Treatment of acquired bilateral nevus of Ota‐like macules (Hori's nevus) using 1064‐nm Q‐switched Nd:YAG laser with low fluence

Background Acquired bilateral nevus of Ota‐like macules (ABNOM), or Hori's nevus, is a common dermal melanocytic hyperpigmentation in Asians. Aim To describe the effect of 1064‐nm Q‐switched Nd:YAG laser (QSNY) with low fluence in South Korean patients with ABNOM. Methods Fifteen South Korean patients (13 women and two men; mean age, 33.2 years; range, 26–52 years; Fitzpatrick skin type IV), clinically diagnosed with ABNOM, and treated using 1064‐nm QSNY with low fluence, were enrolled in this study. Patients were treated with 1064‐nm QSNY using a MedLite C6? (HoyaConBio Inc., Fremont, CA, USA) at 1–2‐week intervals. The laser settings were 2.2–2.6 J/cm² using a 6‐mm spot size, followed by 4–6 J/cm² using a 4‐mm spot size. Results The median number of QSNY treatment sessions was 11 (range, 10–15). Follow‐up results 2 months after the final treatment revealed that seven of the 15 patients (46.7%) demonstrated clinical improvement of 76–100%, and five (33.3%) of 51–75%. Three patients showed moderate clinical improvement between 26% and 50%. Post‐therapy dyschromia, including hypo‐ and hyperpigmentation, was not observed. Conclusion We suggest that QSNY with low fluence provides an easy‐to‐perform, low‐downtime, effective treatment algorithm in certain cases of ABNOM in Asian patients.     

Efficacy of laser treatment of tattoos using lasers emitting wavelengths of 532 nm, 755 nm and 1064 nm

BACKGROUND: Multifunctional laser devices can be used to treat tattoos successfully. OBJECTIVES: To report the efficacy of laser treatment in professional, amateur, accidental and permanent make-up tattoos from our own experience and to compare it with the literature. METHODS: We retrospectively studied 74 consecutive patients with professional, amateur, make-up and accidental tattoos between June 1998 and November 2000. Patients were treated with a Q-switched Nd:YAG laser (wavelengths of 532 nm and 1064 nm), a Q-switched alexandrite laser (755 nm) and a variable pulse Nd:YAG laser (532 nm). RESULTS: Fourteen patients (19%) achieved a complete response (>95% lightening of treated tattoos), 23 (31%) an excellent response (76-95% lightening) and 21 (28%) a good response (51-75% lightening). Sixteen patients (22%) showed only a slight improvement (< or =50% lightening). Make-up tattoos and blue-black professional tattoos were most successfully treated. Multicoloured professional tattoos needed more treatments (mean +/- SD 5.7 +/- 5.4) in comparison with single-colour tattoos (3.5 +/- 2.0). The amateur tattoos needed fewer treatments (2.8 +/- 1.1) in comparison with professional tattoos. With accidental tattoos the results depended on the particles which had penetrated the skin. In contrast to literature reports, newer tattoos showed a trend to better treatment results than older tattoos. CONCLUSIONS: Using modern Q-switched lasers, tattoos are removed successfully with minimal risk of scarring and permanent pigmentary alterations. Even multicoloured tattoos can be treated successfully and with a low rate of side-effects.     

Treatment of traumatic tattoo with the Q‐switched Nd:YAG laser

Traumatic tattoos are undesirable tattoos caused by different foreign bodies such as fireworks' particles, sand, metals, glass, gunpowder, asphalt, dust, or petroleum products embedded forcefully in the dermis. We report the case of a 54‐year‐old man who presented with sand and asphalt tattooing on his face following a bomb explosion 15 years ago. Q‐switched Nd:YAG laser at a wavelength of 1064?nm with a spot size of 4?mm and a fluence of 7.96?J/cm² were applied to treat the patient. The patient tolerated the treatment very well. Most of the blue dots became whitened immediately after the procedure and remained almost clear after a 6‐month follow‐up.     

Treatment of reticulated acropigmentation of Kitamura with Q-switched alexandrite laser

Background Reticulated acropigmentation of Kitamura (RAPK) is a pigmentary disorder of autosomal dominant inheritance, occurring predominantly within the Japanese population, for which no successful treatment has been described. Objective The objective was to describe a 23‐year‐old Saudi woman with reticulated acropigmentation of Kitamura (RAPK), who was successfully treated with a 75‐nm Q‐switched alexandrite laser. Method To report a 23‐year‐old Saudi woman with reticulated acropigmentation of kitamura (RAPK) who was treated with two sessions of the Q‐switched alexandrite laser, six weeks apart with no recurrence after two years. Results Cutaneous pigmentation of reticulated acropigmentation of kitamura (RAPK) almost resolved completely in two laser sessions. Side effects were limited to transient post inflammatory hypopigmentation. Conclusion Cutaneous pigmentation of reticulated acropigmentation of kitamura (RAPK) can be effectively treated by Q‐switched alexandrite (755‐nm) laser, which shows a promising result, and it can be considered as treatment option, although further studies are required to confirm the effectiveness of this treatment modality with other Q‐switched laser; e.g. Q‐switched ND:YAG or Q‐switch Ruby.     

A split-tattoo randomized Q-switched neodymium-doped yttrium–aluminium–garnet laser trial comparing the efficacy of a novel three-pass,one-session method with a conventional method in the treatment of blue/black tattoos in darker skin types

Tattoos with blue/black ink show good lightening of pigment after treatment with 1064 nm Q-switched (QS) neodymium-doped yttrium–aluminium–garnet (Nd:YAG) laser. In this randomized trial, we compared the efficacy of a novel three pass, one session procedure (R15 method) with a conventional method for treating blue/black tattoos in darker skin types. Tattoos were treated with 1064 nm QS Nd:YAG Laser with a spot size of 4 mm, fluence of 5 J/cm² and frequency of 5 Hz. The tattoo pigment lightening was comparable with both methods. Thread-like tattoos had significantly better pigment lightening with fewer side effects than the broad band-like tattoos. We would like to recommend the R15 method of the QS Nd:YAG laser for thread-like tattoos, which can save patients’ time, cut short the frequency of their hospital visits and, more importantly, decrease the cost involved in it.     

Comparison study of a Q‐switched alexandrite laser delivered with versus without compression in the treatment of dermal pigmented lesions

Background: The Q‐switched laser is the treatment of choice when attempting to improve dermal pigmented lesions. However, purpura and dyspigmentation are frequently observed after treatment. Objective: To compare the efficacy and complications of the Q‐switched alexandrite laser when delivered with versus without compression in the treatment of dermal pigmented lesions. Methods: Ten patients with dermal lesions were enrolled in the study. Each patient had a lesion treated with the Q‐switched alexandrite laser delivered with compression. Each patient also had a lesion treated with the Q‐switched alexandrite laser delivered without compression with the same fluence and spot size. The patients were evaluated for efficacy and treatment‐related side effects. Results: There was no significant difference in efficacy, but purpura and dyspigmentation were more likely when pigmented lesions were treated without compression. Conclusion: Purpura from Q‐switched laser treatment in darkly pigmented skin is due to mechanical injury of blood vessels. It is well known that pressure ‘diascopy’ eliminates blood from cutaneous vessels by coapting the vessel lumen. In this study, we used pressure applied by a glass window on the Q‐switched laser handpiece to remove cutaneous blood during laser exposure, making it possible to reduce purpura and dyspigmentation.     

Histological hair removal study by ruby or alexandrite laser with comparative study on the effects of wavelength and fluence

BACKGROUND: Several different laser systems are currently used to remove unwanted hairs. In this study, we studied follicular changes following hair removal with ruby or alexandrite lasers at different fluences.

METHODS: Unwanted hairs were treated with a ruby laser (Chromos 694, ICN PhotonIcs, UK) at 10, 14 or 18?J/cm² or with an alexandrite laser (LPIR, Cynosure, USA) at 11, 14 or 17?J/cm². A 3?mm skin punch biopsy was taken immediately after each laser exposure and also 1 month later. Specimens were stained for histological observation. They were observed using immunohistochemistry with antibodies recognizing factor VIII related antigen or PCNA, and also by the TUNEL method. Similarly, electron microscopic observation was examined.

RESULTS: Immediately after the laser exposure, moderate follicular damage was observed following treatment with either type of laser. One month later, cystic formation of hair follicles and foreign body giant cells were observed in skin treated with either type of laser. A similar fluence with either laser treatment resulted in similar histological changes.

CONCLUSION: In this study, the histological changes following treatment with a ruby or an alexandrite laser at the same fluence are similar.     

Treatment of tattoos by Q-switched ruby laser. A dose-response study

Tattoo treatment with Q-switched ruby laser pulses (694 nm, 40 to 80 nanoseconds) was studied by clinical assessment and light and electron microscopy. Fifty-seven blue-black tattoos or portions thereof (35 amateur and 22 professional) were irradiated with 1.5 to 8.0 J/cm2 at a mean interval of 3 weeks. Substantial lightening or total clearing occurred in 18 (78%) of 23 amateur tattoos and 3 (23%) of 13 professional tattoos in which the protocol was completed. Response was related to exposure dose. Scarring occurred in one case, and persistent confettilike hypopigmentation was frequent. Optimal fluence was 4 to 8 J/cm2. Clinicohistologic correlation was poor. Q-switched ruby laser pulses can provide an effective treatment for tattoos.     

Comparison of treatment with an Alexandrite picosecond laser and Nd:YAG nanosecond laser for removing blue–black Chinese eyeliner tattoos

Objective: To retrospectively evaluate the efficacy of an Alexandrite picosecond laser versus Nd:YAG nanosecond laser for removing blue–black eyeliner tattoos which have existed more than 10 years.

Methods: A total of 40 patients were treated with an Alexandrite picosecond laser in our department from August 2015 to July 2017, with a fluence of 1.96–6.37J/cm², spot size of 2.0–3.6 mm, and pulse width of 750 ps. Another 32 patients were treated with an Nd:YAG nanosecond laser, with a fluence of 2.80–7.00 J/cm², spot size of 3 mm, and pulse width of 5–20 ns. All analysed patients completed at least one treatment and follow-up.

Results: The median number of treatment for all the patients was 1 (range, 1–4). After a single session, no difference was found between the two lasers for the eyeliner removal (p > 0.05). For the people who achieved an excellent response of tattoo clearance, there was still no difference between the two groups (p > 0.05). Transient side effects were observed in two groups, but neither group had significant adverse reactions.

Conclusions: To treat blue–black Chinese eyeliner tattoos over 10 years, Alexandrite picosecond laser does not provide better clearance than the Nd:YAG nanosecond laser.     

Tattooing in the Gulf region: A review of tattoo practices and response to treatment with the Q-switched ruby laser

Abstract

Background: Data regarding tattoo practices in the Gulf region and response to treatment are almost non-existent in the medical literature. Objective: To study the profile of patients with permanent tattoos in the Arab world, and to evaluate their response to Q-switched ruby laser treatment. Methods: A total of 468 consecutive patients with permanent tattoos consulting us for tattoo removal were recruited in the present study. Before starting the treatment each patient was given a set of questionnaires to answer. The patients were then treated with the Q-switched ruby laser, with a time interval of 8 weeks between each laser session, until complete clearance or up to a maximum of 10 sessions. Results: A total of 292 patients out of 348 patients achieved excellent lightening to complete clearance of tattoo pigment after an average of six sittings (range 2–10 sittings). Female patients with fair complexions and amateur tattoos on the face responded best. Seventy-eight (22.4%) patients developed pigmentary changes. Conclusion: More females than males had tattoos, and at a very young age and mostly on the advice of their parents. The majority of patients wanted to remove the tattoos because of religious reasons. The Q-switched ruby laser seems to be highly effective in removing amateur blue-black tattoos in patients with colored skin.     

Paradoxical darkening of unperceived tattoo ink after relatively low fluence from a Q‐switched Nd:YAG (1064‐nm) laser in the course of treatment for melasma

Although Q‐switched (QS) lasers are the mainstay of modern tattoo removal, paradoxical darkening of tattoo ink may occur. This darkening of tattoo ink is dependent on laser wavelength, pulse duration and fluence, with high‐energy, nanosecond‐pulsed lasers more prone to induce tattoo‐ink darkening. Laser toning, consisting of multiple‐passed QS neodymium:yttrium–aluminum–garnet (Nd:YAG), 1064‐nm laser treatment with low fluence, short pulse duration (< 10 ns), and a repetition rate of 10 Hz has been successful in the treatment of melasma. A mistake commonly made during laser toning is to scorch scalp hair, eyebrows or eyelashes, but this phenomenon is reversible. A more problematic error is caused by treatment of eyeliner or eyebrow tattoos. We report a patient who experienced changes in unperceived, skin‐coloured tattoos, turning them blue after QS Nd:YAG laser treatment of melasma.     

Efficacy and safety of 1064‐nm Q‐switched Nd:YAG laser with low fluence for keloids and hypertrophic scars

Background Several treatment modalities using laser devices have been used for the treatment of keloids and hypertrophic scars with various therapeutic outcomes. Objective The purpose of this study was to describe the efficacy and safety of 1064‐nm Q‐switched (QS) Nd:YAG laser with low fluence on keloids and hypertrophic scars. Methods Keloids and hypertrophic scars located at 21 anatomic sites in 12 Korean patients (10 men and 2 women; mean age 23.8 years, range 21–33) were treated using 1064‐nm QS Nd:YAG laser with low fluence at 1–2 week intervals. Treatment settings were 1.8–2.2 J/cm², 7‐mm spot size and 5–6 passes with appropriate overlapping. Results Follow‐up data collected 3 months after the final treatment revealed decreases in the mean score for the following lesion characteristics: pigmentation from 1.8 to 1.2; vascularity from 1.4 to 1.0; pliability from 3.0 to 2.0 and height from 2.3 to 1.8. The modified Vancouver General Hospital Burn Scar Assessment score decreased from 8.6 to 5.9 (P < 0.0001). Observed side‐effects were a mild prickling sensation during treatment, and mild post‐treatment erythema, both of which resolved within few hours. Conclusion Our results demonstrate that QS Nd:YAG laser with low fluence may be used for the treatment of keloids and hypertrophic scars.     

Efficacy of 577‐nm Pro‐Yellow laser in port wine stain treatment

A port‐wine stain (PWS) is a congenital capillary malformation that is seen in 0.3–0.5% of newborns. Although many types of lasers have been used to treat PWSs, few studies have investigated the efficacy of 577‐nm Pro‐Yellow lasers. The aim of this study was to establish the efficacy of Pro‐Yellow lasers in PWS treatment. In total, 26 patients, comprising 15 females (57.7%) and 11 males (42.3%) with a mean age of 24.7 ± 11.8 (range 1–50) years were included in the study. All were treated with a 577‐nm Pro‐Yellow laser at 4‐week intervals, 3–10 times. The sessions initially used scan mode and a fluence dose of 24 J/cm² per session, on average. The mean dose was increased by 4 J/cm each session and the maximum dose administered was 44 J/cm². A mean regression of 68.8 ± 13.9% in the size of the lesions over 5.23 ± 2.7 sessions was observed. There was no statistically significant difference between the female and male patients when they were compared in terms of the number of treatment sessions (p = .789) and treatment success (p = .39). These case series demonstrate that the Pro‐Yellow laser is a safe and well‐tolerated treatment for PWSs. However, deep‐seated lesions required more treatment sessions and it was observed that clinically the lesions did not completely disappear.     

Permanent makeup removal using Q‐switched Nd:YAG laser

Red‐brown tattoos are usually treated with a frequency‐doubled Q‐switched (QS) neodymium : yttrium–aluminum–garnet Nd:YAG laser (532 nm), because red and pink pigments show maximum absorption between 500 and 570 nm. Using a QS laser for red‐brown tattoo removal has sometimes led to paradoxical darkening of the tattoo pigments, and this darkened grey‐black colour may be difficult to remove. A woman with red‐brown cosmetic tattoos on her eyebrows was treated using a QS Nd:YAG laser (1064 nm) initially with low fluence and subsequently with increasing fluences at 6‐weekly intervals. After the first treatment, a slight darkening of the tattoo pigments was seen, but this faded and complete clearance was achieved after five treatments. There was no downtime during every treatment and there were no scars, pigmentary alterations or textural changes.     

Effect of Q‐switched Nd‐YAG laser on the clinical,pigmentary, and immunological markers in patients with lichen planus pigmentosus: A pilot study

The persistent discoloration in lichen planus pigmentosus (LPP) is secondary to persistent melanophages in the superficial dermis in these patients. We evaluated the effect of Q‐switched Nd‐YAG laser on the clinical, pigmentary, and immunological markers in patients with LPP. Nine females with a clinical diagnosis of LPP were included in the study. After six sessions of laser with toning protocol, performed over a representative area of 5 × 5 cm² at 2‐weekly intervals, the mean clinical improvement as per the physician assessment was 25.7% (10–40%). There was no significant reduction in melanin and erythema index. On expression analysis using quantitative‐polymerase chain reaction, the reduction in tyrosinase (p = 0.03) was statistically significant, though, the reduction in other pigment and immunological markers was not significant. The immunohistochemistry quantification data of corresponding proteins also did not show any significant difference. Post inflammatory hypopigmentation was noted in one patient. Q‐switched Nd‐YAG laser toning protocol resulted in modest clinical and histological improvement in patients of LPP.     

Laser treatment of onychomycosis: an in vitro pilot study

Background: Laser treatment of onychomycosis is the object of considerable interest. Laser therapy could be a safe and cost‐effective treatment modality without the disadvantages of drugs. Some studies have described the inhibitory effects of lasers on the growth of fungal colonies. We therefore examined the effects of various laser wavelengths, which have previously shown inhibitory potential, on the fungal isolate Trichophyton rubrum. Patients and Methods: Isolates of fungal colonies were placed clockwise on culture plates. Each culture plate was irradiated on one half with one of the following treatment regimens: 1064 nm‐Q‐switched Nd:YAG laser at 4 J/cm² and 8 J/cm²; 532 nm‐Q‐switched Nd:YAG laser at 8 J/cm²; 1064 nm‐long‐pulsed Nd:YAG laser at 45 J/cm² or 100 J/cm². The other half remained untreated. Standardized photographs were taken and areas of treated and untreated colonies were compared for growth inhibition. Results: There was no inhibition of fungal growth in any of the treated plates. Differences in size between treated and untreated colonies were not significant (p > 0.10). Conclusions: In this in vitro study Nd:YAG laser treatment of Trichophyton rubrum colonies failed to inhibit fungal growth. Nevertheless there might be an effectiveness in vivo which has to be clarified by clinical studies.     

A randomized, observer-blinded, comparison of combined 1064-nm Q-switched neodymium-doped yttrium-aluminium-garnet laser plus 30% glycolic acid peel vs. laser monotherapy to treat melasma

Background. Melasma is a common pigmentary disorder that poses therapeutic challenges. Mixed‐type melasma usually does not respond to conventional monotherapy. Objective. To evaluate the effectiveness and safety of 1064‐nm Q‐switched neodymium‐doped yttrium–aluminium–garnet laser (1064 QNYL) and 30% glycolic acid (GA) peel in the treatment of melasma. Methods. This was a split‐face study, in which 16 patients were treated with 1064 QNYL (6‐mm spot size, 2.0–2.3 J/cm² fluence) for six sessions at 1‐week intervals to the entire face, and with GA for three sessions at 2‐week intervals to the experimental side of the face. Clinical evaluations, measurements on a pigment measuring device (Mexameter), and assessment of patient satisfaction and adverse events were performed at baseline and every visit. Results. After treatment, significant improvements from baseline were seen in Mexameter and modified Melasma Area and Severity Index (mMASI) on both sides of the face. The combined therapy side achieved an average 32.6% improvement in Mexameter readings and 37.4% improvement in mMASI, compared with 22% and 16.7%, respectively, on the side treated with laser only (P ≤ 0.05). Both the physician and patient assessments correlated with the Mexameter results and mMASI. Conclusion. Combined 1064 QNYL and GA seems to be superior to 1064 QNYL alone in the treatment of mixed‐type melasma.     

Alexandrite laser hair removal results in 2359 patients: A Turkish experience

Background: Various lasers have been developed for epilation of unwanted hair. Effective hair removal in the Turkish population can be difficult, and multiple treatments are usually required for effective treatment. Objective: To evaluate the safety and efficacy profile of a long-pulsed alexandrite laser for hair removal in the Turkish population with Fitzpatrick skin types II–V exclusively and to determine the benefit of multiple treatments. Methods: Retrospective clinical evaluation conducted from September 2005 to May 2008 at a referral private clinic. Pre-laser skin testing was performed starting at 16 J/cm² and the energy fluence was selected according to response. All subjects were followed for 6 months after their final treatment. Results: A total of 2359 patients are reported (264 men and 2095 women) ranging in age from 14 to 70 years, for a total of 3830 treatment sites. The majority of treatment sites were axillae (24.2%) followed by the bikini line (16.8%). Maximum reductions observed were 95% for axillae, 92% for the bikini line, 86% for breast, respectively. The patients had a mean 80.6% hair reduction. Complications occurred in only 2.2% of cases. Transient hyperpigmentation (0.7%), folliculitis (0.5%), transient hypopigmentation (0.5%), and blistering (0.4%) were commonly seen complications. No subjects had scarring or long-term pigmentary changes. Conclusion: The long-pulsed alexandrite laser is safe for hair removal in darker skin tones. Although Turkish skin can be effectively treated with a cooled, long-pulsed alexandrite laser, complications do occur.     

Histological characterization of age‐related skin changes following the use of picosecond laser: Low vs high energy

Fractional lasers have become widespread in dermatology owing to their efficacy and safety. Comparative analysis of histological features after laser rejuvenation using a 1064‐nm fractionated handpiece picosecond laser with different energy fluence levels (1.1 or 2.1 J/cm²). An open‐label, study of 28 women aged 36 to 60 years with signs of age‐related photodamage and skin changes of the face and neck was conducted using a fractional picosecond 1064 nm laser in low vs high fluence. The clinical assessment at 3 weeks showed more pronounced effect on facial skin rejuvenation with the higher fluence of 2.1 J/cm² compared to 1.1 J/cm². The effect and safety of laser rejuvenation using a picosecond laser has been shown with more pronounced histological effects at higher fluences.     

Tattoo removal – state of the art

Tattooing has been around since the early beginnings of modern civilization. The discovery of selective photothermolysis at last has made it possible to remove tattoos without leaving a scar. Q‐switched neodymium: yttrium‐aluminum‐garnet, alexandrite, and ruby lasers with pulse durations in the nanosecond domain fulfill this need. Argon or cw‐CO₂ lasers as well as intense pulsed light sources should not be used since they often produce significant scarring. This article provides an overview of current laser systems.Developments leading to new tattoo inks, feedback systems to detect the absorbance characteristics of tattoo inks, dermal clearing agents, and perhaps even lasers with shorter pulse‐durations might improve the results in the future.