Solar Lentigines Research Articles

Solar lentigines and ephelides removal in Asians using a combination of a novel 670 nm picosecond and 1,064 nm laser

Solar lentigines and ephelides removal in Asians using a combination of a novel 670 nm picosecond and 1,064 nm laser

Alterations of the pigmentation system in the aging process.

Human skin aging is a natural phenomenon that results from continuous exposure to intrinsic (time, genetic factors, hormones) as well as extrinsic factors (UV exposure, pollution, tobacco). In areas that are frequently exposed to the sun, photoaging blends with the process of intrinsic aging, resulting in an increased senescent cells number and consequently accelerating the aging process. The severity of photodamage depends on constitutional factors, including skin phototype (skin color, tanning capacity), intensity, and duration of sunlight/UV exposure. Aging affects nearly every aspect of cutaneous biology, including pigmentation. Clinically, the phenotype of age pigmented skin has a mottled, uneven color, primarily due to age spots, with or without hypopigmentation. Uneven pigmentation might be attributed to the hyperactivation of melanocytes, altered distribution of pigment, and turnover. In addition to direct damage to pigment-producing cells, photodamage alters the physiological crosstalk between keratinocytes, fibroblasts, endothelial cells, and melanocytes responsible for natural pigmentation homeostasis. Interestingly, age-independent diffuse expression of senescence-associated markers in the dermal and epidermal compartment is also associated with vitiligo, suggesting that premature senescence plays an important role in the pathology.

Langerhans Cells as Morphologic Mimickers of Atypical Melanocytes on Reflectance Confocal Microscopy: A Case Report and Review of the Literature.

Pagetoid spread of melanocytes in the epidermis is a common indicator of melanocytic atypia, both histopathologically and with reflectance confocal microscopy (RCM). Specifically on RCM, large, bright, atypical dendritic and/or roundish cells are characteristic of melanoma. However, intraepidermal Langerhans cells (ILC) create the potential for diagnostic ambiguity on RCM. We describe one case of a pigmented facial lesion that was initially diagnosed as lentigo maligna (LM) due to numerous atypical perifollicular dendritic cells on RCM. Additionally, we present the findings of a literature review for similar reported cases conducted by searching the following terms on PubMed: reflectance confocal microscopy, RCM, lentigo maligna, melanoma, Langerhans cells, dendritic cells, and atypical cells. In our case, the lesion was determined to be a solar lentigo on histopathology. Immunohistochemistry (IHC) with CD1a identified the atypical-appearing cells as ILC, as it did in 54 reported cases of benign lesions (benign melanocytic nevus, Sutton/halo nevus, labial melanotic macule, and solar lentigo) misdiagnosed as malignant on RCM (melanoma, lip melanoma, lentigo maligna, and LM melanoma). According to our case and the literature, both ILC and atypical melanocytes can present with atypical-appearing dendritic and/or roundish cells under RCM. Currently, there is no method to distinguish the two without IHC. Therefore, the presence of pagetoid cells should continue to alert the confocalist of a potential neoplastic process, prompting biopsy, histopathologic diagnosis, and IHC differentiation.

Citral-Containing Essential Oils as Potential Tyrosinase Inhibitors: A Bio-Guided Fractionation Approach.

Excessive melanin production causes serious dermatological conditions as well as minor aesthetic problems (i.e., freckles and solar lentigo). The downregulation of tyrosinase is a widespread approach for the treatment of such disorders, and plant extracts have often proven to be valuable sources of tyrosinase inhibitors. Citral (a mixture of neral and geranial) is an important fragrance ingredient that has shown anti-tyrosinase potential. It is highly concentrated in the essential oils (EOs) of Cymbopogon schoenanthus (L.) Spreng., Litsea cubeba (Lour.) Pers., Melissa officinalis L., and Verbena officinalis L. However, only L. cubeba EO has been investigated for use as a potential skin-whitening agent. This work evaluates the in vitro tyrosinase inhibitory activity of these EOs and studies, using bio-assay oriented fractionation, whether their differing chemical compositions influence the overall EO inhibitory activities via possible synergistic, additive, and/or competitive interactions between EOs components. The inhibitory activity of C. schoenanthus EO and that of M. officinalis EOs, with negligible (+)-citronellal amounts, were in-line with their citral content. On the other hand, L. cubeba and V. officinalis EOs inhibited tyrosinase to considerably greater extents as they contained β-myrcene, which contributed to the overall EO activities. Similar observations were made for M. officinalis EO, which bears high (+)-citronellal content which increased citral activity.

Epidemiology of Vitiligo - A Dual Population-Based Approach.

BackgroundMost epidemiological data on vitiligo refer to selected environments or focus on the prevalence of comorbidity unrelated to the population.ObjectiveAim of the study was to gain robust representative prevalence data on vitiligo and on associated dermatologic comorbidity in the German adult population.MethodsA dual population-based approach was applied with 1) primary data obtained between 2004 and 2014 from dermatological exams in the general working population; 2) claims data from a large German statutory health insurance, reference year 2010.ResultsIn the working cohort (N = 121,783; 57% male; mean age 43 years), the prevalence of vitiligo was 0.77% (0.84% in men; 0.67% in women). In the claims data (N = 1,619,678; 38% male; mean age 46 years), prevalence was 0.17% (0.14% in men; 0.18% in women). In the working cohort, vitiligo was significantly more common in people with fair skin type, ephelides and port-wine stains and less common in people with acne and solar lentigines. In the claims data, vitiligo was associated with a variety of skin conditions, eg, atopic dermatitis, psoriasis and alopecia areata.ConclusionThe resulting discrepancy of claims vs primary data between 0.17% and 0.77% indicates the most probable spectrum of vitiligo prevalence in Germany. It is more frequently observed in clinical exams than recorded in claims data, indicating a marked proportion of people seeking no medical help. Such nonattendance may result from the fact that many treatment options do not provide satisfying benefits to the patients.

090 White pine bark extract modulates cell-to-cell communication pathway for a lighten skin and age spot benefit

090 White pine bark extract modulates cell-to-cell communication pathway for a lighten skin and age spot benefit

Isolation of leaf and root extracts from Allium sativum and Mentha piperita plants; evaluation of their antioxidant and anti-tyrosinase activities in-vitro

Abstract-Tyrosinase is a key enzyme of melanogenesis which determines the mammalian skin, hair and eye colour. Hyper-pigmentation leads to various skin disorders like melasma, sunspots, age spots and freckles. Moreover, abnormal skin pigmentation is a serious aesthetic concern which leads to psychosocial problems. Thus to achieve melanin inhibition, inhibition of tyrosinase might be an effective approach. To this end we prepared methanolic (MeOH) extracts from leaves and roots of Allium sativum (AS) and Mentha piperita (MP), which were further processed for 1:1 fractional distillation to prepare methanolic n-hexane (MeOH_n-Hx), methanolic ethyl acetate (MeOH_EA) and methanolic chloroform (MeOH_CHCl3) extracts, aiming to evaluate tyrosinase and anti-oxidant activities in-vitro. Our results confirmed that all MeOH-crude AS and MP extracts showed significant anti-oxidant activity with IC50 values ranging from 0.05 ± 0.2 mg/ml to 4.3 ± 2.3mg/ml. Moreover, AS and MP all 16 extracts have significant anti-tyrosinase activity with IC50 range from 0.014 ± 0mg/ml to 1.205 ± 0.07mg/ml. Interestingly, AS leaf MetOH_EA, AS leaf MetOH_CHCl3, AS root MetOH_EA and MP leaf MetOH_CHCl3 showed significant anti-tyrosinase activity even higher than positive control kojic acid. AS leaf MetOH_CHCl3 extract being the most potent among all tested extracts is proposed as potential candidate to treat tyrosinase rooted hyper-pigmentation in future.

Patients with major medical illness seek cosmetic procedures to preserve a healthy appearance and avoid looking ill

Patients with major medical illness seek cosmetic procedures to preserve a healthy appearance and avoid looking ill

Treatment of benign hyperpigmentations and pigmented scars by 755 alexandrite laser comparing the Single Pass versus MultiPass (MoveoPL) emission in skin types I-IV.

Lasers are effective treatments for benign hyperpigmentations but may be difficult especially in darker skin type. In this randomized split-face controlled study on benign hyperpigmentations and pigmented scars, we compare the standard Single Pass (SP) emission with the MultiPass emission (MoveoPL) 755 alexandrite laser. Patients, skin types I-IV, with solar lentigines and ephelides of the face, chest, and hands and patients with pigmented scars of the legs, underwent laser treatment, by treating one side of the body or half scar using the SP and the other side using MoveoPL. Improvements according to a grading score system, side effects, and patient satisfaction were recorded. About 63 patients were enrolled. An overall improvement of benign hyperpigmentations and pigmented scars was recorded, with a grading score (±SD) of 2.8 ± 0.8 for SP and 3.6 ± 0.5 for MoveoPL (range, 0-4). SP emission showed best results in skin types I-II whereas MotusPL obtained successfully results in all the phototypes analyzed (types I-IV). Patients preferred MoveoPL as it was associated with fewer side effects. Both standard SP and MoveoPL emission are effective and safe. MoveoPL showed a higher efficacy and safety profile for the treatment of hyperpigmentations.

A Randomized Controlled Trial on the Effectiveness of Epidermal Growth Factor-Containing Ointment on the Treatment of Solar Lentigines as Adjuvant Therapy.

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.

Clinical brightening efficacy and safety of Melasolv™ (3,4,5-trimethoxy cinnamate thymol ester, TCTE) in Southeast Asian women.

Skin darkening because of increased and irregular synthesis of melanin causes melasma, solar lentigo, and freckles. Melasolv™, produced in the early 2000s, shows potent depigmenting effect and has low cytotoxicity. It has been used as a brightening agent in cosmetics for decades. This study was conducted to investigate whether Melasolv™ is effective for the skin of ASEAN (Southeast Asia) women. We recruited ASEAN women in Singapore and divided them into two groups (active group vs. placebo group). Melasolv™ and placebo formulations were applied twice a day for 12weeks. The changes in the pigmented spots were visually evaluated by an expert and assessed using a spectrophotometer and Mexameter at 0, 4, 8, and 12weeks. The visual evaluation revealed significant improvements, in both size and color intensity, in the active group compared with those in the placebo group at 12weeks. In the spectrophotometric evaluation, the L* value of the pigmented spots in the active group was significantly higher than that in the placebo group at 12weeks. Similar results were obtained in the evaluation using the Mexameter. After 12weeks, the melanin index of the pigmented spots significantly decreased, and it was significantly higher than that in the placebo group. There was no significant change in the erythema index. In the image analysis, there were no significant differences in skin color brightness and evenness in the active group compared with those in the placebo group. Melasolv™ can be effective used for skin brightening.

Patient Satisfaction and Management of Postoperative Complications Following Ablative Carbon Dioxide Laser Resurfacing of the Lower Eyelids.

To describe postoperative management following ablative carbon dioxide laser resurfacing of the lower eyelids. A retrospective review of patients who consecutively underwent bilateral lower eyelid ablative carbon dioxide laser resurfacing by a single experienced oculoplastic surgeon over a 6-year period was conducted. Patient satisfaction, aesthetic outcomes, and postoperative complications were evaluated as adjunctive or monotherapy. Among 424 patients included in the study, most were female (n = 356, 84.0%) and Caucasian (n = 404, 95.3%), with Fitzpatrick skin types II-III (n = 381, 89.9%). Mean age was 62.8 years (standard deviation: 9.7 years). Most (n = 324, 76.4%) underwent fractional ablative carbon dioxide laser resurfacing of the lower eyelids, whereas 91 (21.5%) received traditional laser resurfacing and 9 (2.1%) had both fractional and traditional laser resurfacing during the same session. At the time of lower eyelid laser resurfacing, most patients also underwent concurrent procedures, including upper (n = 321, 75.7%) and lower blepharoplasty (n = 348, 82.1%); a small proportion of patients (n = 39, 9.2%) did not undergo any concurrent surgical procedure. In addition to ablative laser resurfacing of the lower eyelids, 25 (5.9%) had upper eyelid laser resurfacing, 60 (14.2%) had full-face laser resurfacing, 55 (13.0%) had neck laser resurfacing, and 42 (9.9%) had additional treatment of solar lentigines or dyschromias on the face. Median follow-up duration was 3.9 months (interquartile range: 2.0-11.0 months). In the immediate postoperative period, 22 patients (5.2%) developed contact dermatitis from topical antibiotic eye drops and/or ointment prescribed postblepharoplasty. Postinflammatory hyperpigmentation was observed in 40 patients (9.4%) despite topical prophylaxis; all were eventually successfully treated with a combination of topical nonprescription and prescription creams and/or oral tranexamic acid. A localized herpetic outbreak occurred in 3 (0.7%) who underwent full-face laser resurfacing and 1 (0.2%) who underwent periocular laser resurfacing only; all were successfully treated with oral antiviral therapy. Two (0.5%) developed culture-proven atypical mycobacterial infection of the resurfaced lower eyelid skin and were treated with combination antibiotic therapy for several months until resolution. A small scar was noted in 4 patients (0.9%), which resolved after local corticosteroid injections. No patient developed persistent scarring or ectropion. Patient satisfaction was overall high, with 363 (85.6%) very satisfied and 48 (11.3%) satisfied with the aesthetic outcome of lower eyelid laser resurfacing. Ablative carbon dioxide laser resurfacing of the lower eyelids can be a useful tool in the armamentarium of the experienced oculoplastic surgeon, with excellent aesthetic results, high patient satisfaction, and low complication rates as adjunctive or monotherapy. Proper and timely management of postoperative complications is essential to maximizing successful cosmetic outcomes.

Cellulose Nanocrystals for Skin Barrier Protection by Preparing a Versatile Foundation Liquid.

Most of the foundation liquids in the market need makeup removers for cleaning, while the excessive use of makeup removers might lead to skin barrier damage, which would further lead to many kinds of dermatosis, such as skin sensitivity, facial telangiectasia, rosacea, acne, as well as various cosmetic contact dermatitis. Inspired by the protective effect of fiber-rich diet on the intestinal mucosal mechanical barrier, a novel hemp/cellulose nanocrystals (CNCs)-based foundation liquid featuring easy-wiping property has been constructed, which will effectively solve the post-makeup skin cleaning problems. In this experiment, the formula of the foundation liquid can be obtained through hemp/CNCs instead of mineral oil and titanium oxide, which are considered to have undesirable local tolerance, sensitizing potential, and are environmental pollutants, to create a moisture barrier. Industrial hemp is a hot issue in cosmetic research, and a great quantity of discarded industrial hemp stalk is available to be used to produce hemp/CNCs through grinding and acidification. The graft technique is adapted to obtain hemp/CNCs-g-polylactic acid (PLA). By replacing the hydroxyl group on the side of hemp/CNCs, hemp/CNCs-g-PLA reduces the intermolecular hydrogen bonding, resulting in a higher dispersion in the oil phase. The hemp/CNCs-g-PLA has excellent performance in terms of biological compatibility, water resistance, and non-penetration into the skin. With basic features of a foundation liquid to alleviate discoloration, age spots, and skin roughness, the foundation liquid based on hemp/CNCs-g-PLA provides a novel characteristic of easy-wiping, which helps to avoid the damage to the skin barrier caused by excessive cleansing.

Perspective approaches on melanogenesis inhibition

Melanogenesis is a melanin-forming process responsible for protecting the skin against ultraviolet radiation damage. An excess production of melanin, however, may result in hyperpigmentation (darkening of the skin) to adverse dermatological effects (freckles, solar lentigines, and melasma) and skin cancer. These hyperpigmentary skin disorders may also have a major effect on a person's appearance and could even result in emotional and mental distress, as well as a diminished quality of life. A large number of melanogenesis inhibitors have been discovered, but most of them appeared to have undesirable side effects. Therefore, in order to better understand the mechanisms of hyperpigmentary skin disorders and to establish effective and safe melanogenesis inhibitors, more fundamental research is needed. Apart from tyrosinase blockers, there are also alternative approaches that involve the manipulation of melanogenesis regulatory pathway such as α-melanocyte-stimulating hormone blockers, melanosome transferase inhibitors, and cytokines. This review abridges data on the different melanogenesis inhibitors and depigmentation agents from both natural and synthetic agents from the last few years.

The Miniature Macula-Ephelis

An ephelis is a miniature, benign, brown or tan cutaneous blemish which appears upon sun exposed surfaces. Genetic composition and cutaneous subtype of incriminated individual directs the emergence of ephelis. Generally spherical, ephelis demonstrates a localized area of hyperpigmentation contingent to magnitude of sun exposure. Superimposed stratified squamous epithelium exhibits hyperpigmentation of basal keratinocytes and elongation of rete ridges whereas quantifiable melanocytes remain unaltered. Ephelis requires segregation from conditions such as café-au-lait macules, junctional nevus, solar lentigo, melano-acanthoma, melanosis, moles, sun spots, liver spots and malignant epithelial neoplasms. The innocuous ephelis does not require treatment although protection from sun exposure is recommended.

Clinical Evaluation of Safety and Efficacy of a 670-nm Picosecond Laser for Treatment of Benign Pigmented Lesions in Asians

BACKGROUND Picosecond lasers are increasingly being investigated in treating pigmentation disorders because they may provide better treatment efficacy and comfort compared with nanosecond lasers. OBJECTIVE This study aims to evaluate the efficacy and side effect of a novel 670-nm picosecond laser in the removal of benign pigmented lesions (BPLs) in individuals with Fitzpatrick skin types (FST) III and IV. MATERIALS AND METHODS Fifteen subjects with solar lentigines and 7 subjects with ABNOMs received a single treatment with a 670-nm picosecond laser. Blinded physicians assessed the pigment clearance using a 5-category grading system scale. All subjects were evaluated at 1 month, 3 month, and 6 month after a single treatment. Adverse events were recorded at every follow-up visit. RESULTS All subjects with lentigines had complete clearance (95%–100%) of lesions during 3-month follow-up after a single treatment session of 670-nm picosecond laser, whereas 75% of the subjects with ABNOMs noted fair lightning (25%–49%) of lesions. Mild hypopigmentation and hyperpigmentation were observed in 9% and 14% of the subjects, respectively, which resolved within 3 months after the treatment. CONCLUSION The novel 670-nm picosecond laser is a safe and effective treatment for BPLs in subjects with FST III and IV with low rates of transient adverse effects.

Delivering a geriatric OSCE station in times of Covid-19 using makeup artistry.

In the wake of the Covid-19 pandemic, people over 65 or suffering from certain conditions were deemed at high risk and asked to isolate themselves. This led to the simulated patient (SP) program at the University of Bern being depleted of middle-aged and elderly SP. Meanwhile, an OSCE had to be delivered using adapted cases that minimized physical contact between candidates and SP. Short of suitable cases at such short notice, the case of an elderly patient with postural instability had to be added to the exam blueprint. With elderly SP off the roster, it was decided to use makeup effects to achieve visual authenticity. A combination of wigs (grey hair, hairdo), 3D Probondo transfers (forehead wrinkles), old age stipple (crow’s feet), and colouring (age spots) were used to achieve the old-age effects, while SPs wore scarves to cover their neckline. The lower face was covered with protective face masks in accordance with the exam’s Covid-19 hygiene protocol.Case-related feedback from candidates and examiners was analysed for any direct or indirect remark attributable to the ageing effects. As no comment touched upon the subject of the appearance of age, this was interpreted as success, as any distracting effect from the SPs’ appearance in this regard would surely have prompted remarks or even complaints. The SPs’ feedback revealed how applying the ageing effects helped them adopt the octogenarian’s role.This report explains how SP in their fifties were made fit for an octogenarian’s case in an OSCE using makeup effects. The effort required for the ageing simulation was considerable, but it is hoped that in future, with more planning time, the amount of effort required can be reduced. The feedback obtained from the candidates suggest the appearance of SPs was not experienced as a distraction, which was the primary objective of this exercise. Adapting our approach to their own contexts allows educators to include cases with elderly patients in their OSCE that cannot be re-written for younger SP, so long as Covid-19 prevents elderly SP from participating.

18274 Particulate matter

Background: There is increasing evidence that pollution causes premature skin aging, including loss of elasticity and hyperpigmentation. Multiple clinical studies have demonstrated a link between air pollution and skin hyperpigmentation, or age spots. Particulate matter with a diameter <2.5 μm (PM2.5) is one of the main components of air pollution that carries harmful heavy metal and toxic chemical compounds such as polycyclic aromatic hydrocarbons. The current study used cultured melanocytes to demonstrate PM2.5-induced hyperpigmentation and investigate the effect of a known potent antioxidant, a purified feverfew extract.

Teledermatology reduces dermatology referrals and improves access to specialists.

BackgroundTeledermatology may be used for triage in primary care to address skin conditions, improving access and reducing time to treat the most severe or surgical cases. We aimed to evaluate the proportion of individuals who could be assessed in primary care using teledermatology, and how this affected the waiting time for an in-person dermatologist appointment.MethodsA cross-sectional retrospective study, involving 30,976 individuals and 55,624 skin lesions, was performed from July 2017 to July 2018 We assessed the frequency of diagnoses and referrals to biopsy, to in-person dermatologists, or to primary care, and compared the waiting time for an in-person dermatologist appointment before and after the teledermatology implementation.Findings53% of the patients were managed with the primary care physician, 43% were referred to in-person dermatologists and 4% directly to biopsy, leading to a reduction of 78% in the waiting time for in-person appointments when compared to the previous period. The most frequent diseases were: melanocytic nevus, seborrheic keratosis, acne, benign neoplasms, onychomycosis, atopic dermatitis, solar lentigo, melasma, xerosis, and epidermoid cyst, with significant differences according to sex, age and referrals. The most frequent treatment prescribed was emollient.InterpretationThe use of teledermatology as a triage tool significantly reduced the waiting time for in-person visits, improving health care access and utilizing public resources wisely. Knowledge of sex, age, diagnoses and treatment of common skin conditions can enable public policies for the prevention and orientation of the population, as it can be used to train general physicians to address such cases.FundingNone.

Chemical peeling for treatment of Melasma, pigmentary disorders and hyperpigmentation : Indications, effectivity and risks

Pigmentary disorders and hyperpigmentation are widespread. Dark skin types in particular show a tendency to formation of melasmas and to hyperpigmentation. Light skin types have a tendency to ephelides and solar lentigines. In addition to topical treatment with lightening substances, superficial chemical peeling as well as combined procedures of topical treatment with chemical peeling play an important role in the treatment of hyperpigmentation. A strict avoidance of UV light and consequent daily application of sun protectíon factor 50+ are mandatory for successful treatment.