Management of periorbital hyperpigmentation: An overview of nature-based agents and alternative approaches.

Periorbital hyperpigmentation (POH) is a common dermatological condition that presents as dark periorbital area beneath the lower eyelids, and it is commonly found in females belonging to the age group of 16 to 45 years. The data presented in this review include studies conducted on patients with a clinical/histological diagnosis of POH or melasma. Many diverse topical depigmenting agents comprising an array of naturally obtained actives such as arabinoxylans, α-arbutin, asiaticoside, azelaic acid, beta-carotene, boswellic acid, caffeine, chrysin, curcumin, cyanidin-3-glucoside, d-glucoronic acid, dihydrochalcone, dipalmitoyl-hydroxyprolene, fucoxanthin, genistein, glabridin, b-glucogallin, hyaluronic acid, lactic acid, lycopene, niacinamide, pycnogenol, retinol, salidroside, and xymenynic acid demonstrated significant benefits in the management of POH. An exhaustive literature search revealed that other techniques such as blepharoplasty, carboxytherapy, calcium hydroxylapatite fillers, tear trough implant, Q-switched ruby laser, medicated tattoo, fat transfer, micro-needling, chemical peels, nitrogen plasma skin regeneration, intense pulsed light, and radiofrequency have been evaluated and reported to be beneficial in the treatment of POH. The use of topical depigmenting agents is the most widely reported method in the clinical management of POH. Of these, α-arbutin, caffeine, cyanidin-3-glucoside, and dihydrochalcone are reported to exhibit significant benefits. Combination products containing a blend of actives are reported to be better than single active containing products. This review aims to provide a comprehensive perspective on the role of several topical actives in the modulation of melanin and tyrosinase biosynthesis pathway involved in the complex pathophysiology of POH. It also presents the advantages of combination products and other alternative therapies used in the management of POH.

A case report of the first application of culture epithelial autograft (JACE®) for giant congenital melanocytic nevus after its approval in Japan.

In Japan, the JACE® cultured epidermal autograft (CEA) was approved and covered by public healthcare insurance for use in the treatment of giant congenital melanocytic nevus (GCMN) in 2016. We herein report the results of the application of JACE® after curettage and Q-switched ruby laser therapy. The current patient was the first patient with GCMN to be treated with JACE® since its approval. A 3-month-old girl had a hairy GCMN of 9.5 cm in diameter from her cheek to her temple on the left side of her face. We first performed curettage of the nevus on the temple and applied irradiation using a Q-switched ruby laser; however, erosion relapsed at 2 months after first surgery. After preparing JACE®, we performed curettage a second time at 7 months with irradiation of a Q-switched ruby laser and the application of the CEA. The CEA took successfully and the wound was completely epithelized at 1 week after grafting. Re-pigmentation is an important issue that remains to be solved; however, overcoming this would allow for a deeper abrasion or more intense laser irradiation to be performed in cases in which CEA will be subsequently applied.

Combination of fractional QSRL and IPL for melasma treatment in Chinese population.

BACKGROUND: Melasma is the most common and distressing pigmentary disorder presenting to dermatology clinics. Various treatment protocols for melasma have been suggested in the previous literature and applied in various clinical settings. However, no satisfactory therapy has been widely accepted. OBJECTIVE: To evaluate the efficiency and safety of a combination treatment with fractional Q-switched ruby laser (QSRL) and intense pulsed light (IPL) for melasma in Chinese population. METHODS: Fifty-three Chinese melasma patients were enrolled in this study. Each patient underwent 2 courses of treatments at 2-week interval. One course was composed of 3 successive sessions of 694-nm fractional QSRL at intervals of two weeks followed by one IPL. The efficacy was evaluated by non-invasive measurements and subjective assessments. The adverse effects were recorded. RESULTS: Mean melanin index (MI) and erythema index (EI) significantly decreased from 216.1 and 381.8 pre-treatment to 167.8 and 310.3 post-treatment, respectively. Mean melasma area and severity index (MASI) decreased dramatically from 14.66 before treatment to 5.70 after the final treatment. These values remained at low levels at 3-month follow-up. The percentage of patients who achieved moderate or significant improvements was 73.6%. Adverse effects of QSRL and IPL were minimal. CONCLUSION: The combination treatment of fractional QSRL and IPL would be a promising modality for managing melasma in Chinese patients.

Efficacy of 694-nm fractional Q-switched ruby laser (QSRL) combined with sonophoresis on levorotatory vitamin C for treatment of melasma in Chinese patients.

Melasma is a common acquired and distressing pigmentary disorder presenting to dermatology clinics. It is notably difficult to cure and has a tendency to relapse. The efficacy of classical Q-switched laser in treatment of melasma remains controversial. This study aims to investigate the efficacy and safety of 694-nm fractional QSRL combined with sonophoresis on levorotatory vitamin C for the treatment of melasma patients. Twenty-six patients with melasma were enrolled. Each patient received four to six fractional QSRL treatments at pulse energies of 2.5 to 4 J/cm(2) combined with sonophoresis on levorotatory vitamin C at 2-week intervals. The severity and the area of melasma were assessed by two investigators using the melasma area and severity index (MASI). Side effects were documented. Mean MASI score decreased from 15.51 ± 3.00 before treatment to 10.02 ± 4.39 3 months after the final treatment (P < 0.01). Side effects were few and transient. High-density coverage fractional QSRL combined with sonophoresis on levorotatory vitamin C is safe and effective for the treatment of melasma in Chinese patients.

Treatment of infraorbital dark circles using 694-nm fractional Q-switched ruby laser.

The objective of this study was to evaluate the efficacy and safety of using a 694-nm fractional Q-switched ruby laser to treat infraorbital dark circles. Thirty women with infraorbital dark circles (predominant color: dark/brown) participated in this open-labeled study. The participants received eight sessions of 694-nm fractional Q-switched ruby laser treatment using a fluence of 3.0-3.5 J/cm2, at an interval of 7 days. The melanin deposition in the lesional skin was observed in vivo using reflectance confocal microscopy (RCM). The morphological changes were evaluated using a global evaluation, an overall self-assessment, and a Mexameter. Twenty-eight of the 30 patients showed global improvements that they rated as excellent or good. Twenty-six patients rated their overall satisfaction as excellent or good. The melanin index indicated a substantial decrease from 240.44 (baseline) to 194.56 (P < 0.05). The RCM results showed a dramatic decrease in melanin deposition in the upper dermis. The adverse effects were minimal. The characteristic finding of dark/brown infraorbital dark circles is caused by increased melanin deposition in the upper dermis. The treatment of these infraorbital dark circles using a 694-nm fractional QSR laser is safe and effective.

Fractional CO2 laser is as effective as Q-switched ruby laser for the initial treatment of a traumatic tattoo.

BACKGROUND AND OBJECTIVE: Q-switched laser treatments are considered the standard method for removing both regular and traumatic tattoos. Recently, the removal of tattoo ink using ablative fractional lasers has been reported. Ablative fractional CO2 laser and q-switched ruby laser treatments were used in a split-face mode to compare the safety and efficacy of the two types of laser in removing a traumatic tattoo caused by the explosion of a firework. STUDY DESIGN/PATIENTS AND METHODS: A male patient suffering from a traumatic tattoo due to explosive deposits in his entire face was subjected to therapy. A series of eleven treatments were performed. The right side of the face was always treated using an ablative fractional CO2 laser, whereas the left side was treated only using a q-switched ruby laser. RESULTS: After a series of eleven treatments, the patient demonstrated a significant lightening on both sides of his traumatic tattoo, with no clinical difference. After the first six treatments, the patient displayed greater lightening on the right side of his face, whereas after another five treatments, the left side of the patient's face appeared lighter. No side effects were reported. CONCLUSIONS: In the initial stage of removing the traumatic tattoo, the ablative fractional laser treatment appeared to be as effective as the standard ruby laser therapy. However, from the 6th treatment onward, the ruby laser therapy was more effective. Although ablative fractional CO2 lasers have the potential to remove traumatic tattoos, they remain a second-line treatment option.

Early Treatment of Nevus of Ota in Children is More Effective and Beneficial to Mental Health: Observation on the Efficacy of Q-Switched Ruby Laser in Treating 159 Cases of Nevus of Ota in Children.

Background and Objective: Nevus of Ota (NO), also known as "brownish-blue nevus of the palate of the eye", is a benign dermal pigmentation that increases skin disease. The Q-switched ruby laser is a classic treatment for nevus of Ota in children, but the optimal age for treatment is still controversial. The aim of this study was to investigate the treatment effect of Q-switched ruby laser in children with nevus of Ota at different ages and the effect on psychological health status. Materials and Methods: Children with nevus of Ota treated with Q-switched ruby laser in the Department of Dermatology of the Second Affiliated Hospital of Wenzhou Medical University from June 2015 to June 2019 were retrospectively analysed. And the mental health status was assessed using the CDI scale. Results: In the preschool children group (0-7 year age), the significant efficacy rates was 93.1%, the average number of treatments was 3.6, and the overall incidence of adverse reactions was 4.7%. The significant efficacy rates in the school-age children group (7-14 year age) was 90.3%, the average number of treatments was 5.1, and the overall incidence of adverse reactions was 13.7%. The mean post-treatment CDI score in the preschool children group was 10.8, and 9.7% of children exceeding 19 points. The mean pre-treatment CDI score in the school-age children group was 17.3, and 24.6% of children exceeding 19 points. The mean post-treatment CDI score was 13.6 and 15.1% of children exceeded 19 points. The chi-square test for the significant efficacy rate of the two groups showed P>0.05, which was not statistically significant. The significant efficacy rate of the preschool group and that of the school-age children group. The t-test for the number of treatments in the two groups showed P<0.05, which was statistically significant. Adverse reactions in the two groups showed a statistically significant P<0.05. The mean CDI scores and the percentage of depressed individuals in the school-age children group were significantly lower after treatment than before treatment (p<0.05). Conclusion: Q-switched ruby laser is safe and effective in treating nevus of Ota in children. Early treatment can reduce the number of treatments and the incidence of adverse reactions. In addition, early treatment can reduce children's depression, which is beneficial to mental health.

Q-switched ruby laser is safe and effective in treating primary gingival hyperpigmentation.

BACKGROUND: Physiologic gingival hyperpigmentation (PGH) is a benign condition that results from increased melanin production and is prevalent among darker skin individuals. Although the use of lasers for PGH has gained popularity in recent years, the lasers being used are mostly ablative, and act through a non-selective tissue damage mechanism. AIMS: The objective of this study was to evaluate the use of a non-ablative 694-nm Q-switched ruby laser (QSRL) for the depigmentation of PGH. METHODS: A retrospective single-center study of patients diagnosed with PGH and treated with a QSRL Between March 2019 and November 2020. RESULTS: Four patients were treated with QSRL for 1-3 sessions, until complete depigmentation was achieved. The average follow-up was 11 months (range 7-18 months) with no patient exhibiting re-pigmentation. Adverse events included mild local tenderness and transient erosions in two patients. CONCLUSION: The 694-nm QSRL is a novel and promising safe and effective method for treating PGH with the advantages of being a non-ablative modality that minimizes tissue damage and optimizes the outcome.

Laser Removal of Buccal Skin Coloration Caused by India Ink Injection for Cancer Marking.

Why was India ink used in this case of gingival cancer?Why did the skin change color in this case?What are the benefits and limitations of laser treatment?What is the ideal marking method?

Nevus of Ota on the auricle successfully treated with Q-switched ruby laser.

Nevus of Ota is a dermal melanocytosis that consists of blue-brown spots, patches and plaques along the distribution of the first and second branches of trigeminal nerve. The efficacy of Q-switched ruby laser treatment against nevus of Ota on dark skin has not been described. The present case, a 2-month-old Indonesian girl, showed rare auricular involvement. Because ear has complicated steric structure, whose skin is sensitive and thin, pain and inflammatory reaction are inevitable. We discussed the difficulty of laser treatments on auricular lesions.

A retrospective study of FQSRL and IPL in the treatment of Café-au-lait macule.

BACKGROUND: The application of fractional Q-switched ruby laser (FQSRL) or intense pulsed light (IPL) on Café-au-lait macule (CALM) is rational and the data are lacking. OBJECTIVE: To evaluate the efficacy and safety of FQSRL and IPL in CALM. METHODS: The patients with CALM who were treated with FQSRL or IPL were retrospectively observed from April 2016 to April 2019. The laser/light treatments were conducted at an interval of 3-4 weeks. RESULTS: For FQSRL (N = 67), 88.23%, 95.46%, 100% patients achieved >50% improvement by three sessions, four sessions, and more than four sessions of treatment, respectively. A better and better efficacy was shown with the increasing number of sessions (χ2 = 89.51, p < .01). For IPL (N = 54), 45% and 87.5% achieved >50% improvement by three sessions and more than four sessions of treatments, respectively. More than four sessions achieved better efficacy than less sessions (p < .01). Under various time-points, FQSRL presented more favorable responses than IPL (p < .05). All the adverse effects were tolerable and acceptable. CONCLUSIONS: FQSRL or IPL would be an alternative and safe modality for CAML in Chinese patients.

Laser treatment of solar lentigines on dorsum of hands: QS Ruby laser versus ablative CO2 fractional laser - a randomized controlled trial.

BACKGROUND: Lentigines solares (LS) on the dorsum of hands are often esthetically disturbing. Q-switched ruby laser treatment is highly effective in the treatment of these lesions. Ablative fractional photothermolysis may be a suitable alternative. We compared the Q-switched ruby laser with ablative CO2 fractional photothermolysis for the treatment of solar lentigines. OBJECTIVE: To evaluate the efficacy and side-effects of 694nm Q-switched ruby laser (Sinon) with the ablative 10,600nm CO2 fractional laser (Quantel Excel O2) in an intra-individual side-to-side comparison in the treatment of LS on the dorsum of hands. MATERIAL AND METHODS: Eleven patients were included in the study. The hands of each patient were randomized for treatment with the two laser systems. Three treatment sessions were scheduled at weeks 0, 4 and 8. Evaluations by patients, treating physician and blinded experts were scheduled at weeks 0, 4, 8, 16 and 24. RESULTS: The Q-switched ruby laser was significantly more efficacious than the ablative CO2 fractional laser for removing LS on the dorsum of hands (p = 0.01). CONCLUSION: In this first study on this topic, the Q-switched ruby laser was superior to the ablative CO2 fractional laser in the treatment of lentigines solares on the dorsum of hands.