Efficacy and Safety of 1064‐nm Nanosecond Laser Modalities (Q‐NDY and MDF Handpieces) for Treating Hand Skin Aging: A Prospective Randomized Controlled Trial

There are several treatment modalities for mild to moderate photodamage. The demand for effective treatments with minimal side effects has increased. The objective of this study was to determine the effectiveness of short-pulsed erbium:YAG laser in treating mild to moderate photodamage. Twenty patients were treated with the short-pulse erbium:YAG laser on the face and neck. One pass was given over the entire face with two to three passes over the perioral and periorbital regions. Patients were evaluated for improvement of pigmentary irregularities, skin texture, and fine wrinkles. All side effects were recorded at follow-up visits. Two lasers were used, Sciton and Cynosure CO3, under local anesthesia. There was a 58% reduction in pigment irregularities and a 54% improvement in skin texture. There was minimal improvement in fine wrinkles with one pass. Two and three passes resulted in a 50% reduction in wrinkles. The procedure was minimally painful. Side effects included 3 to 5 days of erythema and edema. Patients returned to work within 3 days on average. There were no infections. Patient satisfaction with the procedure was rated as very good. There was no difference in efficacy or adverse effects with either laser. One-pass short-pulse erbium:YAG laser in treating photodamage of the face and neck is safe and effective. There are minimal side effects and patients heal within 3 to 5 days.

BackgroundAcanthosis nigricans (AN) is a common chronic skin disorder clinically presents by velvety hyperpigmented lesions mainly at the flexural areas. Fractional photothermolysis has been reported to improve both pigmentary and textural changes by removing thin layers of skin with minimal thermal damage. Other options are the Q-switched (Qs) Nd:YAG (1064 nm) and Qs KTP (532 nm) lasers. Both can induce collagen remodeling by dermal photo-mechanical microdamage.Aim of the WorkThe aim of this study was to assess the clinical efficacy and the safety of fractional CO2 laser versus Qs Nd:YAG and KTP lasers in the treatment of acanthosis nigricans.MethodsThis randomized-controlled split neck study was conducted on 23 patients suffering from AN. For each patient, one side of the neck was randomly assigned to fractional CO2 laser and the other side to Qs Nd:YAG and KTP lasers every four weeks for four months followed by 4 monthly follow-up assessment. Acanthosis Nigricans Area and Severity Index (ANASI) score, melanin and erythema indices as well as Patient Satisfaction Scale (PSS) were used to assess improvement on each side separately.ResultsThere was no statistically significant difference regarding the clinical improvement between the side treated with Fractional CO2 laser and the side treated with Qs Nd:YAG and KTP lasers (P value >0.05). In most patients, both sides showed improvement during different sessions of therapy, as regards ANASI scores, melanin indices, patient satisfaction scores, and side effects.ConclusionIn this study, we concluded that both fractional CO2 and Q-switched lasers proved to be a safe and effective line of treatment of acanthosis nigricans.

Dear Editor, We read with keen interest the article titled “Correlation between Acanthosis Nigricans Scoring Chart (ANSC) and narrowband reflectance spectrophotometer in assessing severity of acanthosis nigricans.”1 This manuscript offers a comprehensive guide on the use of the ANSC and its validation by correlating its skin color and texture domains with the melanin index measured by narrowband reflectance spectrophotometry (a method used to quantify skin pigmentation). The authors' effort to introduce this tool is commendable, especially given the absence of any standardized visual tools for assessing acanthosis nigricans (AN). While we deeply appreciate their innovative approach, we believe certain aspects of the skin color and texture domains warrant further reflection and discussion. A primary concern is how the ANSC's skin color domain scores the color of AN lesions without considering the patient's baseline skin color. This approach can lead to disparities in severity scores among individuals with varying skin complexions. For instance, even with mild severity, a patient with a dark skin complexion might naturally fall into a more severe color score compared to an individual with a lighter skin complexion. Such discrepancies can impact treatment decisions in skin of color patients, which is especially pertinent as AN disproportionately afflicts patients with skin of color.2 While the authors have made significant strides in developing a visual tool to assess AN severity, we would like to further discuss methodological concerns. We agree with the authors’ decision to correlate the ANSC's skin color domain with the melanin index using narrowband reflectance spectrophotometry, given their mutual emphasis on skin color. However, extending this correlation to the ANSC's skin texture domain, which focuses on skin thickening and skin markings rather than pigmentation, is concerning. This spectrophotometer is designed for skin color, not skin texture, making it suboptimal for assessing the validity of the skin texture domain. While skin thickness might influence the pigmented appearance of AN, solely validating the skin texture domain with a colorimetric method can introduce inaccuracies. In understanding the authors’ challenges with the lack of in vivo tools to measure skin thickness in hyperkeratotic lesions, one might lean toward a subjective colorimetric method. However, given the ANSC's emphasis on skin surface markings (like bumps or ridges), tools like the Visioscan VC 98,3 PRIMOS,3 PRIMOS Lite,3 and the Visiometer SV 600,1 which assess skin surface texture, might be more appropriate for validating this domain rather than a colorimetric method. This emphasizes the need for developing in vivo tools for assessing skin thickness in hyperkeratotic lesions. Acanthosis nigricans, with a prevalence of 19.4% in the United States that is continually increasing,2, 4 leads to significant reductions in self-esteem and heightened levels of depression and anxiety for those affected.5 The lack of FDA-approved pharmacotherapy, potentially due to the absence of a standardized visual tool for assessing AN, highlights the importance of the authors' efforts in developing the ANSC. While we commend this initiative, we are hopeful that our feedback will guide further refinement of the ANSC, positioning it as the first standardized visual tool for assessing AN severity. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

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.

Bawang Dayak (Eleutherine palmifolia (L.) Merr) has bioactivity as an antioxidant that can prevent the damage of macromolecule such as a protein by reactive oxygen species (ROS) produced by UV exposure. This research was conducted to determine the effect of Bawang Dayak extract to melanin index and erythema on rat skin induced by acute UV. The research used 24 male rats (Rattus novergicus), 8 weeks old, and 8 weeks average weight divided into 4 groups. A control group (P0) was without acute UV induced and Bawang Dayak extract; P1 group was induced by acute UV; P2 group was induced by Bawang Dayak extract, and P3 was induced by acute UV+Bawang Dayak extract. Melanin and erythema index were measured based on coloring system L*a*b using a spectrometer, while H2O2 and tyrosine levels were measured using the colorimetric method by spectrophotometer. The results of this study indicate that H2O2 levels and melanin index decreased in UV induced groups+dayak onion extract. But there was an increase in erythema index and tyrosine levels in rat skin.

UV radiation are divided into 3, namely UV A (400 – 315 nm), UV B (315-280 nm), UV C (280 – 100 nm). UV C radiation have the greatest effect on skin damage compared to UV A and UV B. UV radiation can reach the earth's surface, that can cause burning of the skin with signs such as redness of the skin (erythema), pain, blistering and peeling of the skin. Until now there has been no research on the effect of long exposure of UV C radiation on the erythema and melanin index, so aim this research is know about the effect of long exposure of UV C radiation on the erythema and melanine index. This research was conducted by giving exposure to rat that had been shaved with variations in exposure time, namely 5 minutes, 10 minutes, 15 minutes and 20 minutes. The skin that has been exposed with UV radiation will be photographed for color analysis using a chromometer. The results showed that exposure of UV radiation for 10 minutes caused the greatest increase in the melanin and erythema index

7-MEGATM is a food product made from purified Alaska pollack fish oil containing palmitoleic acid (16:1), commonly referred to as omega-7. We sought to quantitatively evaluate whether this substance inhibits skin aging. A total of 101 middle-aged females were randomly allocated to the intervention (N = 50) or placebo group (N = 51). Each participant was advised to take either 500 mg of 7-MEGATM or a placebo twice daily for 12 weeks. The primary outcomes were the degree of improvement in wrinkles and the degree of moisture filling after consumption for 12 weeks compared to baseline. The secondary outcomes were improvement in skin wrinkles; moisture changes at 4 and 8 weeks from baseline; changes in transdermal water loss, skin elasticity, the melanin index, the erythema index, and the Global Photo Damage Score. We found a significant improvement in skin wrinkles and elasticity at 12 weeks in the 7-MEGATM-consuming group compared to that in the placebo group; skin moisture, elasticity, and the melanin index were also improved. No supplement-related adverse reactions were observed and 7-MEGATM was identified as safe. 7-MEGATM was effective for human skin function in terms of wrinkles, moisture, elasticity, and melanin production and may be useful as a skin nutritional supplement.

Effects of hormone replacement therapy and tıbolone on skın thıckness and bone ın postmenopausal women

The clinical features of photoaging include: skin texture changes, laxity, rhytides, pigmentary changes, and vascular changes such as erythema and telangiectasias. In order to meet patients' increasing demands for improving all aspects of photoaging at one office visit, employing a multi-modality treatment for all aspects of photoaging has become increasingly desirable for the physician and patient alike. We examine a novel device that employs bipolar radiofrequency (RF), intense pulsed light (IPL), and infrared diode laser. These laser and light source treatments are performed sequentially. This study aims to evaluate the clinical efficacy and safety of this device (i.e., ELOS Triniti™). Twenty-six subjects received four ELOS Triniti™ treatments at 1-month intervals. They were followed up 1, 3, and 6months after completing the treatments. Two blinded dermatologists used a comprehensive grading scale to evaluate the degree of the photoaging in terms of rhytides, laxity, dyschromia, erythema, telangiectasias, and texture. Subjects used a 0-10 grading scale for self-assessment of photoaging. Additionally, we measured the Erythema Index (EI), Melanin Index (MI), transepidermal water loss scores (TEWL), stratum corneum moisture scores (SC), and dermis moisture scores (D) before treatment and 1, 3, and 6months after treatment. There was a statistically significant improvement in all five aspects of the comprehensive grading scale. Overall, it had excellent efficacy for improving erythema, telangiectasias, and skin texture. It also had a relatively long effect on improving skin laxity; however, it had only a limited ability to improve rhytides and dyschromia. It can mildly to moderately improve the global photoaging. This global effect can be noted 1month after treatment and becomes most clinically apparent 3months after treatment. This is maintained at least 6months after treatment. MI index and SC and D values increased while EI index and TEWL values decreased after the treatment. The subjects' self-assessment improved by 2.7±1.2 points. The overall satisfaction rate was 88%. The degree of pain measured 2.5±1.9 points on average. There was no downtime and no severe side effects reported. The sequential implementation of bipolar radiofrequency based optical combination devices (IPL, IR, diode laser) is effective and safe for global facial photoaging.

Hyperpigmentation of split-thickness skin grafts (STSGs) is commonly found among Asians, and it is also challenging to treat. Although the 1064-nm Q-switched Nd:YAG laser has been used as a standard treatment for skin hyperpigmented lesions, there are limited number of reports focusing on the treatment of hyperpigmentation of STSGs. We aimed to evaluate the efficacy of 1064-nm Q-switched Nd:YAG laser for treatment of hyperpigmented STSGs. Half of each STSGs was treated with the 1064-nm Q-switched Nd:YAG laser, while the remaining was left untreated as comparison. The laser was applied for 4 times with 2-4-week interval. The treatment outcomes were compared by measurement of melanin index, erythema index, and photographs of STSGs at prior to enrollment, before each treatment session, and after 1month of treatment completion. Five patients with 11 skin graft lesions were enrolled. The melanin index was significantly improved after the 2nd session and after treatment completion in laser-treated area (p = 0.006 and p = 0.001, respectively). There was non-significant difference in erythema index. The photographic comparison showed brightened of laser-treated area after treatment completion and improved skin texture. The 1064-nm Q-switched Nd:YAG laser can significantly reduce melanin index of STSGs and can be an alternative treatment for hyperpigmentation of STSGs.

Dark circles of the lower eyelid (DCLE) represent a well-known beauty problem. The pathogenesis of DCLE is obscure, although stasis and hyperpigmentation of the eyelids have been considered to be involved. One reason for the small number of studies on DCLE may be the difficulty in measuring such soft and curved skin as the eyelids using bulky reflectance meters. The purpose of this study was to quantitatively analyze DCLE using various bioengineering methods. The lower eyelid and cheek areas of 14 subjects with DCLE and 28 without DCLE were examined using two kinds of reflectance meters and image analysis to measure erythema index (EI), melanin index (MI), and oxygenation index (OX). Ultrasound echo images were also recorded to evaluate the thickness and echo density of the dermis. An in vitro model using collagen gel and hemoglobin solution was also examined as a phantom of eyelid skin. When contact-type reflectance meters were used, no significant differences in EI, MI, and OX were found between groups with and without DCLE. However, mean values of both MI and EI at eyelids were significantly higher in subjects with DCLE on image analysis, paralleling the results of inspection. Mean dermal thickness was significantly smaller in subjects with DCLE. Evaluation of EI and MI by image processing methods seems suitable for quantitative evaluation of DCLE, since inadequate contact of the measuring head with the skin is avoided. Whether stasis or hyperpigmentation is more responsible for DCLE remains uncertain. Dermal thickness of eyelid skin may be involved in the appearance of DCLE.

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.

Polyurethane integral skin foams comprise a low density foamed core surrounded by a high density skin of the same material, and are made in a single molding operation. Polyurethane integral skin foams find wide application as structural materials, and the mechanical properties of such foams are significantly affected by the foam structure, which in turn is determined by the foaming process. An experimental and theoretical study of the foam formation process is presented. Experimental results show that increase in the mold wall temperature results in an increase in the upper skin thickness, a decrease in the lower skin thickness, and a decrease in the density of both skins. The core density increases with increasing wall temperature. Increase in the blowing agent concentration produces a small increase in the skin thickness. Computations based on the model of Marciano et al. [Polym. Eng. Sci., 26, 717 (1986)] are presented using an efficient numerical technique. Predictions of the model for the skin thickness, core density and pressure and temperature variation with time are in reasonable agreement with experimental data. The model, however, predicts higher skin densities than the experimental measurements. A modification of the initial condition of the model to account for the air bubbles dispersed during mixing gives better agreement between theory and experiment.

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.

BackgroundA combination of minimally invasive modalities can induce collagen regeneration more quickly and promote the penetration of topical agents, thus promoting skin rejuvenation. In this study, we aimed to investigate the synergistic efficacy of extracellular matrix compound (ECM-C) via microneedle (MN) and radiofrequency (RF) on periorbital wrinkles.MethodA total of 25 participants with periorbital wrinkles were selected for this study. The left and right side of the periorbital area was randomly given ECM-C via MN or ECM-C via MN combined with RF. MN combined with ECM-C treatment was given 5 times at 2 weeks intervals, whereas RF treatment was given 3 times at 4-week intervals. The following items were assessed: wrinkles by VISIA® system; biophysical parameters such as skin hydration, transepidermal water loss (TEWL), erythema index, and melanin index by CK multiple probe adapter; and skin elasticity and skin thickness by DermaLab Combo® photographs were taken at the baseline and 2 weeks after the last treatment. Subjective assessments, such as Crow's Feet Grading Scale (CFGS) and Global Aesthetic International Scale (GAIS), were also recorded.ResultA total of 25 participants with an average age of 43 years participated in this trial. Periorbital wrinkles on both sides decreased after the treatment, and the side treated with ECM via MN and RF showed better improvement than the other side with ECM-C via MN alone. Skin hydration increased after the treatment on both sides. TEWL, skin erythema, and skin melanin indexes were not changed. Skin elasticity and skin thickness increased more on the side of ECM-C via MN and RF than on the other side of ECM-C via MN alone. The evaluation scores for CFGS improved on either side; however, no difference was found for CFGS and GAIS between intergroup comparisons after the treatment.ConclusionThe objective assessment of wrinkles, elasticity, and thickness of periorbital skin improved more on the side with ECM-C treatment via MN combined with RF than on the other side of ECM-C treatment via MN only. However, no statistically significant difference was found between the subjective CFGS and GAIS evaluation of the two sides.