Treatment Of Pigmentary Disorders Research Articles

Use of the Q-switched Nd:YAG laser for the treatment of pigmentary disorders in Egyptians

Background and objective: Laser treatment of cutaneous pigmentation is one of the most interesting areas in cutaneous surgery. Our purpose was to study the efficacy of Q-switched Nd:YAG at 1064 nm and 532 nm for the treatment of some pigmented lesions in our locality in Egypt. Methods: A total of 60 subjects were treated with the Q-switched Nd:YAG laser with fluences ranging from 8 to 10 J/cm2 for dermal lesions and 2.5–5 J/cm2 for epidermal lesions. The number of sessions ranged from one to six sittings for epidermal lesions, four to six sessions for dermal lesions, while the mixed group required two to three sessions. Results: A total of 34 patients (56.7%) showed excellent response, seven patients (11.7%) showed good response, nine patients (15%) showed fair response, and 10 (16.6%) showed poor response. Transient postinflamma-tory hyperpigmentation occurred in five patients (8.33%) and erythema in seven patients (11.66%). Complications were common in darker skin types V and VI. Conclusion: The Q-switched Nd:YAG laser is an effective and safe technique for the treatment of pigmented skin lesions. Adverse hyperpigmentation can occur but is transient.

The Role of Topical Retinoids in the Treatment of Pigmentary Disorders

Topical retinoids have been used in the treatment of pigmentary disorders such as melasma, actinic lentigines, and postinflammatory hyperpigmentation. This article evaluates the clinical efficacy and tolerability of retinoid treatment for pigmentary disorders through an evidence-based approach. We searched the MEDLINE and The Cochrane Library databases using the keywords 'retinoid' combined with 'melasma,' 'lentigines,' or 'postinflammatory hyperpigmentation.' For each study, the methodology and outcomes were assessed according to specific criteria. There is fair evidence to support the use of topical tretinoin as a monotherapy in the treatment of melasma as well as in the treatment of lentigines (grade B). Adverse effects of topical retinoids are quite frequent, and include local skin irritation, erythema, and peeling, and their severity is mild to moderate. There is evidence to support the use of topical tretinoin in a fixed, triple-combination therapy (hydroquinone 4%/tretinoin 0.05%/fluocinolone acetonide 0.01%) for the treatment of melasma (grade B). There is poor evidence (grade C) to support the use of combination formulations for the treatment of lentigines, and large, randomized, double-blind, controlled trials are needed to further evaluate their use for this indication. In conclusion, there is evidence to support the use of topical retinoids as monotherapy or in combination with other topical agents in the treatment of pigmentary disorders.

Glutathione as a depigmenting agent: an overview

Glutathione is an ubiquitous compound found in our bodies. Aside from its many ascribed biologic functions, it has also been implicated in skin lightening. We review in vitro and in vivo studies that show evidence of its involvement in the melanogenic pathway and shed light on the its anti-melanogenic effect. Proposed mechanisms of action include: (a) direct inactivation of the enzyme tyrosinase by binding with the copper-containing active site of the enzyme; (b) mediating the switch mechanism from eumelanin to phaeomelanin production; (c) quenching of free radicals and peroxides that contribute to tyrosinase activation and melanin formation; and d) modulation of depigmenting abilities of melanocytotoxic agents. These concepts supported by the various experimental evidence presented form basis for future research in the use of glutathione in the treatment of pigmentary disorders.

Pigmentation disorders in Taiwanese skin: a clinical experience

Pigmentation disorders in Taiwanese skin: a clinical experience

Racial differences in the treatment of pigmentation disorders in outpatient settings: analysis of US national practice data

OBJECTIVE: Pigmentary disorders tend to disproportionately affect individuals with darker skin pigmentation. An understanding of why certain patients or races present more frequently to physicians would help guide attempts for early interventions and education for these patients.METHODS: Data from the National Ambulatory Medical Care Survey (1996–2000) were used to examine associations between the race/ethnicity of the patient and the type of skin‐related visit. We examined the impact of non‐white (and separately, black) individuals and Hispanic ethnicity on the probability of a pigmentary disorder or non‐pigmentary disorder‐related outpatient physician visit in weighted multivariate logistic regression models.RESULTS: Non‐white patients have a higher probability of a pigmentary disorder‐related skin condition visit than white patients (RR: 1.30; 95% CI: 1.29, 1.31). Black patients are more likely than non‐black patients to be seen for a pigmentary disorder (RR: 1.04; 95% CI: 1.03, 1.04). Hispanic patients are less likely to be seen for a pigmentary disorder (RR: 0.90; 95% CI: 0.90, 0.91). This is in contrast to non‐pigmentary skin disorder‐related visits, where non‐white, black, as well as Hispanic patients have a lower probability of visits than white individuals.CONCLUSIONS: There is a race‐related differential in the treatment of pigmentary skin disorders, with non‐white patients having a probability of receiving more care for these conditions in US outpatient settings. This lends support to our hypothesis that darker pigmentation in non‐white populations is the driver of a differential in the utilization of pigmentation‐related skin visits.

Racial differences in treatment of pigmentation disorders in outpatient settings: analysis of us national practice data

Objective: Pigmentary disorders tend to disproportionately affect individuals with darker skin pigmentation. We examined whether there was a difference by race and ethnicity in the incidence of treatment for pigmentary and non-pigmentary skin conditions in the United States.

Efficacy of topical treatment of pigmentation skin disorders with plant hydroquinone glucosides as assessed by quantitative color analysis.

Hydroquinone is a well known reagent used in the treatment of pigmentation disorders. The instability of the quinones and the required active concentration make topical treatment rather difficult. We tested the efficacy of an ascorbate-phytohydroquinone complex that inhibits the synthesis of melanin and promotes the degradation of the existing melanin. Lentigo senile lesions were evaluated before and after 1 month of treatment. Objective skin color evaluation was performed instrumentally. After one month of treatment, a clear depigmentation of the macules was measured. None of the volunteers reported any side effects from the prolonged treatment with the hydroquinone containing product.

Lack of Efficacy of the Q-Switched Ruby Laser in the Treatment of Vitiligo

To the Editor.— The Q-switched ruby laser has become the treatment of choice for the removal of tattoos and is finding increasing application in the treatment of pigmentary disorders. 1 It has been observed that treatment with this laser at low-energy fluences may result in epidermal hyperpigmentation at the treated sites. 2 To explore this observation further, we undertook a study of patients with vitiligo to determine if treatment with the Q-switched ruby laser at subthreshold doses would stimulate pigmentation of affected sites. Patients and Methods.— Seven patients with vitiligo between the ages of 15 and 60 years (mean age, 31 years) participated in the study at New York (NY) University between January and June 1991. Four patients were male and all were white. No patient had associated thyroid disease, pernicious anemia, diabetes, ocular abnormalities, deafness, or a history of melanoma. The onset of vitiligo ranged from 6 months to