A randomized, single-blind, study evaluating a 755-nm picosecond pulsed Alexandrite laser vs. a non-ablative 1927-nm fractionated thulium laser for the treatment of facial photopigmentation and aging

Research Advances in the Treatment of Riehl's Melanosis

Riehl's melanosis (RM) is a contact photodermatitis, with fast progressive gray-brown skin pigmentation as the main manifestation, which can seriously affect the psychology and physiology of patients. Currently, although the etiological factors of Riehl's melanosis is still be unknown, the existing literature proves clearly the cause of it is related to the contacting with suspected allergens. For decades, there has been no standard method for the treatment of RM, but with both conventional drug therapy and laser therapy having been attempted. Topical application of bleaching agents is mainly used as an auxiliary treatment modality. The laser treatment modality remains a hot spot, among which Q-switched Nd:YAG laser is well received for RM. Positive outcomes have been achieved by the combined treatment modalities attempted in recent years also achieve positive outcomes. The purpose of this paper is to review and summarize recent advances in the treatment of the disease.

Adverse Events of Nonablative Lasers and Energy-Based Therapies in Subjects with Fitzpatrick Skin Phototypes IV to VI: A Systematic Review and Meta-Analysis

BACKGROUND

Although there is an abundance of literature on nonablative laser and energy-based therapies for the management of skin conditions, adverse events are inconsistently addressed and range widely across studies. Fitzpatrick skin phototypes (SPTs) IV to VI are believed to be at higher risk.

OBJECTIVES

The aim of this study was to determine the types and rates of adverse events in nonablative laser and energy-based therapies among patients with SPTs IV to VI.

METHODS

Articles addressing nonablative laser and energy-based therapies for skin rejuvenation and acne scarring in patients with SPTs IV to VI that provided data on adverse events were included. The pooled prevalence of each adverse event was calculated. To determine whether age, treatment indication, SPT, and device type influenced incidence, subgroup and meta-regression analyses were performed. Heterogeneity was evaluated with the I2 statistic.

RESULTS

Forty-three studies were included in the meta-analysis. The sample size was 1654, and the median age of subjects was 39.4 years. The most common adverse events were postinflammatory hyperpigmentation (PIH) (rate, 8.1%) and prolonged erythema (rate, 0.6%). The rate of PIH was significantly higher for diode and erbium-doped lasers compared with intense pulsed light and radiofrequency. PIH correlated positively with SPT, laser density, and total energy delivered.

CONCLUSIONS

Although the overall rate of adverse events in nonablative laser and energy-based therapies for SPTs IV to VI is low, the incidence of PIH is not insignificant. Certain lasers, such as diode, Q-switched Nd:YAG, and erbium-doped lasers, tend to have higher rates of PIH, whereas intense pulsed light and radiofrequency have minimal risk. Higher SPTs and higher energy deliverance correlate positively with the incidence of PIH.

LEVEL OF EVIDENCE: 4

Study of a 532/1064 Fractional Picosecond Laser for Facial Rejuvenation

BACKGROUND AND OBJECTIVES

Picosecond (ps) fractional lasers create small wounds, presumably by laser-induced optical breakdown. We studied a ps fractional laser in the treatment of wrinkles and mottled pigment.

MATERIALS AND METHODS

This was a single center, prospective, open-label clinical trial. Patients with at least 2 facial areas, with visible wrinkles and dyschromia, were enrolled in the study and received 3 treatments at monthly intervals and appeared at 3 follow-up visits at 1, 3, and 6 months after treatment. The laser is an 800 ps fractional system with nominal 10 mm macrospot diameter. Both 532 nm and 1,064 nm wavelengths were applied in each subject. Wrinkle and pigmentation clearance were assessed by 2 blinded investigators using a 5-point clearance scale. Skin improvement was assessed by investigators using the 5-point Global Aesthetic Improvement (GAI) Scale based on before/after photographs for the following categories: (1) fine lines/wrinkles and (2) pigmentation.

RESULTS

A total of 18 healthy subjects at a single site were enrolled. At least moderate pigmentation and fine line/wrinkles improvement were observed in 93% and 79% of patients at 1 month after the last treatment according to GAI, respectively. Pigment clearance approached a mean of approximately 40%.

CONCLUSION

A ps 1,064/532 fractional laser achieves reduction in fine lines and pigment.

The effect of a dual-wavelength 532 nm and 1064 nm picosecond-domain laser with a fractionated holographic optic on photoaging and patient age perception: A pilot study

INTRODUCTION

This study evaluated the efficacy of a dual-wavelength 532 nm/1064 nm Nd:YAG picosecond-domain laser with a holographic lens array in treating facial photoaging.

METHODS

Thirteen subjects were enrolled with 10 completing the study. Receiving three-month treatments, subjects underwent full-face spot treatment of facial lentigines with the 532-nm non-fractionated handpiece, followed by two sequential facial passes of the 1064-nm and the 532-nm fractionated handpieces. Improvement was measured by treating physician evaluation of pigmentation and rhytids as well as blinded reviewer evaluation of pre- and post-treatment image sets taken 12 weeks after the final treatment. Participants completed treatment surveys to assess satisfaction.

RESULTS

Physician grading on a 5-point scale revealed an average improvement of 1.6 in pigmentation (p = 0.0042) and 0.9 in rhytids (p = 0.0196). Blinded physicians appropriately selected baseline images in 44 of 50 (88%) image sets (10 subjects; five reviewers). On an 11-point scale for overall facial photoaging (0 = no change, 1 = 10% improvement, 2 = 20% improvement, etc.) treating physicians scored mean improvement as 3.3 ± 1.83 (95% CI 1.99 to 4.61; range 1-6), while blinded reviewers scored mean improvement as 2.32 ± 2.62 (range % -4 to 8, 95% CI 1.57 to 3.07). The greatest majority (80%) of participants reported satisfaction with the treatment. Adverse events were mild; however, one patient developed hyperpigmentation, consistent with melasma that was successfully treated with topical agents.

CONCLUSION

This is the first study to show that picosecond-domain 532 nm/1064 nm laser treatments with combination non-fractionated and fractionated handpieces are well-tolerated, safe, and effective for the treatment of photodamage.

Laser-Assisted Drug Delivery of Tranexamic Acid by Picosecond Laser in Postinflammatory Hyperpigmentation: A Split-Area Double Blind Randomized Prospective Study

Background: Tranexamic acid has been reported to benefit the treatment of postinflammatory hyperpigmentation (PIH). Laser-assisted drug delivery (LADD) could facilitate the efficacy of topically applied drugs into the dermis. This split-area randomized prospective study aims to assess whether early utilization of the LADD procedure with tranexamic acid delivery followed by picosecond lasers can attenuate the PIH better than the utilization of picosecond lasers alone. Patients and methods: Ten post-traumatic cases of PIH in 10 patients (8 female and 2 male) with an average age of 34.2 ± 11.2 years were included in this clinical trial. Using block randomization to determine the treatment side, one side of each area of the PIH was separated from the midline into two halves belonging to the control and tranexamic acid groups. The half area of the tranexamic acid group was further topically applied with 10% tranexamic acid solution. This procedure was repeated every 6 weeks, four times in total. Results: The self-assessment of the hyperpigmentation and overall satisfaction of the treatment outcome were not significantly different between the treatment and control sides. Conclusions: This split-area study revealed that, compared with picosecond alone, there was no significant difference adopting tranexamic acid in LADD after nonablative fractional picosecond laser for PIH.

An Open-Label Study Assessing the Efficacy and Tolerability of a Skincare Regimen in Subjects of Different Ethnicities with Moderate-to-Severe Hyperpigmentation

Background

Hyperpigmentation is a common cosmetic concern that significantly impacts self‐esteem. A skincare regimen has been developed to improve the appearance, tone, texture, and luminosity of subjects with facial hyperpigmentation (Even Up^® Hyperpigmentation Regimen; Colorescience, Inc., Carlsbad, CA).

Aims

The objective of this open‐label trial was to assess the efficacy and tolerability of this regimen for treating facial hyperpigmentation.

Patients/Methods

Subjects with moderate‐to‐severe facial hyperpigmentation (N = 33) were randomized to those not using prescription, advanced or physician‐dispensed skin care products (Group A, n = 23) and those currently using prescription, advanced or physician‐dispensed skincare products for facial hyperpigmentation (Group B, n = 10). Both groups were provided three skincare products comprising the hyperpigmentation regimen and instructions for use. Subjects were evaluated at baseline and Weeks 2, 4, 8 and 12.

Results

The overall median (range) baseline MASI score at baseline was 9.0 (2, 31), decreasing by 0.0 (−7, 0) points at Week 2 (p = 0.002), 0.6 (−8, 0) points at Week 4 (p < 0.0001), 1.5 (−16, 0) points by Week 8 (p < 0.0001) and 2.4 (−20, 0) points at Week 12 (p < 0.0001). At Week 12, the overall median improvement in MASI score was 26% and higher for Group B (32% vs. 22%). By Week 2, subjects reported lighter, less noticeable brown spots (76%), brighter, more luminous skin (88%), more even skin tone (67%), and healthier look and feel (85%). Improvements continued throughout the study. No adverse events were observed or reported.

Conclusions

This regimen addresses facial hyperpigmentation and protects skin against the damaging effects of ultraviolet and high energy visible light (HEV). It is safe to use on all skin types and tones.

Fractional 1064 nm picosecond laser and skin photoaging: in vivo evaluation of treatment effects with reflectance confocal microscopy

Few studies showed the role of picosecond laser (PLS) in the treatment of skin photoaging signs. However, no studies have explored the microscopic effects of PSL in photoaging. The aim of this study is to preliminarily identify clinical variations induced by a 1,064 nm Nd:YAG PSL on the décolleté area, then to apply the treatment protocol to treat facial photoaging and estimate the clinical and microscopic outcomes. A total of 10 consecutive patients with cutaneous photoaging were enrolled. Patients were treated 3 times at monthly intervals with the fractionated 1,064 nm Nd:YAG PSL. In a preliminary phase, PSL treatment was performed on the décolleté to establish its efficacy and safety. Then, the same treatment protocol was applied to all the face and clinical and reflectance confocal microscopy (RCM) were analyzed, comparing baseline (T0) pictures and 4 months after the treatment (T1) ones. On the face, a reduction of dyschromia and wrinkles was observed at T1. Furthermore, the underlying RCM variations were revealed at different skin levels. Our results show the clinical and microscopic effectiveness and safety of the 1,064-nm Nd:YAG PSL in the treatment of skin photoaging signs.

Histological characterization of age-related skin changes following the use of picosecond laser: Low vs high energy

Fractional lasers have become widespread in dermatology owing to their efficacy and safety. Comparative analysis of histological features after laser rejuvenation using a 1064-nm fractionated handpiece picosecond laser with different energy fluence levels (1.1 or 2.1 J/cm² ). An open-label, study of 28 women aged 36 to 60 years with signs of age-related photodamage and skin changes of the face and neck was conducted using a fractional picosecond 1064 nm laser in low vs high fluence. The clinical assessment at 3 weeks showed more pronounced effect on facial skin rejuvenation with the higher fluence of 2.1 J/cm² compared to 1.1 J/cm² . The effect and safety of laser rejuvenation using a picosecond laser has been shown with more pronounced histological effects at higher fluences.

A Randomized, Split-Face, Double-Blind Comparison Trial Between Fractionated Frequency-Doubled 1064/532 nm Picosecond Nd:YAG Laser and Fractionated 1927 nm Thulium Fiber Laser for Facial Photorejuvenation

BACKGROUND AND OBJECTIVE

Fractionated lasers are a popular therapeutic option for facial photorejuvenation. In this study, we compare the safety, tolerability, and efficacy of a fractionated frequency-doubled 1064/532 nm picosecond Nd:YAG fractionated picosecond laser (FPL) versus a fractionated 1927 nm thulium fiber laser (TFL) for facial rejuvenation.

STUDY DESIGN/MATERIALS AND METHODS

This was a double-blind, randomized, split-face comparison study involving 20 subjects. Facial halves were randomized to receive either FPL or TFL treatment. Three treatments were delivered at 1-month intervals. Subjects were followed up for 1, 3, and 6 months post-final treatment session and evaluated by blinded, non-treating investigators for dyspigmentation, erythema, keratosis, texture, and rhytids on a standardized scale. Subjects also recorded a quantitative daily diary rating healing progress for 14 days after every treatment session.

RESULTS

Statistically significant improvements in elastosis, erythema, keratosis, dyschromia, and skin texture were noted in both treatment groups. There were no significant differences detected in clinical efficacy between the two groups. Subject daily dairies revealed statistically significant differences in tolerability during the immediate 14-day post-operative recovery period. The facial half treated with FPL displayed significantly less redness on days 3 and 4; significantly less swelling on day 5; significantly less crusting on days 1 through 9; significantly less peeling on days 3 through 9; and significantly less itch on days 4 and 7. There were no unexpected adverse effects observed.

CONCLUSION

Both FPL and TFL are safe and effective treatment options for facial rejuvenation. FPL may be associated with significantly less downtime. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

A Systematic Review of Picosecond Laser in Dermatology: Evidence and Recommendations

BACKGROUND AND OBJECTIVES

The use of picosecond laser in dermatology was originally focused on optimizing the removal of unwanted tattoos. Subsequent advances in this technology have broadened its clinical indications to include treatment of benign pigmented lesions, photodamage, melasma, and scar revision. In this systematic review, evidence-based recommendations are developed for the use of picosecond laser in dermatology.

STUDY DESIGN/MATERIALS AND METHODS

A comprehensive search of the English language literature was performed up to and including November 2019. Relevant citations were individually evaluated, synthesized, and categorized based on the Level of Evidence. With the addition of the authors' combined clinical experience, clinical recommendations were developed.

RESULTS

After application of inclusion and exclusion criteria, a total of 77 unique studies were evaluated. Treatment of benign pigmented lesions was associated with level I-IV evidence; rejuvenation was associated with level II evidence; melasma was associated with level II evidence; scar revision was associated with level II-III evidence; tattoo removal was associated with level I evidence.

CONCLUSION

Picosecond laser is a safe and effective treatment modality for an increasing range of dermatologic indications. Further development of this technology is warranted. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

Fractional 1,927 nm Thulium Laser Plus Photodynamic Therapy Compared and Combined for Photodamaged Décolleté Skin: A Side-by-Side Randomized Controlled Trial

BACKGROUND AND OBJECTIVES

Décolleté photodamage is a common condition typically treated with light and energy-based devices. This study investigated the efficacy and safety of a fractional 1,927 nm thulium laser (TL) alone and combined with photodynamic therapy (PDT).

STUDY DESIGN/MATERIALS AND METHODS

In a 12-week follow-up study, participant décolletés were divided into four treatment areas and randomized to receive a single treatment with field-directed TL, PDT, combination TL-PDT, or lesion-directed curettage control. All actinic keratoses (AKs) underwent lesion-directed curettage before randomization. TL was delivered at 20 mJ/mb, 500 mJ/cm² fluence, 5 W, and 8 (n = 6 pts.) or 16 (n = 6 pts.) passes. PDT was performed with 16% methyl aminolevulinate (MAL) creme incubated for 3 h, followed by red light-emitting diode light at 37 J/cm² . Outcome measures included clinical assessment of overall photodamage and specific subcomponents, assisted by optical coherence tomography (OCT) imaging.

RESULTS

Twelve women with moderate to severe photodamage on the décolleté and a cumulative total of 184 thin grade I AKs were included. Field-directed treatments TL and combination TL-PDT equally improved the overall photodamage, mottled pigmentation, and rhytides compared with lesion-directed control (P < 0.05). The skin texture improved by TL alone and was further improved by combining TL and PDT (P < 0.05). Median AK complete responses were similar for field-directed interventions TL-PDT (100%), TL (90%), PDT (82%), and lesion-directed curettage control (52%) (P = 0.464). Patients presented with mild local skin responses, slightly more pronounced when combining TL with PDT versus individual treatments (P < 0.05). No scarring or adverse events were observed.

CONCLUSIONS

The 1,927 nm fractional thulium laser is an effective, tolerable, and safe field-directed treatment for décolleté photodamage. Provided alone, TL proved to be as effective as combined TL-PDT for overall photodamage, while a greater improvement in skin texture was achieved using TL and PDT in combination. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.