Facial Freckles Research Articles

Invited Discussion on: Epiderm-Abrasion-Assisted Intensive Pulsed Light and Radiofrequency in Aesthetic Treatment of Extensive Facial Freckles

Invited Discussion on: Epiderm-Abrasion-Assisted Intensive Pulsed Light and Radiofrequency in Aesthetic Treatment of Extensive Facial Freckles

Epiderm-Abrasion-Assisted Intensive Pulsed Light and Radiofrequency in Aesthetic Treatment Extensive Facial Freckles.

Freckles are typical epidermal pigmented disorders that occur at sun-exposed areas, presenting with dark-brown or light-brown circular hyperpigmentation. A lot of treatment modalities have been used for treatment of freckles like chemicals, electrosurgery and cryotherapy. These treatments may cause undesirable side effects such as scaring (Sarkar et al. in Indian J Dermatol 62(6):578-584, 2017). Microdermabrasion has been used in treatment of freckles; however, the results are not satisfactory, as it removes the outermost layer of the epidermis only (El-Domyati et al. in J Cosmet Dermatol 15(4):503-513, 2016). Also ablative lasers and non-ablative lasers have been used but have not proved to be completely satisfactory and share a common risk of post-inflammatory hyperpigmentation (Jang et al. in Dermatol Surg 26:231-234, 2000). In our study, we have used epiderm-abrasion-assisted intensive pulsed light (IPL) and radiofrequency (RF) to study their effect in treatment of freckles. this prospective controlled clinical trial was carried out on 48 patients, who presented with extensive facial freckles, in the period between March 2015 and April 2018. The epiderm-abrasion procedure was performed first, and then, electro-photobiomodulation sessions were started two weeks later. This study was carried out on 48 patients, 39 female and 9 males. Their age ranged between 12 and 58years old. According to Fitzpatrick classification, four patients were type II, 30 patients were type III, and 14 patients were type IV. The results were excellent in 32 cases, good in 12 cases, fair in four cases, and we have no poor results. Side effects like hyperpigmentation were reported in three patients (6.3%), one case grade III and two cases grade IV Fitzpatrick skin type. No cases with hypopigmentation, or scars, were reported. Epiderm-abrasion and electro-photobiomodulation (IPL&RF) are effective methods in treatment of facial freckles. Some complications may occur post-procedure such as hyperpigmentation, hypopigmentation and abnormal scarring. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Clinical Study on Treatment of Facial Freckles with Intense Pulsed Light

Purpose: To explore the clinical effect of intense pulsed light on freckles. Methods: A total of 102 patients with facial freckles treated in our hospital between November 2014 and May 2017 were taken as the subjects of this study. The patients, after being confirmed with facial freckles, were treated with M22 Photorejuvenation, and evaluated at the end of the treatment in terms of therapeutic effect, adverse reactions, changes of indicators before and after treatment as well as relapse. Results: In terms of treatment effect, there were 46 patients (45.10%) above expectation, 50 patients (49.02%) up to expectation and 6 patients (5.88%) below the standard, with a total effective rate of 94.12%. In terms of adverse reactions, there were 8 patients with temporary facial flushing, 4 patients with mild edema and 3 patients with burning sensation, with a probability of 14.71%. In terms of indicator changes before and after treatment, the skin elasticity and skin moisture of each part of the patient’s face were improved, with the skin elasticity of the patient’s forehead and lower jaw up by 8.9% and 8%, respectively, and the skin moisture of the patient’s left cheek up by 25.7%, which was very obvious. In addition, the proportion of melanin and skin oil of the patients were significantly reduced, with the melanin proportion of the left cheek down by 30.1% and the overall skin oil proportion of the face down by about 1%. At the end of the treatment, 5 patients had freckle recurrence, with a recurrence rate of 4.90%, which was statistically significant (P<0.05). Discussion: The intense pulsed light is an effective tool in the treatment of facial freckles. Despite occasional adverse reactions, multiple indicators of various parts of the patient’s face have been significantly improved, with a low probability of later recurrence, making it worthy of clinical promotion.

Factors Related to Nevus-Associated Cutaneous Melanoma: A Case-Case Study

A proportion of cutaneous melanomas display neval remnants on histologic examination. Converging lines of epidemiologic and molecular evidence suggest that melanomas arising from nevus precursors differ from melanomas arising de novo. In a large, population-based study comprising 636 cutaneous melanomas subjected to dermatopathology review, we explored the molecular, host, and environmental factors associated with the presence of neval remnants. We found that nevus-associated melanomas were significantly associated with younger age at presentation, non-brown eye color, trunk site, thickness of less than 0.5 mm, and BRAFV600E mutation. Compared with patients with de novo melanomas, those with nevus-associated tumors were more likely to self-report many moles on their skin as a teenager (odds ratio= 1.94, 95% confidence interval= 1.01-3.72) but less likely to report many facial freckles (odds ratio= 0.49, 95% confidence interval= 0.25-0.96). They also had high total nevus counts (odds ratio= 2.18, 95% confidence interval= 1.26-3.78). On histologic examination, nevus-associated melanomas exhibited less dermal elastosis in adjacent skin compared with de novo melanomas (odds ratio= 0.55, 95% confidence interval= 0.30-1.01). These epidemiologic data accord with the emerging molecular paradigm that nevus-associated melanomas arise through a distinct sequence of causal events that differ from those leading to other cutaneous melanomas.

Chemical Peeling with a Modified Phenol Formula for the Treatment of Facial Freckles on Asian Skin.

Chemical peeling is an efficient method for the treatment of pigment disorders. For freckles, medium-depth to deep peeling using a phenol solution is one of the most effective chemical peels, and modifications of facial skin can be observed up to 20years after peeling. However, applying phenol to the skin may cause serious side effects. Phenol peeling has been rarely used in Asia due to its tendency to cause permanent pigmentary changes and hypertrophic scars. In total, 896 Chinese inpatients with facial freckles were enrolled in this study. The phenol formula was modified with crystalline phenol, dyclonine, camphor, anhydrous alcohol and glycerin and adjusted to a concentration of 73.6-90.0%. The entire peeling treatment was divided into two procedures performed separately on 2days. All patients exhibited 26% or greater improvement, and 99.66% of patients exhibited 51% or greater improvement (good and excellent). Scarring and systemic complications were not observed in any patient. The modified phenol formula is very effective and safe for the treatment of facial freckles in Asian patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Influence of MC1R Variants on Facial Aging Rate.

Aging of the skin is influenced both by intrinsic factors, such as chronological age, and by extrinsic or environmental factors, such as chronic ultraviolet exposure and smoking. Skin photoaging is defined as premature aging of the skin due to chronic sun exposure. Variation in human skin and hair color is due to differences in the absolute amounts and the relative proportions of black photoprotective eumelanin and red pheomelanin, which is regulated by the action of melanocortin-1 receptor (MC1R). Specific mutations in the MC1R gene are associated with distinct phenotypic features such as red hair, fair skin, and freckles. We have analyzed MC1R variants in 530 Caucasian women and have simultaneously assessed their degree of photoaging (Elfakir et al., 2010). After adjustment for possible confounders, the presence of two common variants of MC1R was identified as a risk factor for severe photoaging (adjusted odds ratio (AOR) (95% confidence interval (CI)): 2.33 (1.17–4.63)). This risk reached 5.61 (1.43–21.96) when two major diminished function variants of MC1R were present. Surprisingly, also the minor variant, V92M, was associated with increased risk of photoaging (2.57 (1.23–5.35)). In the same study, we found that two constitutive host factors were found to be independently associated with a history of facial freckles: frequent sunburns and the presence of diminished function variants of the MC1R gene. By contrast, in addition to age, five factors were independently associated with solar lentigines: constitutive host factors (dark skin color and tanning capacity), a history of freckles, sun-exposure behavior, and current intake of oral contraceptive or progestogen treatments. Surprisingly, we found an additional link between genetic variants of the MC1R gene and skin signs, i.e., the presence of two major diminished function variants of the MC1R gene was identified as a strong risk factor for sleep lines (AOR (95% CI): 8.25 (2.62–25.97)). Together, our studies confirm that genetic traits are major determinants of skin aging, and suggest that they should be considered when devising antiaging strategies.

Erratum to: Efficacy and safety of fractional carbon dioxide laser for treatment of unwanted facial freckles in phototypes II–IV: a pilot study

Erratum to: Efficacy and safety of fractional carbon dioxide laser for treatment of unwanted facial freckles in phototypes II–IV: a pilot study

Efficacy and safety of fractional carbon dioxide laser for treatment of unwanted facial freckles in phototypes II-IV: a pilot study.

Facial freckles are a cosmetic concern to Egyptians, particularly young females. Several therapeutic lines exist with variable response rates and limitations. Fractional carbon dioxide (FCO2) laser provides minimal ablation and therefore less down time and less side effects. The efficacy and safety of this laser technology have still not been studied in freckles. The aim of this study is to assess the efficacy and safety of FCO2 laser in the treatment of unwanted facial freckles in Egyptians. Twenty patients undergone a single session of FCO2 laser and then were followed up clinically a month later. Photographs were taken before treatment and at follow-up visit and were assessed by three blinded investigators. Percent of global improvement was measured on a 4-point grading scale. Patient's satisfaction and adverse events were recorded. Two patients (10%) showed grade 1 improvement, while eight patients (40%) showed grade 2 improvement. Nine patients (45%) showed grade 3 improvement, and only one patient (5%) showed grade 4 improvement. FCO2 laser resurfacing is effective and safe in treatment of facial freckles in skin phototypes II-IV. It can offer a more practical alternative to topical treatments, and a cheaper alternative to Q-switched lasers.

‘Eruptive’ amelanotic compound nevi in children with facial freckles and pale skin colour: more than an occasion?

‘Eruptive’ amelanotic compound nevi in children with facial freckles and pale skin colour: more than an occasion?

Freckles and solar lentigines have different risk factors in Caucasian women

To date, few epidemiological data on the relationships between solar lentigines, freckles and behavioural and constitutional risk factors in Caucasian populations exist. To investigate the potential impact of behavioural and phenotypic variables, as well as the MC1R genetic background, on the history of facial freckles and the severity of solar lentigines in Caucasian women. The severity of solar lentigines was graded from facial digital images of 523 French middle-aged women by a dermatologist and summarized by a score afterwards. The history of facial freckles was assessed and the sun-exposure behaviour was characterized using a six-category typology. Risk factors including MC1R polymorphism were evaluated using logistic regression models. Two constitutive host factors were found to be independently associated with a history of facial freckles: frequent sunburns and the presence of diminished function variants of the MC1R gene. In addition to age, five factors were independently associated with solar lentigines: constitutive host factors (dark skin colour and tanning capacity), a history of freckles, sun-exposure behaviour and current intake of oral contraceptive or progestogen treatments. These results strengthen the hypothesis that solar lentigines are markers of photoaging, whereas freckles are mainly determined by genetic factors. The finding that hormonal treatment is associated with a higher risk for solar lentigines merits further investigations.

Mutation screening of <I>MITF</I> gene in patients with Waardenburg syndrome type 2

Warrgenburg syndrome type 2 (WS2) is the most common autosomal dominantly-inherited syndrome with hearing loss. MITF (microphthalmia associated transcription factor)is a basic-helix-loop-helix-luecine zipper (bHLHZip) factor which regulates expression of tyrosinase, and is involved in melanocyte differentiation. Mutations in MITF associated with WS2 have been identified in some but not all affected families. Here, we report a three-generation Chinese family with a point mutation in the MITF gene causing WS2. The proband exhibits congenital severe sensorineural hearing loss, heterochromia iridis and facial freckles. One of family members manifests sensorineural deafness, and the other patients show premature greying or/and freckles. This mutation, heterozygous deletion c.639delA, creates a stop codon in exon 7 and is predicted to result in a truncated protein lacking normal interaction with its target DNA motif. This mutation is a novel mutation and the third case identified in exon 7 of MITF in WS2. Though there is only one base pair distance between this novel mutation and the other two documented cases and similar amino acids change, significant difference is seen in clinical phenotype, which suggests genetic background may play an important role.

A genome-wide scan for naevus count: linkage to CDKN2A and to other chromosome regions

High numbers of melanocytic naevi (moles), and mutations in the p16 gene (CDKN2A), are two strong risk factors for cutaneous malignant melanoma. We have previously reported linkage of mole count to the CDKN2A locus. Here, we report genome-wide scans for mole counts (differentiated into flat, raised and atypical subtypes) with a total of 796 microsatellite markers for 424 families with 1024 twins and siblings, plus genotypes for 690 parents. Inclusion of 221 pairs of MZ twins enabled separation of shared environmental and polygenic influences, so placing an upper limit to estimates of QTL variance. Maximum likelihood multipoint variance component methods were used to assess linkage of naevus count. Sex, age, body surface area, skin colour, hair colour, sunburn and facial freckles were included as covariates. Peak linkage of flat mole count was to regions on chromosomes 2, 9, 8 and 17 with lod scores 2.95, 2.95, 2.50 and 2.15, respectively. The support for linkage to the CDKN2A gene region (9p21) increased to 3.42 when additional fine mapping markers were added. For raised mole count, there was suggestive evidence of linkage in our sample to chromosome 16 (lod=1.87), and for atypical mole count on chromosomes 1, 6 and X with lod scores of 2.20, 2.00 and 2.00, respectively. The multivariate linkage peaks generally match those from individual trait analyses, with the exception of a new peak on chromosome 4 (point-wise empirical P-value=0.001). We replicate our earlier finding of linkage to CDKN2A and discovering linkage to several novel regions that may also influence risk of the development of malignant melanoma.

Intense Pulsed Light for the Treatment of Facial Freckles in Asian Skin

BACKGROUND Freckles are melanotic lesions frequently seen on the face and other sun-exposed areas. Previously evaluation of the severity of freckles has relied on the ultimately subjective assessment of the doctor or patient. Intense pulsed light (IPL) is newly introduced to treat facial freckles in Asian skin. OBJECTIVE To determine the effectiveness of IPL treatment for Asian patients with freckled skin and to assess a new and objective method for evaluation of the severity of freckling and posttherapy improvement using an ultraviolet (UV)-sensitive camera and film. METHODS Thirty-six patients with freckles were enlisted. IPL treatment was administered to patients with freckles in 4-week sessions. Irradiation wavelength was controlled using cutoff filters ranging from 550 to 590 nm, with a fluence of 25–35 J/cm2, with single- or double-pulse illumination and a pulse width of 4.0 msec. The assessments of the physician and patient were compared with the objective dermatologic evaluation with black-and-white and UV photography used to derive two treatment parameters, cosmetic density of freckles (CDF) and freckles area and severity index (FASI), which are applicable in a clinical setting. RESULTS By the end of the study, two attending physicians assessed the results for 86.1% of the subjects as excellent or good, with 91.7% of the patients reporting that they were extremely or very satisfied. A statistically significant improvement in mean FASI score was demonstrated at 6 months after treatment compared with baseline (n = 36, p < .005; paired t-test). Mean overall improvement rate (n = 36), as determined from the difference in mean FASI score, was 63% at 12 weeks and 58% at 6 months. CONCLUSION IPL is an effective and safe treatment for facial freckles in Asian skin, with relatively few adverse effects and high satisfaction levels.