Clinicopathologic Efficacy of Copper Bromide Plus/Yellow Laser (578 nm with 511 nm) for Treatment of Melasma in Asian Patients

Compact efficient high-power continuous-wave Nd:YVO4/KGW/LBO Raman lasers for selectable wavelengths within 559-603 nm

Compact efficient high-power continuous-wave Nd:YVO4 Raman lasers for selectable wavelengths within 559-603 nm are achieved by using KGW crystal for intracavity stimulated Raman scattering (SRS) and lithium triborate (LBO) crystal for intracavity sum frequency generation (SFG) and second harmonic generation (SHG). The LBO crystal with the cut angle in the XY plane for the type-I phase matching is used to perform intracavity SHG or SFG. Experimental results reveal that the participated Stokes lines include the internal vibration mode at 901 cm-1, the external vibrational mode at 209 cm-1, and the combination mode of the 901 cm-1 and 209 cm-1 Raman shifts. By tuning LBO temperature for attaining the maximum output power, the output spectrum reveals the triple peaks of 588.7, 595.7, and 603.1 nm with the intensity ratio of 10:4:1. Under this circumstance, the output power can reach the highest value of 10.8 W at a pump power of 40 W. Furthermore, the output spectrum can be simply concentrated on the single peaks among 588.7 (orange), 565.7 (yellow), and 559.1 nm (lime) by tuning LBO temperature to fulfill the selection of the critical phase matching. The output powers at a pump power of 40 W can be up to 8.0, 6.1, and 9.8 W for the single-peak emission at 588.7, 565.7, and 559.1 nm, respectively. Finally, a dual-peak emission of 565.7 and 572.3 nm with total output power of 5.2 W can be generated by tuning LBO temperature to match the SFG for 572.3 nm.

Photobiomodulation for melasma treatment: Integrative review and state of the art

PURPOSE

Photobiomodulation therapy (PBM) is a versatile technique for treating skin diseases. Melasma, a chronic hyperpigmentation condition, has recently been associated with vascular features and dermal photoaging and poses significant management challenges. We review the recent literature on melasma etiology and the evidence supporting PBM as a therapeutic modality for melasma treatment.

METHODS

We conducted a comprehensive literature search in three different databases from May to August 2023, focusing on studies published in the past 10 years. The inclusion criteria comprised full-text studies investigating low-power lasers and/or light-emitting diodes (LEDs) in in vitro or in vivo models, as well as clinical trials. We excluded studies discussing alternative melasma therapies or lacking experimental data. We identified additional studies by searching the reference lists of the selected articles.

RESULTS

We identified nine relevant studies. Clinical studies, in agreement with in vitro experiments and animal models, suggest that PBM effectively reduces melasma-associated hyperpigmentation. Specific wavelengths (red: 630 nm; amber: 585 and 590 nm; infrared: 830 and 850 nm) at radiant exposures between 1 and 20 J/cm2 exert modulatory effects on tyrosinase activity, gene expression, and protein synthesis of melanocytic pathway components, and thus significantly reduce the melanin content. Additionally, PBM is effective in improving the dermal structure and reducing erythema and neovascularization, features recently identified as pathological components of melasma.

CONCLUSION

PBM emerges as a promising, contemporary, and non-invasive procedure for treating melasma. Beyond its role in inhibiting melanogenesis, PBM shows potential in reducing erythema and vascularization and improving dermal conditions. However, robust and well-designed clinical trials are needed to determine optimal light parameters and to evaluate the effects of PBM on melasma thoroughly.

Partial Unilateral Lentiginosis Successfully Treated with the Combination of 511 nm and 578 nm Copper Bromide Laser in an Indonesian Woman

Partial unilateral lentiginosis (PUL) is a pigmentation disorder characterized by multiple lentigines restricted to the normal skin in a unilateral and segmental pattern. Various lasers have been used for the treatment of this pigmented disorders, one of which is the copper bromide (CuBr) laser, which emits a dual-wavelength beam at 511 nm and 578 nm. A 35-year-old woman presented with multiple brown macules with a sharp demarcation from the midline of the forehead to the right cheek in a dermatomal distribution. Histopathological results showed increased melanin pigmentation in the basal layer with elongated rete ridges, supporting the diagnosis of PUL. Following photoprotection and skin priming, CuBr laser treatment was performed in two steps using 511 nm and 578 nm wavelength as the first and second steps, respectively, with the second step delivered immediately after. Clinical improvement was achieved after two sessions of treatment at a one-month interval, as shown by an increasing lightness value (L*) in spectrophotometry. No side effects, such as hyperpigmented macules, was observed. The patient also expressed satisfaction at her brighter facial skin. A sustainable favorable result persisted after six months of laser treatment. Interactions between cutaneous vasculature and melanocytes can affect the development of pigmented lesions. Melanocytes express the functional vascular endothelial growth factor receptor (VEGF) and are responsive to angiogenic factors. Ideally, these conditions should be treated with a dual-wavelength CuBr laser. The combination of 511 nm and 578 nm CuBr laser showed favorable results, supporting its potential as an effective treatment choice for PUL.

Structure and spectral properties of Dy3+ doped CaYAlO4 single crystal

A 2 at.% Dy³⁺: CaYAlO₄ single crystal was grown successfully. The electronic structures of Ca²⁺/Y³⁺ mixed sites in CaYAlO₄ were investigated using first-principles based on density functional theory. The effects of Dy³⁺ doping on the structural parameters of host crystal were studied using XRD pattern. The optical properties including absorption spectrum, excitation spectrum, emission spectra and fluorescence decay curves were thoroughly investigated. The results show that the Dy³⁺: CaYAlO₄ crystal could be pumped by the blue InGaN and AlGaAs or 1281 nm laser diodes. Furthermore, an intense 578 nm yellow emission was obtained directly under excitation at 453 nm, meanwhile, evident mid-infrared light emitting was observed by 808 or 1281 nm laser excitation. The fitted fluorescence lifetimes of ⁴F_9/2 and ⁶H_13/2 levels were about 0.316 ms and 0.038 ms, respectively. It can be concluded that this Dy³⁺: CaYAlO₄ crystal could simultaneously act as a promising medium for both solid-state yellow and mid-infrared laser outputs.

Highly efficient diode-pumped passively Q-switched Nd:YVO4/KGW Raman lasers at yellow and orange wavelengths

Efficient diode-pumped passively Q-switched Nd:YVO₄ yellow and orange lasers are developed with the pulse pumping scheme and the intracavity stimulated Raman scattering (SRS) and second harmonic generation (SHG). A Np-cut KGW is exploited in the SRS process to generate the yellow 579 nm laser or the orange 589 nm laser in a selectable way. The high efficiency is achieved by designing a compact resonator to include a coupled cavity for intracavity SRS and SHG and to provide a focused beam waist on the saturable absorber for reaching an excellent passive Q-switching. The output pulse energy and peak power can reach 0.08 mJ and 50 kW for the orange laser at 589 nm. On the other hand, the output pulse energy and peak power can be up to 0.10 mJ and 80 kW for the yellow laser at 579 nm.

Nonlinear optical properties and passively Q-switched laser application of a layered molybdenum carbide at 639 nm

Molybdenum carbide (Mo₂C) exhibits enormous potential applications in various optoelectronic and photonic fields due to its remarkably electrical and optical characteristics. Here, we fabricate a high-quality Mo₂C film by the radio frequency magnetron sputtering deposition method. The nonlinear optical response and ultrafast dynamics are thoroughly studied based on open-aperture Z-scan and nondegenerate pump-probe experimental measurements. The open-aperture Z-scan experimental result exhibits a modulation depth of 8.5% and a saturation fluence of 0.28 mJ/cm². Simultaneously, the relaxation time constant is fitted by a biexponential decay function, showing an ultrafast intraband carrier recovery time of 0.58 ps at 530 nm. Consequently, by employing the Mo₂C film as a saturable absorber (SA), stable Q-switched Pr:YLF laser pulses with the shortest pulse width of 160 ns are generated at 639 nm. Our experimental results demonstrate excellent nonlinear optical properties of the layered Mo₂C in the visible region and will further advance their potential applications in visible nonlinear optics.

Defining Skin Quality: Clinical Relevance, Terminology, and Assessment

BACKGROUND

Flawless skin is one of the most universally desired features, and demand for improvements in skin quality is growing rapidly. Skin quality has been shown to substantially impact emotional health, quality of life, self-perception, and interactions with others. Although skin quality improvements are a common end point in studies of cosmeceuticals, they are rarely assessed in clinical studies of other aesthetic treatments and products. Descriptive terminology for skin quality parameters also varies considerably within the aesthetic field, relying on a range of redundant and occasionally contradictory descriptors. In short, skin quality has not been clearly defined.

OBJECTIVE

The goal of this review is to highlight the importance of skin quality to patients and physicians, explore known and unknown factors comprising skin quality, and provide clarity regarding terminology, descriptors, and evaluation tools for assessing skin quality.

MATERIALS AND METHODS

A review of the literature on skin quality was performed without limitation on publication date. Relevant articles are presented.

RESULTS AND CONCLUSION

We propose a framework of attributes contributing to skin quality rooted in 3 fundamental categories-visible, mechanical, and topographical-with the aim to provide information to help guide clinicians and inform future clinical studies.

The formulation and efficacy of topical Dorema ammoniacum in treating Melasma: a randomized double-blind, placebo-controlled trial

OBJECTIVES

An acquired melanin-related hyperpigmentation that occurs in sun exposure areas is Melasma which presents as gray-brown ridges and macules with prominent margins on the skin. The aim of this assay was to assess the formulation and efficacy of topical Dorema ammoniacum among Melasma patients.

METHODS

This study was a 30 days double-blind, randomized clinical trial in Melasma with a placebo group. The study was carried out on 49 patients with Melasma attending Haji Daii Nursing Center in Kermanshah, Iran. Optimized topical formulation of D. ammoniacum gum extract was prepared by evaluating the characteristics of different topical formulations of this plant. Mean Melasma severity index (MMASI) instrument was applied to assess the product effectiveness and to determine the skin stains. Patients were pursued to receive the treatment throughout the 30 days trial. This scaling was accomplished before the intervention and 30 days after the use of the herbal product. To analyze the quantitative variables, t-test and Mann-Whitney test were evaluated by SPSS 21 software, and p-value <0.05 was considered as the statistically significant.

RESULTS

The survey was performed on 40 female subjects (81.6%) and nine male subjects (18.4%) with the mean age of 32.18 ± 8.69. According to the results, the mean MSI in the drug group was significantly lower than before treatment and decreased from 86.98 ± 69.48 to 31.03 ± 32.62 (p-value <0.05).

CONCLUSIONS

In compliance with findings this survey revealed a positive effect of the cream formulation of D. ammoniacum extract on Melasma. As it was represented no side effects, this formulation is appropriate for the treatment of Melasma.

Treatment of pyogenic granuloma with copper vapor laser radiation

Background. Pyogenic granuloma (PG) or lobular capillary hemangioma, ICD10 code: L98.0. appears as a single bright red or violet papule up to 20 mm in size, on the face, fingers, skull surface, arms, and intergluteal fold, as well as on the oral mucous membranes. Surgical removal of facial PG is not always possible due to insufficient thickness of the dermis. Treatment of PG with a pulsed dye laser (PDL) or neodymium laser (Nd:YAG) can achieve a noticeable elimination of the lesion but is reported to be accompanied by such side effects as purpura or scarring. It determines the feasibility of introducing into clinical practice the methods of laser treatment of PG using the radiation of a copper vapor laser (CVL) with a wavelength of 578 nm, which effectively absorbed by the blood. Aim. The assessment of the clinical efficacy and safety of the CVL treating PG. Methods. 26 adult patients with PG in various parts of the face, including the lips, limbs, and trunk, were included in this study. PG treatment was carried out in one session with CVL (Yakhroma-Med, FIAN) at an average power of 0.71.0 W, at a wavelength of 578 nm, exposure time 0.20.3 s. The diameter of the light spot is 1 mm. Results. Immediately after the single laser treatment, the PG involved area became grey. In 710 days, the irradiated area was utterly similar to the adjacent intact skin. No postoperative bleeding or infection was noted. Side effects included mild skin atrophy. During the follow-up observation for five years, no side effects were found. Conclusion. The high efficiency of PG elimination using CVL in the absence of pronounced side effects allows suggesting this method for introducing into dermatologists and cosmetologists' clinical practice as a highly effective and inexpensive method of treatment.

The Vascular Component of Melasma: A Systematic Review of Laboratory, Diagnostic, and Therapeutic Evidence

BACKGROUND

Melasma is a common acquired disorder of hyperpigmentation, classically manifesting as symmetric brown patches on the face. Although the exact pathogenesis is not fully understood, vascular abnormalities have been implicated in melasma.

OBJECTIVE

To evaluate the laboratory and clinical evidence regarding the safety and efficacy of antivascular agents for the treatment of melasma.

METHODS

A systematic review of PubMed, EMBASE, and Cochrane was conducted on May 13, 2020, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Original research articles investigating the role of vascularity and/or evaluating the use of antivascular therapeutics in melasma were included. Clinical recommendations were based on the American College of Physicians guidelines.

RESULTS

A total of 34 original research articles as follows were identified: 4 laboratory studies, 15 diagnostic studies, and 15 therapeutic studies.

CONCLUSION

There is promising evidence supporting the use of tranexamic acid and laser/light therapies to treat the vascular component of melasma, and more rigorous clinical trials are needed to validate their efficacy. Clinicians may consider treatment with one or more antivascular therapeutics in patients with melasma. Further research is warranted to characterize the role of cutaneous vascularization in melasma and may provide insights for novel therapies.

Treatment of the nevus sebaceous of Jadasson by a copper vapor laser

Introduction. Nevus sebaceous of Jadassohn (synonym: nevus of the sebaceous glands) (NSG) presents the congenital malformation of the skin with possible transformation into benign or malignant tumors during the adolescence or adulthood. Commonly appeared on the scalp or neck NSG is frequently concern with cosmetic problems making patients look for opportunities for its removal. Surgical removal of the NSG is related to an elevated risk of scarring. Using ablative lasers has proven to be effective in the removal of small NSG. However, the removal of medium and large NSG with ablative lasers was reported to be linked with a high risk of scarring and recurrence. The removal of the medium-sized NSG with a copper vapor laser (CVL) is described here for the first time. Case report and procedure. Laser removal of NSG (linear sized of 27 mm) was performed in a 25-year-old female patient with Fitzpatrick skin type II during eight CVL treatments. Laser settings were selected as follows: the average power of 1 W at the power ratio of 3:2 radiation at a wavelength of 511 and 578 nm. Pulse duration 20 nanoseconds, reprate 16.6 kHz, exposure duration 200 ms, and the light spot's diameter on the skin 1 mm. Results. After 8 procedures, the skin in the area of the removed NSG acquired a natural color and appearance. During 24 months of follow-up, there was no hyperpigmentation or signs of scars in the irradiated area. No relapses were observed for 24 months after the CVL removal of NSG. Conclusion. The application of non-ablative CVL removal of NSG ensured a desired cosmetic result without side effects.

Dynamic Optical Coherence Tomography of Cutaneous Blood Vessels in Melasma and Vessel Response to Oral Tranexamic Acid

BACKGROUND AND OBJECTIVES

Melasma may be related to aberrant blood vessels, but there has been no report on the utility of dynamic optical coherence tomography (D-OCT) in studying vessel characteristics in melasma. We studied the characteristics of cutaneous blood vessels in melasma and the effects of oral tranexamic acid (TXA) with D-OCT.

STUDY DESIGN/MATERIALS AND METHODS

Six patients with moderate to severe melasma had a D-OCT scanning of the areas on the face affected by melasma and not affected by it. Three of them had scans within 3 months after starting oral TXA and at a follow-up visit. Blood flow at different depths of the skin and vessel diameter were compared between the melasma and normal skin. For those taking oral TXA, we compared the percent change of blood flow and diameter between the melasma and normal skin.

RESULTS

Dermal blood flow and vessel diameter were greater in the melasma skin than in the normal skin. Oral TXA reduced dermal blood flow in both the melasma and normal skin, but the reduction was more dramatic in the lesional melasma skin.

CONCLUSIONS

D-OCT findings that (i) dermal blood vessels in melasma are increased in size and flow and (ii) oral TXA reduced the vessel size and flow, providing evidence supporting the relationship between melasma and cutaneous blood vessels. D-OCT may be utilized in measuring response to treatments targeting melasma. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

[Laser treatment of pigmentation disorders]

Pigmentation disorders are among the most common cutaneous changes and occur in up to 60% of all people. They can be genetic or acquired, functionally or cosmetically disturbing, or the expression of a medical disorder. The best treatment options for hyperpigmentation are usually lasers and intense pulsed light (IPL). However, they can also worsen some conditions and are occasionally associated with side effects. A correct diagnosis is therefore essential, taking into account the skin type, the type of pigmentation and how deep the pigmentation is located in the skin. The most common indications for which laser treatment is recommended include genetically predisposed nevi (Becker, Ota, Hora, Ito, acquired bilateral nevus of Ota-like macules [ABNOM]), pigmentation (e.g., lentigines, postinflammatory hyperpigmentation, ephelides, café au lait, nevus spilus, linear and whorled hypermelanosis [LWNH]), nevus cell nevi, exogenous pigments, tattoos and cosmetic pigments.

High-power diode-pumped Nd:GdVO4/KGW Raman laser at 578 nm

A diode-pumped neodymium-doped gadolinium vanadate (Nd:GdVO₄) laser is developed as a compact efficient yellow light at 578 nm by means of intracavity stimulated Raman scattering (SRS) in a potassium gadolinium tungstate (KGW) crystal and the second-harmonic generation in a lithium triborate crystal. The SRS process with a shift of 768cm^-1 is achieved by setting the polarization of the fundamental wave along the N_g axis of the KGW crystal. The self-Raman effect arising from the Nd:GdVO₄ crystal is systematically explored by employing two kinds of coating specification for the output coupler. With a specific coating on the output coupler to suppress the self-Raman effect, the maximum output power at 578 nm can reach 3.1 W at a pump power of 32 W. Moreover, two different lengths for the Nd:GdVO₄ crystal are individually used to verify the influence of the self-Raman effect on the lasing efficiency.

Treatment of сongenital melanocytic nevus in infants and children by a dual-wavelengths copper vapor laser

Introduction.Congenital melanocytic nevus (CMN) is detected at birth or shortly after birth in 1% of infants. The localization of CMN in aesthetically significant areas causes a decline in child self-esteem and causes concern for his parents. Surgical excision of skin areas with CMN is associated with an increased risk of cosmetic side effects and is often followed by long-term stress conditions after the invasive intervention. Aim of the study.To evaluate the efficacy of the CMN removal in infants, children and adolescents with the dual-wavelengths copper vapor laser (CVL) radiation. Patients and Methods.Medium-sized (up to 9 cm) single CMN was treated in nine fair-skinned patients: seven girls and two boys, aged from 2 months to 16 years. The procedures were carried out at an average CVL power of 0.61.0 W, with a power ratio of 3:2 at 511 nm and 578 nm wavelengths, and an exposure time of 0.20.3 s. Light spot diameter 1 mm. The treatment was carried out during 210 sessions with an interval of 12 months between sessions. Results.In children and adolescents, the treatment of CMN with CVL dual-wavelengths radiation made it possible to achieve significant clarification of the involved area without hypertrophic scars. The duration of the healing of the irradiated area lasted 23 weeks. Side effects were manifested with subtle skin atrophy. Conclusion.The high efficacy of CVL removal of medium-sized CMN in infants and children using the dual-wavelengths CVL radiation without pronounced side effects allows introducing such an approach in the clinical practice of pediatric dermatologists and cosmetologists.

Tranexamic Acid Inhibits Angiogenesis and Melanogenesis in Vitro by Targeting VEGF Receptors

Melasma is a common but complex skin condition concerning cosmetic problems. Tranexamic acid (TA) has been proved to be effective in treatment of melasma with still unclear mechanisms. Here, we show that VEGF165 enhanced the expression of VEGF receptors (VEGFRs, including VEGFR-1, VEGFR-2 and NRP-1) in human umbilical vein endothelial cells (HUVECs), which was attenuated by TA. VEGF165 also promoted tyrosine phosphorylation of VEGFR-1 and VEGFR-2 in HUVECs, which was again abolished by TA. TA further showed similar effects to neutralization of VEGFR-1 and VEGFR-2 in inhibiting cell proliferation, migration, invasion and tube formation of HUVECs induced by VEGF165, suggesting that TA could inhibit angiogenesis by targeting VEGFRs in HUVECs. In addition, VEGF165 enhanced the expression of VEGFRs and promoted tyrosine phosphorylation of VEGFR-1 and VEGFR-2 in normal human melanocytes, which were also attenuated by TA. Furthermore, TA showed similar effects to neutralization of VEGFR-1 and VEGFR-2 in inhibiting tyrosinase activity, melanin production and even melanogenic proteins induced by VEGF165, suggesting that TA could reduce melanogenesis via inhibiting activation of VEGFRs and subsequent expression of melanogenic proteins in melanocytes. Taken together, we demonstrate that TA can inhibit angiogenesis and melanogenesis in vitro at least in part by targeting VEGFRs, which may offer a new understanding of the pathogenesis of melasma as well as the molecular mechanism for TA in treatment of the disease.

Treatment of seborrheic keratosis with a copper vapour laser

Aim: to assess the efficacy and side-effect risk of the surgical treatment of seborrheic k eratosis (SK) using a copper vapour laser (CVL).

Patients and methods. 3980 patients (1214 men and 2766 women aged 20 to 78 years) suffering from SK were treated using a CVL (Yakhroma-Med model, Russian producer) equipped with a laser pen and a scanning nozzle. The laser treatment was performed without anaesthesia in one to four sessions. During the treatment procedure, the following radiation parameters were applied: wavelengths ranging from 511 to 578 nm (in the ratio of 3 to 2), an average power of 0.6–1.2 W and an exposure duration ranging from 0.2 to 0.4 s. The diameter of the light spot on the skin surface was 1 mm. The follow-up observation lasted 24 months.

Results. The computer simulation of tissue heating by CVL and other laser systems showed that CVL is an optimal treatment choice for seborrheic keratosis in terms of the energy deposition depth. According to our clinical data and the results of computer simulation, the CVL is established to be the safest and the most effective for seborrheic keratosis treatment.

Low-fluenced erbium:yttrium-aluminium-garnet laser treatment in combination with broadband light pretreatment for various pigmentation disorders in Asian patients

BACKGROUND

Low-fluenced 2940-nm erbium (Er):yttrium-aluminium-garnet (YAG) resurfacing elicits ablative photothermal tissue reactions confined to the uppermost parts of the epidermis.

OBJECTIVE

To demonstrate the efficacy and safety of low-fluenced ablative Er:YAG laser treatment in combination with broadband light (BBL) pretreatment for various pigmentation disorders.

METHODS

In total, 35 Korean patients with various pigmentation disorders were pretreated with BBL, and then, low-fluenced Er:YAG laser resurfacing was performed with a beam size of 4 mm and a fluence of 1.0-1.5 J/cm² .

RESULTS

An average of 1.1 ± 0.4 sessions of combined BBL and low-fluenced Er:YAG resurfacing treatment was delivered to the patients. Most post-Er:YAG scaling fell off spontaneously over 3-5 days, and most of the post-BBL crusting disappeared spontaneously over 5-7 days. At 2 months after final treatment, the mean global aesthetic improvement scale score for the clinical improvement of pigmentation lesions was estimated as 2.5 ± 0.8, and that for the improvement of overall skin tone, texture, and wrinkles was 2.8 ± 1.0.

CONCLUSION

Our data demonstrated that post-BBL, low-fluenced Er:YAG laser resurfacing can be used to effectively treat various pigmentation disorders in Asian patients. Further improvements in overall skin tone, texture, and wrinkles were also achieved without major side effects.

Melasma: Updates and perspectives

Management of melasma is highly challenging due to inconsistent treatment results and frequent relapses. However, recent studies revealed that melasma may not only be a disease of melanocytes, but also a photoaging skin disorder. Herein, we attempt to validate that melasma is indeed a photoaging disorder by presenting the histopathologic findings of melasma: solar elastosis, altered basement membrane, increased vascularization and increased mast cell count. We also provide some therapeutic implications based on these findings and a discussion on the latest updates and perspectives regarding treatment.

Treatment of Melasma with Pulsed-Dye Laser and 1,064-nm Q-Switched Nd:YAG Laser: A Split-Face Study

Background

Melasma is an acquired pigmentary disorder that is often therapeutically challenging. Recent evidence suggests that vascular abnormalities are involved in melasma pathogenesis. Pulsed-dye laser (PDL) is considered as standard therapy for vascular lesions.

Objective

To assess the efficacy of PDL combined with low-fluence Q-switched Nd:YAG laser (QSNY) in the treatment of melasma.

Methods

Seventeen melasma patients were enrolled in this study. All subjects were treated with a total of nine QSNY treatment sessions at one-week intervals. Three sessions of PDL were additionally performed immediately after QSNY treatment on the half of the face at baseline, week 4, and week 8. The melasma area and the severity index (MASI) score was calculated at the baseline, one week after the last treatment (week 9), as well as at the follow-up 8 weeks after the last treatment (week 16). Dermoscopic images at the baseline were classified as to whether the visibly widened capillaries were detected or not.

Results

MASI scores on the PDL+QSNY and QSNY side decreased significantly during the study period. There was no significant difference in the MASI score change between both sides in all periods. However, seven patients who had visibly widened capillaries on dermoscopy showed significant difference in both sides in terms of changes in the MASI score during treatment.

Conclusion

PDL combined with QSNY may be considered as a safe and effective treatment for melasma patients who show visibly widened capillaries on dermoscopy.

Light-emitting diode 585nm photomodulation inhibiting melanin synthesis and inducing autophagy in human melanocytes

BACKGROUND

Melasma is a common hyperpigmentation skin disease on face. Light-emitting diode (LED) photomodulation (585nm) is reported to be effective for the treatment of melasma. However, whether and how LED photomodulation would influence melanogenesis of human epidermal melanocytes (HEMs) is unknown.

OBJECTIVE

To evaluate the effects of LED photomodulation (585nm) on melanogenesis in HEMs.

METHODS

HEMs were irradiated with fluences of 0, 5, 10 and 20J/cm² 585nm LED light. After 5-day treatment, cell viability was analyzed by CCK-8 assay, and apoptosis was assessed by Annexin V APC assay. Melanin content and tyrosinase activity were measured by spectrophotometer. Melanosome stage and autophagosomes were determined under transmission electron microscope (TEM). The formation of autophagic punctate structures was observed under confocal microscope. RT-PCR and western blotting were used to assess the expression of relative mRNA and protein levels.

RESULTS

Yellow light LED 585nm had no effects on HEMs cell viability and apoptosis. Treatment with LED 585nm from 5J/cm² to 20J/cm² inhibited melanosome maturation, decreased melanin content and tyrosinase activity. Inhibition was accompanied by the decreased expression of tyrosinase (TYR), tyrosinase-related protein-1 (TRP-1) and microphthalmia-associated transcription factor (MITF) on both mRNA and protein levels. Autophagosomes were observed under TEM. Autophagic punctate structures of microtubule-associated protein light chain 3 (LC3) proteins were induced by LED 585nm light. The configuration change of LC3 from LC3-I to LC3-II, and the degradation of p62 protein were observed after LED 585nm. Furthermore, we also revealed that the anti-melanogenic effect of LED 585nm photomodulation was reversed by 3-Methyladenine (3-MA), which inhibits autophagy by blocking autophagosome formation via the inhibition of type III Phosphatidylinositol 3-kinases (PI-3K).

CONCLUSIONS

Our finding demonstrated that LED photomodulation with 585nm wavelength suppressed melanin content in HEMs, and the effect was caused by its dose-dependent inhibition on melanogenesis and the induction of HEMs autophagy. This may provide new insights into the efficacy of LED photomodulation in the treatment of hyperpigmentation disorders.

Melasma: an Up-to-Date Comprehensive Review

Melasma is a common acquired condition of symmetric hyperpigmentation, typically occurring on the face, with higher prevalence in females and darker skin types. Multiple etiologies, including light exposure, hormonal influences, and family history, have been implicated in the pathogenesis of this disorder. Overall prevalence ranges widely at 1-50%, since values are typically calculated within a specific ethnic population within a geographic region. Histologically, melasma can display increased epidermal and/or dermal pigmentation, enlarged melanocytes, increased melanosomes, solar elastosis, dermal blood vessels, and, occasionally, perivascular lymphohistiocytic infiltrates. Various topical, oral, and procedural therapies have been successfully used to treat melasma. Traditional topical therapies including hydroquinone, tretinoin, corticosteroids, and triple combination creams; however, other synthetic and natural topical compounds have also shown varying efficacies. Promising oral therapies for melasma include tranexamic acid, Polypodium leucotomos, and glutathione. Procedures, including chemical peels, microneedling, radiofrequency, and lasers, are also often used as primary or adjunctive treatments for melasma. Notably, combination therapies within or across treatment modalities generally result in better efficacies than monotherapies. This review serves as a comprehensive update on the current understanding of the epidemiology, pathogenesis, clinical and histologic features of melasma, as well as treatments for this common, yet therapeutically challenging, condition.

A review of laser and light therapy in melasma

Melasma is a dysregulation of the homeostatic mechanisms that control skin pigmentation and excess pigment is produced. Traditional treatment approaches with topical medications and chemical peels are commonly used but due to the refractory and recurrent nature of melasma, patients often seek alternative treatment strategies such as laser and light therapy. Several types of laser and light therapy have been studied in the treatment of melasma. Intense pulsed light, low fluence Q-switched lasers, and non-ablative fractionated lasers are the most common lasers and light treatments that are currently performed. They all appear effective but there is a high level of recurrence with time and some techniques are associated with an increased risk for postinflammatory hyper- or hypopigmentation. The number and frequency of treatments varies by device type but overall, Q-switched lasers require the greatest number of treatment applications to see a benefit. Vascular-specific lasers do not appear to be effective for the treatment of melasma. Ablative fractionated lasers should be used with caution because they have a very high risk for postinflammatory hypo- and hyperpigmentation. The use of nonablative fractionated laser treatments compared with other laser and light options may result in slightly longer remission intervals. Picosecond lasers, fractional radiofrequency, and laser-assisted drug delivery are promising future approaches to treat melasma. The goal of this review is to summarize the efficacy and safety of the most commonly used laser and light therapies to treat melasma, briefly present future laser-based treatment options for patients with melasma, and provide recommendations for treatment on the basis of the reviewed information.

Heterogeneous Pathology of Melasma and Its Clinical Implications

Melasma is a commonly acquired hypermelanosis that affects sun-exposed areas of the skin, with frequent facial involvement. Its histologic manifestations are evident in the epidermis, extracellular matrix, and dermis. In addition to epidermal pigmentation, pathologic findings of melasma include extracellular matrix abnormality, especially solar elastosis. The disrupted basement membrane has been described in melasma with variable incidences. In the dermis, an increase in vascularity and an increase in the number of mast cells were observed, indicating that dermal factors have critical roles in the pathogenesis of melasma, despite the fact that melasma is characterized by epidermal hyperpigmentation. This review discusses such histologic characteristics of melasma, with consideration to their implications for melasma treatment.

New insight in the treatment of refractory melasma: Laser Q-switched Nd: YAG non-ablative fractionated followed by intense pulsed light

The purpose of our study was to verify the results of the association of Q-switched Nd: YAG non-ablative fractionated with intense pulsed light, in order to treat patients with refractory melasma. The combination of these two devices seems to be the best treatment to combat hyperpigmentation produced by melasma, with low occurrence of side effects, which may be justified by the selective photothermolysis at subcellular level.

Pilot Study of the Efficacy of 578 nm Copper Bromide Laser Combined with Intralesional Corticosteroid Injection for Treatment of Keloids and Hypertrophic Scars

Background

Treatments including intralesional corticosteroid injection, pressure therapy, cryotherapy, and various laser therapies have had limited success for keloids and hypertrophic scars.

Objective

This trial evaluated the efficacy of a combination of 578 nm copper bromide laser and the more traditional intralesional corticosteroid injection for the treatment of keloids and hypertrophic scars with respect to scar color.

Methods

Keloids or hypertrophic scars of 12 Korean patients were treated five times by the combined treatment at 4-week intervals. Clinical improvement was assessed by the physicians' global assessment (PGA) comparing pre- and post-treatment photographs, as well as 4 weeks after the last treatment. Erythema intensity was quantified using a mexameter.

Results

Most scars showed significant clinical improvement in PGA and decreased erythema intensity after 5 treatments. All patients showed improvements in symptoms like pruritus.

Conclusion

The combined treatment is effective for keloids and hypertrophic scars, especially when the telangiectatic portion of the scars is prominent. The adjunctive use of 578 nm copper bromide laser decreased the telangiectatic side effects of an intralesional corticosteroid injection by reducing the vascular components of scars.

A practical comparison of Copper Bromide Laser for the treatment of vascular lesions

The recent rapid growth in demand for aesthetic non-invasive laser treatments such as unwanted skin rejuvenation, removal of age-related vascular blemishes has led to a boom in the medical devices to treat these conditions. Among diverse laser for skin treatment, copper bromide laser is a very effective, safe, and well tolerated treatment for facial telangiectasia at various energy levels and the most important thing of the copper bromide laser device is that the stability of the energy. However there is no evidence about effective copper bromide laser's energy level for the treatment of vascular lesions. We compared energy stability and treatment performance between two energy levels in 2 W and 8 W which commonly use in laser treatment for the vascular lesions. 8 W copper bromide laser was more stable compared than 2 W copper bromide laser. Also, 8 W copper bromide laser was effectively superior to 2 W copper bromide laser in treatment of vascular legion. Consequently, 8 W copper bromide laser treatment for vascular lesion might be more suitable than 2 W copper bromide laser.

Combined treatment with 578-/511-nm copper bromide laser and light-emitting diodes for post-laser pigmentation: a report of two cases

Postinflammatory hyperpigmentation (PIH) developing after cosmetic procedures such as lasers and chemical peels is always a concern, especially in darker skin types. We report two cases of laser-related PIH of the face successfully treated by combined therapy with 578-/511-nm copper bromide laser and light-emitting diodes (LED). Good cosmetic results were achieved in both patients. The side effects during and after treatment included a mild stinging and redness, but these were resolved within several days without any treatment. Combined 578-/511-nm copper bromide laser with LED provided safe and effective treatment for post-laser pigmentation in Korean patients.

Lasers

Lasers are a very effective approach for treating many hyperpigmented lesions. They are the gold standard treatment for actinic lentigos and dermal hypermelanocytosis, such as Ota nevus. Becker nevus, hyperpigmented mosaicisms, and lentigines can also be successfully treated with lasers, but they could be less effective and relapses can be observed. However, lasers cannot be proposed for all types of hyperpigmentation. Thus, freckles and café-au-lait macules should not be treated as the relapses are nearly constant. Due to its complex pathophysiology, melasma has a special place in hyperpigmented dermatoses. Q-switched lasers (using standard parameters or low fluency) should not be used because of consistent relapses and the high risk of post-inflammatory hyperpigmentation. Paradoxically, targeting the vascular component of the melasma lesion with lasers could have a beneficial effect. However, these results have yet to be confirmed. In all cases, a precise diagnosis of the type of hyperpigmentation is mandatory before any laser treatment, and the limits and the potential side effects of the treatment must be clearly explained to patients.