Correlation between the efficacy of picosecond-domain laser treatment for solar lentigo and the vascularity in the upper dermis using optical coherence tomography angiography in Asian women.

OBJECTIVES: The purpose of this study was to noninvasively confirm the characteristics of the dermal vasculature in patients with solar lentigo (SL) and determine any association with the efficacy of picosecond-domain laser (PSL) treatment. METHODS: Thirteen facial SL lesions in 11 Asian female patients were included in this study and evaluated over 12 weeks. An Nd:YAG laser was used at 532 nm and 750 ps. Skin color and morphological structure were evaluated by ANTERA-3D® and optical coherence tomography (OCT), respectively. To analyze the vascularity in the upper dermis, an OCT angiography (OCTA) algorithm was applied to the OCT data. RESULTS: After PSL treatment, significant improvement in both hyperpigmentation and abnormally thickened epidermis was observed, but the efficacy varied for each lesion. There was a significant correlation between the change in the melanin index due to PSL treatment and preoperative vascular density in the upper dermis. CONCLUSIONS: To the best of our knowledge, this is the first report to demonstrate a correlation between the efficacy of PSL treatment of SL lesions and the vascularity in the upper dermis. Methods to evaluate the vasculature in the upper dermis may be useful for preoperative prediction of the efficacy of PSL treatment for SL lesions.

Prospective study of removing solar lentigines in Asians using a novel dual-wavelength and dual-pulse width picosecond laser.

OBJECTIVES: Quality-switched (QS) lasers are known to be an effective treatment for removing solar lentigines, however, high incidence of post-inflammatory hyperpigmentation (PIH) is a concern in darker skin types. The objective of this study was to evaluate the efficacy and safety of a dual-wavelength and dual-pulse width picosecond Nd:YAG laser for removing solar lentigines in Asians. METHODS: This was a prospective, IRB-approved study. Twenty cases with solar lentigines on the face were enrolled for treatment and evaluated at 1- and 3-month after the final treatment. Results were assessed by blinded evaluators using a 5-grade percentage improvement scale and Melanin index (MI) measured by a reflectance spectrophotometer. A patient self-assessment questionnaire was also administered using a 5-grade improvement scale. Additional treatment was performed if the improvement was less than 75% or the lentigo partially remained after 4 weeks. Histological evaluation was performed to compare the differences between the current picosecond laser and a QS Nd:YAG laser 532-nm using light and electron microscopy. RESULTS: Forty-three lesions in 20 females, skin type III or IV, age 53.7 ± 9.75 were treated and evaluated. The laser setting was: 532-nm, 750 picoseconds, average fluence of 0.35 ± 0.06 J/cm [2] using a spot size of 3 or 4 mm. Forty lesions (93.02%) achieved over 75% clearance with a single treatment and the other three lesions (6.98%) needed two treatments. PIH occurred only in 4.65% of lesions. The average score of the blinded evaluators' assessment was 4.77 and 4.58 on a 5-grade percentage improvement scale. The patients' self-assessment rating was 4.76 and 4.67 on a 5-grade scale at 1- and 3-month follow-up, respectively. The improvement rate of relative MI (MI in the lesion minus that of the normal area) was 77.60 ± 36.27% and 76.93 ± 20.95% at 1-and 3-month follow-up. Histology showed vacuolar formation by both lasers in the epidermis that were different sizes between lasers. Electron microscopy showed destruction of melanosomes with surrounding tissue damage with the QS laser and without particular damage with the picosecond laser. CONCLUSIONS: To the best of our knowledge, this is the first study using a picosecond Nd:YAG laser 532-nm for removing solar lentigines in darker skin types that includes histological evaluation. Although there are many options to treat solar lentigines, our results suggest that picosecond laser with preferable endpoint determination can be a safer and more effective treatment over conventional treatments in Asian patients. Lasers Surg. Med. 50:851-858, 2018. © 2018 Wiley Periodicals, Inc.

Prospective, randomized, evaluator-blinded study of the long pulse 532-nm KTP laser alone or in combination with the long pulse 1064-nm Nd: YAG laser on facial rejuvenation in Asian skin.

BACKGROUND AND OBJECTIVE: Hyperpigmentation is a common concern in Asian patients. Few published studies address overall skin rejuvenation in this group using long-pulse (LP) laser to target pigmentation and stimulate dermal remodeling. The LP KTP 532-nm laser (LP 532-nm) is used primarily to remove epidermal lesions, while the LP Nd: YAG 1064-nm laser (LP 1064-nm) is used to stimulate dermal remodeling in Asian patients with varying efficacy. The LP 532-nm used alone and in combination with LP 1064-nm to reduce pigmentation and rejuvenate skin was previously evaluated in lighter skin, but not in Asian skin. We evaluated the safety and effectiveness of using LP 532-nm for overall photorejuvenation, with and without LP 1064-nm. STUDY DESIGN/MATERIALS AND METHODS: Four treatments were administered at 3-week intervals to 22 Japanese females with photodamaged facial skin and bilateral solar lentigines. A direct split-face treatment with LP 532-nm was used on the full-face, and an additional, randomized LP 1064 treatment was administered to one-half of the face. Patients were not fully aware which side of the face was treated with which treatment. Results were evaluated at each treatment, and at 1- and 3-month follow-up visits. RESULTS: Scoring of a modified pigment severity index (mPSI) and measurement of the melanin index (MI) showed that facial skin treated with LP 532-nm alone and in combination with LP 1064-nm resulted in improvement at the 1- and 3-month follow-up (P < 0.001), but there was no difference between the two sides of the face. Notably, the three dimensional analysis of skin surface showed improvements for the dual-wavelength treatments with significant differences between the two sides (P = 0.003). Most patients reported moderate improvement and were extremely satisfied or satisfied with the outcome. Adverse events were minor and rare. CONCLUSIONS: Pigment-related skin rejuvenation using LP 532-nm appears to be safe and effective for Asian skin. The addition of LP 1064-nm showed no clinical difference but the subtle difference was detected by the 3D analyzing device. Lasers Surg. Med. 48:844-851, 2016. © 2016 Wiley Periodicals, Inc.

The clinical experience and efficacy of bipolar radiofrequency with fractional photothermolysis for aged Asian skin.

Bipolar radiofrequency (RF) technology is developed based on fractional thermolysis, and the literature concerning the efficacy of the rejuvenation and treatment of acne scars has been reported in Europe and the United States of America. Therefore, we examined bipolar RF treatment using fractional thermolysis to evaluate the efficacy and safety of the treatment of Asian photo-aging skin, particularly 'wrinkles' and 'sagging.' Ten Japanese women (mean age: 58.6, skin type III-IV) received three fractional bipolar RF treatments every 4-6 weeks. For the objective evaluation, we evaluated the improvement of the wrinkles on the forehead, lateral canthus (crow's feet) and lower eyelid, and the sagging of the nasolabial fold using digital photographs captured using Visia(™) . For the subjective evaluation, the participants were asked to describe the improvements observed in the wrinkles on the forehead, lateral canthus (crow's feet) and lower eyelid, and sagging nasolabial fold and to evaluate the level pain experienced using a 10-point VAS score. The objective evaluation in each category showed significant improvements in the wrinkles on the lateral canthus (crow's feet) and lower eyelid. As for the nasolabial fold, 60% of the subjects showed improvements, scoring from good to excellent (51-100% improvement), although there was a little improvement of the wrinkle on the forehead. Similar improvements were observed in the subjective evaluation. During each treatment, oedema and erythema were observed in all participants, but the oedema disappeared the following day in all cases. However, mild erythema persisted for an average of 3.1 days. Micro debris disappeared after an average of 5.2 days. The participants were satisfied, as we allowed them to apply make-up the next day. There were no other severe adverse reactions observed during the treatment. The 10-point VAS score was 3.8, and no participants dropped out due to discomfort. Little improvement was observed in the forehead wrinkles in either the objective or the subjective evaluation. The results obtained in this study indicate that fractional bipolar RF is an effective and safe treatment for the 'wrinkling' and 'sagging' of Asian photo-aging skin.

Successful Treatment of Congenital Lymphangioma Circumscriptum of the Vulva with CO2 and Long-Pulsed Nd:YAG Lasers.

A 16-year-old girl presented with a 9-year history of vesicles on the vulva. She had initially taken a wait-and-see approach, but required treatment because of bleeding. Histological examination of a biopsied vesicle revealed dilated lymph channels in the upper dermis, suggesting lymphangioma circumscriptum (LC). The challenge for this pathology has been to find a conservative treatment with low morbidity and better results than those reported for surgical excision, which has been the mainstay of therapy. In this case, LC of the vulva was successfully treated using a 10,600-nm CO2 laser and long-pulsed Nd:YAG laser. Use of the 10,600-nm CO2 laser and long-pulsed Nd:YAG laser appeared effective for treating LC.

Histologic study of collagen and stem cells after radiofrequency treatment for aging skin.

BACKGROUND: Monopolar radiofrequency (mRF) devices have been shown to be clinically effective for treating aging skin, but there are few histologic studies about the mechanisms. OBJECTIVE: To histologically analyze chronologic and quantitative change in collagens after mRF treatment to determine the mechanisms of the antiaging effect. METHODS: Five patients were enrolled in this study. Skin specimens were taken before and 1 and 3 months after treatment. Immunostaining was performed to determine change in type I and III collagen levels and stem and other cell counts in skin layers. RESULTS: In all cases, both types of collagen significantly increased after irradiation in the dermis (p < .05), and their changes were noticed uniformly in all layers. No significant change was noticed in stem and other cell counts. CONCLUSIONS: This study histologically demonstrated that type I and III collagen increased significantly in the dermis after mRF treatment. The amount of stem cells did not affect the increase in collagens.

In vivo microscopic approaches for facial melanocytic lesions after quality-switched ruby laser therapy: time-sequential imaging of melanin and melanocytes of solar lentigo in Asian skin.

BACKGROUND: The quality-switched ruby laser (QSRL) has been widely used for the treatment of pigmented lesions, but clinical evaluations in most studies have been conducted on macroscopic skin color observation comparing the laser-treated skin with its nontreated surrounding area. A few investigations examined skin changes after laser therapy at a cellular level, but almost none did so noninvasively. OBJECTIVE: To elucidate the dynamic changes after QSRL irradiation of facial solar lentigo using noninvasive optical techniques. MATERIALS AND METHODS: Time-sequential imaging of Japanese female patients with a clinical diagnosis of solar lentigo was performed using ultraviolet photography, high-magnification videomicroscopy, and reflectance-mode confocal microscopy to examine pigmentary change after QSRL irradiation. RESULTS: The present study showed that remaining melanocytes were visible in the solar lentigo of all subjects when crusts peeled off, despite hardly observable skin pigmentation to the naked eye. Moreover, noninvasive confocal imaging revealed that pigmented melanocytes varied in each solar lentigo after QSRL treatment, as indicated by melanin reflection level. CONCLUSIONS: Optical techniques facilitate the evaluation of the in vivo dynamics of epidermal-melanocytic changes in solar lentigo after QSRL therapy and may be useful for monitoring outcomes after laser irradiation.

Photorejuvenation by intense pulsed light with objective measurement of skin color in Japanese patients.

BACKGROUND AND OBJECTIVES: This study had two objectives: subjective evaluation of overall skin rejuvenation effects of relatively short-wavelength intense pulsed light (IPL) and objective changes in basic skin tone as measured by a spectrophotometer. STUDY DESIGN/MATERIALS AND METHODS: Twenty-five women selected at random received a series of three IPL treatments. Efficacy was evaluated over a 3-month follow-up period. Concurrently, a spectrophotometer was used to measure "lightness" (L(*)) to quantify the lightening effect changes to pretreatment and posttreatment basic skin tone. RESULTS: Subjective improvement of 50% or more was seen in 18 of 25 patients for pigmentation. One patient showed exacerbation of latent epidermal melasma as a complication. In the spectrophotometric analysis, the mean value of L(*) increased from a baseline value of 60.86 to 63.22, at 3-month follow-up period, with statistical significance. CONCLUSION: IPL skin rejuvenation using relatively shorter wavelengths and pulse widths brought about significant macroscopic and quantitative improvements, especially in the treatment of epidermal pigmentation and improvement of basic skin tone.

c-JUN N-terminal kinase-1 (JNK1) but not JNK2 or JNK3 is involved in UV signal transduction in human epidermis.

BACKGROUND: c-Jun N-terminal kinase (JNK) plays a critical role in UV-induced apoptotic cell death. Although three isoforms are known in mammals, physiological roles of each isoform are still obscure. Furthermore, our recent findings show that serpin squamous cell carcinoma antigen (SCCA1) binds to JNK. OBJECTIVE: To determine which isoform is responsible for the UV signal transduction in human epidermis and whether SCCA1 is capable to regulate kinase activity of a specific isoform. METHODS: Immunohistochemical localization of each JNK isoform was investigated after UV irradiation in vivo and in vitro. Effect of recombinant SCCA1 on JNK kinase activity was also analyzed. RESULTS: Immunostaining for JNK1, 2 and 3 demonstrated marked elevation of JNK1 in spinous to granular cells of UV-irradiated skin, whereas they were expressed weakly in upper epidermis of the sun-protected, buttock skin. In cultured keratinocytes, only JNK1 is translocated into nucleus after UV irradiation. JNK2, which localized in the cytoplasm, or JNK3, which was confined in nucleus, remained in the same compartment after UV irradiation. We confirmed that only JNK1 mRNA was up-regulated after UV irradiation in cultured keratinocytes. In addition, recombinant SCCA1 suppressed kinase activity of JNK1 but did not affect JNK2 or JNK3 kinase activity. CONCLUSION: JNK1 is associated with UV signal transduction in human epidermis and SCCA1 is a suppressor of this process.

Intense pulsed light therapy for superficial pigmented lesions evaluated by reflectance-mode confocal microscopy and optical coherence tomography.

Intense pulsed light (IPL) therapy is reported to be effective for pigment removal from pigmented lesions. However, the dynamic mechanism of pigment removal by IPL therapy is not completely understood. We investigated the mechanism of IPL therapy for the removal of pigmented skin lesions through non-invasive observation of the epidermis. Subjects with solar lentigines on the face were treated with three sessions of IPL therapy. The solar lentigines were observed on consecutive days after the treatments using reflectance-mode confocal microscopy (RCM) and optical coherence tomography (OCT). In addition, desquamated microcrusts that formed after the treatment were investigated by transmission electron microscopy (TEM). The images of RCM and OCT showed that the melanosomes in the epidermal basal layer rapidly migrated to the skin surface. The TEM images of the extruded microcrusts revealed numerous melanosomes together with cell debris. It was also found that the IPL irradiated melanocytes in the lesions seemed to be left intact and resumed their high activity after treatment. We conclude that IPL therapy effectively removed the dense melanosomes in the epidermal-basal layer. However, additional application of suppressive drugs such as hydroquinone or Q-switched laser irradiation is necessary to suppress the remaining active melanocytes.

Is topical anesthesia useful in noninvasive skin tightening using radiofrequency?

BACKGROUND: The radiofrequency (RF) system has been applied to Asian skin for noninvasive skin tightening. The only drawback is the pain during the treatment. OBJECTIVE: The relationships between the effectiveness of a topical anesthetic at various RF levels and the respective treatment results were compared and assessed after 3 months. SUBJECTS AND METHODS: Eighty-four females, ranging in age from 30 to 60 years, were divided into three groups of 28 subjects each. In all groups, the entire bilateral cheeks were treated. Group A underwent RF treatment (ThermaCool TC, Thermage, Hayward, CA, USA) with topical anesthesia and group B without anesthesia, and in group C, half of the face was treated with anesthesia and the other half was not. The degree of pain was recorded. Digital photographs of the patients pre- and post-treatment were objectively assessed by double-blinded physicians. Subjective assessment was performed with questionnaires. RESULTS: The average treatment levels for groups A and B were 14.13 and 14.02, respectively. Although anesthesia was useful for pain reduction, it did not allow a significant energy upgrade. In group C, 8 (28.6%) patients showed a statistically insignificant difference in the treatment levels, but not in the results, between the anesthetized and the unanesthetized sides. CONCLUSIONS: The use of anesthesia did not affect the final efficacy of the treatment compared with no anesthesia.

Non-ablative skin tightening with radiofrequency in Asian skin.

BACKGROUND AND OBJECTIVES: The recent successful application of radiofrequency (RF) in non-ablative skin tightening for skin laxity has attracted attention worldwide. The efficacy and clinical effect of RF were assessed in Asian skin, with additional study on the duration of the effect and any complications. STUDY DESIGN/MATERIALS AND METHODS: Eighty-five Japanese females were enrolled in the study for treatment of nasolabial folds, marionette lines, and sagging jowls with 6-month follow-up. RESULTS: RF treatment was effective for nasolabial folds, marionette lines, and jowls. Objective physician evaluation found relatively good improvement at 3 months post-treatment, and even better improvement at the 6-month evaluation. CONCLUSIONS: RF treatment was very satisfactory for skin tightening in Asian facial skin. When compared with published literature from the United States, the results suggested that there might be race-related differences in the treatment parameters.

Study of the incidence and nature of "very subtle epidermal melasma" in relation to intense pulsed light treatment.

BACKGROUND: Skin rejuvenation with intense pulsed light (IPL) is effective for clearing epidermal pigment disorders. Complications are mild and limited to epidermal burns caused by excessive settings. Some patients, however, experience IPL-induced melasma-like hyperpigmentation despite the appearance of normal skin. These patients seem to have very subtle epidermal melasma not visible to the naked eye. Ultraviolet photography has been useful in identifying these patients and preventing complications. OBJECTIVE: The study investigated the incidence of very subtle melasma in patients using UV photography, and assessed this tool in identifying high-risk patients. SUBJECTS AND METHODS: 223 Japanese women, 30-69 years old, participated in the study. Very subtle melasma invisible to the naked eye under normal light was diagnosed by UV photography by two physicians, and any relationship among the disease incidence, age, and regular sunscreen use was examined. RESULTS: Sixty-three cases of very subtle melasma (28.3%) were identified among the 223 subjects, with a significantly lower incidence in sunscreen users. CONCLUSIONS: Patients diagnosed with subtle epidermal melasma and treated with mild IPL parameters did not suffer induced secondary hyperpigmentaion. To help avoid complications after treatment, IPL users should be aware of the age and sunscreen-related incidence of this phenomenon in Asian patients.

Full-face photorejuvenation of photodamaged skin by intense pulsed light with integrated contact cooling: initial experiences in Asian patients.

BACKGROUND AND OBJECTIVES: For Asian skin, recent "non-ablative" skin rejuvenation techniques have become the focus of attention for darker complected patients. In our earlier research, we have shown that intense pulsed light (IPL) technology can be applied to Asian skin with a high degree of safety and efficacy. In this study, we performed full-face photorejuvenation using a new IPL device incorporating a 560 nm filter and integrated contact cooling system for the improvement of various symptoms associated with photoaging in Asian patients. STUDY DESIGN/MATERIALS AND METHODS: A total of 73 patients were treated with a series of five or more full-face treatments at 3-4 week intervals using IPL with integrated contact cooling. One month after the third and fifth treatments, the patient and the treating physicians subjectively evaluated improvement in five areas-in pigmentation, telangiectasia, fine wrinkles, skin texture, and over-all improvement. In addition, histological changes were evaluated. RESULTS: Pigmentation improvement, telangiectasia reduction, fine wrinkle reduction, smoother skin texture, and over-all improvement were evaluated according to five grades of percentage improvement. In addition, the subjective rating by the patients and the physicians was averaged, and the combined results were evaluated. After the fifth treatment, a combined rating of greater than 60% improvement was given to more than 80% of patients for pigmentation improvement, telangiectasia reduction or removal, smoother skin texture, and overall improvement. Histological evaluations showed strong staining of Type I and Type III collagen. Complications were minor and transitory, with burning sensations and erythema in only two patients. CONCLUSION: Full-face photorejuvenation for Asian patients using this device is not only effective but is also associated with fewer post-treatment complications than other more invasive modalities. We conclude that IPL photorejuvenation can be the basis for safe and effective skin rejuvenation in Asian patients.