Q-switched Nd:YAG laser treatment for labial lentigines associated with Peutz-Jeghers syndrome

Clinical Guidelines for Diagnosis and Management of Peutz-Jeghers Syndrome in Children and Adults

BACKGROUND

Peutz-Jeghers syndrome (PJS) is a rare disease characterized by the presence of hamartomatous polyposis throughout the gastrointestinal tract, except for the esophagus, along with characteristic mucocutaneous pigmentation. It is caused by germline pathogenic variants of the STK11 gene, which exhibit an autosomal dominant mode of inheritance. Some patients with PJS develop gastrointestinal lesions in childhood and require continuous medical care until adulthood and sometimes have serious complications that significantly reduce their quality of life. Hamartomatous polyps in the small bowel may cause bleeding, intestinal obstruction, and intussusception. Novel diagnostic and therapeutic endoscopic procedures such as small-bowel capsule endoscopy and balloon-assisted enteroscopy have been developed in recent years.

SUMMARY

Under these circumstances, there is growing concern about the management of PJS in Japan, and there are no practice guidelines available. To address this situation, the guideline committee was organized by the Research Group on Rare and Intractable Diseases granted by the Ministry of Health, Labour and Welfare with specialists from multiple academic societies. The present clinical guidelines explain the principles in the diagnosis and management of PJS together with four clinical questions and corresponding recommendations based on a careful review of the evidence and involved incorporating the concept of the Grading of Recommendations Assessment, Development and Evaluation system.

KEY MESSAGES

Herein, we present the English version of the clinical practice guidelines of PJS to promote seamless implementation of accurate diagnosis and appropriate management of pediatric, adolescent, and adult patients with PJS.

Clinical Efficacy of 755 nm Laser Treatment of Lip Mucosal Pigmentation in Children with Peutz–Jeghers Syndrome

Peutz–Jeghers syndrome (PJS) is a rare genetic disorder characterized by multiple gastrointestinal polyps and mucocutaneous pigmentation. Abnormal pigmentation typically develops in infancy or childhood. As PJS-related facial pigmentation can lead to psychological burden due to its effects on esthetics, treatment is required. Herein, we report on the efficacy and safety of treatment of lip mucosal pigmentation using a Q-switched 755 nm Alexandrite Laser in children with PJS, aged 2–12 years of age. A topical anesthetic was used prior to the application of laser therapy. A treatment efficacy of 100% was achieved with one to three treatments, with an excellent outcome achieved in five cases (62.5%) and a good outcome in three (37.5%). Recurrent pigmentation was observed in one case over the 6-month follow-up period. There were no adverse effects, such as scarring or hyperpigmentation or hypopigmentation. The treatment did cause pain, apprehension, and crying in some children, requiring special attention. Although our sample size is small, our findings do provide support of the high efficacy and safety of the Q-switched 755 nm Alexandrite Laser for the treatment of lip mucosal pigmentation in children with PJS. Further studies are required to confirm these findings.

Picosecond 755-nm alexandrite laser treatment for oral lentiginosis in Peutz-Jeghers disease

We present the case of a 16-year-old boy with Peutz-Jeghers disease with successful treatment of oral lentiginosis with one session of picosecond 755-nm alexandrite laser. To date, only in one other article picosecond laser is used for lentiginosis in Peutz-Jeghers disease. Other therapeutical options include Q-switched 755-nm alexandrite, 1064-nm Nd:YAG, 532-nm KTP-laser, ruby and intense pulsed light, which generally require more sessions, are less pigment-selective and have overall worse results than picosecond laser treatment.

Efficacy of 532-nm Q-switched Nd:YAG Laser in the Treatment of Lip Melanosis

Introduction:

Lip pigmentation is frequently encountered in the Dermatology outpatient department. No effective treatment is available so far. Topical treatment requires longer time and is often unsatisfactory.

Aim:

The aim of this work was to study the efficacy of 532-nm Q-switched Nd:YAG laser in the treatment of lip melanosis.

Settings and Design:

This was a prospective interventional study.

Materials and Methods:

Twenty patients in the age group 27–53 years were included in the study. Eight patients had diffuse pigmentation and twelve patients had focal pigmentation. Test spot was done. After topical anesthesia, Q-switched Nd:YAG laser was used. Treatment interval was 4 weeks. Follow-up was done at 1 week and then monthly.

Statistical Analysis Used:

Wilcoxon signed ranks test and P value.

Results:

Seven patients (35%) showed an excellent response with more than 75% of pigment clearance. Seven patients (35%) showed a good response, two patients (10%) moderate response, and two patients (10%) had a mild response. Two patients had recurrence after 3 months follow-up. The average number of sessions required for clearance of pigmentation was 2.5. No scarring was seen.

Conclusion:

532-nm Q-switched Nd:YAG laser is safe and effective in the management of lip pigmentation and gives rapid results.