Treatment Of Lentigines Research Articles

S2k guideline: Laser therapy of the skin.

This guideline aims to improve the efficiency and safety of lasers and optical radiation sources with similar effects (especially IPL). Laser therapy of skin lesions with an increased amount of melanocytes should be performed with caution. Laser treatment of pigmented melanocytic nevi is not recommended. The guideline contains recommendations regarding the treatment of lentigines and café-au-lait spots, non-pigmented dermal nevi, Becker nevus, nevus of Ota/Hori/Ito and melasma. Further recommendations focus on the treatment of skin lesions without an increased amount of melanocytes (ephelides, postinflammatory hyperpigmentation including berloque dermatitis, seborrheic keratoses, traumatic/decorative tattoos and metallic deposits), hypopigmentation (vitiligo), benign non-pigmented neoplasms (fibrous papule of the nose, nevus sebaceus, epidermal nevus, neurofibroma, sebaceous gland hyperplasia, syringoma, xanthelasma palpebrarum), inflammatory dermatoses (acne papulopustulosa/conglobata, acne inversa, granuloma faciale, lichen sclerosus, lupus erythematosus, psoriasis vulgaris, rosacea, rhinophyma), wrinkles/dermatochalasis/striae, hypertrichosis, scars (atrophic, hypertrophic; keloids, burn/scald scars), laser-assisted skin healing, onychomycosis, precancerous lesions and malignant tumors (actinic keratoses/field cancerization, cheilitis actinica, basal cell carcinoma), vascular skin lesions (angiokeratoma, angioma, hemangioma, malformation, spider veins, granuloma telangiectaticum (pyogenic granuloma), rubeosis (erythrosis interfollicularis colli, ulerythema ophryogenes), nevus flammeus, telangiectasias and Osler's disease (hereditary hemorrhagic telangiectasia) and viral skin lesions (condylomata acuminata, mollusca contagiosa, verrucae planae juveniles/vulgares/ verrucae palmares et plantares).

A Prospective Study in the Treatment of Lentigines in Asian Skin Using 532 nm Picosecond Nd:YAG Laser.

To evaluate safety and efficacy of treatment with the picosecond Nd:YAG 532 nm forlentigines in Asian skin. This was a prospective, open-label cohort study, using a novel picosecond 532-nm laser for the treatmentof facial lentigines. Subjects received up to three laser treatments every 4-6 weeks and were assessed at 4 and 12 weeks after final treatment. Primary endpoint was degree of improvement in lentigines at 12 weeks after the final treatment, assessed by treating investigator based on Physicians Global Assessment. Secondary end-points included degree of improvement in lentigines at 12 weeks after final treatment, assessed by subject (Subject's Global Assessment), and change in mean relative Melanin index (MI) value at 3 months after final treatment as compared to baseline as assessed by mexameter measurement. A total of 20 patients (3 male, and 17 female) of Asian-descent with Fitzpatrick skin type III and IV, with lentigines on the face were included in this study. A total of 89 lesions were treated with the laser setting of 532-nm, 750 picoseconds, fluence of 0.2-0.5 J/cm 2 , and spot size of 4 mm. One hundred and thirty-seven treatment sessions were given in total. Eighteen patients (90%) achieved a moderate to significant improvement at 12-week follow-up based on a 5-grade physician global assessment scale. The improvement rate of relative MI (MI in the lesion minus normal skin) was 33.30 ± 18.71 and 37.63 ± 19.25% at 4- and 12-week follow-up. Post-inflammatory hyperpigmentation (PIH) occurred in 14 of 137 sessions (10.2%), and hypopigmentation occurred in one patient with five lesions (3.6%). This study demonstrates that using picosecond Nd:YAG laser 532 nm for removal of solar lentigines in darker skin type appears to be safe and effective. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc. Small study group.

Sound levels and safety in cosmetic laser surgery.

Measure the sound levels produced by various lasers commonly used during routine outpatient cosmetic surgery to determine whether or not their use exceeds exposure levels set forth by the US National Institute for Occupational Safety and Health (NIOSH) and the US Occupational Safety and Health Administration (OSHA). Using two different meters, the sound levels of lasers commonly used in cosmetic surgery were recorded during various procedures for several indications: tattoo removal, treatment of lentigines and pigmented lesions, facial erythema and vascular lesions, hair removal and resurfacing of acne scars, and photoaging. All but five lasers had a maximum sound level below 85 dBA, the limit proposed by NIOSH. The loudest laser examined was a fully ablative 2,940 nm Er:YAG during facial resurfacing, with an average maximum sound level of 101.5 decibels (dBA). Two other lasers used for resurfacing exceeded 85 dBA including a fractional ablative 1064 Nd:YAG with an average maximum of 97.8 and a different fully ablative 2,940 nm Er:YAG which had an average maximum of 96.3 nm. The two other lasers that exceeded 85 dBA were picosecond lasers used to treat black tattoos, including a 1,064 nm Nd:YAG with an average maximum of 93.7 dBA and a 755 nm alexandrite with an average maximum of 93.6 dBA. Although some lasers in cosmetic surgery may be perceived as being quite loud, they remain safe. Even the loudest laser studied would have to be used for nearly 2 hours before exceeding the OSHA recommended exposure limit. Even physicians who spend a large amount of time using lasers in clinical practice should be reassured that these devices are not likely to produce noise-induced hearing loss (NIHL) hearing loss. Lasers Surg. Med. 51:491-494, 2019. © 2019 Wiley Periodicals, Inc.

Effectiveness of the Pulse Dye Laser Treatment in a Caucasian Women With Dermatosis Papulosa Nigra.

Dermatosis papulosa nigra (DPN) is a group of superficial, benign papules commonly in African-American and Asian persons. DPN is considered to be a form of seborrheic keratosis with a specific localization and it is less frequently described in the white population. Treatment modalities include cryosurgery, curettage, electrosurgery, shave removal, and different laser treatment. Pulsed dye laser (PDL) has traditionally been used to treat vascular lesions, but it has been shown to be effective in treatment of lentigines, ephelides, seborrheic keratosis, and rarely DPN. A 43-year-old white female presents with a 5 year-old history of hyperpigmented papules on malar region, neck and upper trunk. The patient is diagnosed with DPN based on her clinical and histopathological findings. The PDL treatment was used successfully. In our opinion PDL is an effective alternative cure option for DPN.

Q‐switched alexandrite laser treatment of facial and labial lentigines associated with Peutz–Jeghers syndrome

The Q-switched alexandrite laser used at 752 nm, a wavelength well absorbed by melanin relative to other optically absorbing structures in skin, causes highly selective destruction of pigment-laden cells. In addition, the 75-nanosecond pulse duration produced by this laser approximates the thermal relaxation time for melanosomes, thereby confining the energy to the target. Facial and labial dark brown macules quickly identify patients with Peutz-Jeghers syndrome. These lentigines may be cosmetically disfiguring. The Q-switched alexandrite laser produces clinically significant fading of mucocutaneous melanosis in association with Peutz-Jeghers syndrome without complications often seen with other therapeutic modalities. To evaluate the efficacy and safety of the Q-switched alexandrite laser in treating facial and labial lentigines of Peutz-Jeghers syndrome. 43 patients diagnosed with Peutz-Jeghers syndrome were treated and studied in our laser center from 2000 to 2010. We used a Q-switched alexandrite laser specified with 75 ns pulse length, emitting at 752 nm and with a 2.4 mm-diameter spot size. The lesional skin was irradiated with fluences of 5-7 J/cm2. The treatment intervals were 3 months. After treatment with the Q-switched alexandrite laser, 55.8% (24/43) of the patients had excellent results in which more than 75% of the pigments cleared, and 44.2% (19/43) showed good results. Three sessions were required to obtain excellent results. We observed no serious complications. We obtain a successful outcome in the treatment of these lentigines with Q-switched alexandrite laser and consider it the treatment of choice for these lesions.

Q-Switched Alexandrite Laser Treatment of Oral Labial Lentigines in Chinese Subjects with Peutz-Jeghers Syndrome

Peutz-Jeghers syndrome (PJS) is characterized by gastrointestinal hamartomatous polyps and visible mucocutaneous lentigines distributed in the oral and anal mucosa, hands, face, and nails. Although there are many reports regarding successful treatment of intestinal polyps of PJS, there is little information regarding treatment of lentigines. Q-switched lasers are the preferred method of treatment for benign melanocytic lesions. To evaluate the efficacy of the Q-switched alexandrite laser (QSAL) in treating oral labial lentigines of PJS. Fourteen cases of laser treatment of oral labial lentigines in patients diagnosed with PJS were studied between 2005 and 2008. All were treated using a single treatment with a QSAL with a 3-mm handpiece and a fluence of 4.0 to 9.0 J/cm(2). Retrospective analysis of the effect of QSAL was conducted. All 14 cases exhibited successful elimination of treated lentigines after one laser treatment. There were significant acute side effects. After a median 2-year follow-up, there were no recurrences or scars in treated sites. The QSAL provides effective treatment for removal of labial lentigines associated with PJS.

Comparison Study of Intense Pulsed Light Versus a Long-Pulse Pulsed Dye Laser in the Treatment of Facial Skin Rejuvenation

Currently, various nonablative skin resurfacing techniques are being used to rejuvenate facial skin, including lasers and intense pulsed light (IPL). There are few direct comparison studies between IPLs and lasers. The objective of our study is to compare the effectiveness of intense pulsed light versus a long-pulse pulsed dye laser (LPDL) in the treatment of facial skin rejuvenation. Ten Asian patients with Fitzpatrick skin types III-IV were enrolled in this study. One half of the face was treated with IPL (6 treatment sessions) and the other side was treated by LPDL (3 treatment sessions). An LPDL with a wavelength of 595 nm and spot size of 7 mm was used. Utilizing the compression method, lentigines were treated using a PDL with a fluence between 9-12 J/cm and a pulse duration of 1.5 ms. Wrinkles were treated with fluences between 10 to 12 J/cm and a pulse duration of 20 ms, using a pulse-stacking technique. An IPL with a type B handpiece was used. Lentigines and wrinkles were treated with fluences between 27 to 40 J/cm and a pulse duration of 20 ms. The improvement of lentigines was 62.3% and 81.1% for IPL and LPDL respectively. There was no significant difference between IPL and LPDL in wrinkle reduction. There was no scarring or pigmentary change seen with either device. Both IPL and LPDL are effective for facial skin rejuvenation in Asians, but LPDL treatment is significantly better than IPL treatment in the treatment of lentigines. The use of the compression technique may allow this LPDL to be used effectively for facial rejuvenation and with fewer treatment sessions, when compared with the IPL.

The use of lasers and intense pulsed light sources for the treatment of acquired pigmentary lesions in Asians

Asians are prone to the development of lentigines as a result of photoageing. Lasers and intense pulsed light sources have been used in the treatment of lentigines but there is a risk of post‐inflammatory hyperpigmentation in Asian skin. This report examines the role of lasers and intense pulsed light sources in treating lentigines and other acquired pigmentary lesions in Asians.

Use of the KTP Laser in Cosmetic Surgery

The KTP is a versatile laser system when used for cosmetic surgery. When combined with a hexascanner or small spot size handpiece, it is equivalent to a continuous-wave yellow dye laser or copper vapor laser in the treatment of vascular lesions. The KTP laser wavelength (532 nm) is near the peak of a hemoglobin absorption curve as is the wavelength of the continuous-wave yellow dye or copper vapor laser. The KTP laser is also excellent for use in the treatment of Lentigines. The solar lentigines of the hand, arm, and leg are particularly treatable. The hexascanner delivery system makes the KTP laser particularly time-efficient when used to treat the multiple lesions that usually occur with this condition. The KTP laser can also be combined with special quartz contact probes and used for incisional cosmetic surgery such as blepharoplasty, rhytidectomy, forehead lifting, and new “endolaser” small-incision cosmetic surgery. The contact probes focus and defocus the laser quickly allowing the precision use of the laser deep under a flap with a spot size of 0.1 mm. The coagulative abilities of the laser allow an almost bloodless dissection. The Laserlift™ produces less swelling and bruising for the patient and allows the surgeon to complete complicated surgery with excellent visualization in a bloodless field.