Laugier-Hunziker syndrome: complete clearance of mucosal lentigines with a single session of Q-Switched Nd:YAG laser.

Background: Laugier-Hunziker (LH) syndrome is a rare condition in which melanocyte overactivity produces lentiginous lesions of the lips and buccal mucosa. Objective: Given the paucity of reports on therapeutic options in LH syndrome, this case is herein reported to show the response to treatment with the Q-Switched Nd:YAG laser in a 32-year-old man with LH Syndrome. Methods: The Q-Switched Nd:YAG laser was used to treat the lentiginous lesions on the mucosal surface of the lower lips using a single pass at 532 nm. Results: There was complete clearance of the mucosal lentiginous lesions with a single laser session, and recurrence was not observed after 12 months. Conclusion: The Q-Switched Nd:YAG laser is an effective treatment option for cosmetic benefit in LH Syndrome.

Melanocyte Activation Mechanisms and Rational Therapeutic Treatments of Solar Lentigos.

To characterize the pathobiology of solar lentigos (SLs), analyses by semiquantitative RT-PCR, Western blotting, and immunohistochemistry revealed the upregulated expression of endothelin (EDN)-1/endothelin B receptors (EDNBRs), stem cell factor (SCF)/c-KIT, and tumor necrosis factor (TNF)α in the lesional epidermis, which contrasted with the downregulated expression of interleukin (IL) 1α. These findings strongly support the hypothesis that previous repeated UVB exposure triggers keratinocytes to continuously produce TNFα. TNFα then stimulates the secretion of EDNs and the production of SCF in an autocrine fashion, leading to the continuous melanogenic activation of neighboring melanocytes, which causes SLs. A clinical study of 36 patients with SLs for six months treated with an M. Chamomilla extract with a potent ability to abrogate the EDN1-induced increase in DNA synthesis and melanization of human melanocytes in culture revealed a significant improvement in pigment scores and color differences expressed as L values. Another clinical study using a tyrosinase inhibitor L-ascorbate-2-phosphate 3 Na (ASP) demonstrated that L values of test lotion (6% APS)-treated skin significantly increased in SLs and in non-lesional skin with a significantly higher ΔL value in SLs when compared with non-lesional skin. The sum of these findings strongly suggests that combined topical treatment with EDN signaling blockers and tyrosinase inhibitors is a desirable therapeutic choice for SLs.

Efficacy and safety of intense pulsed light with a KTP filter for the treatment of solar lentigines.

BACKGROUND: Optical energy-based devices, including intense pulsed light (IPL) and potassium titanyl phosphate (KTP) lasers achieve reduction of pigmented and vascular lesions in a relatively similar number of treatments. This study aimed to evaluate the efficacy and safety of an IPL with a "KTP-like" filter emitting a wavelength of 525-585 nm for the treatment of solar lentigines on the hands and face. METHODS: This was a single center, prospective, open-label clinical trial including 16 healthy Caucasian subjects (15 females, mean age, 55 years; skin types II and III) with hand and facial solar lentigines. Subjects were treated with three IPL treatment sessions with a KTP-like filter conducted at monthly intervals. Follow-up evaluations were performed 1, 3, and 6 months after the last treatment session. Overall pigmentation improvement, pigmentation clearance per lesion, adverse events, and subject tolerability to treatment were evaluated. RESULTS: Significant improvements in facial and hand pigmentation were noted at all follow-up visits (P < 0.0001). One month after the last treatment session, good to excellent outcomes were noted in 74.6% of treated facial areas and 90% of treated hand regions. Although the effect of treatment gradually declined in both treatment regions over the 6-month follow-up period, over 60% of subjects demonstrated good to excellent results at the study end. Clinical effectiveness was further confirmed by the reduction in Melanin Index (MI) following each treatment as compared to baseline. Downtime and complications were minimal. CONCLUSIONS: IPL treatment with a KTP-like filter is a well-tolerated and effective method for reducing facial and hand pigmentation. Lasers Surg. Med. 51:500-508, 2019. © 2019 Wiley Periodicals, Inc.

Efficacy and Safety of Topical Pidobenzone 4% as Adjuvant Treatment for Solar Lentigines: Result of a Randomized, Controlled, Clinical Trial.

BACKGROUND/OBJECTIVE: This study aims at the evaluation of the efficacy and safety of a combination therapy based on pidobenzone 4% and fractional CO2 laser or cryotherapy in the treatment of solar lentigines and the prevention of eventual posttreatment hyperchromia. METHODS: Efficacy was clinically evaluated by grading the pigmentation level with the Skin Tone Color Scale (STCS), and by grading patients' impression through a Visual Analog Scale (VAS). RESULTS: Our study shows that the associated treatment was safe and that it improves the therapeutic results on solar lentigines and prevents postiatrogenic hyperpigmentation compared with physical therapy alone. CONCLUSION: The combination of cryotherapy and pidobenzone 4% has been found to be the most useful treatment.

A Multimodal Approach to Rejuvenation of the Lower Face.

BACKGROUND: Facial aging is multifactorial, including changes in all the anatomical layers of the face including bone, fat, connective tissues and skin. METHODS: An evaluation of the multifactorial causation of facial aging pointed to the need for a multifactorial approach to restoration and rejuvenation of the aging human face. RESULTS: The varied aetiologies of the expressions of facial aging require more interventions than a unipolar approach. Combinations of neuromodulators, three and two-dimensional fillers and energy based devices were discussed. Surgical interventions were also discussed but were not addressed in this paper. CONCLUSIONS: A multimodal approach to lower facial rejuvenation and restoration is discussed as the most effective and appropriate method to achieve noninvasive aesthetic treatment success.

Objective assessment of intensive targeted treatment for solar lentigines using intense pulsed light with wavelengths between 500 and 635 nm.

BACKGROUND AND OBJECTIVES: Solar lentigines are commonly found in sun-exposed areas of the body including hands, neck, or face. This study evaluates the efficacy of an intense pulsed light (IPL) device, with wavelengths between 500 and 635 nm and delivered with a targeted tip, for the treatment of solar lentigines on Japanese skin. STUDY DESIGN/MATERIALS AND METHODS: Forty Japanese patients with solar lentigines received one IPL treatment with a targeted treatment tip that emits wavelengths between 500 and 635 nm and contact cooling. Pulses were delivered through a targeted tip to each lentigo until mild swelling and a gray color were observed. Digital photographs and gray level histogram values were taken pre- and post-treatment, and patient assessments were recorded post-treatment. RESULTS: Significant improvement was observed for all patients in digital photographs and mean values of gray level histograms (P < 0.0001). Ninety percent of patients reported satisfaction with the improvement of the treatment area and convenience of the procedure. Complications were minor and transitory, consisting of a slight burning sensation and mild erythema which resolved within 5 hours of treatment. No serious adverse events were observed. CONCLUSIONS: A short-wavelength IPL, delivered with a targeted tip and contact cooling, offers a highly efficacious treatment for solar lentigines in Japanese skin with minimal downtime and complications.

Triple combination as adjuvant to cryotherapy in the treatment of solar lentigines: investigator-blinded, randomized clinical trial.

BACKGROUND: Post-inflammatory hyperpigmentation is a frequent concern when treating solar lentigines. OBJECTIVES: To assess the safety and efficacy of a triple combination cream with fluocinolone acetonide 0.01%, hydroquinone 4% and tretinoin 0.05% as adjuvant to cryotherapy in the treatment of solar lentigines in hands dorsum, and in the prevention of post-inflammatory hyperpigmentation after cryotherapy. METHODS: This prospective, randomized, controlled, investigator-blinded, single-centre study enrolled 50 patients. Twenty-five patients received a 2-week daily triple combination cream plus sunscreen pre-treatment and 25 received sunscreen alone. After that, cryotherapy was performed in all patients followed by a 3-week recovery period. After this period, patients received the same initial treatment and were followed up for 8 weeks. Melanin and erythema levels of a target and a control lentigo were objectively measured using a narrowband reflectance spectrophotometer. Lentigines count, colour homogeneity and global improvement were also assessed. RESULTS: The number of solar lentigines reduced in the first 2 weeks only in patients who used the triple combination 25 ± 7 vs. 22 ± 8 (P < 0.0001), and reduced at the end of the study for both groups (P < 0.0001). The melanin levels also reduced in the first 2 weeks only in patients who used the triple combination 297 ± 69 vs. 273 ± 66 (P < 0.0001) and reduced at the end of the study for both groups (P < 0.0001). Erythema and residual blisters from cryotherapy were the reported adverse reactions. CONCLUSION: Triple combination cream can be used to enhance the resolution of solar lentigines, and to significantly reduce melanin levels and lentigines count, improving treatment results. It was well-tolerated and did not increase the occurrence of neither erythema nor other side-effects after the cryotherapy.

Future directions in cutaneous laser surgery.

This article presents an overview of future trends in cutaneous laser therapy and technology. To enhance efficacy and specificity of treatment, new wavelengths directed at both old and new targets are on the horizon. New applications, including the use of lasers to aid in the detection of skin cancers and to enhance drug delivery, are being used and investigated. A trend toward combining different lasers and light sources to optimize results continues. Advancements in at-home devices have been made. Future applications will include waveforms beyond those in the visible light and infrared spectrum, such as microwaves, ultrasound waves, and radiofrequency.

[Dermocosmetic management of hyperpigmentations]. / Prise en charge dermo-cosmétique des hyperpigmentations.

Hyperpigmentations are very frequent situations that can have considerable impact on the quality of life of affected individuals. However, even if the esthetic prejudice they generate is undeniable, lentigo and melasma are benign conditions that require above all a risk-free management. In addition to the dermatological procedures (peeling, laser, etc.) and the topical drugs available to the dermatologist, there remains significant room for depigmenting dermocosmetic products. These products succeeded to transpose features of the classic pharmaceutical formula invented by Kligman from which they were inspired to the field of dermocosmetics. They comprise activators of epidermal turn-over, skin exfoliants, and active ingredients that interfere with the different stages of melanogenesis, without having the side effects of hydroquinone whose usage remains limited to the field of prescription drugs. Antioxidants are a particularly interesting addition because they participate in reducing cutaneous inflammation and efficiently complete the action of the other components of a depigmenting formula. It is important to remind the aggravating role that sun exposure has on hyperpigmentations. Therefore, measures of rigorous photoprotection are mandatory. Medical makeup, transitory or definite, is an interesting option for the management of hyperpigmentations. Consequently, depigmenting dermocosmetics, used in monotherapy but - most frequently - in combination with dermatological procedures, can be used in literally all types of hyperpigmentations with an efficacy that is dependent on the specific etiology. They are suited to be part of a treatment program that has to be adapted on a case-by-case basis.

Hyperbaric oxygen improves ultraviolet B irradiation-induced melanin pigmentation and diminishes senile spot size.

BACKGROUND: The effects of exposure to hyperbaric oxygen on ultraviolet B (UVB) irradiation-induced melanin pigmentations of skins and on senile spot sizes of faces were investigated. METHODS: In the first experiment, male subjects were irradiated with UVB on their upper arms for inducing erythema and the subsequent melanin pigmentation. They were exposed to a hyperbaric environment at 1.25 atmospheres absolute (ATA) with 32% oxygen for 1 h/day, three times per week. In the second experiment, female subjects were exposed to a hyperbaric environment at 1.25 ATA with 32% oxygen for 1 h/day, two times per week. RESULTS: In the first experiment, melanin pigmentations lightened after 4 weeks of exposure to hyperbaric oxygen. In the second experiment, senile spot sizes became small after 12 weeks of exposure to hyperbaric oxygen. CONCLUSION: We concluded that exposure to hyperbaric oxygen used in this study accelerates both the fading in melanin pigmentation and the decrease in senile spot size.

Clinical effectiveness of intense pulsed light therapy for solar lentigines of the hands.

Intense pulsed light (IPL) treatment, as a nonablative phototherapy, is known to improve various signs of facial photoaging skin, e.g., solar lentigines, fine wrinkles, and telangiectasias. The purpose of the present study was to investigate the efficacy and tolerability of IPL with a 515-nm filter in patients with solar lentigines on the back of hands. An open study was performed in 31 patients who were treated with a 1-month interval up to five times. Sixty-two percent of patients had more than 50% improvement and 23% had more than 75% improvement. No patients discontinued due to adverse effects, and no patients showed hyperpigmentation or scarring after the treatments. Phototherapy using this IPL source was effective and well tolerated in the patients, suggesting that this phototherapy may be an appropriate modality for the treatment of solar lentigines of the hands.

Vitiligo following intense pulsed light treatment.

Vitiligo is an acquired depigmenting disorder characterized by the progressive loss of melanocytes from the epidermis and epidermal appendages, which results in milky-white macular lesions. Various factors are suspected to affect the induction and progression of vitiligo such as emotional shock, sunburn, pregnancy, physical illness and trauma. The intense pulsed light (IPL) device which mostly affects redness and dyspigmentation has a broad spectrum of emissions of white light with wavelengths between approximately 515 and 1200 nm. Adverse effects such as purpura and pigmentary changes are known to be rare. We present a 41-year-old woman who developed multiple round, hypopigmented macules on both the cheek and mandibular area following the treatment with IPL for lentigines and dyspigmentation. Based on biopsy and Wood's lamp examination, diagnosis as vitiligo was made. She was treated with a 308-nm excimer laser. After 3 months of treatment, almost complete repigmentation was seen but another coin-sized hypopigmented patch was noted after 5 months later. Herein, we report a case of vitiligo which developed after IPL treatment. This is the first case to be reported which vitiligo developed after IPL treatment. Therefore, dermatologists should be aware of unsighted vitiligo lesion before IPL treatment.

Clinical effectiveness of a novel intense pulsed light source on facial pigmentary lesions.

Intense pulsed light (IPL) therapy improves various clinical symptoms of photoaging skin. In this study we have investigated clinical effects of a novel IPL, Lumenis One (LUMENIS, Tokyo) on facial pigmentary lesions in 18 Japanese female patients. Measurement was performed after 3-5 treatments. IPL showed marked and slight improvements in 28 and 39%, respectively. The data of melanin index demonstrated the improvement after IPL therapy. These results indicated that IPL therapy using Lumenis One may be useful to treat solar lentigines and ephelides on the face.

Reduction of pain and side effects in the treatment of solar lentigines with pneumatic skin flattening (PSF).

BACKGROUND: Energy densities utilized in the treatment of pigmented lesions such as solar lentigines with intense pulsed light systems are often limited by pain and post-treatment erythema and edema. The sensation of pain associated with the treatment is immediate and acute. Application of topical anesthesia is time-consuming, with only very moderate pain relief. OBJECTIVE: (a) To test pain reduction as well as the reduction of post-treatment erythema and edema when using pneumatic skin flattening (PSF). This new technology utilizes an evacuation chamber to generate skin compression and activates tactile neural receptors in the skin. The result is an afferent inhibition of pain transmission in the dorsal horn (the 'gate theory'). (b) To test the efficacy of PSF. METHODS: Twenty patients were treated for solar lentigines. The patients were treated by three different IPLs. The evaluation of acute pain and post-treatment erythema and edema was performed on all 20 patients: one to three sites per patient treated with PSF and the same number of control sites without PSF. Identical energies and IPL were applied to both sites on each patient. The pain evaluation was performed on a 10-level scale modified McGill Pain Questionnaire. The clinical response to treatment was also evaluated. RESULTS: All 20 patients completed the study and preferred the PSF treatment side over the non-PSF side. Substantial pain reduction was observed in 19/20 patients (95%). The average reduction of pain was by two levels, from very painful to very mild pain. Erythema reductions were observed on 14/18 (77%) patients and edema reduction on 8/9 (88%) patients. Treatment efficacy on PSF sites was identical to that of non-PSF sites. CONCLUSION: The pneumatic skin flattening (PSF) technology considerably reduces pain, erythema and edema in the treatment of solar lentigines by IPLs. Treatment efficacy is preserved. The enhanced safety of PSF enables the increase of energy density and the acceleration of results.

New approach to the evaluation of skin color of pigmentary lesions using Skin Tone Color Scale.

Objective methods of measuring skin color are needed to evaluate pigmentary lesions quantitatively. We have developed a new method of measuring skin color using a plastic bar system called the Skin Tone Color Scale based on Munsell's color space system. We have also evaluated the effectiveness of various therapies using this measurement system. Our system was designed to measure skin color in normal skin, pigmentary lesions of solar lentigo, chloasma and ephelides, and postinflammatory pigmentation. Moreover, effectiveness of various therapies for these pigmentary lesions was evaluated. The evaluations made with this system were closely related to physician assessment. This method may be useful in measuring of skin color and evaluating the effectiveness of therapies for pigmentary diseases.

Objective evaluation of the effect of intense pulsed light on rosacea and solar lentigines by spectrophotometric analysis of skin color.

BACKGROUND: To date, intense pulsed light (IPL) has been applied to various skin diseases, but there have been few objective evaluations of its efficacy. OBJECTIVE: The aim of this study was to perform objective evaluations of the effect of the IPL system on rosacea and solar lentigines. METHODS: Twelve patients with rosacea were treated with IPL at the wavelength of 550 to 670 nm, three times every 4 weeks, and the skin color was determined with L(*)a(*)b(*) color space using a spectrophotometer. In addition, 18 patients with solar lentigines were treated once, and the lightness L(*) was determined. RESULTS In all of 6 erythematotelangiectatic rosacea patients and in 5 of 6 papulopustular rosacea patients, each of the L(*)a(*)b(*) values of the posttreated lesions approached those of normal skin areas (efficacy rate, 91.6%). The mean level of the L(*)a(*)b(*) values improved significantly after treatment and particularly in the erythematotelangiectatic rosacea patients. In 12 of 18 patients with solar lentigines, the lightness L(*) was elevated after treatment (efficacy rate, 66.6%). CONCLUSION: As demonstrated by spectrophotometric analysis of skin color, IPL at the wavelength of 550 to 670 nm is effective for rosacea and solar lentigines, particularly most useful for erythematotelangiectatic rosacea.

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.

A comparison of Q-switched alexandrite laser and intense pulsed light for the treatment of freckles and lentigines in Asian persons: a randomized, physician-blinded, split-face comparative trial.

BACKGROUND: Q-switched (QS) pigmented lasers and intense pulsed light (IPL) successfully treat pigment disorders. OBJECTIVE: We sought to compare efficacy and side effects of QS alexandrite laser (QSAL) and IPL for freckle and lentigo treatment in Asians. METHODS: In all, 15 patients with freckles and 17 patients with lentigines were treated randomly with one session QSAL in one cheek and two sessions IPL in the other cheek at 4-week intervals. Efficacy was determined using a new pigmentation area and severity index score. RESULTS: All patients experienced improvement (P < .0001). Postinflammatory hyperpigmentation developed in one patient with freckles and 8 patients with lentigines after QSAL. No postinflammatory hyperpigmentation occurred after IPL. Freckles achieved greater improvement after QSAL than IPL (P = .04). In lentigines, the results after IPL were better than QSAL among those with postinflammatory hyperpigmentation after QSAL. LIMITATIONS: Limitations include a small case number and short follow-up period. CONCLUSION: QSAL was superior to IPL for freckle treatment. IPL should be used for lentigines in Asian persons.

Combination therapy for solar lentigines.

Solar lentigines are benign, hyperpigmented lesions that present a significant cosmetic nuisance for many middle-aged and elderly patients with chronic accumulated sun exposure. While previous monotherapies designed to lighten these lesions offer relatively modest improvement, there are several new treatment options. Combination topical therapy using 2% mequinol/0.01% tretinoin [Solagé Topical Solution] has been shown to markedly reduce lesion darkness with few side effects. Chemical peels can give good results either alone or in combination with topical therapy. Cryotherapy is an effective and inexpensive way of treating solar lentigines while IPL and lasers are more costly treatment options. For patients desiring treatment, optimal cosmetic improvement can be achieved using a combination of topical and procedural therapies.