosmetic problem with multiple causative factors and limited treatment options.ObjectiveThis study sought to assess the efficacy and safety of Q-switched (QS) double-frequency 532-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser therapy for dark lips.MethodsA prospective pilot study of 24 patients with lip hyperpigmenation treated with a QS double-frequency 532-nm Nd:YAG laser was performed. Photographs taken before and three months after the laser therapy sessions were evaluated for improvement and/or any complication by two blinded dermatologists using the color score chart and a visual analog scale (VAS). Patients were asked to assess their pain and satisfaction scores following the procedure using a VAS.ResultsThe mean VAS scores of the photographs decreased by 10.18 percent, from a baseline of 6.09±1.53 to 5.47±1.72 (p=0.16). Also, the color score decreased by 9.38 percent, from 2.44±0.61 to 2.23±0.71 points (p=0.23) after the last treatment. Overall, the photographic assessment indicated that, of the 24 participants, 14 (58.3%) showed moderate to excellent improvement, four (16.7%) showed mild or no improvement, and six (25.0%) showed worsening/mottling of the pigmentation. The overall mean pain and satisfaction scores were 4.08±1.14 and 6.50±2.92, respectively.ConclusionQS Nd:YAG 532-nm laser therapy appears to be a safe and moderately effective treatment for hyperpigmentation of the lips. Further studies should evaluate a larger number of patients and undertake a longer period of follow-up.     

The Use of the 308-nm Excimer Laser for the Treatment of Vitiligo

BACKGROUND: Recent reports show that 308-nm excimer laser may be an effective and safe method for the treatment of vitiligo, which is usually resistant to other available treatment methods. OBJECTIVE: The objective was to study the effectiveness of the new 308-nm excimer laser for the treatment of vitiligo. METHODS: A retrospective chart review of thirty-two patients with 55 spots of vitiligo were enrolled; a population-based sample was studied that included men and women, adults and children, with different ethnic backgrounds. The treatment was started with the lowest dose, which is 100 mJ/cm(2) (comparable to one minimal erythema dose value and one multiplier). Depending on Fitzpatrick skin type, the dose was raised gradually in a stepwise fashion. In skin types I to II, the same does was repeated twice before going up to avoid burns. Patients were treated for 30 sessions, or 75% repigmentation, whichever comes first. RESULTS: Overall 55 spots were treated: 29 (52.8%) had 75% pigmentation or greater, and 35 (63.7%) had 50% pigmentation or greater. The best results were on the face: of the 21 spots treated 15 (71.5%) had 75% pigmentation, and 16 (76.2%) had 50% pigmentation or greater. Other areas (neck, extremities, trunk, and genitals) had moderate response in comparison to the face. The least response was on the hands and feet; of the 5 spots treated only 20% showed 50% pigmentation or more. CONCLUSION: Slightly more than 50% of the patients tested showed 75% or more pigmentation of their lesions, after 30 treatments or less; most of the responders had Fitzpatrick skin type III and above. All the untreated patches (controls) remained unchanged. This demonstrates that the 308-nm excimer laser is an effective method of treatment for vitiligo.     

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.     

Pigmentation-dependent side effects to copper vapor laser and argon laser treatment

Background and Objective: Melanin is a limiting factor for obtaining beneficial results in dermatological treatment of vascular malformations. The aim of our study was to establish a relation between pretreatment skin pigmentation and the occurrence of side effects. Study Design/Materials and Methods: Thirteen human volunters selected to have a varying degree of skin pigmentation were laser-treated on the inside of the brachium with an argon laser (AL, 488 nm and 514.5 nm) and a copper vapor laser (CVL, 578 nm), both connected to a Hexascan. Total exposure areas were 1.26 cm² and beam diameters were 1 mm. Three intensities were used, 0.7, 1.0, and 1.3 W. Pulse duration was 200 ms, resulting in fluences of 17.8, 25.5, and 33.1 J/cm². Pretreatment skin pigmentation was objectified by skin reflectance measurements. Results: At 1, 2, and 6 months after laser treatment, significant correlations were demonstrated between pretreatment skin pigmentation and laser-induced pigmentary changes and scar formation. At the 6-month assessment, the AL induced significantly higher scores of clinically evaluated scar formation as compared with the CVL (1.0 and 1.3 W/spot) and tended to induce higher clinical scores of pigmentary changes (not significant, ns). Conclusions: We recommend skin pigmentation to be taken into consideration in dermatological laser treatment of vascular malformations. © 1995 Wiley-Liss, Inc.     

Q开关紫翠宝石激光治疗Peutz-Jeghers综合征色素沉着的疗效分析

目的:观察Q开关紫翠宝石激光治疗Peutz-Jeghers综合征色素沉着的临床疗效及不良反应。方法:采用Q开关紫翠宝石激光对18例Peutz-Jeghers综合征患者的色素沉着进行治疗,治疗次数1～3次,每次治疗间隔3～6个月,根据治疗前后的照片对比判定疗效。结果:18例患者,11例痊愈(占61.1%),6例显效(占33.3%),1例有效(占5.6%),总有效率达94.4%,无瘢痕等严重不良反应。结论:Q开关紫翠宝石激光治疗Peutz-Jeghers综合征临床疗效佳,不良反应少。     

Combined Therapy Using Q-Switched Ruby Laser and Bleaching Treatment With Tretinoin and Hydroquinone for Acquired Dermal Melanocytosis

BACKGROUND AND OBJECTIVE: Acquired dermal melanocytosis (ADM; acquired bilateral nevus of Ota-like macules) is known for its recalcitrance compared with Nevus of Ota, and we assume that one of the reasons is a higher rate and degree of postinflammatory hyperpigmentation (PIH) seen after laser treatments. METHODS: Topical bleaching treatment with 0.1% tretinoin aqueous gel and 5% hydroquinone ointment containing 7% lactic acid was initially performed (4 to 6 weeks) to discharge epidermal melanin. Subsequently, Q-switched ruby (QSR) laser was irradiated to eliminate dermal pigmentation. Both steps were repeated two to three times until patient satisfaction was obtained (usually at a 2-month interval for laser sessions). This treatment was performed in 19 patients with ADM. Skin biopsy was performed in six cases at baseline, after the bleaching pretreatment, and at the end of treatment. RESULTS: All patients showed good to excellent clearing after two to three sessions of QSR laser treatments. The total treatment period ranged from 3 to 13 (mean of 8.3) months. PIH was observed in 10.5% of the cases. Histologically, epidermal hyperpigmentation was observed in all specimens and was dramatically improved by the topical bleaching pretreatment. CONCLUSION: QSR laser combined with the topical bleaching pretreatment appeared to treat ADM consistently with a low occurrence rate of PIH and lessen the number of laser sessions and total treatment period and may also be applied to any other lesions with both epidermal and dermal pigmentation.     

The effect of laparoscopic treatment of polycystic ovarian disease by CO2-laser or Nd:YAG laser

Summary The feasibility and efficacy of laparoscopic CO₂ laser and Nd:YAG non-contact laser application for the treatment of polycystic ovarian disease (PCOD) were evaluated in 30 patients (19 patients treated with the CO₂ laser, and 11 with the Nd:YAG laser). The criteria for inclusion of PCOD in our study were: amenorrhea or oligomenorrhea with chronic anovulation, failure to ovulate in response to clomide or human menopausal gonadotropin, elevated serum levels of luteinizing hormone (LH) or an elevated LH/follicle-stimulating hormone ratio, exaggerated LH response to gonadotrophin-releasing hormone (GnRH), elevated serum androgen levels, and ultrasonographic features of polycystic ovaries. Eight pregnancies after CO₂ laser and three after Nd:YAG laser were achieved. Decline of serum androgen concentrations was noted in both groups, but was significantly higher in the Nd:YAG laser group (from 3.4±0.4 ng/ml to 2.2±0.2 ng/ml). Nine patients checked before and after laser treatment showed a decrease in the characteristically exaggerated pituitary response to exogenous GnRH injection. There were no consistent findings of the pattern in LH pulsatility studied in 5 patients after Nd:YAG laser treatment. Ovarian status was investigated in 11 patients by second-look laparoscopy or cesarian section. There were absolutely no adhesions after Nd:YAG laser coagulation. Filmy adhesions were seen in 3 patients in the CO₂ laser group.     

A case of labial lentigines in Peutz-Jeghers syndrome treated using a Q-switched alexandrite laser

Peutz-Jeghers syndrome (PJS) is a polygenic autosomal dominant disease characterized by multiple gastrointestinal polyps and pigmentation of the mucosa and skin. While there are a few reports regarding successful treatment of intestinal polyps in PJS, there is little research regarding treatment of mucocutaneous melanosis. This study investigated the many advantages of using a Q-switched alexandrite laser to treat mucocutaneous melanosis. In this case, a 19-year-old male with PJS presented with labial lentigines and received two Q-switched alexandrite laser treatments in 2018. Subsequently, the efficacy of the treatment was evaluated. The result of the evaluation was that, after the two laser treatments, the labial lentigines were successfully removed, and there were no complications.     

A clinical study on the removal of gingival melanin pigmentation with the CO(2) laser.

BACKGROUND AND OBJECTIVE: In a previous study, the possibility of removal of dog gingival melanin pigmentation with CO(2) laser therapy was reported. The present study was designed to investigate the effect of the CO(2) laser on human gingival pigmentation and evaluate the clinical outcome. STUDY DESIGN/MATERIALS AND METHODS: A CO(2) laser (output: 6-8 W, pulse duration: 0.2 seconds) was irradiated on the melanin pigmented gingival surface of 10 patients, aged 20-49 years. Follow-up clinical and histopathological evaluations were performed. RESULTS: The CO(2) laser was effective in removing melanin pigmentation in all patients. In the histopathological study, no pigmented-laden cells nor any inflammatory cell infiltration was observed following laser irradiation. No re-pigmentation was seen in any case in the first year. However, four of seven cases showed re-pigmentation at 24 months. The re-pigmentation was almost equal to the preoperative state. CONCLUSIONS: The CO(2) laser has proved to be another effective, safe, and easily applicable therapy for the removal of gingival melanin pigmentation.     

308-nm Excimer Laser Treatment of Mature Hypopigmented Striae

BACKGROUND: The 308-nm excimer laser has been shown to be effective in the treatment of disorders of hypopigmentation. OBJECTIVE: To evaluate the effectiveness of the 308-nm excimer laser in the treatment of mature hypopigmented striae. RESULTS: Seventy-five subjects were treated for a total of 615 treatments. All patients achieved a substantial increase in the darkening of their striae after an average of 8.4 treatments. Clinically evident improvement in cosmetic appearance of striae was noted by 80% of subjects. CONCLUSION: The 308-nm excimer laser is effective for increasing pigmentation in mature hypopigmented striae. This pigmentation is cosmetically significant. Future studies are required to determine the duration of clinical improvement.     

黑斑息肉综合征的研究进展

目的介绍黑斑息肉综合征(PJS)的研究和临床诊治进展。方法对。PJS近几年国内、外的研究和临床诊治进展的文献作一概述。结果PJS是一种常染色体显性遗传病，以口周皮肤、唇、颊黏膜和指趾末端存在黑色素沉着和消化道存在多发性息肉为特征，其肠内、肠外组织和器官易发生癌症，是一种肿瘤易感综合征，其致病基因为19p上的STK11基因。结论PJS致病基因与肿瘤的发生和发展密切相关。PJS患者消化道内和消化道外组织和器官都容易发生恶变。     

Multiple Color Changes Following Laser Therapy of Cosmetic Tattoos

OBJECTIVE: To emphasize the wisdom of small test areas when treating cosmetic tattoos and the need for multiple laser systems. METHODS: A 48-year-old woman requested removal of permanent makeup (cosmetic tattoos) of her eyebrows and around her lips. Physical examination revealed a brown tattoo of both eyebrows and dark red lip liner around both lips. A test area was performed on the red tattoo of the lips. A frequency-doubled Nd:YAG laser (532 nm, 2.0 J/cm2, 2 mm spot size) was used for the lip area, while the same laser at 1064 nm, 3.9 J cm2, 2 mm spot size was utilized for the eyebrows. The lip area immediately turned black. The patient returned for follow-up 1 month later; the black ink on the lip was treated with the same laser at 1064 nm, 3 mm spot size, 4.2 J/cm2, with satisfactory resolution in two monthly treatments. Both brown eyebrow turned bright orange and were treated with 532 nm, 3 mm, 3.0 J/cm2. One month later the eyebrows were a mixture of yellow ink and dark green. The yellow area was treated with 532 nm, 3 mm, 2.3 J/cm2, while the dark green was treated with the 1064 nm, 3 mm spot size, 4.2 J/cm2. One month later little improvement was noted, so Q-switched ruby laser at 694 nm, 6 mm spot size, 16 J/cm2 was utilized. An additional four monthly treatments were given utilizing a combination of both ruby and 532 nm ND:YAG lasers for green and yellow pigment, respectively. RESULTS: Significant but incomplete resolution of the tattoo ink was achieved. CONCLUSION: Multiple laser systems are needed to remove cosmetic tattoos. Test areas must be done before treatment.     

Treatment of Acquired Bilateral Nevus of Ota-Like Macules (Hori''s Nevus) with a Combination of the 532 nm Q-Switched Nd:YAG Laser Followed by the 1,064 nm Q-Switched Nd:YAG Is More Effective: Prospective Study

BACKGROUND: Acquired bilateral nevus of Ota-like macules (Hori's nevus) is a common dyschromatosis among Asian women. Q-switched lasers have been used successfully as a treatment modality. OBJECTIVE: The purpose of this study was to compare the efficacy of using the Q-switched 532 nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser followed by the 1,064 nm laser versus the Q-switched 1,064 nm Nd:YAG laser alone in the treatment of Hori's nevus. METHODS: This is a prospective left-right comparative study. Ten women with bilateral Hori's nevus were recruited and treated with a combination of the Q-switched 532 and 1,064 nm Nd:YAG lasers on the right cheek and the Q-switched 1,064 nm Nd:YAG laser alone on the left cheek. Only one laser treatment session was performed. The degree of pigmentation was objectively recorded with a mexameter. Subjective assessment was made by both patients and two blinded, nontreating dermatologists. RESULTS: At 6 months, there was a statistically significant difference (p = .009) of 35.10 points using objective mexameter measurements between the two sides, favoring the side treated with a combination of 532 and 1,064 nm laser treatment. Subjective grading by the patients and blinded dermatologists also confirmed that combination therapy was more successful after one treatment. Although combination treatment had a higher incidence of mild postinflammatory changes, this disappeared within 2 months. CONCLUSIONS: Concurrent use of the Q-switched 532 nm Nd:YAG laser in combination with the 1,064 nm laser is more effective in pigment clearance than the Q-switched 1,064 nm Nd:YAG laser alone for Hori's nevi.     

Treatment of traumatic tattoos with the Nd YAG laser: a series of nine cases.

Inadequate primary skin cleansing for dirt-ingrained skin abrasions can result in disfiguring traumatic tattoos. We present nine cases of traumatic tattoos treated with the Nd YAG laser. In six cases the pigmentation was completely cleared and in three cases minimal pigmentation remained. The Nd YAG laser offers effective late treatment of traumatic tattoos with many advantages over conventional destructive treatment modalities. The best treatment is still immediate debridement and cleaning.     

Successful Treatment of Dowling–Degos Disease with Er:YAG Laser

BACKGROUND: Dowling-Degos disease is a rare condition with a genetically determined disturbance of epidermal proliferation. The typical clinical picture is a reticulate pigmentation of the flexures, genital folds, and pectoral skin areas. Many different treatment options have been tried in recent years without a convincing therapeutic benefit. OBJECTIVE: To determine the effectiveness of Er:YAG laser in Dowling-Degos disease. METHODS: A 44-year-old woman suffering from Dowling-Degos disease was treated with the Er:YAG laser pulse energy between 1,000 and 1,200 mJ, three consecutive passes. RESULTS: The laser treatment led to a good clinical result. CONCLUSION: Our case suggest that treatment with the Er:YAG laser might be a successful strategy in Dowling-Degos disease.     

Effectiveness of the normal-mode ruby laser and the combined (normal-mode plus q-switched) ruby laser in the treatment of congenital melanocytic nevi: a comparative study

The effect of the normal-mode ruby laser (NMRL) and the combined (normal mode plus Q-switched) ruby laser on congenital melanocytic nevi (CMN) was evaluated, and the degree to which both laser treatment regimens remove melanocytes was compared in 15 patients. Each nevus was marked to designate half of the lesion for the NMRL treatment and half of the lesion for combined ruby laser treatment. The efficacy of each laser treatment was correlated with the degree of clinical improvement determined by photographic assessment, histological examination, and melanin reflectance spectrometry before and 3 months after laser treatment. A single treatment using the NMRL with energy fluences of both 20 J per square centimeter and 30 J per square centimeter resulted in a slight, but not significant, improvement in lightening of pigmentation (42.61% and 30.38%, respectively). A better clinical response (excellent to good) and higher percentage of lightening (64.45%-72.43%) was noted in the combined ruby laser-treated areas than the NMRL-treated areas. Histological results showed that the combined ruby laser provided a marked decrease in the number of the nevomelanocytic nests in both the junctional area and the papillary and reticular dermis, whereas the NMRL (with energy fluences of either 20 J per square centimeter or 30 J per square centimeter) caused a decrease in the junctional area and the papillary dermis. None of the nevi had complete clearance of the pigmentation after a single treatment. Therefore, multiple (four to five) treatment sessions are needed to cause complete removal of nevomelanocytic nests in CMN. In conclusion, the combined ruby laser is more effective than the NMRL alone in the treatment of CMN without scarring or textural change of the skin.