Facial Lentigines Research Articles

Q‐switched ruby versus long‐pulsed dye laser delivered with compression for treatment of facial lentigines in Asians

Q-switched lasers have been used for the treatment of lentigines but post-inflammatory hyperpigmentation (PIH) can be an issue especially in Asians. The 595 nm long-pulsed dye laser (LPDL) has been used for the treatment of vascular lesions and although it is well absorbed by oxyhemoglobin, it is also absorbed by melanin. To use this device for the treatment of facial lentigines, we attached a flat glass lens to the tip of the laser's handpiece, allowing compression of the skin during treatment. In doing so, eliminated the absorption by oxyhemoglobin. This prospective study aims to compare the efficacy and complications of such an approach to the use of Q-switched ruby laser (QSRL) in the treatment of facial lentigines in Asians. Eighteen Asian patients (1 male, 17 female) with facial lentigines Fitzpatrick skin types III-IV were enrolled. One of the lentigines present was treated with LPDL by compression method and the other one was treated with QSRL. A LPDL emitting wavelength of 595 nm, spot size of 7 mm was used, with fluence between 10 and 13 J/cm(2) and pulse duration of 1.5 milliseconds. Cryogen spray cooling was not used. A 694 nm QSRL was used with a spot size of 4 mm, fluence of 6-7 J/cm(2), and pulse duration of 30 nanoseconds. Lightening of the lesions was assessed by reflectance spectrometer Erythema, hypo- or hyperpigmentation and scarring were also assessed by clinical examinators. The degree of clearing achieved with the two lasers was 70.3% and 83.3% for QSRL and LPDL, respectively. All QSRL treated areas developed erythema whereas only 4 of 18 LPDL treated areas developed erythema. Hyperpigmentation was seen in four patients after QSRL, but not after LPDL. There was no scarring or hypopigmentation. LPDL delivered with a compression method is more effective than QSRL for facial lentigines. Complications after LPDL treatment were substantially less frequent than after QSRL. The addition of compression technique may allow "vascular" pulsed dye laser to be used for treating a variety of pigmented lesions.

Treatment of Facial Lentigines in Peutz–Jeghers Syndrome With an Intense Pulsed Light Source

BACKGROUND Peutz–Jeghers syndrome is a hereditary condition characterized by distinctive mucocutaneous lentigines and intestinal hamartomatous polyposis. The cutaneous lesions may be cosmetically disfiguring and frequently present a therapeutic challenge. OBJECTIVE To determine if intense pulsed light (IPL) is effective in treating facial lentigines in Peutz–Jeghers syndrome. METHODS The IPL, utilizing a 590 nm cutoff filter, was used to treat facial lentigines in a 10-year-old girl with Peutz–Jeghers syndrome. RESULTS A series of 12 treatment sessions, each to different facial regions, resulted in complete clearance of lentigines in the treated areas. Most of the lentigines resolved after a single treatment, with a few areas requiring a second treatment. CONCLUSION In this case, treatment with IPL resulted in dramatic improvement of cosmetically disfiguring lentigines. To our knowledge, this is the first report of using IPL in Peutz–Jeghers syndrome.

Myelolipoma: A New Adrenal Finding in Carney's Complex?

Pigmented nodular cortical hyperplasia. a rare cause of Cushing's syndrome, is characterized by resistance to inhibition with dexamethasone and normal sized adrenal glands with multiple, small, pigmented nodules. The disorder may be a component of a syndrome inherited as an autosomal dominant pattern that includes intra- and extracardiac myxomas, lentiginous lesions, blue nevi, other functional endocrire tumors, and perppheral nerve tumors (Carney's complex). We report a patient in whom bilateral myelolipomas were found, in addition to the usual features of this complex. A 29-yr old man was admitted to the hospital for Cushing's syndrome of probably more than 15 yr duration. Physical examination showed diffuse facial hyperchromatic macules. 02-05 cm, predominantly around the lips and on the palmar surfaces of the fingers. Results with dexamethasone suppression nocturnal testing (1 and 8 mg) were compatible with an adrenal adenoma. The computed tomography (CT) of the sella turcica was normal. Adrenal CT showed a tumor in the left gland with a double component one solid and another suggestive of fat, consistent with an angiomyelolipoma. Following 5 wk treatment with ketoconazole, 800 mg per day po, serum cortisol decreased to 5.9 Ag/dL. morning and evening, respectively. Bilateral adrenalectomy was performed. Pathologic examination revealed pigmented nodular cortical hyperplasia and a dominant myelolipoma in the left adrenal. A microscopic myelolipoma was identified in the right adrenal. An echocardiogram showed a mass on the posterior wall of the left ventricle which was a myxoma. Study of the patient's family disclosed two sisters with facial lentigines. Echocardiograms were performed on all available first degree relatives: all were normal. Nocturnal inhibition with dexamethasone revealed that one of the patient's sisters with lentigines also had hypercortisolism. Myelolipoma has been reported in association to Cushing syndrome in humans and experimentally after pituitary extracts in animals. The relationship between this finding and the Carney's complex remain elusive.

Lentiginosis Profusa Syndrome (Multiple Lentigines Syndrome)

A mother and daughter exhibited typical manifestations of lentiginosis profusa syndrome, including widespread lentigines, hypertelorism, defective oculomotility, hearing loss, and cardiopathy. Previously unreported findings included granular cell myoblastomas, pronounced degree of oculomotor defects, interdigital webs, onychodystrophy, certain dermatoglyphic abnormalities, and a distinctive pattern of lentigines fading on the upper part of the trunk around mid-life. An underlying neurogenic disorder, possibly mutant stem cells in the embryonic neural crest, might account for the melanocytic alterations, granular cell neoplasms, oculomotor defects, hearing loss, and cardiac conduction defects. Dermabrasion eradicated many of the facial lentigines. Since typical sized lentigines gave no evidence of evolving into nevocytic nevi, cosmetic benefits derived from dermabrasion of sufficient depth may be lasting. Lentiginosis profusa syndrome shares a constellation of manifestations with other genopathies, notably neurofibromatosis and Noonan's syndrome.