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.

Efficacy of a laser with a pulse duration of 300 ps in skin rejuvenation and treatment of pigmentation disorders in Asians: a series of four cases.

The photothermal effect of lasers is minimized and the photoacoustic effect is maximized as the pulse duration is shortened. Therefore, picosecond lasers with a short pulse and high peak power can be used to effectively treat various pigment disorders by reducing tissue damage. The first picosecond lasers were used for tattoo removal; they are also widely used for pigment treatment because of their reduced side effects compared with nanosecond lasers. Recently, picosecond lasers have been shown to be effective in the treatment of various skin conditions such as acne scars and large pores. There are many studies on picosecond lasers; however, there are no studies on a laser with a pulse duration of 300 ps. This report describes the use of a 300 ps Nd:YAG laser for treating pigment disorders and for skin rejuvenation in four Asians, with no side effects. Determining the clinical significance of the 300 ps pulse duration through comparative studies with various picosecond lasers is needed.

Treatment of poikiloderma of Civatte using a redesigned pulsed dye laser with a 15 mm diameter treatment spot.

OBJECTIVES: The pulsed-dye laser has long been a gold standard in the treatment of poikiloderma of Civatte. Recent advances in pulsed dye laser technology enable output energies 50% higher, enabling beam diameters of up to 15 mm with clinically relevant fluences. In this study, we investigate this new laser for treatment of this condition. MATERIALS AND METHODS: Twenty subjects were enrolled in the study. A total of four treatments were administered at monthly intervals. Blinded assessment of digital, cross-polarized photographs taken at baseline and two months following the last treatment was performed by blinded physician raters using an 11-point clearance scale. Subject reported pain scores immediately following treatment and side effects at all visits were recorded by the investigator. RESULTS: Seventeen subjects completed the study. Blinded reviewers correctly identified the baseline photo in 48 of 51 cases (94%). All three reviewers mis-identified the same subjects. The blinded reviewers scored 14 out of the 17 subjects with an improvement greater than 40% and 10 out of the 17 subjects greater than 50%. Average improvement was 49% for all 17 subjects. Side effects were limited to mild edema, and mild to moderate erythema and purpura. Pain scores averaged 3.5 on using an 11-point scale. CONCLUSION: This study demonstrates the safety and effectiveness of a new pulsed-dye laser with a 15 mm spot and 50% higher fluences for the treatment of poikiloderma of Civatte. Lasers Surg. Med. 51:54-58, 2019. © 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Evolution of the Picosecond Laser: A Review of Literature.

BACKGROUND: Picosecond pulse duration lasers (PS) have altered the field of dermatology. PS were initially used in tattoo removal, to optimize efficacy and reduce side effects with nanosecond domain lasers. More recently, they have been demonstrated to be effective in the treatment of pigmentary disorders, acne scarring, and photoaging. OBJECTIVE: In this article, we critically analyze the published data on the many uses of picosecond lasers in dermatology. MATERIALS AND METHODS: A systematic review of PubMed was conducted using the following search terms: "picosecond," "picosecond laser," "picosecond laser dermatology," "picosecond laser pigment/pigmentation," and "picosecond laser tattoo removal." Articles ranged from 1988 until 2017. RESULTS: Forty-one articles were identified, and 27 met inclusion criteria for review. Indications for the PS included a variety of dermatologic applications include tattoo removal, benign pigmented lesions/pigmentary disorders, acne scarring, and photoaging. Most studies demonstrated safe and effective treatment. CONCLUSION: The development of the picosecond pulse duration is a breakthrough innovation in laser technology, changing the scope of laser treatment. Encouraging findings in tattoo pigment clearance spurred the use of PS in a wider array of dermatologic issues. The increasingly positive results and low incidence of adverse effects further substantiates PS efficacy for a variety of dermatologic uses.

A 1064-nm Neodymium-doped Yttrium Aluminum Garnet Picosecond Laser for the Treatment of Hyperpigmented Scars.

BACKGROUND: Pigmentation is one of the few major characteristics according to which scars are evaluated. Data on the treatment of the hyperpigmented component of scars are sparse. OBJECTIVE: The authors aimed at evaluating the efficacy of the fractional 1,064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) picosecond laser in the treatment of the hyperpigmented component of scars. METHODS: Sixteen patients with hyperpigmented scars underwent 3 to 8 treatment sessions at 3- to 6-week intervals with the 1,064-nm Nd:YAG picosecond laser (PicoWay, Candela, Resolve handpiece). The treatment response was evaluated by 2 noninvolved dermatologists on a global assessment scale (GAS) of 1 to 4. A Mexameter quantitatively evaluated the melanin content of the scar before and after laser treatments. RESULTS: The average GAS score of the 2 noninvolved dermatologists was 3.31 ± 0.57. The patients assessed their level of tolerance as good or excellent and their satisfaction level as moderate or high. The Mexameter showed that the melanin index decreased considerably (by 39.11 ± 11.58%) in all patients after treatment. CONCLUSION: The fractionated nonablative picosecond Nd:YAG laser was effective for the treatment of the hyperpigmented component of scars.

Epidermal Fluence Threshold Determination by Real-Time Melanin Measurements.

BACKGROUND AND OBJECTIVE: Epidermal preservation is essential during laser treatment for vascular, hair, and benign pigment dyschromias. Epidermal tolerance is determined by epidermal melanin content, fluence, pulse width, wavelength, skin cooling, and spot size. The authors' objective was to determine the maximum epidermal tolerance for the long-pulse alexandrite 755 nm and the long-pulse neodymium-doped yttrium aluminum garnet (Nd:YAG) 1064-nm lasers for varying epidermal melanin content. MATERIALS AND METHODS: Skin melanin measurements were performed at the test sites with a melanin reader, and 0.5 to 1 second of refrigerated air precooled the skin. Then, alexandrite and Nd:YAG laser test spots of 5 to 18 mm were delivered in a series of ascending fluences using 5-, 20-, and 50-ms pulse widths. Skin response at 24 to 48 and 96 hours was scored from 0 to 15 varying from "no reaction" to "severe scabbing." RESULTS: Alexandrite laser, mean threshold fluences increased by a factor of 1.2 increasing from 5 to 20 ms, and by a factor of 1.4 increasing from 5 to 50 ms, among subjects with a melanin index (MI) from 9 to 25 (Fitzpatrick skin phototype I-III). The Nd:YAG fluence to reach epidermal tolerance was 6X the fluence with the alexandrite laser for the same MI in subjects with MI 26 to 35. CONCLUSION: Epidermal melanin measurements are quantitative and objective, therefore, improving treatment setting determination by decreasing the risk of overtreatment or undertreatment.

Clinical evaluation and in-vivo analysis of the performance of a fractional infrared 1550 nm laser system for skin rejuvenation.

Background: This study was done to demonstrate the safety and efficacy of a novel fractional 1550 nm laser device with a rolling mechanism (FRAX1550 Ellipse Medical, Horsholm, Denmark). Objectives: To evaluated the effectiveness of the 1550 nm device for improvement in wrinkles, pigmentation, and texture on a six point (-1 to 4) global improvement scale. Methods: Five female subjects between the ages of 44 and 71 years, with visible wrinkles and/or dyspigmentation were enrolled in the study. Two full face treatments were performed four weeks apart Follow-up visits at 1 and 3 months posttreatment were scheduled for photographic assessments. Assessment of improvement were performed by the investigators and two blinded evaluators through use of a six-point scale. Results: All subjects demonstrated improvement in all monitored parameters. The mean improvement scores were: wrinkles 1.6, skin texture 1.8, and pigmentation 1.7. All score improvements were statistically significant. Biopsy was performed on one patient immediately post-treatment and showed 800 µ penetration depth at a treatment level of 88 mJ and 400 µ at 44 mJ. Conclusions: The new rolling fractional 1550 nm laser device from this study offers improvement of aging facial skin with short downtime and minimal side effects.

Successful treatment of Schamberg's disease with fractional non-ablative 1540 nm erbium:glass laser.

Schamberg's disease is one of the pigmented purpuric dermatoses (PPD). PPD encompass a large and heterogeneous group of dermatologic disorders featuring purpuric lesions often located on the lower limbs. The various forms of PPD are notoriously known to be resistant to treatment. Fractional photothermolysis has been described as a successful and safe method to induce dermal remodeling. We report three patients with Schamberg's disease who were successfully treated with 4 monthly sessions of fractional non-ablative 1540 nm erbium:glass laser, with resolution of their purpuric pigmented rash lasting up to 9 months after the last treatment session.

Evaluation of the Safety and Efficacy of a Low Fluence, Picopulsed, Alexandrite Laser in a Pico-Toning Technique With a Diffractive Lens Optic for the Treatment of Photodamage and Textural Improvement in "Off the Face" Applications.

BACKGROUND: The diffractive optic coupled with a picosecond pulsed alexandrite laser has been shown to effectively minimize pigmen- tation while improving the appearance of textural irregularities and rhytides. We evaluated the safety and ef cacy of the diffractive optic laser treatment for off of the face applications including the hands and décolletage in a pico-toning technique. STUDY: 20 healthy female patients (40-70 years of age) were treated with a picosecond pulsed alexandrite laser with a diffractive lens. 10 of the patients were enrolled in a prospective hand assessment study (20 hands) while the remaining 10 subjects were enrolled in an IRB approved study treating photodamage of the décolletage. Protocol for both groups included 4 treatments to the designated area with a picopulsed alexandrite laser with a diffractive lens on a 6mm handpiece delivering 0.71 j/cm2 with 10 hz repetition at 3 week intervals (+- 7 days) with follow up at 1 month and 3 months post fourth treatment using standardized digital photography. RESULTS: Statistically signi cant improvement in the overall appearance of pigmentation, texture and rhytides were recorded at each sub- sequent visit and at 1 and 3 months post the nal laser treatment. Clinical photographs were evaluated from baseline to the final photo at 3 months post last laser treatment by the treating physician, patient, and an independent evaluator. All hand subjects and chest subjects showed improvement in all 3 areas which were found to be statistically signi cant. No adverse events occurred in either study group. CONCLUSION: These study results show signi cant improvement in not only pigmentation, but in texture and rhytides in all subjects receiving pico-toning laser treatments to off of the face areas. The laser was well tolerated by all patients with no adverse effects. The use of a diffractive lens optic on a 6 mm xed spot size handpiece with a picopulsed alexandrite laser, in a pico-toning technique, provides a safe, low uence, yet effective treatment for not only pigment dyschromia but also textural irregularities and rhytides when treating the hands and décolletage. J Drugs Dermatol. 2016;15(11):1398-1401..

Comparison of intense pulsed light with 1,927-nm fractionated thulium fiber laser for the rejuvenation of the chest.

BACKGROUND: Rejuvenation of the aging chest is important to prevent noticeable disparities between the treated skin of the face and that of the untreated chest. OBJECTIVE: To compare a high-density thulium fiber laser (TFL)-based protocol for the rejuvenation of the aging chest with intense pulsed light (IPL). METHODS AND MATERIALS: We conducted a retrospective chart review comparing patients treated with IPL and those treated with TFL in combination with a quality-switched alexandrite laser and long pulsed dye laser. Blinded photographic assessment of overall improvement, rhytides, skin texture, dyspigmentation, and telangiectasia was performed. Patient satisfaction was assessed in a standardized follow-up survey. Cost and practicality were compared. RESULTS: At a mean follow-up of 45.8 days for IPL and 78.3 days for TFL, the two protocols had comparable clinical efficacy in achieving rejuvenation of the chest. Differences existed in terms of cost and practicality. CONCLUSION: TFL can be used at high density and in simultaneous combination with other targeted laser modalities to achieve rejuvenation of the aging chest. IPL achieves similar clinical efficacy. The choice between treatment modalities depends on physician and patient preferences.

Using an intense pulsed light (IPL) module for the treatment of pigmented lesions.

BACKGROUND: Pigmented lesions are largely benign and may lead to extreme distress. Various light and lasers may be used to treat pigmentation, often Q-switched lasers are considered the method of choice, while intense pulsed light (IPL) devices may offer a less invasive treatment with a shorter downtime. OBJECTIVE: The purpose of this study is to evaluate the safety and efficacy of a narrowband IPL module for the treatment of pigmented lesions. METHODS: A retrospective study of 20 patients with pigmented lesions underwent treatment with an IPL module. Treatment was assessed by blinded evaluation of clinical photographs using a GAIS scale of 0-10, as well as through patient satisfaction ratings on a scale of 0-10. Throughout the treatment, pain levels and adverse events were monitored. RESULTS: The mean GAIS score was 7.55 ± 1.15 (mean ± SD), and the mean patient satisfaction score was 7.3 ± 1.26 (mean ± SD). There was a strong positive correlation between GAIS and patient satisfaction scores (r = 0.83), and no significant difference between them (p-value = 0.516). The number of treatments did not significantly affect GAIS and patient satisfaction scores (p-values 0.364 and 0.126). Additional positive unexpected outcomes were improved skin firmness and reduced wrinkles. CONCLUSION: The results of the study indicate that the IPL module is both safe and effective in treating pigmented lesions and may have the potential to stimulate collagen production.

Two cases of eczematid-like purpura of Doucas and Kapetanakis responsive to narrow band ultraviolet B treatment.

Eczematid-like purpura of Doucas and Kapetanakis is a type of pigmented purpuric dermatoses (PPDs) with eczematous changes in the purpuric surface. A 10-year-old male and a 44-year-old male patients were admitted to our clinics for itching and flaking of the skin rashes. Based on the clinical and histopathological evaluations, the rashes were identified as eczematid-like PPDs of Doucas and Kapetanakis. Both patients were treated with narrow band ultraviolet B. The lesions were remarkably regressed following the treatment. These cases reported due its rarity and good response to narrow band ultraviolet B.

Formation of new melasma lesions in the periorbital area following high-fluence, 1064-nm, Q-switched Nd/YAG laser.

Although ultraviolet (UV) light or exogenous hormones have been associated with the development or exacerbation of melasma, the use of laser as a treatment modality has not been cited as a factor linked to the development of melasma lesions. It is unclear whether epidermal trauma caused by laser or other treatment can lead to the formation of a new melasma lesion. We report on the formation of new melasma lesions in a patient who was treated for acquired bilateral nevus of Ota-like macules (ABNOM) with a high-fluence 1064 nm Q-switched (QS) neodymium-doped yttrium aluminum garnet (Nd/YAG) laser.

Generalized pigmented purpuric dermatosis in a boy treated with narrow-band-ultraviolet B therapy.

A 14-year-old boy presented with extensive capillaritis. Narrow-band ultraviolet B was administered on a thrice-weekly schedule followed by once-a-week maintenance. A favorable response to treatment was seen without any side effects.

Formation of fibrosis after nonablative and ablative fractional laser therapy.

BACKGROUND: Fractional laser therapy (FLT) has become a widely accepted modality for skin rejuvenation and has also been used in various other skin diseases. OBJECTIVE: To observe long-term histologic effects of nonablative and ablative FLT in the treatment of pigment disorders. METHODS: A randomized controlled observer-blinded study was performed in 18 patients with pigment disorders. Two similar test regions were randomized to receive FLT with intermittent topical bleaching or topical bleaching alone. Patients with ashy dermatosis (AD) and postinflammatory hyperpigmentation (PIH) were treated using nonablative 1,550-nm FLT (15 mJ/microbeam, 14-20% coverage), whereas patients with Becker's nevus (BN) were treated with ablative 10,600-nm FLT (10 mJ/microbeam, 35-45% coverage) for three to five sessions. Biopsies were obtained 3 months after the last treatment. RESULTS: At follow-up, dermal fibrosis was observed in four of eight patients treated using ablative FLT and no patients treated using nonablative FLT (p < .05). CONCLUSIONS: Assuming that the dermal response is comparable in AD, PIH, and BN, at the given settings, ablative FLT may induce fibrosis, whereas treatment with nonablative FLT does not. Whether formation of fibrosis has to be regarded as dermal remodeling or a subtle subclinical form of scarring should be investigated in future research.

Histopathologic changes induced by intense pulsed light in the treatment of poikiloderma of Civatte.

BACKGROUND: The clinical efficacy of intense pulsed light (IPL) in the treatment of poikiloderma of Civatte (PC) is well documented, but little is known about microscopic changes. OBJECTIVE: To analyze histopathologic findings on the necks of individuals with PC after IPL therapy. MATERIALS AND METHODS: Fourteen patients with PC on the neck underwent three monthly sessions of IPL. Biopsies and clinical photographs were taken before and 60 days after treatment. A dermatopathologist analyzed histopathologic slides stained with hematoxylin and eosin, Masson's trichrome, Verhoeff-van Gieson and Fontana-Masson or processed for CD-34 immunohistochemistry. The slides also underwent digital image analysis. Clinical results were based on the analysis of the pictures by three dermatologists and on patient satisfaction. RESULTS: Intense pulsed light treatment resulted in more-homogeneous melanin distribution; a greater number of fibroblasts and nonfragmented elastic fibers; and greater density (p = .01), color intensity (p = .02), number and thickness of the collagen bundles. No significant changes in vessels' number or diameters were observed. Clinical results were positive in 92.9% of the cases. CONCLUSION: IPL treatment of PC induced a more-homogeneous distribution of melanin and increased nonfragmented elastic fibers, collagen density, and intensity. These changes were related to clinical improvement.

Four methods of evaluation of facial erythema and pigment treated with intense pulsed light or cream.

AIM: To evaluate methods of evaluation of patients with mild to moderate facial pigmentation or erythema and compare clinical and photographic grading with instrumental evaluation. METHODS: Of the 24 female subjects treated, 12 were treated with intense pulsed light (IPL) and 12 were treated with daily cream program. Evaluations before and at 16 weeks consisted of: 1. Clinical examination and severity grading by a dermatologist without knowledge of treatment given. 2. Standardised photographs were evaluated by two other dermatologists without knowledge of treatment given. 3. A computer controlled photographic skin analysis systems was used to grade severity of erythema and pigmentation. 4. Subjects were asked to assess their response at the end of a 16-week period, that is, subject self-evaluation. RESULTS: On clinical evaluation of IPL subjects, 12 showed improvement. Of the cream subjects, 11 showed improvement. There was correlation between dermatologist facial examination and the instrumental method. Overall the different assessments showed a slightly greater trend for improvement with IPL treatments for erythema and pigmentation, but no statistical differences were found between the treatments using Student's t-test and Anova analysis of comparative improvement.

Ablative fractional CO2 resurfacing for photoaging of the hands: pilot study of 10 patients.

Extrinsic aging of the hands involves alterations in pigmentation, wrinkling, and texture as a result of chronic ultraviolet and environmental exposures. Inherent tissue properties of the skin of the dorsal hand have made it challenging to safely and effectively improve all three parameters of photoaging with a single device. Recent successes with non-ablative fractional lasers on the hands, as well as success of ablative fractional lasers on the neck and chest, raise the question of potential efficacy of ablative lasers for photorejuvenation of the hands. This was a prospective pilot study of ablative fractional CO(2) laser in 10 participants, each receiving three treatments to one hand at 4-6-week intervals. Subjective assessments by investigator and participants were performed 1 month after each treatment. At 1-month follow-up after final treatment, investigators rated mean improvement of 26-50% for wrinkles, 51-75% for pigment, and 26-50% for texture. Participants rated mean improvement after final treatment as 26-50% for wrinkles, 51-75% for pigment, and 51-75% for texture. Other than significant edema noted in one participant after the first treatment, side effects were limited to transient erythema and edema, with no long-term scarring or pigmentary alteration. In this pilot study, ablative fractional resurfacing was safe and effective for the treatment of all markers of extrinsic aging of the hands. A high degree of improvement was achieved in two to three treatments with no long-term sequelae.