Sunscreens prescribed to patients with skin of color and/or with melasma: A survey of 221 dermatologists and dermatology residents in Spain.

BACKGROUND: Dark-skinned individuals (DSI) present high rates of melasma and post-inflammatory hyperpigmentation. The use of sunscreens with mineral filters is essential for prevention and treatment. Our objective was to determine the preferences of dermatologists and dermatology residents in the prescription of sunscreens for DSI. METHODS: An anonymous survey of attendees at an online photoprotection event held on March 31, 2022, in Spain. RESULTS: The survey was answered by 66.6% (221/332) of the attendees: 159 dermatologists (71.9%) and 62 dermatology residents (28.1%). Respondents reported recommending the use of sunscreen to a median of 80% of DSI [interquartile range (IQR), 50-90]. Physicians reported prescribing tinted sunscreens to a median percentage of 60% (IQR, 25-90) of DSI with acne; and to a median percentage of 90% (IQR, 58-99) of DSI with melasma. The most prescribed photoprotectors to DSI with melasma were organic broad-spectrum sunscreens with antioxidants: 102/220 (46.4%) and mineral broad-spectrum sunscreens (with iron oxides): 45/220 (20.4%). In DSI with melasma or other pigmentary disorders, the most preferred features of sunscreens were as follows: sun protection factor ≥ 30: 217/221 (98.2%), UVA protection: 214/221 (96.8%), color for camouflage: 150/220 (68.2%) and mineral filters such as titanium dioxide and zinc oxide: 151/220 (68.6%) or iron oxides: 131/220 (59.5%). LIMITATIONS: Online survey, potential inclusion bias. CONCLUSIONS: Respondents reported to prescribe sunscreens to the majority of DSI, and tinted sunscreens for the majority of DSI with pigmentary disorders. However, the most frequently recommended sunscreens for DSI were organic broad-spectrum sunscreens with antioxidants.

Fixed Drug Eruption on the Penis Due to Trimethoprim-Sulfamethoxazole: A Case Report.

A fixed drug eruption (FDE) is a common dermatological drug side effect but can go unnoticed. It is characterized by an oval-circular erythematous patch, sometimes with itching and burning pain localized in many parts of the body, such as the face, lips, torso, limbs, and anogenital area. Its diagnosis is generally clinical, but it can be mistaken for other dermatological diseases seen in primary care, like balanitis, genital herpes, and lichen planus. It can be a diagnostic challenge for primary care physicians when it is not considered. We present a 26-year-old man who developed an FDE in the penis with intense itching and burning pain during his labor hours after 15 minutes of consuming an oral dose of trimethoprim-sulfamethoxazole for a gastrointestinal infection. The patient was treated with topical corticosteroids twice per day and educated to avoid the use of the antibiotic again. In the next few days, the symptoms fully resolved, and he developed post-inflammatory hyperpigmentation in the area. The primary management of an FDE is immediate discontinuation of the offending drug and use of topical corticosteroids to prevent possible generalized reactions and recurrence of lesions. Therefore, the primary care physician should consider this condition in his or her diagnosis when new dermatologic lesions occur after exposure to a new drug.

Repair of a right coronary artery rupture with perforated right ventricle following spontaneous pseudoaneurysm: a case report.

BACKGROUND: Following the rupture of a coronary artery, a patient's condition usually deteriorates rapidly due to cardiac tamponade. A pseudoaneurysm due to a coronary artery rupture is rare; however, when a spontaneous coronary artery pseudoaneurysm occurs without tamponade, it creates a fistula in the right ventricle, often requiring surgical repair. CASE PRESENTATION: This report describes the case of a 68-year-old man who presented with chest discomfort after a 12-day course of antibiotic treatment for bacteremia. Following coronary angiography, echocardiography, and enhanced computed tomography, he was diagnosed with a right coronary artery pseudoaneurysm accompanied with perforation of the right ventricle. Severe adhesions were observed during emergency surgery surrounding the entire heart. The patient presented with risk factors for coronary artery disease, including hypertension and smoking history. His coronary artery was severely calcified due to end-stage renal failure requiring dialysis; thus, a covered stent could not fit inside the arterial lumen. Consequently, coronary artery bypass grafting to the right coronary artery and right ventricle repair were performed. Unfortunately, the patient died postoperatively due to sepsis from intestinal translocation. This rare development was hypothesized to be an incidental result of the combination of severe post-inflammatory adhesions, extensive coronary artery calcification, and rupture of the calcification crevices. CONCLUSIONS: In the case of a severe post-inflammatory response, shock without cardiac tamponade may require further scrutiny by assuming the possibility of inward rupture. For patients in poor condition, two-stage surgical treatment might be considered after stabilization with a covered stent.

Effects of 15% Azelaic Acid Gel in the Management of Post-Inflammatory Erythema and Post-Inflammatory Hyperpigmentation in Acne Vulgaris.

INTRODUCTION: The aim of this study was to assess the efficacy and safety of 15% azelaic acid (AzA) gel in treating acne-induced post-inflammatory erythema (PIE) and post-inflammatory hyperpigmentation (PIH). The effects of 15% AzA gel on acne, skin barrier function, and quality of life were also evaluated. METHODS: A total of 72 patients with mild to moderate acne were enrolled in a randomized, double-blind, placebo-controlled trial. Patients were divided into two groups: patients in the AzA group applied 15% AzA gel twice daily for 12 weeks, and those in the placebo group applied AzA-free gel. Clinical evaluations using non-invasive skin detection technologies, including VISIA skin analysis, dermoscopy, and skin physiological function tests, were performed at 0, 4, 8, and 12 weeks. Main outcome measures included the post-acne hyperpigmentation index (PAHPI), melanin, hemoglobin, individual typology angle, water content, transepidermal water loss, and sebum. Investigator Global Assessment) and Dermatology Life Quality Index (DLQI) assessments were conducted at weeks 0 and 12. Adverse reactions were recorded. RESULTS: Of the 72 patients at study initiation, 60 completed the trial. At 8 and 12 weeks, patients in the AzA group showed significantly reduced PAHPI for PIE lesions compared to baseline and patients receiving placebo (P < 0.05). Patients in both groups exhibited reduced PIH lesions at weeks 8 and 12 that differed significantly from baseline (P < 0.05). Hemoglobin content decreased significantly in AzA-treated PIE lesions compared to those treated with placebo at week 12 (P < 0.05). Melanin content decreased significantly in AzA-treated PIH lesions at week 12 (P < 0.05). The AzA group showed higher improvement in DLQI (P < 0.05), and greater overall satisfaction (P < 0.05) compared to placebo. CONCLUSION: The results indicate that 15% AzA gel effectively improved acne-induced PIE and PIH with minimal adverse reactions, making it a viable clinical application. In the study population, it had no adverse effects on skin barrier function and contributed positively to acne improvement and patient quality of life. TRIAL REGISTRATION: This study was registered with the Chinese Clinical Trial Registry (ChiCTR.org.cn) under the identifier ChiCTR2300076959. The registration date was 25 October 2023, retrospectively registered.

Lichen Striatus: An Updated Review.

BACKGROUND: Lichen striatus is a benign dermatosis that affects mainly children. This condition mimics many other dermatoses. OBJECTIVE: The purpose of this article is to familiarize pediatricians with the clinical manifestations of lichen striatus to avoid misdiagnosis, unnecessary investigations, unnecessary referrals, and mismanagement of lichen striatus. METHODS: A search was conducted in June 2023 in PubMed Clinical Queries using the key term "Lichen striatus". The search strategy included all observational studies, clinical trials, and reviews published within the past ten years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of this article. RESULTS: Lichen striatus is a benign self-limited T-cell mediated dermatosis characterized by a linear inflammatory papular eruption seen primarily in children. The onset is usually sudden with minimal or absent symptomatology. The eruption in typical lichen striatus consists of discrete, skin- colored, pink, erythematous, or violaceous, flat-topped, slightly elevated, smooth or scaly papules that coalesce to form a dull red, potentially scaly, interrupted or continuous band over days to weeks. Although any part of the body may be involved, the extremities are the sites of predilection. Typically, the rash is solitary, unilateral, and follows Blaschko lines. In dark-skinned individuals, the skin lesions may be hypopigmented at onset. Nails may be affected alone or, more commonly, along with the skin lesions of lichen striatus. The differential diagnoses of lichen striatus are many and the salient features of other conditions are highlighted in the text. CONCLUSION: Lichen striatus is a self-limited condition that often resolves within one year without residual scarring but may have transient post-inflammatory hypopigmentation or hyperpigmentation. As such, treatment may not be necessary. For patients who desire treatment for cosmesis or for the symptomatic treatment of pruritus, a low- to mid-potency topical corticosteroid or a topical immunomodulator can be used. A fading cream can be used for post-inflammatory hyperpigmentation.

Sonographic detection of massive colonic pseudopolyposis in inflammatory bowel diseases.

PURPOSE: Colonic pseudopolyps are a frequent finding in inflammatory bowel disease (IBD). Yet there are no published data describing the characteristics of pseudopolyposis in intestinal ultrasound (IUS). This study aimed at identifying the key features of pseudopolyposis in IUS. METHODS: This case-control study included 12 patients with ulcerative colitis or Crohn's colitis with extensive left colon pseudopolyposis and 18 matched IBD patients without pseudopolyps at colonoscopy. Luminal (diameters, thickening, stratification, margins, and vascularity) and intraluminal (vascular signals at color Doppler), and extraluminal (mesenteric fat) parameters of the left colon were compared. Anonymized still images and videos of these patients were blindly reviewed to estimate the accuracy in detecting this condition. RESULTS: Among the IUS parameters assessed, the anteroposterior diameter ≥ 12 mm and the presence of luminal vascular signals were significantly correlated with pseudopolyposis. The detection of both these findings were able to detect extensive pseudopolyposis a sensitivity of 75% (CI 95%: 42.8-94.5%) and a specificity of 100% (CI 95%: 81.5-100%). CONCLUSION: This is the first study describing the IUS features of pseudopolyposis in IBD. The potential use of IUS to assess pseudopolyposis might have an impact on IUS monitoring and surveillance of IBD patients with condition.

Magnetic resonance imaging characteristics in patients with psoriatic arthritis and axial manifestations from the MAXIMISE cohort.

OBJECTIVE: The current analysis of the MAXIMISE trial was conducted to investigate the presence of post-inflammatory and degenerative spinal changes and inflammatory changes in spinal processes identified in baseline MRIs and their potential for predicting differential treatment effects in a cohort of PsA patients with axial manifestations. METHODS: Baseline spinal MRIs from the MAXIMISE trial were re-read to identify additional inflammatory (spinal process), post-inflammatory, and degenerative changes, and investigate the differential treatment effect of these imaging features using logistic regression modelling. RESULTS: In addition to bone marrow oedema assessed at primary analysis, spinal process inflammation and post-inflammatory changes evaluated by FAt Spondyloarthritis Spine Score were documented in 11.1% and 20.2% patients, respectively. At least one type of degenerative change was noted in 64% patients, with Pfirrmann grade ≥3 (51.1%) being the most common. Combining primary and re-read MRI findings, 67.1% of patients presented with inflammatory or post-inflammatory changes while 21.2% had degenerative changes alone. Although not statistically significant, post-inflammatory changes were associated with a trend for better efficacy outcomes in terms of ASAS20, ASAS40 and BASDAI50 responses; a trend for worse outcomes was observed in the presence of degenerative changes. CONCLUSION: The current analysis revealed the occurrence of additional inflammatory and post-inflammatory changes suggestive of axial PsA (axPsA) and a trend for better clinical outcomes for patients treated with secukinumab. These results elucidate the imaging characteristics and improve our current understanding of axPsA thereby supporting the interpretation of future trials. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02721966.

Paediatric acute epididymo-orchitis temporally related to SARS-CoV-2 infection: A case series and review of the literature.

INTRODUCTION: Acute epididymo-orchitis (AEO) is becoming an increasingly common differential diagnosis in children with acute scrotal pain. It has been noted in adult men that SARS-CoV-2 has a propensity for involving the testis and epididymis, affecting sperm and testosterone production. Our literature search revealed only one case report of COVID-19 presenting with epididymo-orchitis in a child. We present three more children who presented with AEO, all recovering from PCR-confirmed SARS-CoV-2 infection. This article reviews the post-inflammatory aetiology of paediatric epididymo-orchitis, and the propensity SARS-CoV-2 has for the testis. PATIENTS AND METHODS: Two pre-pubertal ten-year-old patients presented to the emergency department with a 48-h history of gradual onset unilateral scrotal pain and increasing erythema of the ipsilateral scrotal skin. One fifteen-year-old boy was referred for ongoing symptoms four days following a diagnosis of AEO made by his General Practitioner. On further questioning, all three had PCR-confirmed COVID infection two weeks prior to the onset of their scrotal symptoms and had just ended their isolation period. A literature search was then performed using the keywords SARS-CoV-2, testes and paediatric acute epididymo-orchitis. DISCUSSION: The SARS-Cov-2 virus has a propensity for affecting the testis and epididymis. This puts patients at increased risk of acute epididymo-orchitis during COVID infections. The inflammation induced by the virus appears to affect the cells responsible for testosterone production and sperm quality. However, there is no evidence that viral transmission can happen via semen. CONCLUSION: SARS-Cov-2 infection can lead to acute epididymo-orchitis. Knowledge of this is clinically significant, firstly to avoid unnecessary surgical intervention due to a mistaken diagnosis of testicular torsion and secondly, due to the potential of the virus to affect sperm quality and testosterone production.

The role of epidermal growth factor-containing topical products on recovery and post-inflammatory hyperpigmentation prevention after laser surgeries: A systematic review and meta-analysis.

BACKGROUND: Post-inflammatory hyperpigmentation (PIH) is a common complication after laser surgeries. Recent studies applied epidermal growth factor (EGF) on the lasered area after laser surgery to decrease the incidence of PIH with controversial results. Therefore, a comprehensive literature review of randomized controlled trials (RCTs) was conducted to investigate the issue. METHODS: Two reviewers independently searched the literatures, extracted, and analyzed the data. A total of seven RCTs involving 169 patients were included to evaluate the efficacy of EGF on recovery and PIH prevention after laser surgery. RESULTS: The results show that the incidence of PIH in the EGF group was relatively lower than that in the control group, although the difference was not statistically significant (OR 0.64, 95% CI 0.33 ~ 1.25, p = 0.19). However, the EGF groups had a significant decrease in melanin index (MI) scores at the 1st month after the laser surgery when compared to the control groups (SMD -1.57, 95% CI -2.83 ~ -0.31, p = 0.01). In addition, the patients on the EGF side rated significantly higher satisfactory scores (SMD 0.49, 95% CI 0.22 ~ 0.76, p = 0.0004). There was no significant difference as regard to changes in MI at the 2nd week and 2nd month, erythema index (EI), and trans-epidermal water loss (TEWL) at days 3 and 7 after laser therapy, respectively. CONCLUSION: The current meta-analysis found a limited temporary inhibitory effect of EGF-containing topical products on PIH with no significant effect on reducing post-laser erythema or promoting epidermal barrier repair. More studies are needed in the future due to the small sample size and marked intergroup heterogeneities.

12-Week, Single-Center Study of a Targeted Pigment-Correcting Dark Spot Treatment for Post-Inflammatory Hyperpigmentation and Solar Lentigines.

Purpose: Post-inflammatory hyperpigmentation (PIH) and solar lentigines are dark spots of skin from excessive melanin production due to injury or UV exposure. This 12-week single-center study assessed the efficacy and tolerability of a novel targeted pigment-correcting spot treatment gel suspension cream (Dark Spot Treatment) for improving mild-to-moderate PIH or solar lentigines. Patients and Methods: Female participants (N = 41) aged 25-65 with mild-to-moderate facial dark spots applied Dark Spot Treatment daily for 12 weeks. Investigators assessed overall hyperpigmentation, skin tone evenness, and dark spot intensity, contrast, and size at Weeks 2, 4, 8, and 12. Participant self-assessments occurred at Weeks 1, 2, 4, 8, and 12. Tolerability was assessed by clinical grading and participant reporting. Results: Dark Spot Treatment improved overall hyperpigmentation, skin tone evenness, and dark spot intensity and contrast at Weeks 2 through 12, and dark spot size at Weeks 4 through 12 (all p < 0.001 compared to baseline). Participant self-assessments showed high overall satisfaction. Dark Spot Treatment was well tolerated. Conclusion: The novel pigment-correcting Dark Spot Treatment significantly improved the appearance of PIH and solar lentigines, had high participant satisfaction, and was well tolerated.

Special considerations in adolescents of color with acne and textured hair.

Acne is a common dermatologic condition that affects most adolescents. In adolescents of color with textured hair, it is paramount to consider how hair care practices may affect acne distribution and treatment. Dermatologists should be familiar with hair care cultural norms when treating this population.

Alveolar epithelial cell growth hormone releasing hormone receptor in alveolar epithelial inflammation.

Purpose: Growth hormone-releasing hormone (GHRH) is a 44-amino acid peptide that regulates growth hormone (GH) secretion. We hypothesized that GHRH receptor (GHRH-R) in alveolar type 2 (AT2) cells could modulate pro-inflammatory and possibly subsequent pro-fibrotic effects of lipopolysaccharide (LPS) or cytokines, such that AT2 cells could participate in lung inflammation and fibrosis. Methods: We used human alveolar type 2 (iAT2) epithelial cells derived from induced pluripotent stem cells (iPSC) to investigate how GHRH-R modulates gene and protein expression. We tested iAT2 cells' gene expression in response to LPS or cytokines, seeking whether these mechanisms caused endogenous production of pro-inflammatory molecules or mesenchymal markers. Quantitative real-time PCR (RT-PCR) and Western blotting were used to investigate differential expression of epithelial and mesenchymal markers. Result: Incubation of iAT2 cells with LPS increased expression of IL1-ß and TNF-α in addition to mesenchymal genes, including ACTA2, FN1 and COL1A1. Alveolar epithelial cell gene expression due to LPS was significantly inhibited by GHRH-R peptide antagonist MIA-602. Incubation of iAT2 cells with cytokines like those in fibrotic lungs similarly increased expression of genes for IL1-ß, TNF-α, TGFß-1, Wnt5a, smooth muscle actin, fibronectin and collagen. Expression of mesenchymal proteins, such as N-cadherin and vimentin, were also elevated after prolonged exposure to cytokines, confirming epithelial production of pro-inflammatory molecules as an important mechanism that might lead to subsequent fibrosis. Conclusion: iAT2 cells clearly expressed the GHRH-R. Exposure to LPS or cytokines increased iAT2 cell production of pro-inflammatory factors. GHRH-R antagonist MIA-602 inhibited pro-inflammatory gene expression, implicating iAT2 cell GHRH-R signaling in lung inflammation and potentially in fibrosis.

Opposing effects of 5-HT1A receptor agonist buspirone on supraspinal abdominal pain transmission in normal and visceral hypersensitive rats.

The serotonergic 5-HT1A receptors are implicated in the central mechanisms of visceral pain, but their role in these processes is controversial. Considering existing evidences for organic inflammation-triggered neuroplastic changes in the brain serotonergic circuitry, the ambiguous contribution of 5-HT1A receptors to supraspinal control of visceral pain in normal and post-inflammatory conditions can be assumed. In this study performed on male Wistar rats, we used microelectrode recording of the caudal ventrolateral medulla (CVLM) neuron responses to colorectal distension (CRD) and electromyography recording of CRD-evoked visceromotor reactions (VMRs) to evaluate post-colitis changes in the effects of 5-HT1A agonist buspirone on supraspinal visceral nociceptive transmission. In rats recovered from trinitrobenzene sulfonic acid colitis, the CRD-induced CVLM neuronal excitation and VMRs were increased compared with those in healthy animals, revealing post-inflammatory intestinal hypersensitivity. Intravenous buspirone (2 and 4 mg/kg) under urethane anesthesia dose-dependently suppressed CVLM excitatory neuron responses to noxious CRD in healthy rats, but caused dose-independent increase in the already enhanced nociceptive activation of CVLM neurons in post-colitis animals, losing also its normally occurring faciliatory effect on CRD-evoked inhibitory medullary neurotransmission and suppressive action on hemodynamic reactions to CRD. In line with this, subcutaneous injection of buspirone (2 mg/kg) in conscious rats, which attenuated CRD-induced VMRs in controls, further increased VMRs in hypersensitive animals. The data obtained indicate a shift from anti- to pronociceptive contribution of 5-HT1A-dependent mechanisms to supraspinal transmission of visceral nociception in intestinal hypersensitivity conditions, arguing for the disutility of buspirone and possibly other 5-HT1A agonists for relieving post-inflammatory abdominal pain.

Post-inflammatory Hyperpigmentation in an African American Female: An Atypical Presentation and Treatment Dilemma.

We present the case of a 32-year-old African American female with a known history of primary Sjogren's syndrome, multiple vitamin deficiencies, and prior facial cellulitis who presented with diffuse facial post-inflammatory hyperpigmentation following a motor vehicle accident. Following glucocorticoid treatment, only select hyperpigmented areas associated with inflammation, infection, or trauma improved, which thereby posed a clinical challenge to improve the patient's appearance and condition. Such results may warrant the consideration of adjunctive topical therapies to lighten the remaining areas of hyperpigmentation.

Sun exposure, a relevant exposome factor in acne patients and how photoprotection can improve outcomes.

BACKGROUND: Acne pathophysiology includes a complex interaction among inflammatory mediators, hyperseborrhea, alteration of keratinization and follicular colonization by Propionibacterium acnes. AIMS: To describe the impact of the exposome on acne and how photoprotection can improve outcomes. METHODS: A narrative review of the literature was carried out; searches with Google Scholar and Pubmed from January 1992 to November 2022 were performed. The keywords used were "acne," "sunscreens," "photoprotection," "cosmetics," "cosmeceuticals," "pathogenesis," "etiology," "exposome," "sunlight," "stress," "lack of sleep," "diet," "postinflammatory hyperpigmentation," "pollution," "exposome," "ultraviolet radiation," and "visible light." RESULTS: Environmental factors such as solar radiation, air pollution, tobacco consumption, psychological stress, diverse microorganisms, nutrition, among others, can trigger or worsen acne. Solar radiation can temporarily improve lesions. However, it can induce proinflammatory and profibrotic responses, and produce post-inflammatory hyperpigmentation and/or post-inflammatory erythema. While photoprotection is widely recommended to acne patients, only four relevant studies were found. Sunscreens can significantly improve symptomatology or enhance treatment and can prevent post-inflammatory hyperpigmentation. Furthermore, they can provide camouflage and improve quality of life. Based on acne pathogenesis, optimal sunscreens should have emollient, antioxidant and sebum controlling properties. CONCLUSIONS: The exposome and solar radiation can trigger or worsen acne. UV light can induce post-inflammatory hyperpigmentation/erythema, and can initiate flares. The use of specifically formulated sunscreens could enhance adherence to topical or systemic therapy, camouflage lesions (tinted sunscreens), decrease inflammation, and reduce the incidence of post-inflammatory hyperpigmentation/erythema.

Post-Inflammatory Hypopigmentation: Review of the Etiology, Clinical Manifestations, and Treatment Options.

Post-inflammatory hypopigmentation is a common acquired pigmentary disorder that is more prominent in skin of color, leading to great cosmetic and psychosocial implications. Often, a diagnosis with a pigmentary disorder can negatively impact an individual's health-related quality of life and may result in stigma. Although most cases of post-inflammatory hypopigmentation resolve spontaneously over time, a systematic diagnostic approach can help with identifying the underlying etiology and informing treatment strategies. It can be due to cutaneous inflammation, sequelae of inflammatory or infectious dermatoses, or dermatologic procedures. Therefore, a thorough understanding of the epidemiology, patient history, physical exam findings, and clinical features of post-inflammatory hypopigmentation phenomenon can explain the primary cause to providers and allow for patient education. It is also important to understand the various therapeutic approaches available and the efficacy of these options, which will inform providers to choose the appropriate therapy for patients. Although algorithms exist for classifying acquired disorders of hypopigmentation, there are no established algorithms for the diagnosis and treatment of post-inflammatory hypopigmentation, which warrants further exploration and discourse.

Prospective comparison study of a 550 picosecond 755 nm laser vs a 50 ns 755 nm laser in the treatment of nevus of Ota.

Since the introduction of selective photothermolysis, Q-switched nanosecond lasers have been used for the treatment of dermal pigmented lesions. Over the past several years, picosecond lasers have been introduced to the cosmetic community. We recently performed a study comparing a 550 picosecond 755 nm laser versus a 50 ns 755 nm laser, with the purpose of evaluating the clinical efficacy and complications of each laser when treating nevus of Ota. Ten Asian patients with nevus of Ota were enrolled in the study. Each lesion was split into 2 parts, and patients were treated with a 755 nm picosecond laser (PSL) and a 755 nm nanosecond laser (NSL). The clinical endpoint for fluence choice was immediate whitening (PSL: 2.33 ~ 3.36 J/cm2, NSL: 5.5 ~ 7 J/cm2) of the treated area. The pulse duration was fixed at 550 picoseconds (PSL) and 50 ns (NSL). The spot size of each laser was 2.5-3 mm. Laser treatments were performed until excellent clinical improvement was observed. Patients were examined 1 week after the first treatment, at each follow-up visit, and 6 months after the last laser treatment. The average number of treatment sessions to achieve excellent clinical improvement was 4.2 treatments using PSL and 5.4 treatments using NSL. One case of hyperpigmentation and one case of hypopigmentation were observed in the NSL treatment group. There were no complications in the PSL treatment group. The 755 nm 550 picosecond laser is significantly more effective than the 755 nm 50 ns laser in the treatment of nevus of Ota. The PSL treatment group also had minimum side effects.