Transient Hypopigmentation Research Articles

COMPARATIVE ASSESSMENT OF TATTOO REMOVAL WITH SINGLE SESSION OF R20 TECHNIQUE AND CONVENTIONAL TECHNIQUE

Background: Most suitable devices for tattoo removal at present are Q-switched ruby, Nd:YAG and Alexandrite lasers. 1 These are the current gold standard for laser tattoo removal . But there are few limitations, such as long duration of treatment, large interval between sessions; side effects such as blistering, scarring and dyschromia. The current methods attempted to reduce the total number of sessions and total duration to achieve clearing of tattoos. R20 method of tattoo removal is based on principle of repeated exposure of laser light in a single session. Aim: 1) to compare lightning of tattoos with a single pass Q-switched laser treatment with 4 treatment passes separated by 20 minutes 2) To compare the Adverse effects between two methods Methods and Material: It included 50 patients and were divided in half and randomized. Half of them received single pass treatment with Q-switched Nd:YAG laser 1064 nm used at energy of 360 mJ. Other half received multipass treatment (each pass at 20 minutes interval with maximum of 4 pass). Tattoo lightening and adverse effects compared 1month later i.e. after single session. Results: 1 month later, treatment with the R20 method was much more effective than conventional single-pass laser treatment. With R20 method, 100% patients experienced immediate erythema and edema, 16% patient experienced blistering, crusting. No obvious Scarring/permanent pigmentary changes in any patient. >75% fading experienced by 18 patients after single session, 50-75% fading in 4 patients, 40% experienced transient hypopigmentation. With single pass technique, all patients experienced <50% fading. Conclusion: With R20 method the number of sessions required for tattoo removal is greatly reduced thus decreasing the number of visits. It is more effective but also safe in most of the patients. The disadvantages are one single session can take 3½ to 4 hours.

Mental-Growth Retardation, Microphthalmia, Microcornea, Iris and Uvea Colobomata, Transient Ocular Hypopigmentation, and Contralateral Optic Disc Colobomata, and Dilated Third Ventricle: A New Syndrome

There is a large number of dysmorphic mental-growth retardation syndromes associated with various combinations of low set ears, ocular abnormalities such as microphthalmia, microcornea, ocular hypopigmentation, and colobomatas of the iris, uvea, and optic disc. The aim of this paper is to report the novel occurrence of a new dysmorphic mental-growth retardation syndrome associated with asymmetric ocular abnormalities including microphthalmia, microcornea, iris and uvea colobomata, transient ocular hypopigmentation, and contralateral optic disc colobomata, and dilated third ventricle.

Lasers in tattoo and pigmentation control: role of the PicoSure(®) laser system.

Background and objectivesThe use of picosecond lasers to remove tattoos has greatly improved due to the long-standing outcomes of nanosecond lasers, both clinically and histologically. The first aesthetic picosecond laser available for this use was the PicoSure® laser system (755/532 nm). Now that a vast amount of research on its use has been conducted, we performed a comprehensive review of the literature to validate the continued application of the PicoSure® laser system for tattoo removal.Study design and methodsA PubMed search was conducted using the term “picosecond” combined with “laser”, “dermatology”, and “laser tattoo removal”.ResultsA total of 13 articles were identified, and ten of these met the inclusion criteria for this review. The majority of studies showed that picosecond lasers are an effective and safe treatment mode for the removal of tattoo pigments. Several studies also indicated potential novel applications of picosecond lasers in the removal of various tattoo pigments (eg, black, red, and yellow). Adverse effects were generally mild, such as transient hypopigmentation or blister formation, and were rarely more serious, such as scarring and/or textural change.ConclusionAdvancements in laser technologies and their application in cutaneous medicine have revolutionized the field of laser surgery. Computational modeling provides evidence that the optimal pulse durations for tattoo ink removal are in the picosecond domain. It is recommended that the PicoSure® laser system continue to be used for safe and effective tattoo removal, including for red and yellow pigments.

A retrospective analysis on the management of pigmented lesions using a picosecond 755-nm alexandrite laser in Asians.

Photo-aging in Chinese often presents with benign pigmentary lesions. Q-switched lasers for pigmentary lesions in Asians had reported a risk of post-inflammatory hyperpigmentation (PIH) up to 25%. Longer pulse widths in the millisecond domains were advocated with reduced risk of PIH. Recently, picosecond lasers of various wavelengths were introduced with proven efficacy in tattoo removal. The objective of this study is to assess the efficacy and safety of a novel picosecond 755-nm alexandrite laser for the treatment of benign pigmented lesions in Asians retrospectively. A list of all patients who received picosecond 755-nm alexandrite laser treatment at a private dermatology center in Hong Kong was included. Those who had any other laser or topical treatment during the period of picosecond laser treatment were excluded. The age, skin phototype, type of pigmentary lesion, number of treatments performed was recorded. The baseline and most recent standardized photographs were assessed by trained physicians for comparison. A score of 0-4, representing poor 0-24%, fair 25-49%, good 50-74%, excellent 75-95%, and complete 95%+ improvement was given. Adverse events associated with the laser treatment were also recorded. All patients were followed up until 6 months after the last laser session. A total of 13 subjects were included in the present study. The number of treatment sessions received ranged from one to seven. The benign pigmentary lesions consist of Nevus of Ota, café-au-lait patches, lentigines, Becker's nevus, Hori's macules, and nevus spilus. Among patients with Nevus of Ota, one patient achieved complete clearance after four treatments and two other patients had excellent clearance after three and four sessions, respectively. Patients with café-au-lait had fair to good clearance after one to seven treatment sessions. One patient who has Hori's macules was resistant to laser treatments and a fair response was achieved after eight treatments. In the present series, two patients (4.8%) developed transient hypopigmentation, which had improved upon subsequent follow-up in both cases and none had post-inflammatory hyperpigmentation. The novel picosecond 755-nm alexandrine laser is effective for the treatment of benign pigmentary lesions in Chinese, especially for the clearance of Nevus of Ota. Picosecond laser appears to be associated with a much lower risk of PIH for treatment of pigmentary lesions in Asians.

EXTERNAL TRIGEMINAL NERVE STIMULATION (ETNS) FOR EPILEPSY

We offer patients with drug resistant epilepsy (aged 9+) eTNS and audit outcome. A self-adhesive electrode is placed on the forehead stimulating both trigeminal nerves (120 Hz, 30 seconds on/off). Patients set the current (noticeable/comfortable, 8 hours overnight). Results mean±SD, comparisons: paired ttest. Seven children started eTNS but two discontinued early (headache). Another developed transient hypopigmentation from the adhesive. Outcome for other 5 awaited. Sixteen adult started eTNS before October 2013. Two discontinued early (disliked sensation/unhappy with seizure pattern) and one after 15 weeks (efficacy). The remaining tolerated eTNS, completing 18 weeks; 8 chose to continue (116–277 days to date). One had transient forehead reddening when hot. eTNS was worn for 6½–12 hours/night with currents 2.6–7.6 mA. Efficacy could not be assessed in four. Of the remaining 10, seizure rate reduced from baseline 2.9±1.9 to 2.2±1.5 at 18 weeks (p=0.07): 5 had a greater than 30% reduction (one 50%). QOLIE-10w improved from 37±26 (n=12) to 18±17 (n=10), p=0.02, and BDI from 12±8 (n=12) to 6±5 (n-10), p=0.01. There was significant improvement in Pittsburgh and Epworth scales (p=0.04). These data support the safety, efficacy and tolerability of eTNS.

Treatment of café au lait macules in Chinese patients with a Q-switched 755-nm alexandrite laser

Background: Café au lait macules (CALMs) are a benign epidermal hyperpigmentation disorder. Although CALMs have been removed successfully with lasers, there have been few investigations on the use of the Q-switched 755-nm alexandrite laser. Objective: To evaluate the efficacy and safety of the Q-switched 755-nm alexandrite laser for the treatment of CALMs in Chinese patients. Materials and Methods: In this retrospective study, data of CALMs patients (n = 48) treated with a Q-switched 755-nm alexandrite laser were collected. Patients received an average of 3.2 treatments. Clinical responses were assessed by three blinded investigators. Adverse effects and recurrence rates were also evaluated. The mean follow-up time was 16.1 months. Results: Good to excellent responses were achieved in 26 patients (54.1%) and poor responses in 8 patients (16.7%). Recurrence was noted in five patients (10.4%) and transient hypopigmentation was observed in one patient. Efficacy was significantly greater in males than in females while patient age and lesional area did not show significant correlation with efficacy. Conclusions: The Q-switched 755-nm alexandrite laser shows relatively high efficacy in removing CALMs and the recurrence rate is low. Males respond might more favorably than females.

Evaluation of CROSS technique with 100% TCA in the management of ice pick acne scars in darker skin types

Acne scars are difficult to treat. Chemical reconstruction of skin scars (CROSS) is a technique using high strength trichloroacetic acid (TCA) focally on the atrophic acne scars to induce collagenization and cosmetic improvement. The aim of this study was to evaluate the efficacy and safety of CROSS technique using 100% TCA in ice pick scars in dark skin types IV and V. Thirty patients with ice pick acne scars were initially primed for 2 weeks before the procedure. The priming agents used were hydroquinone 4% applied in the morning and tretinoin 0.025% in the night. Sunscreens were advised to prevent postinflammatory hyperpigmentation. Subsequently, they underwent focal application of 100% TCA with a wooden toothpick in each individual scar, at 2 weekly intervals, for four sessions. Improvement was assessed by the physician, photographic assessment by an independent investigator, and patient feedback by visual analogue scale after the fourth treatment. Excellent improvement (more than 70%) was observed in the majority of patients (73.3%), while 20% patients showed good improvement (50-70%) and 6.7% patients had fair results (30-49%) at the end of four sessions. Transient hypopigmentation was observed in one patient and hyperpigmentation in two patients. However, no significant adverse effects such as prolonged pigmentary changes or scarring were noted. Treatment of ice pick acne scars with the CROSS technique using high strength 100% TCA is a safe, minimally invasive, efficacious, and cost-effective technique in darker skin. Adequate priming and continued use of hydroquinone and tretinoin reduces complications and promotes healing.

An assessment of the efficacy and safety of cross technique with 100% TCA in the management of ice pick acne scars

Background:Chemical reconstruction of skin scars (CROSS) is a technique using high concentrations of trichloroacetic acid (TCA) focally on atrophic acne scars to induce inflammation followed by collagenisation. This can lead to reduction in the appearance of scars and cosmetic improvement.Aims:The aim of this pilot study is to investigate the safety of the CROSS technique, using 100% TCA, for atrophic ice pick acne scars.Settings and Design:Open prospective study.Material and Methods:Twelve patients with predominant atrophic ice pick post acne scars were treated with the CROSS technique, using 100% TCA, applied with a wooden toothpick, at two weekly intervals for four sittings. Efficacy was assessed on the basis of the physician’s clinical assessment, photographic evaluation at each sitting and patient’s feedback after the fourth treatment, and at the three-month and six-month follow-up period, after the last treatment.Results:More than 70% improvement was seen in eight out of ten patients evaluated and good results (50 – 70% improvement) were observed in the remaining two patients. No significant side effects were noted. Transient hypopigmentation and hyperpigmentation was observed in one patient each. Physician’s findings were in conformity with the patient’s assessment. Three months after the last treatment, one patient noted a decrease in improvement with no further improvement even at the six-month follow-up period.Conclusion:The CROSS technique with 100% TCA is a safe, efficacious, cost-effective and minimally invasive technique for the management of ice pick acne scars that are otherwise generally difficult to treat. In few patients the improvement may not be sustained, probably due to inadequate or delayed collagenisation.

Alexandrite laser hair removal results in 2359 patients: A Turkish experience

Background: Various lasers have been developed for epilation of unwanted hair. Effective hair removal in the Turkish population can be difficult, and multiple treatments are usually required for effective treatment. Objective: To evaluate the safety and efficacy profile of a long-pulsed alexandrite laser for hair removal in the Turkish population with Fitzpatrick skin types II–V exclusively and to determine the benefit of multiple treatments. Methods: Retrospective clinical evaluation conducted from September 2005 to May 2008 at a referral private clinic. Pre-laser skin testing was performed starting at 16 J/cm2 and the energy fluence was selected according to response. All subjects were followed for 6 months after their final treatment. Results: A total of 2359 patients are reported (264 men and 2095 women) ranging in age from 14 to 70 years, for a total of 3830 treatment sites. The majority of treatment sites were axillae (24.2%) followed by the bikini line (16.8%). Maximum reductions observed were 95% for axillae, 92% for the bikini line, 86% for breast, respectively. The patients had a mean 80.6% hair reduction. Complications occurred in only 2.2% of cases. Transient hyperpigmentation (0.7%), folliculitis (0.5%), transient hypopigmentation (0.5%), and blistering (0.4%) were commonly seen complications. No subjects had scarring or long-term pigmentary changes. Conclusion: The long-pulsed alexandrite laser is safe for hair removal in darker skin tones. Although Turkish skin can be effectively treated with a cooled, long-pulsed alexandrite laser, complications do occur.

A newly modified 595-nm pulsed dye laser with compression handpiece for the treatment of photodamaged skin

The pulsed dye laser set the standard of care for the treatment of vascular lesions, and recent modifications have enabled improved efficacy with fewer side effects. An investigational high energy, variable pulse duration pulsed dye laser has been modified to treat both vascular and pigmented lesions associated with photoaging. Each laser pulse is comprised of a sequence of eight uniform micropulses, which evenly distribute the pulse energy, effectively increasing the purpura threshold at any given fluence. Pigmented lesions are treated with a compression handpiece (CHP) that removes competing vascular target from the field, and helps to prevent purpura. This pilot study was undertaken to determine the optimum laser settings, and to investigate the ability of this device to improve vascular and pigmented lesions associated with photoaging. Twenty-four patients with photoaged skin and phototype I-III were enrolled in the study. Thirteen received treatment for vascular and pigmented lesions, and 11 subjects were treated for pigmented lesions alone. Subjects received one to three treatments at 3-4 weeks intervals, and underwent 3- and 12-week follow-up evaluation. The degree of improvement was assessed by subject evaluation as well as comparison of standardized digital photographs by three independent dermatologists. Background erythema was treated with a 12-mm spot size, at a fluence of 7 J/cm(2), and a pulse width of 10 ms. The cryogen cooling was set at 30 mseconds with a 30 ms delay. Individual telangiectasias were treated with a 5- or 7-mm spot size at fluences of 9-14 J/cm(2) and pulse widths of 6-20 mseconds. Pigmented lesions were treated using a 5- or 7-mm spot size, with energy of 9-15 J/cm(2) and a pulse width of 1.5-10 ms without cooling. The CHP had a 7-mm spot size, and fluences of 9-16 J/cm(2), and pulse widths of 1.5 or 3 ms were used in the treatment of pigmented lesions. The treatment was well tolerated without the use of topical anesthetic. All subjects noted improvement in the both vascular and pigmented lesions, and were satisfied with their outcomes. Objectively, there was moderate improvement in background erythema, telangiectasia, and pigmented lesions. Three subjects who were treated with sun tans developed transient hypopigmentation and two subjects developed a transient textural change following pulse stacking for the treatment of pigmented lesions with the conventional handpiece. Purpura was noted in all patients treated for pigment with the conventional handpiece at pulsewidths less than 6 mseconds, as compared to only one that was treated with the CHP. Three patients treated in rapid succession for vascular, and then pigmented lesions with the CHP exhibited purpura, which was prevented in future treatments with 1-2 minutes of topical ice cooling between passes. This novel 595-nm pulsed dye laser, with a modified pulse sequence and CHP, now has the versatility to safely treat both pigment and vascular changes associated with photoaging.

Effective treatment of permanent tattoos with combustible particles due to blast injuries with a V-shaped device

Permanent tattooing due to blast injuries is a rare condition. Treatment with various different methods often yields unsatisfactory results. An innovative way to remove permanent traumatic tattoos is presented. A normal curettage blade is simply compressed with a pincer in order to create the new device. This V-shaped blade was used for surgical excision of the particles. No suture material or special dressing was used. Four patients with multiple explosive tattoos on the face were treated with the V-shaped knife. Due to the ease and speed of this method up to 300 particles were removed in one session. Histological analysis of the tissue samples showed deep dermal and subcutaneous particle location. At follow-up transient hypopigmentation but only minimal scarring was seen. Patients suffered less from itching, a chief complaint preoperatively, and aesthetic appearance of the facial skin was improved. In conclusion, treatment of traumatic tattoos with the V-shaped knife is effective, results in minimal scaring and restores the natural colour of the skin because the particle is completely removed. It is a promising method for treating multiple deep skin inclusions.

Er:YAG Laser Treatment of Verrucous Epidermal Nevi

BACKGROUND The term verrucous epidermal nevi refers to benign hyperplasia of the epidermis. Numerous treatment modalities have been tried, but no ideal treatment is yet available. We would like to present our experience with Er:YAG laser ablation in the treatment of verrucous epidermal nevi. OBJECTIVE The purpose of this study is to assess the long-term results of Er:YAG laser treatment of verrucous epidermal nevi. METHODS Twenty patients with verrucous epidermal nevi were treated with Er:YAG laser. Twelve patients were treated with the variable-pulsed Er:YAG laser, a 5-mm handpiece at the setting of 7.0 to 7.5 J/cm2, at a 500-μs pulse duration. The dual-mode Er:YAG laser, with a 2-mm handpiece at the setting of 6.3 J/cm2, at a 350-μs pulse duration (25 microns ablation), was used in eight patients. The laser was fired at 5 Hz until all epidermal nevi were removed. The results of treatment were evaluated for the changes of skin lesions, texture, and color by physicians over a 24-month period. RESULTS After a single laser treatment, successful elimination of the verrucous epidermal nevi was observed in 15 patients. Five patients (25%) showed a relapse within 1 year after the treatment. Postoperative healing time was 7 to 10 days. Erythema occurred in all patients after the laser treatment and subsided in 2 months. Postinflammatory hyperpigmentation occurred in two patients (10%). One patient (5%) experienced transient hypopigmentation. Mild to moderate postoperative acne flare-up occurred in one patient (5%) with facial lesions. No other adverse effects, including scarring, were observed. CONCLUSION The Er:YAG laser ablation is an effective, safe, and nonscarring method for the treatment of verrucous epidermal nevi.

Er:YAG laser treatment of verrucous epidermal nevi.

The term verrucous epidermal nevi refers to benign hyperplasia of the epidermis. Numerous treatment modalities have been tried, but no ideal treatment is yet available. We would like to present our experience with Er:YAG laser ablation in the treatment of verrucous epidermal nevi. The purpose of this study is to assess the long-term results of Er:YAG laser treatment of verrucous epidermal nevi. Twenty patients with verrucous epidermal nevi were treated with Er:YAG laser. Twelve patients were treated with the variable-pulsed Er:YAG laser, a 5-mm handpiece at the setting of 7.0 to 7.5 J/cm2, at a 500-micros pulse duration. The dual-mode Er:YAG laser, with a 2-mm handpiece at the setting of 6.3 J/cm2, at a 350-micros pulse duration (25 microns ablation), was used in eight patients. The laser was fired at 5 Hz until all epidermal nevi were removed. The results of treatment were evaluated for the changes of skin lesions, texture, and color by physicians over a 24-month period. After a single laser treatment, successful elimination of the verrucous epidermal nevi was observed in 15 patients. Five patients (25%) showed a relapse within 1 year after the treatment. Postoperative healing time was 7 to 10 days. Erythema occurred in all patients after the laser treatment and subsided in 2 months. Postinflammatory hyperpigmentation occurred in two patients (10%). One patient (5%) experienced transient hypopigmentation. Mild to moderate postoperative acne flare-up occurred in one patient (5%) with facial lesions. No other adverse effects, including scarring, were observed. The Er:YAG laser ablation is an effective, safe, and nonscarring method for the treatment of verrucous epidermal nevi.

Treatment of Pseudofolliculitis Barbae Using the Long-Pulse Nd:YAG Laser on Skin Types V and VI

BACKGROUND Pseudofolliculitis barbae (PFB) is a foreign body inflammatory condition that is caused by in-grown hairs of the face and body. An effective treatment to alleviate this condition without the risk of side effects has yet to be found. OBJECTIVE The objective of this study was to evaluate the Lyra 1064-nm long-pulse ND:YAG laser in the treatment of PFB on skin types V and VI. METHODS Twenty subjects (12 males and 8 females) were given two treatments approximately 3 to 4 weeks apart and were assessed by objective papule/pustule and hair counts at 1, 2, and 3 months after final treatment. Laser treatments with the Lyra Nd:YAG laser were applied onto 2×2-cm regions on the upper and lower mandible and neck regions. Contralateral controls were used to assess overall effectiveness. Subjective evaluations were also obtained from both subjects and investigators. Assessments of any abnormal side effects caused by laser treatment, including dyspigmentation and/or scarring, were also evaluated. RESULTS A reduction in the quantity of papules/pustules and hairs when compared with baseline data was statistically significant for treatment of PFB in the mandibular and neck regions at the 1-, 2-, and 3-month follow-up evaluations. Subject evaluations ranged from satisfied to very satisfied. Side effects included transient hyperpigmentation, transient hypopigmentation, mild erythema, and itching. CONCLUSIONS The use of the 1064-nm long-pulse Nd:YAG laser for the treatment and management of PFB on skin types V and VI is both safe and effective, with positive results lasting for up for to 3 months after two treatments.

Treatment of pseudofolliculitis barbae using the long-pulse Nd:YAG laser on skin types V and VI.

Pseudofolliculitis barbae (PFB) is a foreign body inflammatory condition that is caused by in-grown hairs of the face and body. An effective treatment to alleviate this condition without the risk of side effects has yet to be found. The objective of this study was to evaluate the Lyra 1064-nm long-pulse ND:YAG laser in the treatment of PFB on skin types V and VI. Twenty subjects (12 males and 8 females) were given two treatments approximately 3 to 4 weeks apart and were assessed by objective papule/pustule and hair counts at 1, 2, and 3 months after final treatment. Laser treatments with the Lyra Nd:YAG laser were applied onto 2x2-cm regions on the upper and lower mandible and neck regions. Contralateral controls were used to assess overall effectiveness. Subjective evaluations were also obtained from both subjects and investigators. Assessments of any abnormal side effects caused by laser treatment, including dyspigmentation and/or scarring, were also evaluated. A reduction in the quantity of papules/pustules and hairs when compared with baseline data was statistically significant for treatment of PFB in the mandibular and neck regions at the 1-, 2-, and 3-month follow-up evaluations. Subject evaluations ranged from satisfied to very satisfied. Side effects included transient hyperpigmentation, transient hypopigmentation, mild erythema, and itching. The use of the 1064-nm long-pulse Nd:YAG laser for the treatment and management of PFB on skin types V and VI is both safe and effective, with positive results lasting for up for to 3 months after two treatments.

A retrospective study on the efficacy and complications of Q-switched alexandrite laser in the treatment of acquired bilateral nevus of Ota-like macules.

Acquired bilateral nevus of Ota-like macules (ABNOM), or Hori's macules, is a common Asian condition that is characterized by bluish hyperpigmentation in the bilateral malar regions. Unlike nevus of Ota, ABNOM is an acquired condition that often develops after 20 years of age and involves both sides of the face, but there is no mucosal involvement. Recently Q-switched (QS) 1064 nm Nd:YAG lasers have been effective in clearing this condition. The effectiveness of QS alexandrite lasers has not yet been studied. To retrospectively assess the efficacy and complications of QS alexandrite lasers in the treatment of ABNOM. Thirty-two Chinese women with ABNOM ranging in age from 28 to 66 years were involved in the study. All underwent QS alexandrite laser treatment (755 nm, spot size 3 mm, 8 J/cm(2)). Topical hydroquinone and tretinoin cream were given to those with hyperpigmentation after the laser surgery. Clinical photographs were taken before and after laser surgery and assessed by two independent observers. The degree of clearing was scored and complications, including hypopigmentation, hyperpigmentation, scarring, and erythema, were assessed. The mean number of treatment sessions was 7 (range 2-11) and the mean treatment interval was 33 days. Both observers identified more than 80% of the patients as having more than a 50% degree of clearing, and complete clearance was seen in more than 28% of patients. Although most patients had postlaser hyperpigmentation and were on depigmentary regimes, the hyperpigmentation was seen in only 12.5% of the patients during photographic evaluation. Hypopigmentation was seen in 50% of patients and erythema in 41%. QS alexandrite appears to be effective in the treatment of ABNOM. Postoperative pigmentary changes were frequent and the use of topical depigmentary agents was necessary to achieve a satisfactory result. Transient hypopigmentation risk was high, affecting up to 50% of the patients. Further study is warranted to compare the efficacy and complications of different laser systems in the treatment of this condition.

“Hot” KTP‐laser treatment of facial angiofibromata*

Treatment of facial angiofibromata (AF) relied largely upon cutaneous resurfacing. While effective, resurfacing affects large areas with attendant risks of dyspigmentation, infection, and scarring. We investigated the pulsed KTP (532 nm) laser energy for its high absorption by melanin and hemoglobin as a photothermal destructive method for treating AF. In five patients (Fitzpatrick phototypes II-;VI), AF were treated with the KTP laser (10 ms, 20 J/cm(2), 2 mm beam) using stacked pulses (2-3.3 Hz) or passes. No cooling device was employed. Each pulse evoked puffs of steam and caused progressive flattening of AF. Normal intervening skin was strictly avoided. Patients underwent one to five sessions in which as many as 100 lesions were treated. Individual lesions responded with complete flattening in one or two treatments. While this effect has persisted for 18-;24 months, slow recrudescence is expected. Transient hypopigmentation and hyperpigmentation were localized to treated skin. No scarring, infection, or other adverse events were observed. Patient satisfaction with this method was high due to rapid healing time ( < 10 days), minimal pain, ease of wound care, and efficacy. "Hot" KTP laser is an effective and safe method of treatment for facial AF. Limiting treatment only to lesional skin allowed rapid healing and very limited adverse effects despite the increased non-specific thermal damage caused by high fluence, long pulse duration, and an absence of superficial tissue cooling.

Treatment of nevus of Ota with the Q‐switched alexandrite laser*

Q-switched laser systems have been shown to be useful for removal of nevus of Ota, a pigmented lesion on the face. The purpose of this study was to evaluate the efficacy of Q-switched alexandrite laser in the treatment of nevus of Ota in 13 patients. A spot test was made at 6.0, 7.0, and 8.0 J/cm(2) energy fluence, and the best energy fluence was selected after a 2-month postoperative evaluation. Q-switched alexandrite laser with a mean fluence of 7.290.46 J/cm(2) was used at 8-week intervals. Total treatment ranged from 1 to 15 sessions (mean 7.1 +/- 5.1 sessions). The single shot technique was used. More than 75% lightening was achieved in seven patients, between 51% and 75% in three, less than 50% in one, and less than 25% in one. In two patients with excellent clearance, a very light gray macula in the lower eyelid persisted after 8 and 14 treatment sessions, respectively. Mild transient hypopigmentation that subsided spontaneously after 2 months was observed in one patient. No repigmentation was seen. The Q-switched alexandrite laser seems to be an effective and safe modality for the treatment of nevus of Ota.

Laser removal of tattoos.

Tattoos are placed for different reasons. A technique for tattoo removal which produces selective removal of each tattoo pigment, with minimal risk of scarring, is needed. Nonspecific methods have a high incidence of scarring, textural, and pigmentary alterations compared with the use of Q-switched lasers. With new advances in Q-switched laser technology, tattoo removal can be achieved with minimal risk of scarring and permanent pigmentary alteration. There are five types of tattoos: amateur, professional, cosmetic, medicinal, and traumatic. Amateur tattoos require less treatment sessions than professional multicolored tattoos. Other factors to consider when evaluating tattoos for removal are: location, age and the skin type of the patient. Treatment should begin by obtaining a pre-operative history. Since treatment with the Q-switched lasers is painful, use of a local injection with lidocaine or topical anaesthesia cream may be used prior to laser treatment. Topical broad-spectrum antibacterial ointment is applied immediately following the procedure. Three types of lasers are currently used for tattoo removal: Q-switched ruby laser (694 nm), Q-switched Nd:YAG laser (532 nm, 1064 nm), and Q-switched alexandrite laser (755 nm). The Q-switched ruby and alexandrite lasers are useful for removing black, blue and green pigments. The Q-switched 532 nm Nd:YAG laser can be used to remove red pigments and the 1064 nm Nd:YAG laser is used for removal of black and blue pigments. The most common adverse effects following laser tattoo treatment with the Q-switched ruby laser include textural change, scarring, and pigmentary alteration. Transient hypopigmentation and textural changes have been reported in up to 50 and 12%, respectively, of patients treated with the Q-switched alexandrite laser. Hyperpigmentation and textural changes are infrequent adverse effects of the Q-switched Nd:YAG laser and the incidence of hypopigmentary changes is much lower than with the ruby laser. The development of localized and generalized allergic reactions is an unusual complication following tattoo removal with the Q-switched ruby and Nd:YAG lasers. Since many wavelengths are needed to treat multicolored tattoos, not one laser system can be used alone to remove all the available inks and combination of inks. While laser tattoo removal is not perfect, we have come a long way since the advent of Q-switched lasers. Current research is focusing on newer picosecond lasers, which may be more successful than the Q-switched lasers in the removal of the new vibrant tattoo links.

Adverse effects associated with the 577- and 585-nanometer pulsed dye laser in the treatment of cutaneous vascular lesions: A study of 500 patients

Background: The flashlamp-pumped pulsed dye laser has been used in the treatment of cutaneous vascular disorders since 1986. Although this laser is now widely used for the treatment of port-wine stains, telangiectases, and hemangiomas, the incidence of adverse reactions has not been clearly defined in a large series of patients. Objective: We assessed the incidence of adverse effects associated with the use of the pulsed dye laser in the treatment of vascular lesions. Methods: We studied 500 patients undergoing pulsed dye laser treatments for port-wine stains, telangiectases, and hemangiomas. All patients were examined during the course of their treatment to assess the incidence of adverse effects associated with the use of the pulsed dye laser. Results: There were no cases of hypertrophic scarring. The incidence of atrophic scarring was less than 0.1%. A spongiotic dermatitis was seen in 11 of 297 patients (0.04%) after multiple treatments of port-wine stains. Hyperpigmentation was seen in five of 500 patients (1%), whereas transient hypopigmentation was seen in 13 (2.6%). Conclusion: These findings demonstrate that the flashlamp-pumped pulsed dye laser is safe for the treatment of port-wine stains, telangiectases, and hemangiomas in children and adults.