Comparative Efficacy of Fractional CO2 Laser and Q-Switched Nd:YAG Laser in Combination Therapy with Tranexamic Acid in Refractory Melasma: Results of a Prospective Clinical Trial

Pigmentation and Scaring Management after Hypodermoclysis, a Case Report

Hypodermoclysis is the continuous subcutaneous infusion of a parenteral solution into dermal tissue, which is typically associated with skin lesions and cosmetic issues in the majority of patients. Scarring and pigmentation are two of the potential skin lesions after hypodermoclysis. The way skin diseases and cosmetic issues are treated has altered dramatically as a result of laser technology. This is the first article to our knowledge that describes the treatment of pigmentation and scarring produced by Hypodermoclysis cutaneous damage by using laser treatment. It was vital to select the appropriate endpoint, technology, and configuration parameters. The lesion was completely resolved after five months of treatment with four laser sessions. The first session used a fractional Er-Yag laser to perform cold ablation. The remaining sessions used 1064 and 585 nm Nd-Yag Q-switch lasers to operate in the nanosecond region. To minimize the danger of post-inflammatory hyperpigmentation (PIH), the treated region was prepped between laser treatments with 4% hydroquinone (HQ) cream. Our protocol may reduce scars and pigmentation while minimizing adverse effects and downtime.

Nanosecond Q-Switched 1064/532 nm Laser to Treat Hyperpigmentations: A Double Center Retrospective Study

(1) Benign hyperpigmentations are a common problem in cosmetic dermatology. Melasma, solar lentigo, and other acquired hyperpigmentations represent an aesthetic issue for an increasing number of patients. The gold standard in managing this condition is currently 1064/532 nanometers (nm) Q-Switched lasers. This study reports our experience on the use of a Q-switched laser with a nanosecond pulse to treat these conditions. (2) Methods: A total of 96 patients asking for benign hyperpigmentation removal were consecutively enrolled at the Magna Graecia University of Catanzaro and Tor Vergata University of Rome. Treating parameters were the following: 1064 nm with a pulse duration of 6 nanoseconds (ns) for dermic lesions and 532 nm with 6 ns for epidermal ones. Up to five treatments with a minimum interval between laser treatments of thirty days were performed. A follow-up visit three months after the last session assessed patient satisfaction with a Visual Analogue Scale (VAS). Two blinded dermatologists assessed the cosmetic result using a five-point scale comparing pictures before treatment and at follow-up. (3) Results: 96 patients were included; 47 participants were women (49.0%) and 49 men (51.0%). The mean reported age was 50.0 ± 17.3 years. All patients reached a good to complete hyperpigmentation removal at the dermatological evaluation with a mean VAS score of 8.91 ± 1.07. (4) Conclusions: Q Switched 1064/532 nm laser may be considered the gold standard treatment for benign hyperpigmentations. Our results confirm the literature findings on the effectiveness of these devices.

Melanogenesis and Melasma Treatment

Melanocytes are highly specialised dendritic cells that transfer melanin to keratinocytes in subcellular lysosome-like organelles called melanosomes, where melanin is synthesised and stored. Melanin is a complex pigment that provides colour and photoprotection to the skin, hair, and eyes of mammals. The regulation of melanogenesis includes various mechanisms and factors including genetic, environmental, and endocrine factors. Knowledge of the pigmentation process is important not only to understand hyperpigmentation but also to design treatments and therapies to treat them. Whitening cosmetics with anti-melanogenesis activity are very popular. In the present manuscript, we review the mechanisms and the signalling pathways involved in skin pigmentation and we specifically focus on the alteration of melanogenesis that leads to melasma and results in hyperpigmentation. Finally, current therapies and treatments including topical, oral, and phototherapies are discussed and described, with a special emphasis on the cosmetics’ action.

Q-Switched 1064/532 nm Laser with Picosecond Pulse to Treat Benign Hyperpigmentations: A Single-Center Retrospective Study

(1) Benign melanoses are a frequent issue in aesthetic dermatology. Solar lentigo, ephelides, café au lait spots, and other melanoses represent a cosmetic issue for a growing number of subjects. The Q-switched 1064/532-nanometer (nm) laser may be considered the gold standard for management of these aesthetic issues. A new generation of Q-switched lasers, capable of concentrating the energy pulse in the spectrum of hundreds of picoseconds, is emerging, promising better results than previous ones. In this paper, we report the use of a Q-switched laser with a picosecond pulse to manage hypermelanoses. (2) Methods: 36 patients seeking melanosis removal were retrospectively enrolled at Magna Graecia University of Catanzaro. Treatment parameters, although variable, were the following: 1064 nm with a pulse duration of 450 picoseconds (ps) for dermic lesions and 532 nm with 370 ps for epidermal lesions. Up to four treatments, with a minimum interval between laser treatments of 30 days, were performed. After the last session, patients’ satisfaction was assessed at a three-month follow up with a Visual Analogue Scale (VAS). Two blinded dermatologists measured the aesthetic outcome using a five-point scale comparing pictures before laser sessions and during follow-up. (3) Results: 36 patients were enrolled; 23 were females (63.9%) and 13 males (36.1%). The mean reported age was 49.2 ± 18.9 years. All participants were assessed with a complete/almost complete melanosis removal at the dermatological evaluation, with a mean VAS score of 9.39 ± 0.90. (4) Conclusions: The Q-switched 1064/532 nm laser may be considered the main weapon in treating benign hypermelanosis. The picosecond pulse seems to guarantee better results than other devices. However, a clinical trial comparing Q-switched nanosecond pulse with picosecond pulse is necessary to confirm this study’s findings.