A Pilot Study on the Use of Topical Gold and Diamond Suspension Combined With 1,064 nm Picosecond Nd:YAG Laser for the Treatment of Facial Melasma

Traditional attempts at alleviating photoaging-associated facial pigmentation conditions such as melasma, mottled hyperpigmentation, and post-inflammatory hyperpigmentation have yielded disfiguring cosmetic results. Laser toning using a low-fluence Q-switched 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser has been more commonly applied to date. However, the treatment efficacy and safety of this approach have not been widely reported. This study therefore evaluated the efficacy and safety of picosecond 1064-nm Nd:YAG laser application for photoaging-associated facial pigmentation treatment in Korean subjects. Forty-seven Korean subjects with photoaging-associated facial pigmentation underwent picosecond 1064-nm laser application. The clinical improvement of 17 patients was assessed by objective measurements such as melanin and erythema indices. All subjects received six biweekly treatments with the laser in a three-pass fashion delivering approximately 2000 to 2500 shots using a zoom handpiece with a spot size of 7mm, fluence ranging from 0.4 to 0.7J/cm2, and a repetition rate of 10Hz. Clinicians evaluated the improvement of pigmentation using the pigmentation area and severity index (PSI), and subjects reported their satisfaction level on a four-point scale. Statistical analyses were performed using the SPSS version 19.0 for Windows software program (IBM Corp., Armonk, NY, USA). Forty-seven subjects (45 females and two males) completed this study with a 12-week follow-up period. The average decrease in PSI value at 12weeks after treatment was 6.85 ± 6.35 points (p < 0.001). The average decreases in the values of the erythema and melanin indices were 19.41 ± 64.64 points (p = 0.234) and 28.88 ± 32.89 points (p = 0.002). An analysis of 32 subjects' reports (68.1%) suggested good or excellent improvement. No serious adverse effects were observed during treatment or the follow-up period. Picosecond 1064-nm Nd:YAG laser application appears to be safe and effective in improving various photoaging-associated facial pigmentation conditions in Korean skin.

Facial melasma is a disfiguring pigmentation and occurs frequently with aging skin. Topical treatment alone was often suboptimal. A recent study showed that fractional picosecond laser has promising result in benign pigmentary lesions. This study aims to investigate the efficacy and safety of 1064 nm picosecond laser in treatment of facial melasma and skin rejuvenation in Asian skin. Patients of Asian descent seeking treatment for facial melasma and skin rejuvenation were screened and recruited. Each patient received up to nine laser treatments at 4-6 weeks intervals with a fractionated nonablative 1064 nm picosecond laser. Baseline and posttreatment modified Melasma Area Severity Index (mMASI) and Global Aesthetic Improvement Scale (IGAS) were assessed by blinded investigators based on the clinical photographs. Subject overall satisfaction was assessed by the questionnaires after treatment. All adverse events were documented. Twenty patients were recruited with a median age of 52.7 ± 8.2 years. Three subjects had Fitzpatrick skin type III and 17 had skin type IV. All subjects received nine laser sessions. Over 70% of patients were satisfied with the treatment outcomes. There was a statistically significant improvement in mMASI which reduced from 10.8 at baseline to 2.7 and 3.6 at 6 and 12 weeks post-treatment, respectively (both P < 0.01). For skin rejuvenation, 70% reported at least a moderate improvement at 6 weeks of post-treatment. No major side-effect was reported. Erythema was the most frequent transient response, while some reported edema (1.1%). Both resolved spontaneously. None reported hypo- or hyperpigmentation after treatment. The overall mean pain scare (VAS) was 1.92. Fractionated non-ablative 1064 nm picosecond laser was effective in treatment of melasma and skin rejuvenation. It was also safe and well tolerated. Importantly, there was no hypo or hyperpigmentation reported. Lasers Surg. Med. 00:00-00, 2021. © 2021 Wiley Periodicals LLC.

ABSTRACTBackground: High recurrence has previously been reported in the treatment of melasma with low-fluence 1,064-nm Q-switched neodymium-doped yttrium aluminium garnet (QS-Nd:YAG) laser. On the other hand, the efficacy and safety of the QS-Nd:YAG laser plus microneedling with vitamin C have not been evaluated in patients with mixed-type melasma. Material and methods: Sixteen patients with recalcitrant dermal- or mixed-type melasma were included in the study. One side of patients’ face was treated with QS-Nd:YAG laser plus microneedling with vitamin C (Group A) and the other side with QS-Nd:YAG laser alone (Group B) for four sessions at four-week intervals. Melasma Area Severity Index (MASI) scores and clinician’s evaluation of clinical response were assessed monthly. Results: Group A had a significantly lower mean MASI score and better treatment response than Group B according to clinician’s evaluation. According to MASI scores, in Group B, two patients had a good response while 12 were unresponsive to treatment. Good or very good improvement was reported by 10 patients in Group A and three patients in Group B. Adverse effects and recurrence rates were similar in Groups A and B (31.3 and 43.8%, respectively). Discussion: QS-Nd:YAG increases the blood circulation in the dermis, thereby enhancing the mechanical effect of microneedling to promote the penetration of vitamin C. Conclusion: Vitamin C application with microneedling immediately after treatment with QS-Nd:YAG laser is a promising adjunctive method for the treatment of recalcitrant melasma.

Melasma is an acquired disorder of symmetrical hyperpigmentation commonly seen in patients with Fitzpatrick skin types III and IV. Various novel therapeutic modalities have emerged to treat melasma. The large-spot low-fluence QS Nd:YAG laser has been widely used in Asia; however, the modality needs to be optimized because of the high recurrence rate. The objective of this study is to explore the clinical efficacy and safety of fractional-mode (Pixel) Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) 1064-nm laser for treatment of melasma in Chinese patients. Twenty-seven patients were enrolled and completed all the treatment sessions and the 12-week follow-up. All were treated using the fractional-mode Pixel QS Nd:YAG (1064nm) laser for eight sessions at a 2-3-week interval. Clinical photographs were taken using the Visia skin analysis imaging system. Two blinded assessors evaluated melasma area and severity index (MASI) scores before and 4weeks after the final session. Melanin index (MI) and erythema index (EI) was measured before each treatment visit and after the final treatment. The degree of pigmentation and erythema was assessed using a tristimulus color analyzer. Physicians' global assessment (PGA) and patients' self-assessment were taken as the subjective assessments. Wilcoxon signed-rank test was performed to evaluate clinical response. Recurrence rate were also evaluated. Mean MASI scores decreased from 12.84 ± 6.89 to 7.29 ± 4.15 after treatment (p = 0.000). Seventy percent of patients got moderate to good improvements after all the treatment. Mean MI decreased significantly from 56.52 ± 23.35 to 32.75 ± 12.91 (p = 0.000). L value increased from 59.21 ± 2.22 before treatment to 61.60 ± 2.40 (p = 0.000) after therapy. The mean score of PGA was 3.76 ± 0.71, indicating a "moderate" clearance of the lesion. In patients' self-evaluations, 70% of the patients rated the result as "good" to "remarkable." Partial recurrence was seen in 40% patients at the 3-month follow-up. No severe adverse events were observed during the study, and the treatment was well tolerated. The fractional mode (Pixel) QS Nd:YAG 1064-nm laser is an effective and safe treatment for melasma. The recurrence rate was relatively lower than that reported in studies treating with large-spot low-fluence QS Nd:YAG laser.

Conventional 5-aminolevulinic acid-photodynamic (ALA-PDT) therapy (10-20%) has been widely applied for moderate-to-severe acne. The aim of this study is to investigate the effects of non-ablative Q-switched 1064-nm Nd:YAG laser-assisted ALA-PDT with low concentration (2%) on the treatment of acne vulgaris. Enrolled patients were randomly assigned to 2 groups. One group received combined therapy of 2% ALA-PDT and non-ablative Q-switched 1064-nm Nd:YAG laser, and the other received only 2% ALA-PDT. Patients in each group had received 3-session treatments with 4-week intervals (week 0, 4, and 8). Sebum secretion, melanin index, erythema index, and transepidermal water loss (TEWL) were assessed at week 2, 8, 12, and 24. VISIA® skin image system score and global esthetic improvement scale (GAIS) were also evaluated. Twenty-four participants were enrolled and evenly randomized to two groups. Significant improvement in sebum secretion was noted in combined therapy group compared to the monotherapy group at week 12 (37.5% versus 16.3%), and the improvement would still be noted until week 24 (18.3% versus 17.4%). Combined group also showed more severe melanin index and erythema index after treatment. For VISIA® skin analysis, patients in combined group had better percentile ranking in porphyrins and red-light images. There were no significant differences in GAIS at the end of the follow-up between each group, whereas higher proportion of satisfaction was noted in combined group at week 2. With the assistance of laser, low concentrations (2%) of 5-ALA can provide effective phototoxic reactions in treating acne vulgaris. The satisfaction of patients is high with acceptable adverse effects.

Melasma is a common pigmentary disorder that affects all skin types but is seen more in individuals with Fitzpatrick skin type IV to VI. Safe and effective treatment options for melasma need to be explored. Already proven effective for the treatment of pigmentary disorders, lasers have been used to treat melasma in recent years. To evaluate the efficacy and safety profile of a 1,064-nm Q-switched neodymium-doped yttrium aluminum garnet (QS Nd:YAG) laser in the treatment of melasma. Fifty patients were recruited for this study (47 female; 3 male). All were treated using the 1,064-nm QS Nd:YAG laser at low energy levels weekly for nine sessions. Follow-up was done 3 months after the final laser session, and recurrence rates were evaluated. Digital photographs were taken and the melanin index (MI) measured before each treatment visit and after the final treatment. Melasma Area and Severity Index (MASI) scores were evaluated for all of the patients. Patients were required to evaluate their satisfaction at the end of the nine treatments. We also used a confocal laser scanning microscope (CLSM) for several patients to investigate pathologic changes at baseline, after the treatments, and at the time of recurrence. Statistical analysis was performed to evaluate clinical response and factors related to the therapeutic outcome. Mean MI decreased 35.8%, from 70.0 at baseline to 44.9 after the treatment (p<.001). Mean MASI scores decreased 61.3% after therapy (from 10.6-4.1, p<.001); 70% of patients had more than a 50% decrease in their MASI values, and 10% had 100% clearance. Recurrence rate at the 3-month follow-up was 64%. CLSM findings indicated less melanin in the treated regions, although it increased at recurrence. Multiple linear regression indicated that the therapeutic outcome depended on disease severity at baseline (p=.001, R=0.494). Minimal adverse events were observed during the study. The 1,064-nm QS Nd:YAG laser is an effective and safe treatment for melasma, although recurrence rates remain high, and further adjunctive therapy needs to be explored to prevent this recurrence.

BackgroundMelasma is a difficult-to-treat hyperpigmentary disorder. Ablative fractional laser (AFL)-assisted delivery of topically applied drugs to varied targets in the skin has been an area of ongoing study and research.ObjectiveThe objective of this study was to evaluate the efficacy and safety of fractional erbium-doped yttrium aluminum garnet (Er:YAG) laser as an assisted drug delivery for enhancing topical hydroquinone (HQ) permeation into the skin of melasma patients.Patients and methodsThirty female patients with bilateral melasma were randomly treated in a split-face controlled manner with a fractional Er:YAG laser followed by 4% HQ cream on one side and 4% HQ cream alone on the other side. All patients received six laser sessions with a 2-week interval. The efficacy of treatments was determined through photographs, dermoscopic photomicrographs and Melasma Area Severity Index (MASI) score, all performed at baseline and at 12 weeks of starting therapy. The patient’s level of satisfaction was also recorded.ResultsEr:YAG laser + HQ showed significantly better results (p<0.005) with regard to decrease in the degree of pigmentation as assessed on the 4-point scale than HQ alone. There was a significant decrease in MASI scores on Er:YAG laser + HQ side vs HQ side. Minor reversible side effects were observed on both sides.ConclusionAFL-assisted delivery of HQ is a safe and effective method for the treatment of melasma.

Background: The 1064 nm Q-switched neodymium-doped yttrium aluminum garnet (QS Nd:YAG) laser was developed to treat unwanted pigmentation in the skin such as lentigines caused by photoaging, and tattoos from dye/ink insertion. This laser has also been used for non-ablative epidermal rejuvenation (skin toning). Objective: To evaluate changes in skin tone, skin texture and overall improvement after a series of treatments with the QS Nd:YAG laser. Methods: Participants received seven full-face treatments with M22 or Stellar M22, a 1064 nm QS Nd:YAG laser, at 2-week intervals. The investigators and participants evaluated the improvement in skin tone and texture at 1, 3 and 6 months after the last treatment. Patient satisfaction, patient discomfort, downtime and adverse events were recorded. Histological changes in the treated area were also evaluated. Results: Thirteen women with a median age of 45 years (range, 34–61 years) were included in the study. The majority of the participants (53.9%) had skin type VI. One month after the last treatment session, 38% of participants reported good to very good improvement. This value increased to 100% participant improvement at both the 3-month and 6-month follow-up visits. The reduction in melanin index and the histological analysis demonstrated that the laser procedure contributed to a reduction in epidermal melanin content. Treatments were not associated with high levels of pain or discomfort. The most common immediate post-treatment response was erythema and edema. Most participants were satisfied with the resulting treatment outcome. Conclusion: Skin treatment with the 1064 nm QS Nd:YAG laser module on the M22 and Stellar M22 devices, using a large spot size, low fluence, moderately high repetition rate, improves skin tone and texture in patients with skin types II–VI.

Background: Low-fluence 1064 nm Q-switched Nd:YAG laser has recently been popular in the treatment of melasma but with dissatisfaction of a high recurrence and adverse effects in our practice. The optimal regime of 1,064- nm QS-Nd:YAG laser in the treatment of melasma is not established. It raises a question as to whether we can explore the possibility of a new treatment model. Objectives: To establish a new laser regime of treatment using 1064 nm Q-switched Nd:YAG laser of melasma in Chinese patients, which on the hypothesis to decrease the melanosome without destroying the normal balance of production and transportation of melanin. Materials and Methods: 35 Chinese with melasma were treated with the 1064 nm Q-switched Nd:YAG laser (4-mm spot size, 4.5 J/cm² fluence, one pass) at 4-week interval for an average of 24 months to the entire lesion. Two independent investigators evaluated the results by Modified Melanin Area and Severity Index (mMASI), Derma- Spectrometer of melanin index (MI) and erythema index (EI) at baseline, each session and 8,16 weeks after the completion of the treatment. Patients were asked to rate satisfaction at last visit. All possible side effects were recorded. Results: The effective rate of patients at 8, 16 weeks follow up was 85.71% (30/35), 88.57% (31/35) compared with the baseline (P<0.01). The mean mMASI score decreased from 17.56 ± 10.74 at baseline to 3.11 ± 2.73 at the last visit. Correspondingly, the mean MI data lowered from (49.04 ± 10.32)% to (34.82 ± 7.70)% at 16-week follow up and showed a statistically decrease (P<0.01). There was no liner correlation between MI and EI. No severe adverse events were observed. Conclusions: The new approach of 1064 nm Q-switched Nd:YAG laser (4.5 J/cm2, 4.0 mm, one pass) can be effectively and safely used in the treatment of melasma and achieved a marked curative effect. It can supply a good alternative option compared with low fluence laser therapy.

Objective: To explore the clinical efficacy of a Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser with different parameters in the treatment of chloasma. Methods: In this study, 30 patients with chloasma, symmetrically distributed on the left and right sides of the face and who were treated with a Fayton Q-switched 1064 nm Nd:YAG laser, were recruited. The patients were randomly selected for the treatment of facial lesions on the left and right sides of the face using a spot diameter of 9 mm and an energy density of 0.8 J/cm2 on one side, and, on the opposite side, a spot diameter of 6 mm with an energy density of 1.2 J/cm2. The laser frequency was 5 Hz and treatment was conducted once every 7-10 days and repeated eight times as a course of treatment. At the end of the course of treatment, as well as 1, 3, and 6 months after treatment, front-facing images and 45° left- and right-side images were taken, respectively. The curative effect of the treatment was evaluated using the Melasma Area Severity Index (MASI) score. Results: The results of this study showed that the total effective rate of a Fayton Q-switched 1064 nm Nd:YAG laser in the treatment of chloasma was 60%. Conclusions: Using a Q-switched 1064 nm Nd:YAG laser represents a safe and effective approach for the treatment of chloasma. The therapeutic effects of the parameter sets, that is, a spot diameter of 9 mm and an energy density of 0.8 J/cm2, and a spot diameter of 6 mm with an energy density of 1.2 J/cm2, were similar. The treatment time and average effective times of the latter were relatively shortened. Clinical Trial Registration number researchregistry6799.

Established pigment lasers have been used in partial unilateral lentiginosis (PUL) have shown unsatisfactory results. To determine the effectiveness and safety of low-fluence 1,064-nm Q-switched neodymium-doped yttrium aluminum garnet (QS Nd:YAG) laser treatment of PUL in Koreans. Ten Korean patients with facial PUL were treated with 1,064-nm QS Nd:YAG laser, 7-mm spot size, 1.5- to 2.5-J/cm(2) fluence at 2-week intervals. Standard digital photographs were taken under the same condition at baseline and at each follow-up visit. Independent dermatologists evaluated the photographs. All patients completed a questionnaire to assess their subjective satisfaction with the laser treatment using a 5-point grading system. Degree of pain was assessed using a visual analog scale (0-10). Any complications and side effects were recorded at each visit. Patients were followed up every 4weeks for 12weeks after the last laser treatment. Five of 10 patients (50%) had achieved excellent improvement (76-100%) at the end of treatment, and the remaining 50% had good improvement (51-75%). In patient self-evaluation of the degree of improvement of PUL, nine (90%) assessed it as very much to much improved (>50% improvement), and 1 (10%) assessed it as moderate (50-75%). Subjects rated the pain associated with laser treatment at a mean score of 3.3 (range: 1-5) on a scale of 1 to 10. Mottled hypopigmentation developed in two patients. At follow-up, 12weeks after the last laser session, all of the patients had partial recurrence, which wqw resolved with one to two sessions of laser treatment. Low-fluence 1,064-nm QS Nd:YAG laser treatment for facial PUL in Koreans showed improvement with no significant side effects. We recommend the low-fluence 1,064-nm QS Nd:YAG laser as a treatment option for facial PUL.

High-intensity focused ultrasound (HIFU) is regarded as an effective skin-lifting device; however, literature regarding treatment of the aging neck and décolletage with HIFU is scarce. Our study aimed to evaluate the efficacy of combination with HIFU and low-fluence Q-switched Nd:YAG (LQSNY) laser on the aging neck and décolletage. Nineteen women were assessed. HIFU at two visits and LQSNY laser at six visits were used to irradiate the neck and chest. At week 16, improvements were rated using the Dedo classification, Fabi/Bolton Chest Wrinkle Scale (FBCWS), and Global Aesthetic Improvement Scales (GAIS). Erythema and melanin indices (EMIs) and cervicomental angle were measured. Subject GAIS and satisfaction were evaluated at follow-up visits. At week 16, neck sagging and chest rhytides were improved on Dedo classification and FBCWS, respectively. Pigmentation and rhytides of the neck and chest were rated as improved in 30% or more of the subjects by physician GAIS and in approximately 80% of the subjects by subject GAIS. The above differences seemed to be attributable to the initial expectation level and mild severity pertaining to dress custom in Korea. Eighty-four percent of subjects were satisfied with treatment outcomes. EMIs were decreased on the chest. The combination of HIFU and LQSNY is an effective treatment option to mitigate rhytides and pigmentation of the neck and décolletage.

Melasma is a hard-to-manage disorder with considerable relapsing behavior. Dermoscopy emerged to help in comprehensive evaluation of pigmentary disorders and melasma. The aim of the study was to evaluate the potential role of dermoscopy in assessing melasma and monitoring the efficacy of 1064-nm low-fluence Q-switched neodymium:yttrium-aluminum-garnet (QS Nd:YAG) laser. A total of 31 patients with facial melasma were included. A total of five laser sessions were performed with 2-week intervals. Patients were evaluated at baseline and 2 weeks after the last session (at the 10th week) by using digital photography, modified melasma area and severity index (mMASI), and colorimetry, as well as dermoscopic score for pigment and vascular elements. Adverse effects were reported. Postlaser sessions, mMASI scores as well as the colorimetric melanin and erythema indices had showed significant improvement. The "dermoscopic score of pigmentary and vascular elements" displayed significant change and confirmed the improvement. Side effects were tolerable. mMASI, colorimetry, and dermoscopy had ascertained the efficacy of low-fluence 1064-nm QS Nd:YAG laser in melasma; however, dermoscopy is superior to other assessments as it can help in the diagnosis of melasma besides the follow-up assessment and can precisely detect the detailed changes in response to treatment.

To assess the efficacy and safety of topical 5% cysteamine versus 4% hydroquinone in the treatment of facial melasma in women. Topical 5% cysteamine is an antioxidant and tyrosinase inhibitor that has been shown to be effective in the treatment of melasma. However, to date, no study has compared the performance of topical cysteamine to hydroquinone for facial melasma. A quasi-randomized, multicenter, evaluator-blinded clinical trial was conducted on 40 women with facial melasma who were submitted to the nightly application of 5% cysteamine (CYS) or 4% hydroquinone (HQ) on hyperpigmented areas for 120days. Both groups were required to use tinted sunscreen (SPF 50; PPD 19). Subjects were assessed at the inclusion and after 60 and 120days of treatment for mMASI, MELASQoL, and the difference in colorimetric luminosity between melasma and the adjacent unaffected skin. The Global Aesthetic Improvement Scale was used to assess the difference in the appearance of the skin through standardized photographs. The mean reduction of the mMASI scores was 24% for CYS and 41% for HQ (P=0.015) at 60days, and 38% for CYS and 53% for HQ (P=0.017) at 120days. The photographic evaluation revealed up to 74% improvement for both groups, without statistically significant difference between them (P=0.087). The MELASQoL score showed a progressive decrease for both groups over time, despite the greater reduction for HQ after 120days (P=0.018). Colorimetric assessment disclosed progressive depigmenting in both groups, without statistically significant difference between them (P>0.160). No severe adverse effects were identified in either group. Erythema and burning were the most important local adverse effects with cysteamine, although their frequency did not differ between groups (P>0.170). Cysteamine proved to be safe, well-tolerated, and effective, despite its inferior performance to hydroquinone in decreasing mMASI and MELASQoL in the treatment of melasma.

Background and Objective: Little is known about the anti-pigmentation effects of whitening agents on solar lentigines. Epidermal growth factor (EGF) has been used as a booster for wound healing in the skin, and it has been suggested to have anti-pigmentation effects. This study aimed to evaluate the effect and safety of EGF-containing ointment for treating solar lentigines with a Q-switched (QS) 532 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser (Bluecore company, Seoul, Republic of Korea). Materials and Methods: Subjects who underwent QS 532 nm Nd:YAG laser treatment of solar lentigines were randomly assigned to treatment with an EGF ointment or petrolatum. After the laser procedure, the subjects were administered the test ointment twice a day for 4 weeks. The physician’s assessment of the degree of pigment clearance and patient’s satisfaction were assessed after 4 and 8 weeks. Additionally, the melanin index (MI), erythema index (EI), transepidermal water loss (TEWL), and post-inflammatory hyperpigmentation (PIH) were evaluated. This trial was registered with ClinicalTrials.gov (NCT04704245). Results: The blinded physician’s assessment using 5-grade percentage improvement scale and patient’s satisfaction were significantly higher in the study group than in the control group at the 4th and 8th weeks. The MI was significantly higher in the control group than in the study group at the 4th and 8th weeks. The EI and TEWL did not differ significantly between the two groups at either time point. The incidence of PIH was higher in the control group (37.5%) than in the EGF group (7.14%) at the 8th week. Conclusions: The application of EGF-containing ointment on facial solar lentigines with a QS 532 nm Nd:YAG laser showed efficient and safe therapeutic effects, with less PIH. Thus, EGF-containing ointment could be suggested as the promising adjuvant treatment strategy with a QS laser for solar lentigines.