Triple combination as adjuvant to cryotherapy in the treatment of solar lentigines: investigator-blinded, randomized clinical trial

Successful treatment of solar lentigines by topical application of stabilized cysteamine: A vehicle-controlled, double-blind randomized study

Background

Solar lentigines are common hyperpigmented lesions typically appearing after 50 years of age and associated with negative psychological effects in affected individuals. Topical depigmenting products, such as hydroquinone and even the Kligman's formula, are usually ineffective for treating lentigines. Stabilized cysteamine has been recently shown to be as effective as the modified Kligman's formula for treating melasma. In this study, we evaluated the therapeutic effect of a stabilized cysteamine on solar lentigines.

Methods

A vehicle-controlled, double-blind, and randomized study was performed on 30 patients with solar lentigines. Stabilized cysteamine or vehicle control creams were applied on solar lentigines on the dorsum of the hands daily for 12 weeks. Clinical measurements with colorimetry and visual analog scale were performed at baseline, 4, 8, and 12 weeks.

Results

Statistically significant results were obtained in the cysteamine group versus the vehicle control group. Stabilized cysteamine provided a 40% reduction in colorimetric values (p < 0.002) versus a 2% reduction in the vehicle group (p < 0.405). Cysteamine also provided a 40% reduction in VAS (p < 0.001) versus a 2% reduction in the vehicle group (p < 0.245).

Conclusion

Significant improvement of solar lentigines was observed after 12 weeks of application of stabilized cysteamine by all evaluation methods. Stabilized cysteamine represents a highly effective topical treatment for solar lentigines and can be considered as one of the first topical therapies effective on this hyperpigmentary disorder.

Efficacy and safety of topical hydrogen peroxide 35% solution versus cryotherapy in the treatment of senile lentigo

BACKGROUND

Senile lentigines (SLs) are hyperpigmented macules that predominantly affect the elderly. We aimed to compare the efficacy and safety of hydrogen peroxide35% solution with cryotherapy in the treatment of SLs.

PATIENTS AND METHODS

This clinical trial included 33 patients with SLs referred to our center. Lesions of each side of the body were randomly allocated to receive 3 sessions of treatment with hydrogen peroxide or cryotherapy at a three-week interval. All patients were followed up 1 week after each round of treatment for the evaluation of side effects, the general effect of the treatment, and the general assessment of response to treatment.

RESULTS

Thirty-three patients were included in this study with the mean age of 61.79 ± 4.59 years. Average and excellent effects were significantly higher with cryotherapy after the 2^nd and 3^rd sessions of treatment, respectively. Positive response to treatment was significantly higher with cryotherapy at all time points. Severe erythema was only observed with cryotherapy. Pigmentation was significantly more frequent with cryotherapy than with hydrogen peroxide at any time point (p < 0.001). Also, blisters were only seen with cryotherapy. Moreover, the pain score was significantly higher with cryotherapy at all time points (p < 0.001). Up to one week after the 3^rd session of treatment, no recurrence of lesions occurred in any of the groups.

CONCLUSIONS

Cryotherapy appears to be more efficacious for the treatment of SLs compared to hydrogen peroxide 35% solution; however, hydrogen peroxide seems to have fewer side effects.

Treatment of flat and elevated pigmented disorders with a 755-nm alexandrite picosecond laser: clinical and histological evaluation

The novel picosecond lasers, initially developed for faster tattoo removal, have also shown great efficacy in endogenous pigmentary disorders. To describe the efficacy and safety profile of an alexandrite (755-nm) picosecond laser in a wide range of pigmented flat and elevated cutaneous lesions. A retrospective study was performed in which we collected all the clinical images of patients treated with the 755-nm alexandrite picosecond laser for 12 months (November 2016-November 2017). Clinical features were obtained from their medical charts. Patients treated for tattoo removal were excluded. All the images were analyzed by three blind physicians attending to a visual analogue scale (VAS) from 0 to 5 (0, no change; 1, 1-24% clearance; 2, 25-49% clearance; 3, 50-74% clearance; 4, 75-99% clearance; 5, complete clearance). Patient satisfaction was obtained from a subjective survey including four items: very satisfied, satisfied, non-satisfied, and totally dissatisfied. Thirty-seven patients were included (12 males; 25 females). The mean age of the study was 42.35 years. Twenty-five patients (68%) were treated for different pigmented flat disorders such as solar and mucosal lentigines (5), stasis dermatitis (4), or nevus of Ota (4), among other diagnoses. Twelve patients (32%) were treated for epidermal elevated lesions such as warts (5), epidermal nevi (2), and seborrheic keratosis (3), among other elevated lesions. Mean number of laser treatment was 3.02 sessions while mean follow-up after last laser treatment was 4.02 months. Mean VAS score of the three observers was 3.44 (61% of clearance) for pigmentary flat disorders and 3.60 (67%) for elevated lesions. Adverse effects reported were mild blistering in the first 2-5 days following laser treatment in some of the patients. Overall satisfaction among the patients included was high. The novel 755-nm picosecond alexandrite laser is effective not only for the resolution of pigmented flat lesions of different nature but also for the treatment of the more difficult elevated pigmented lesions.

Skin Hyperpigmentation in Indian Population: Insights and Best Practice

Skin pigmentation is one of the most strikingly variable phenotypes in humans, therefore making cutaneous pigmentation disorders frequent symptoms manifesting in a multitude of forms. The most common among them include lentigines, postinflammatory hyperpigmentation, dark eye circles, and melasma. Variability of skin tones throughout the world is well-documented, some skin tones being reported as more susceptible to pigmentation disorders than others, especially in Asia and India. Furthermore, exposure to ultraviolet radiation is known to trigger or exacerbate pigmentation disorders. Preventive strategies for photoprotection and treatment modalities including topical and other medical approaches have been adopted by dermatologists to mitigate these disorders. This review article outlines the current knowledge on pigmentation disorders including pathophysiology, molecular profiling, and therapeutic options with a special focus on the Indian population.

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.