A Prospective Trial Comparing Q-Switched Ruby Laser and a Triple Combination Skin-Lightening Cream in the Treatment of Solar Lentigines

A 15% Trichloroacetic Acid + 3% Glycolic Acid Chemical Peel Series Improves Appearance of Hand Lentigines: An Evaluator-Blinded, Split-Hand Prospective Trial

BACKGROUND

Improving the appearance of lentigines on the hands is a key component to hand rejuvenation. Soft tissue fillers revolumize hands, but do not address pigmentary changes. OBJECTIVE: This study investigated the effiacy of a 15% trichloroacetic acid (TCA) + 3% glycolic acid (GA) combination peel in improvement of appearance of hand lentigines.

METHODS

A prospective evaluator-blinded, split-hand study was performed using a 15% TCA + 3% GA peel to treat patients with hand lentigines. Subjects received a total of 3 treatments at 4-week intervals on 1 hand, with the other hand serving as an untreated control. Final photographs were taken 12 weeks after the last treatment. Two blinded board-certified dermatologists graded improvement in hand lentigines using a 5-point scale.

RESULTS

Eighteen of 20 patients completed the study (90%). The mean age was 64.4 years (SE 1.6, range 51-71). The mean pain scores were 3.8 (SE 0.4) on a 10-point scale (1 = no pain, 10 = extremely painful). Blinded evaluators correctly identified the after-treatment photographs in 16 patients (88%). Physician and patient-graded mean improvement of lentigines was significant for treated versus control hands ( p < .01). No adverse events were noted.

CONCLUSION

A series of three 15% TCA + 3% GA peels are effective and safe in the treatment of hand lentigines.

Combination treatment algorithm for pigmentary disorders of the face: A prospective observational study in Asian patients

BACKGROUND

Most patients with facial pigmentary disorders have multiple disorders. However, there is no definitive treatment algorithm improving various pigmentary disorders simultaneously.

OBJECTIVES

To investigate the clinical efficacy and safety of the combination of the Q-switched alexandrite and the carbon dioxide lasers with ZO SKIN HEALTH^Ⓡ for facial pigmentary disorders.

PATIENTS/METHODS

This prospective observational study enrolled 251 patients with at least one facial pigmentary disorder. We assessed treatment efficacy and investigated which disorders were most responsive to combination treatment and the relationship between doctors' skills, outcomes, and dropout rates.

RESULTS

There were 246 patients with lentigo senilis, 186 with moles, 79 with melasma, 53 with seborrheic keratosis, 17 with acquired dermal melanocytosis (ADM), and 16 with freckles. Overall, 227 patients completed treatment. Post-treatment outcomes were excellent in 97, good in 113, fair in 17, and poor in 0 patients. Freckles were the most responsive, and ADM was the least responsive. Patient withdrawal and treatment outcomes did not differ significantly based on the doctors' skills. Overall, 3.2% of patients had adverse events.

CONCLUSIONS

Our combination algorithm improved several pigmentary disorders of the face simultaneously, regardless of the doctors' proficiency level.

A Retrospective Analysis of Er:YAG Laser Treatment in Solar Lentigines: Our Clinical Observations

Objectives:

To investigate the efficacy of erbium-doped yttrium aluminium garnet (Er:YAG) laser in the treatment of solar lentigines.

Methods:

A retrospective study was conducted on patients treated with the only Er:YAG laser. In this study, 14 patients with multiple solar lentigines before treatment were included. Treatment parameters and all side effects were recorded. One independent, blinded dermatologist evaluated the clinical improvement and the patients also scored their satisfaction degree with the treatment.

Results:

The mean age of the patients was 41.07±7.16 years. The number of mean treatment session for each patient was 1.79±1.05. At the final visit, excellent improvement (76–100% clearance) was reached in eight (57.1%) patients, while good improvement (51-75% clearance) was achieved in five (35.7%) patients. Ten patients (71.4%) were very satisfied and four (28.5%) patients were satisfied with the results of the treatment. No side effects occurred.

Conclusion:

Er:YAG laser treatment may be an effective and safe optional modality for solar lentigines.

Laser Treatment of Accidental Tattoos: Experience at a Tertiary Referral Center

BACKGROUND

To date, information on laser treatment of accidental tattoos is limited.

OBJECTIVES

This study analyzes the efficacy and safety of quality-switched ruby, quality-switched Nd:YAG and picosecond lasers in the treatment of accidental hyperpigmentation in a larger patient cohort. To date, there is limited information on laser therapy of accidental hyperpigmentation.

METHODS

We conducted a retrospective systematic single-center analysis on 70 patients, which presented with accidental hyperpigmentation at the Dermatology Department of the University Hospital of Zurich between 2008 and 2017. Patients with accidental tattoos due to road injuries, explosives or other traumas and iatrogenic measures were included. We analyzed the data including laser parameters such as wavelength, energy density, spot size and intervals between the sessions. Also, the number of sessions performed and the overall success were registered.

RESULTS

We treated 38 patients by quality-switched nano- and/or picosecond laser therapy and completed the treatment in 28 cases within a mean number of 3-5 laser sessions. No complications occurred.

CONCLUSION

We demonstrate the validity and safety of quality-switched and picosecond lasers in the treatment of accidental hyperpigmentation. Using a combination of different wavelengths and pulse lengths on the same lesion and gradually increasing the fluence in the course of the laser treatment is recommendable to increase efficacy. We observed a tendency towards faster elimination of facial accidental tattoos and/or originating from road injuries compared to tattoos located on the extremities and those caused by explosions, piercings or iatrogenic measures or consisting of metal pigment particles.

Keratinocytic Malfunction as a Trigger for the Development of Solar Lentigines

Introduction

Solar lentigines (SL) affect chronically UV-radiated skin. Treatment is often refractory. Deeper knowledge on its pathogenesis might improve therapeutic effects.

Material and Methods

Morphological characterization of 190 SL was performed and epidermal thickness, pigment distribution, dendricity, and cornification grade were measured. Immunoreactivity was investigated using Melan A, Tyrosinase, MITF, p53, and CD20, as well as Notch1 using immunofluorescence.

Results

We found 2 groups of histological patterns, i.e., either acanthotic or atrophic epidermis. Lesions with basket-woven cornification and atrophic epidermis were observed in 6 out of 9 and 14 out of 16 cases from the face, respectively. Consistency of areas with a high pigmentation was observed in 96-97% of the cases. Hyperpigmentation grade and acanthosis or cornification disorders correlated positively in 88.5% of the cases. Overexpressed of p53 was found in 19 out of 20 lesions, presenting in a scattered distribution. A significant correlation of p53 and acanthosis (p = 0.003) and cornification grade (p = 0.0008) was observed. Notch1 was expressed in all SL, with the highest immunoreactivity in atrophic facial lesions. Lesions from the hands expressed Notch1 mainly in acanthotic areas with elongated rete ridges and less compact cornification.

Discussion

We suggest that Notch1-dependent keratinocytic malfunction causes the development of SL. Consequently, hyperpigmentation would be a result and not the primary cause of the pathogenesis. Confirmation of these findings might have clinical implications as hitherto treatment has mainly focused on melanocytes and pigmentation and not on the proliferation/differentiation balance of keratinocytes.