Clinical effectiveness of intense pulsed light therapy for solar lentigines of the hands

Prospective Study of 532-nm Picosecond Laser for the Treatment of Pigmented Lesions of the Face and Dorsal Hands

BACKGROUND

Pigmented lesions from chronic UV photoaging are extremely common on the face and hands.

OBJECTIVE

To evaluate the safety and efficacy of a 532-nm picosecond laser for these types of pigmented lesions.

METHODS

This was a single-center, prospective, open-label clinical trial. Eligible subjects with pigmentation on the face and hands received 3 monthly treatments, with 1 month (1M) and 3 months (3M) follow-up. Change in investigator-graded overall facial and per lesion pigmentation and subject-graded satisfaction and pigmentation improvement was evaluated by a 5-point scale. Immediate skin response and adverse events (AEs) were evaluated post-treatment. The melanin index was measured using a mexameter. Randomized before and after photographs were graded by 3 blinded physicians for degree of pigmentation improvement.

RESULTS

Twenty-five subjects (22F/3M) with Fitzpatrick skin types I-III were enrolled, with 23 subjects completing. Treatments used a 532 nm wavelength, 800 ps pulse duration, 4-6mm spot size, and 0.1 to 0.6J/cm2 fluence. Good-to-excellent clearance at 1M/3M was demonstrated in ≥95% of lesions (n = 116). Only mild treatment-related pain was reported, with transient post-treatment AEs (mean downtime of 2.1 ± 2.0 days) and no serious treatment-related AEs. Subject satisfaction (satisfied or very satisfied) was 95% at 1M and 91% at 3M.

CONCLUSION

Treatment with a 532-nm picosecond laser is safe and highly effective for the treatment of the pigmented lesions of the face and dorsal hands.

Laser treatment of benign melanocytic lesion: a review

Treatment of pigmented lesions is one of the major challenges of laser and cosmetic practitioners. The most common pigmented lesions that are treated by lasers are melanocytic nevi, ephelides, solar lentigines, and café au lait macules. Melanin absorbs different wavelengths (500-1100 nm); thereby, treatment of various pigmented lesions requires the application of lasers with different wavelengths. Choosing the most appropriate type of laser depends on various factors such as the chromophore and the location of a specific lesion in the skin. In this paper, we aim to review the most efficient laser treatment protocols for each pigmented skin lesion and compare their efficacy in each part based on the previous studies.

The Efficacy of Intense Pulsed Light as a Treatment for Benign Pigmented Lesions on the Dorsal Hand

BACKGROUND

Intense pulsed light (IPL) is a noninvasive therapeutic option to treat benign pigmented lesions by targeting melanin.

OBJECTIVE

The purpose of this study was to assess IPL as a treatment for benign pigmented dorsal hand lesions.

MATERIALS AND METHODS

A total of fifteen subjects, 40 to 73 years old, received 3 monthly IPL treatments over the dorsal hands. Subjects followed up 1 and 3 months after treatment. At every visit, photographs were taken using the VISIA Complexion Analysis System (Canfield Scientific, Fairfield, NJ) and analyzed using the RBX Brown Spots Analysis algorithm. The Clinician Global Aesthetic Improvement Scale and Subject Global Aesthetic Improvement Scale were completed at both follow-up visits.

RESULTS

A total of fifteen subjects completed all six visits. The number of brown spots decreased 9.26% ( p = .0004) and 7.52% ( p = .0132) at each follow-up visit. The mean brown intensity decreased 6.15% ( p = .0183) and 7.67% ( p = .0178), whereas the mean contrast intensity decreased 8.88% ( p < .0001) and 6.60% ( p = .0007) 1 and 3 months after treatment, respectively. The mean Clinician Global Aesthetic Improvement Scale was 2.03 and 2.23, whereas the mean Subject Global Aesthetic Improvement Scale 1 and 3 months after treatment was 1.6 and 1.8, respectively.

CONCLUSION

Objective analysis, along with clinician and subject assessments, showed an improvement in the appearance of benign pigmented lesions in the treated area after 3 IPL treatments.

Dorsal Hand Rejuvenation: A Systematic Review of the Literature

BACKGROUND

Dorsal hand appearance undergoes changes with aging. Grading systems have been designed to provide numerical scores to dorsal hand appearance. Various modalities have been utilized to improve the aesthetic appearance and rejuvenate the dorsal hand.

METHODS

The MEDLINE database was searched for articles investigating dorsal hand rejuvenation. Studies were grouped by method including fat grafting, injectable filler, laser/light-based treatments and miscellaneous treatments. Treatment protocols and outcomes were compiled along with patient information and complications.

RESULTS

Forty-six articles were identified for inclusion. This included 9 studies of fat grafting procedures, 20 studies of injectable filler, 10 studies of laser/light-based treatments and 7 miscellaneous. Most studies showed overall good results with high patient satisfaction. Satisfaction rates were lower in laser/light-based treatments compared with the other modalities. The average patient age for included studies ranged from 41.5 to 69. Across all studies, 96.8% of patients were female and 3.2% male.

CONCLUSIONS

Procedures for dorsal hand rejuvenation in the literature include procedures to address volume atrophy and superficial wrinkling. These procedures are overall safe with most studies reporting no complications or only mild adverse events. With high satisfaction rates and anecdotal reports of increasing patient interest, these procedures represent a developing area in aesthetic surgery likely to continue increasing in popularity.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Efficacy of D-pigment dermocosmetic lightening product for solar lentigo lesions of the hand: A randomized controlled trial

Solar lentigo, benign lesions which mostly appear on chronically, sun-exposed surfaces, are associated with ageing. Patients are increasingly requesting a more uniform skin texture, especially for hands. Treatment options include dermoabrasion, intense pulsed light, cryotherapy, peelings, and laser therapy. Topical compounds can be employed, in alternative or associated with dermatologic procedures. The current study was designed to evaluate solar lentigo hyperpigmentation, skin architecture and clinician and patient assessments comparing a dermocosmetic lightening product (active) with a moisturizing product (control) according to clinical, digital and subjective analyses in 72 lesions over 12-month follow up period. Statistically significant differences were observed between the lesions treated with the active compared to the control in terms of papillary brightness (p = 0.03) and contrast (p = 0.03), and in the limitation of dermal-epidermal junction destructuring (p = 0.03) according to dermal-epidermal junction destructuring score at Reflectance Confocal Microscopy. Luminance (p = 0.04) and redness (p = 0.03) were improved at color analysis, and physician and patient evaluations favored the active in efficacy and patient satisfaction investigations. The dermocosmetic lightening product utilized in the current study proved to be more effective, according to clinical, digital and subjective analyses in reducing lesion hyperpigmentation, stabilizing the lesion skin architecture and increasing patient satisfaction compared to the control in a cohort of 36 subjects, over a 12-month period. Beside demonstrating the efficacy of this topical lightening product, we propose a “destructuring score”, which improves the robustness of solar lentigo’s evaluation, and can be used in future studies to standardize the quantitative comparisons of different treatment options.

Effects of topical application of B-Resorcinol and Glycyrrhetinic acid monotherapy and in combination with fractional CO2 laser treatment for benign hand hyperpigmentation treatment

BACKGROUND

Hand solar lentigines are frequent benign lesions of elderly population, requiring longtime treatments with topical agents or laser to lighten.

AIMS

The aim of this study was to evaluate and compare the efficacy of CO₂ fractional laser photothermolysis followed by topical application of B-Resorcinol and Glycyrrhetinic acid vs. only topical B-Resorcinol and Glycyrrhetinic acid application for hand solar lentigines treatment.

METHODS

Hand solar lentigines of eleven volunteers were divided into two groups: Group A spots received CO₂ fractional laser photothermolysis followed by 4 weeks topical application of B-Resorcinol and Glycyrrhetinic acid, and Group B spots received only 4 weeks topical treatments. All hands were photographed, and hand solar lentigines scanned with dermatoscope at the beginning of the study (T₀ ), 1 month after laser treatment (T₁ ), and at the end of the study (T₂ ) to document spots dimensions and color. A blinded dermatologist evaluated dermoscopic T₀ and T₂ images. The considered variables were assessed for significance by the nonparametric Mann-Whitney U-test.

RESULTS

In all volunteers, investigators and blinded dermatologist's evaluation hand solar lentigines features improved, with no statistical differences in the two groups.

CONCLUSION

Topical application of B-Resorcinol and Glycyrrhetinic acid is effective to lighten hand solar lentigines after 4 weeks of treatment, with or without a previous fractional laser photothermolysis.

Comparison of effectiveness of 1,064-nm Nd:YAG laser and Nd:YAG laser-IPL combination treatments in hand skin rejuvenation

OBJECTIVE

Evaluation of the efficacy and side effects of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser and Nd:YAG laser-intense pulsed light (IPL) combination treatments in photorejuvenations of skin of the hand, and determining their impacts on patient satisfaction.

MATERIALS AND METHODS

Thirty-five female patients with signs of photoaging on the skin of their hands were included in the study. Three sessions of IPL and four sessions of Nd:YAG laser treatment were applied to the right hand in total with 2-week intervals between each session, whereas six sessions of Nd:YAG laser treatment were applied to the left hand of patients with 2-week intervals between each session.

RESULTS

The patients' ages ranged between 31 and 78, and mean age was 60.77 ± 9.48. While there was no difference in pigment distribution, fine wrinkles, coarse wrinkles, and global scores between the right and left hand prior to treatment (p > 0.05), average pigment tone score was higher in the right hand with a statistically significant difference (p < 0.05). There was greater improvement in scores of pigment distribution, fine wrinkles, sallowness, pigment tone parameters, and global score on the right hand compared to left hand, which was statistically significant (p <0.001).

CONCLUSION

In rejuvenation of photoaged dorsal skin of the hand, IPL-Nd:YAG laser combination treatment surpasses Nd:YAG laser treatment.

The role of lasers and intense pulsed light technology in dermatology

The role of light-based technologies in dermatology has expanded dramatically in recent years. Lasers and intense pulsed light have been used to safely and effectively treat a diverse array of cutaneous conditions, including vascular and pigmented lesions, tattoos, scars, and undesired hair, while also providing extensive therapeutic options for cosmetic rejuvenation and other dermatologic conditions. Dermatologic laser procedures are becoming increasingly popular worldwide, and demand for them has fueled new innovations and clinical applications. These systems continue to evolve and provide enhanced therapeutic outcomes with improved safety profiles. This review highlights the important roles and varied clinical applications that lasers and intense pulsed light play in the dermatologic practice.