Laser treatment of pigmented lesions--2000: how far have we gone?

Changes in melanocytic nevi treated with laser hair removal: A systematic review

BACKGROUND

Incidental treatment of melanocytic nevi during laser hair removal (LHR) has been noted to cause clinical and dermoscopic changes that may appear similar to findings seen in atypical or neoplastic melanocytic lesions. The rate and characteristics of these changes has not been well-studied.

OBJECTIVES

The objective of this review article is to assess the literature for reported changes in melanocytic nevi following LHR to guide clinical practice.

METHODS

PubMed was searched December 5, 2022 for articles evaluating changes in melanocytic nevi after LHR treatment using the following search terms: "nevi laser hair removal," "nevi diode," "nevi long pulse alexandrite," "nevi long pulse neodymium doped yttrium aluminum garnet," and "melanoma laser hair removal." All English language patient-based reports discussing incidental treatment of melanocytic nevi while undergoing LHR with a laser were eligible for inclusion, while reports of changes following hair removal with non-laser devices such as intense pulsed light were excluded. Studies evaluating non-melanocytic nevi such as Becker's nevus or nevus of Ota were excluded as were those evaluating the intentional ablation or removal of melanocytic lesions.

RESULTS

Ten relevant studies were included, consisting of seven case reports or series and three observational trials, two of which were prospective and one retrospective. Among the seven case reports or series there were a total of 11 patients, six of which had multiple affected nevi. Clinical and dermoscopic changes to nevi following LHR appear to be common in clinical practice, though not well studied. Clinical and dermoscopic changes have been noted to present as early as 15 days after treatment and persist to the maximum time of follow up at 3 years. Commonly reported changes include regression, decreased size, laser induced asymmetry, bleaching, darkening, and altered pattern on dermoscopy. Histologic changes include mild atypia, thermal damage, scar formation, and regression. Although some of the clinical and dermoscopic alterations may be concerning for malignancy, to our knowledge, there are no documented cases of malignant transformation of nevi following treatment with LHR.

LIMITATIONS

This study is limited by the low number of relevant reports and their generally small sample size, many of which is limited to single cases. Additionally, comparison of available data was limited by variable reporting of treatment regimens and outcomes.

CONCLUSIONS

Changes to nevi treated during LHR are not uncommon. Modifications to nevi may occur and look similar to changes seen in dysplastic or neoplastic melanocytic lesions. Notably, despite the widespread use of LHR since the first device was Food and Drug Administration approved in 1995, a time span of nearly three decades, there have been no reported cases of melanoma or severe dysplastic changes within treated nevi. However, dermatologists should be aware that morphologic and dermoscopic alterations can occur after LHR to prevent unnecessary surgical procedures. Although melanoma has not been reported to occur in nevi treated with LHR nor with any other laser exposures, further long-term data is needed to fully elucidate this concern. Optimally, nevi should be examined by a dermatologist before LHR to determine a baseline clinical and dermoscopic morphology. If there is concern for potential atypia, laser should be avoided over such nevi to avoid confusion at future follow up visits.

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.

Evaluation of Laser Effects on the Human Body After Laser Therapy

Lasers have wide applications in the treatment and diagnosis of diseases and various medical fields. Laser therapy like the other methods has advantages and disadvantages. Some risks such as bleeding, pain, and infection are created after laser therapy. Explanation and evaluation of laser effects on cell function, tissue, and the body are the aims of this study. We reviewed papers available from 1986 to 2019 about the effects of lasers on cells and tissue. An online search of PubMed, Science Direct and Google scholar using such keywords as "laser", "cell", "tissue", "body" and "side effects" was performed. The laser photons are absorbed by chromophores, resulting in the target heating and localized damage. Laser irradiation alters cellular metabolism and cellular functions. These alterations may be accompanied by undesired side effects which can be monitored via metabolites level change in the body. Based on this finding, laser therapy may be associated with several side effects and complications; therefore, before treatment, the determination of laser types and their properties is necessary to avoid creating side effects. The advantages and disadvantages of the treatment type should be considered in order to choose the best treatment with the least side effects. The patients' awareness of possible side effects before treatment and also an effective follow-up and management of patients after action are two important points in laser therapy. Training curriculum definition should be determined for laser applicant qualifications in different medical fields.

Pediatric Laser Therapy in Pigmented Conditions

Advances in laser therapy have led to novel therapeutic approaches to common pediatric skin conditions. As a non-invasive alternative to surgical options, laser therapy is efficacious in treating a broad range of conditions, from vascular and pigmented lesions to tattoo and hair removal. This paper reviews the basic mechanics of laser therapy, its role in common pigmented pediatric dermatoses, and special considerations for this unique age group.

Postinflammatory Hyperpigmentation: Epidemiology, Clinical Presentation, Pathogenesis and Treatment

Postinflammatory hyperpigmentation (PIH) is a reactive hypermelanosis that develops following cutaneous inflammation. Common causes of PIH include intrinsic skin conditions (e.g., acne and eczema) as well as external insults to the skin, such as burn injuries and dermatologic procedures. PIH more commonly occurs in individuals with darker skin, for whom it is often a source of significant psychological distress. Several therapeutic modalities are available for the treatment of PIH, including topical agents, chemical peels, and energy-based devices. We review the epidemiology, clinical presentation, pathogenesis, and treatment of PIH.

Lasers and ancillary treatments for scar management Part 2: Keloid, hypertrophic, pigmented and acne scars

The formation of a wide range of excessive scars following various skin injuries is a natural consequence of healing. Scars resulting from surgery or trauma affect approximately 100 million people per annum in the developed world and can have profound physical, aesthetic, psychological and social consequences. Thus, scar treatment is a priority for patient and physician alike. Laser treatment plays an important role in scar management with additional support from ancillary modalities. Subsequent to part 1: Burns scars, part 2 focuses on our strategies and literature review of treatment of keloid, hypertrophic, pigmented and acne scars where lasers are used in conjunction with other measures, and illustrated with case studies.

The dual toning technique for melasma treatment with the 1064 nm Nd: YAG laser: A preliminary study

BACKGROUND AND AIMS

Melasma is a treatment-resistant and acquired pigmentary facial skin condition of uncertain etiology particularly prevalent in the older Asian female. Traditional bleaching agents have offered some success. Intense pulsed light (IPL), fractionated nonablative and more recently ablative laser technology have also been used, but were associated with postoperative hyperpigmentation in the Asian skin. The present study examined the consecutive application of 2 modes of the 1064 nm Nd:YAG laser in the 'dual toning' process.

SUBJECTS AND METHODS

Thirty females, mean age 41.4 ± 11.96 yr, Fitzpatrick skin type IV, participated in the prospective uncontrolled study. All subjects were treated with the 1064 nm Nd:YAG laser, first with the 5 ns Q-switched mode, 1.2 J/cm(2), 8 mm collimated handpiece with multiple passes and then immediately after with the micropulsed mode, 300 µs, 7.0 J/cm(2), 5 mm handpiece, multiple passes. Mild and even erythema was the endpoint. Treatments were given every other week until maximum improvement was obtained. Improvement was rated at a final assessment 6 weeks after the final treatment on a 5 point scale where 1 was little or no improvement and 5 was maximum improvement.

RESULTS

At the final treatment session and at the 6-week assessment, 20 of the 30 patients (67%) saw a fair to excellent degree of improvement, 7 (23%) had visible improvement and little or no improvement was seen in 3 (10%) patients. There were no unexpected side effects in any patients.

CONCLUSIONS

The dual toning technique using the 1064 nm Nd:YAG laser was safe and effective, and well-tolerated by all patents without anesthesia. Larger controlled studies are merited with more objective measurement techniques to confirm the results of this preliminary study.

Lasers for treatment of melasma and post-inflammatory hyperpigmentation

Hyperpigmentary disorders, especially melasma and post-inflammatory hyperpigmentation (PIH), cause significant social and emotional stress to the patients. Although many treatment modalities have been developed for melasma and PIH, its management still remains a challenge due to its recurrent and refractory nature. With the advent of laser technology, the treatment options have increased especially for dermal or mixed melasma. To review the literature on the use of cutaneous lasers for melasma and PIH. We carried out a PubMed search using following terms “lasers, IPL, melasma, PIH”. We cited the use of various lasers to treat melasma and PIH, including Q-switched Nd:YAG, Q-switched alexandrite, pulsed dye laser, and various fractional lasers. We describe the efficacy and safety of these lasers for the treatment of hyperpigmentation. Choosing the appropriate laser and the correct settings is vital in the treatment of melasma. The use of latter should be restricted to cases unresponsive to topical therapy or chemical peels. Appropriate maintenance therapy should be selected to avoid relapse of melasma.

The dysplastic nevus: from historical perspective to management in the modern era: part II. Molecular aspects and clinical management

The dysplastic nevus is a discreet histologic entity that exhibits some clinical and histologic features overlapping with common nevi and melanoma. These overlapping features present a therapeutic challenge, and with a lack of accepted guidelines, the management of dysplastic nevi remains a controversial subject. Although some differences between dysplastic and common nevi can be detected at the molecular level, there are currently no established markers to predict biologic behavior. In part II of this continuing medical education article, we will review the molecular aspects of dysplastic nevi and their therapeutic implications. Our goal is to provide the clinician with an up-to-date understanding of this entity to facilitate clinical management of patients with nevi that have histologic dysplasia.

Dysplastic nevi

Dysplastic nevi have been a subject of much debate since their original description in 1978. Although some question the biological potential of dysplastic nevi themselves, several studies have shown that their presence confers substantial risk for melanoma. In addition to predisposing patients to melanoma, dysplastic nevi have been shown to harbor genetic mutations, indicating their position on a continuum between banal nevi and melanomas. Dysplastic nevi are also clinically relevant as mimickers of melanoma, and can be challenging diagnostically. This article reviews the history, epidemiology, biology and genetics, clinical features, histopathologic features, and management guidelines for patients with these lesions.

Efficacy and safety of 1,064 nm Q-switched Nd:YAG laser treatment for removing melanocytic nevi

Background

Until recently, the removal of melanocytic nevi has been performed with a CO₂ laser or Er:YAG laser. These lasers have been useful for removing affected spots. However, enlargement of spots or some sequelae, including depressed or hypertrophic scars, could develop as unwanted results. The Q-switched Nd:YAG laser has been used to remove deep-seated melanocytes, such as Ota nevus or tattoos. However, there have been no previous experiments performed to test the efficacy and safety of this laser treatment for melanocytic nevi.

Objective

The objective of this study was to investigate the efficacy and safety of the 1,064 nm Q-switched Nd:YAG laser for removing melanocytic nevi, including congenital nevomelanocytic and acquired nevomelanocytic nevi.

Methods

Two thousand and sixty four Korean patients with small melanocytic nevi were treated with a Q-switched Nd:YAG laser from 2005 to 2009. High-resolution photographs were taken in identical lighting and positions before and after the six weeks of treatment to observe the procedural efficacy.

Results

About 70% of the nevi treated using a 1,064 nm Q-switched Nd:YAG laser were completely removed after one session. The other 30% were completely treated within three sessions. The appearance of sequelae such as hollow scars noticeably decreased compared to the results seen in CO₂ or Er:YAG laser treatments.

Conclusion

Use of the 1,064 nm Q-switched Nd:YAG laser is a safe and effective treatment modality for melanocytic nevi.

Atypical mole syndrome and dysplastic nevi: identification of populations at risk for developing melanoma - review article

Atypical Mole Syndrome is the most important phenotypic risk factor for developing cutaneous melanoma, a malignancy that accounts for about 80% of deaths from skin cancer. Because the diagnosis of melanoma at an early stage is of great prognostic relevance, the identification of Atypical Mole Syndrome carriers is essential, as well as the creation of recommended preventative measures that must be taken by these patients.

Role of laser therapy in pediatric patients

BACKGROUND

Laser applications have revolutionized the treatment of many cutaneous vascular anomalies. Because most of these lesions are congenital, the pediatric population has benefited primarily. In this article, the authors focus primarily on laser treatment options, realizing that this modality is but one part of an overall comprehensive plan of management options for these affected children.

METHODS

The literature was reviewed and interjected into the authors' 20 years of experience in the use of lasers in the pediatric population.

RESULTS

The use of different therapy modalities, such as the neodymium:yttrium-aluminum-garnet laser, pulsed dye laser, erbium:yttrium-aluminum-garnet laser, and intense pulsed light systems, is discussed. Outcomes, risks, benefits, and treatment protocols vary for each entity and for each laser. The authors' results and those of others are presented.

CONCLUSIONS

Lasers play a vital role as an adjunctive therapy or definitive therapy in many of the authors' pediatric patients. Anyone treating such patients should be well aware of lasers as a valuable tool.

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/cm(2) for dermal lesions and 2.5-5 J/cm(2) 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 postinflammatory 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 "dysplastic" nevus

Dysplastic nevi have become an increasing focus clinically, with evidence that they are associated with a higher risk of developing melanoma. However, there still is contention regarding the significance of dysplastic nevi. This contribution provides an overview of the history, epidemiology, genetics, clinical and histologic features, and procedures for clinical management of dysplastic nevi. Since dysplastic nevi were described originally in 1978, a great deal of research has examined the epidemiology of these lesions and the genetic factors related to the development of dysplastic nevi. However, there is disagreement regarding the clinical management of dysplastic nevi and the histologic definition of dysplastic nevi. Current recommendations include preventative measures, such as sun protection and careful surveillance and biopsies of suspicious lesions as needed. The advent of new technologies, such as computer-vision systems, have the potential to significantly change treatment of dysplastic nevi in the future.

Treatment of solar lentigines

Therapy for solar lentigines is diverse but can be divided into two broad categories: physical therapy and topical therapy. Physical therapies are frequently used with excellent clinical success rates, but this has to be balanced against associated side effects and recurrence rates with certain therapies. A range of topical therapies have been used and, more recently, fixed combinations of topical agents have been investigated. The Pigmentary Disorders Academy undertook to evaluate the clinical efficacy of the different treatments of solar lentigines in order to generate a consensus statement on their management. Clinical papers published during the past 20 years were identified through MEDLINE searches and methodology and outcome were assessed according to guidelines adapted from the US Preventive Services Task Force (USPSTF) on health care. The consensus of the group was that first-line therapy for solar lentigines was ablative therapy with cryotherapy. Although no large-scale studies have been completed, there is also good evidence to suggest that lasers are an effective treatment. An alternative to ablative therapy is topical therapy and there is good evidence to support the use of a fixed double combination, as well as retinoids, such as adapalene and tretinoin. Topical therapy can also be considered as maintenance therapy after the primary therapy has been applied. Because of the diversity of scoring systems used in the assessment of treatment outcome, the group recommends the development of treatment guidelines.

Dysplastic naevi: to shave, or not to shave? A retrospective study of the use of the shave biopsy technique in the initial management of dysplastic naevi

The management of dysplastic naevi is a controversial subject. This study sought to assess the usefulness of the shave biopsy technique in the initial management of dysplastic naevi, and to demonstrate the advantages over the punch biopsy technique. We report a retrospective observational study of histopathology specimens examined in one histopathology practice over a 14-month period. Patients who had a clinical diagnosis of 'dysplastic naevus', which had initially been biopsied using either a shave or punch biopsy, and then followed up with a full-thickness elliptical excision, were included in the study. Histopathological concordance between the shave and punch biopsy specimens and their respective follow-up elliptical excisions was compared. We found that 21 of 22 (95.5%) shave biopsies were concordant with their respective excision specimens, and that 29 of 41 (70.7%) punch biopsies were concordant with their respective elliptical excision specimens. Of the shave biopsy specimens reviewed, 66% showed that the dysplastic naevi were completely excised with the initial biopsy, compared with 21.2% of the punch biopsy specimens. These findings confirm that shave biopsies provide accurate diagnostic information in the assessment of dysplastic naevi. Shave biopsies enable the entire lesion to be submitted for histopathological assessment, improving the chances of an accurate diagnosis.

Melanin pigmentary disorders: treatment update

Most of the melanin pigmentary disorders are cosmetically important and have a strong impact on the quality of life of affected individuals. This article examines recent advances in the treatment of melanin pigmentary disorder including hypermelanosis and hypomelanosis. The development of laser technologies has completed the use of the increasing number of bleaching agents in treating hyperpigmented lesions. The treatment of hypomelanotic disorders is still often disappointing, but new therapeutic options provide encouraging results.

Lasers in dermatology: four decades of progress

Advances in laser technology have progressed so rapidly during the past decade that successful treatment of many cutaneous concerns and congenital defects, including vascular and pigmented lesions, tattoos, scars, and unwanted hair-can be achieved. The demand for laser surgery has increased substantially by patients and dermatologists alike as a result of the relative ease with which many of these lesions can be removed, combined with a low incidence of adverse postoperative sequelae. Refinements in laser technology and technique have provided patients and practitioners with more therapeutic choices and improved clinical results. In this review, the currently available laser systems with cutaneous applications are outlined, with primary focus placed on recent advancements and modifications in laser technology that have greatly expanded the cutaneous laser surgeon's armamentarium and improved overall treatment efficacy and safety.

Treatment of phacomatosis pigmentovascularis: a combined multiple laser approach

BACKGROUND

Phacomatosis pigmentovascularis (PPV) consists of a capillary malformation with a variety of melanocytic lesions, which involve various regions of the body and are difficult to treat with conventional therapeutic tools.

OBJECTIVE

We described two cases with PPV (type IIa and IIb) that were successfully treated with different lasers.

METHODS

The areas involved by both melanocytic lesions and port-wine stains were treated using the Q-switched ruby laser, the Q-switched Alexandrite laser, and the flashlamp pumped pulsed-dye laser.

RESULTS

Removal of a good portion of cutaneous and vascular lesions using combined multiple laser approach was achieved after 6 sessions in the first case under general anesthesia and after 31 sessions under local anesthesia in the second case.

CONCLUSION

PPV type II can be treated successfully by laser treatment. We prefer to start combined multiple laser treatment of PPV in childhood period under general anesthesia because it will reduce the number of treatment, improve the patient's quality of life, and increase the cost-effectiveness of the treatment.

Chemical and instrumental approaches to treat hyperpigmentation

Many modalities of treatment for acquired skin hyperpigmentation are available including chemical agents or physical therapies, but none are completely satisfactory. Depigmenting compounds should act selectively on hyperactivated melanocytes, without short- or long-term side-effects, and induce a permanent removal of undesired pigment. Since 1961 hydroquinone, a tyrosinase inhibitor, has been introduced and its therapeutic efficacy demonstrated, and other whitening agents specifically acting on tyrosinase by different mechanisms have been proposed. Compounds with depigmenting activity are now numerous and the classification of molecules, based on their mechanism of action, has become difficult. Systematic studies to assess both the efficacy and the safety of such molecules are necessary. Moreover, the evidence that bleaching compounds are fairly ineffective on dermal accumulation of melanin has prompted investigations on the effectiveness of physical therapies, such as lasers. This review which describes the different approaches to obtain depigmentation, suggests a classification of whitening molecules on the basis of the mechanism by which they interfere with melanogenesis, and confirms the necessity to apply standardized protocols to evaluate depigmenting treatments.

Photothermal time-resolved imaging of living cells

BACKGROUND AND OBJECTIVES

Thermal effects of laser radiation at cell level play very important role in cell functioning and in many laser applications. The aim of this study was to evaluate a new method of photothermal imaging (PTI) for monitoring short-time nano-scale thermal effects in individual living cells.

STUDY DESIGN/MATERIALS AND METHODS

PTI is based on the irradiation of a cell with a short laser pump pulse (8 nanoseconds, 532 nm) and on registration of the laser-induced local thermal effects using time-resolved phase-contrast imaging with a pulsed probe laser.

RESULTS

PT images of lymphocytes, lympholeukemia cells in vitro were obtained at different laser energies. PTI in time-resolved mode allowed visualizing the structures with size less than diffraction limit (90-nm liposomes). The photodamage process was visualized for a single human leukocyte in suspension.

CONCLUSIONS

PTI in non-invasive mode offered better contrast of living cell image than conventional optical phase-contrast microscopy. The data obtained showed that PTI is in perspective for studies of live non-fluorescent cells.

Combined ultrapulse CO2 laser and Q-switched alexandrite laser compared with Q-switched alexandrite laser alone for refractory melasma: split-face design

BACKGROUND

: Melasma is common and can cause major psychological impact. To date, the mainstay of treatment, including various hypopigmenting agents and chemical peels, is ineffective and can cause adverse effects. Laser is a new approach and is yet to be explored for its efficacy and safety.

OBJECTIVE

: To compare combined Ultrapulse CO2 laser and Q-switched alexandrite laser (QSAL) with QSAL alone in the treatment of refractory melasma.

METHODS

: Six Thai females were treated with combined Ultrapulse CO2 laser and QSAL on one side of the face and QSAL alone on the other side. The outcome was evaluated periodically for up to 6 months using the modified Melasma Area and Severity Index score and the modified Melasma Area and Melanin Index score.

RESULTS

: The side with combination treatment had a statistically significant reduction of both scores. On the QSAL side, the score reduction was not significant. Two cases developed severe postinflammatory hyperpigmentation and were effectively treated with bleaching agents. Transient hypopigmentation and contact dermatitis were observed with the combination treatment side.

CONCLUSIONS

: Combined Ultrapulse CO2 laser and QSAL showed a better result than QSAL alone but was associated with more frequent adverse effects. Long-term follow-up and a larger number of cases are required to determine its efficacy and safety for refractory melasma.

Laser therapy of freckles and lentigines with quasi-continuous, frequency-doubled, Nd:YAG (532 nm) laser in Fitzpatrick skin type IV: a 24-month follow-up

BACKGROUND

Newly developed lasers produce excellent results with minimal complications compared with traditional treatments for freckles and lentigines.

OBJECTIVES

To assess the efficacy and safety of the frequency-doubled Nd:YAG (532 nm) laser in the treatment of freckles and lentigines in type IV skin.

PATIENTS AND METHODS

Twenty adult patients (14 with freckles and six with lentigines) were subjected to a variable number of treatments with a minimum 4-week interval until no additional improvement occurred or > 75% improvement was obvious. Patients manifesting > 50% improvement were followed up once every 3 months for 24 months. The rest were regarded as treatment failures and not followed up.

RESULTS

Sixteen (80%) of 20. patients (freckles, n = 10; lentigines, n = 6) manifested more than 50% improvement. They were treat- irradiated between three and eight times with a 4-12-week interval. Complications included hypopigmentation (25%), mild textural changes (15%) and hyperpigmentation (10%). All these were mild and resolved within 2-6 months. Of 10 patients with freckles followed up for 24 months, four (40%) patients showed partial recurrence. However, all the patients maintained > 50% improvement. None of the patients with lentigines showed recurrence.

CONCLUSION

The quasi-continuous, frequency-doubled Nd:Y AG (532 nm) laser safely and effectively treats freckles and lentigines in Fitzpatrick skin type IV.

Intense pulsed light for the treatment of facial freckles in Asian skin

BACKGROUND

Freckles are melanotic lesions frequently seen on the face and other sun-exposed areas. Previously evaluation of the severity of freckles has relied on the ultimately subjective assessment of the doctor or patient. Intense pulsed light (IPL) is newly introduced to treat facial freckles in Asian skin.

OBJECTIVE

To determine the effectiveness of IPL treatment for Asian patients with freckled skin and to assess a new and objective method for evaluation of the severity of freckling and posttherapy improvement using an ultraviolet (UV)-sensitive camera and film.

METHODS

Thirty-six patients with freckles were enlisted. IPL treatment was administered to patients with freckles in 4-week sessions. Irradiation wavelength was controlled using cutoff filters ranging from 550 to 590 nm, with a fluence of 25-35 J/cm2, with single- or double-pulse illumination and a pulse width of 4.0 msec. The assessments of the physician and patient were compared with the objective dermatologic evaluation with black-and-white and UV photography used to derive two treatment parameters, cosmetic density of freckles (CDF) and freckles area and severity index (FASI), which are applicable in a clinical setting.

RESULTS

By the end of the study, two attending physicians assessed the results for 86.1% of the subjects as excellent or good, with 91.7% of the patients reporting that they were extremely or very satisfied. A statistically significant improvement in mean FASI score was demonstrated at 6 months after treatment compared with baseline (n = 36, p <.005; paired t-test). Mean overall improvement rate (n = 36), as determined from the difference in mean FASI score, was 63% at 12 weeks and 58% at 6 months.

CONCLUSION

IPL is an effective and safe treatment for facial freckles in Asian skin, with relatively few adverse effects and high satisfaction levels.

The dilemma of the dysplastic nevus

There are few areas in dermatology that provoke as much controversy as dysplastic nevus. Over the past decade, there have been significant strides made in terms of understanding the biology and etiology of the lesion. Distinct and reliable clinical and histologic features have been delineated. In this article, the management of patients with dysplastic nevi and the role for dermoscopy, photographic surveillance, genetic mapping and counseling, chemoprevention, and nevi removal are discussed.

Side effects and complications of laser therapy

Laser skin surgery is not without risk and some degree of downtime in most situations. Patient satisfaction is key to the perceived success of the procedure. Therefore, the physician must fully explain all risks, potential complications, and expected morbidity associated with any laser treatment to be performed. Although many side effects can be avoided by use of appropriate intraoperative technique and adequate postoperative management, untoward effects may still occur and must be promptly identified and addressed. An informed patient is an important factor in the healing process and contributes to the success of the procedure.

Histologic features seen in changing nevi after therapy with an 810 nm pulsed diode laser for hair removal in patients with dysplastic nevi

BACKGROUND

The majority of lasers used for hair removal target melanin as the chromophore. In contrast with other cutaneous applications of lasers, lasers used for hair removal must generate a limited, controlled degree of thermal damage to permanently remove hairs.

AIM

To remove excess back hair from two male patients, one with a history of multiple nevi, and prior biopsies showing features of dysplastic nevi, and the other with large nevi greater than 6 mm in diameter and a family history of malignant melanoma.

METHODS

Both patients received monthly treatments with an 810 nm, pulsed, high-power diode laser using a fluence of 20 J/cm2 and 25-30 J/cm2, respectively, and a pulse duration of 30 ms.

RESULTS

Both patients presented 1 month after their last treatment with changing nevi within the treatment areas. Neither patient had clinical inflammation or other alterations suggestive of change in the nevi related to treatment. Thus, the nevi were excised with no mention of the previous laser treatment. The histologic features in all nevi were similar. There was subepidermal blister formation with elongation and disruption of nevus cells. There was homogenization of the collagen within the papillary dermis in all lesions. Only small foci of nevus cells could be identified in the dermis in some of the biopsy specimens. In these biopsy specimens, the dermal stromal matrix homogenization extended into the reticular dermis.

CONCLUSIONS

Laser targeting of nevus cells and surrounding structures may produce clinically atypical nevi in areas previously treated for hair removal. This should be kept in mind, especially in patients with a history of dysplastic nevi or with a personal or family history of malignant melanoma.