A pilot study for triple combination therapy with a low-fluence 1064 nm Q-switched Nd:YAG laser, hydroquinone cream and oral tranexamic acid for recalcitrant Riehl's Melanosis.

BACKGROUND: Riehl's melanosis presents as a diffuse gray-brown to black hyperpigmentation around face. The treatment of this disease is challenging and quite limited despite patients' excessive psychological stresses. OBJECTIVE: In this prospective pilot study, we evaluated the efficacy and safety for a novel combination therapy based on low-fluence Q-switched 1064 nm Nd:YAG laser, hydroquinone cream and oral tranexamic acid for recalcitrant Riehl's melanosis. METHODS: Totally eight patients with Riehl's melanosis who had failed improvements previously received multiple sessions (10-18 times) of combination treatment regimen. The primary endpoint was clinical score by the physician and the secondary endpoints were clinical score by the patients, instrumental analysis using melanin and erythema values, and histopathological score. RESULTS: Among eight patients, three received "Almost clear" grade, the other five patients received "Marked improvement" grade at final visits. No serious adverse events and post-treatment downtime was observed. Mean Melanin and Erythema Indexes also showed significant decreases compared with baseline. Histopathologic examination confirmed a significantly greater reduction of melanin content in melanophages. CONCLUSION: This combination method can be a viable option for Asian patients having Riehl's melanosis with high risk of post-inflammatory hyperpigmentation, maintaining low-dose laser irradiation.

Photodynamic therapy using chlorophyll-a in the treatment of acne vulgaris: a randomized, single-blind, split-face study.

BACKGROUND: Chlorophyll-a is a novel photosensitizer recently tested for the treatment of acne vulgaris. OBJECTIVE: We sought to evaluate the clinical efficacy and safety of chlorophyll-a photodynamic therapy used for acne treatment. METHODS: Subjects with acne on both sides of the face were included. Eight treatment sessions were performed over a 4-week duration. Half of the face was irradiated using a blue and red light-emitting diode after topical application of chlorophyll-lipoid complex. The other half underwent only light-emitting diode phototherapy. The lesion counts and acne severity were assessed by a blinded examiner. Sebum secretion, safety, and histologic changes were also evaluated. RESULTS: In total, 24 subjects completed the study. Facial acne improved on both treated sides. On the chlorophyll-a photodynamic therapy-treated side, there were significant reductions in acne lesion counts, acne severity grades, and sebum levels compared with the side treated with light-emitting diode phototherapy alone. The side effects were tolerable in all the cases. LIMITATIONS: All the subjects were of Asian descent with darker skin types, which may limit the generalizability of the study. A chlorophyll-a arm alone is absent, as is a no-treatment arm. CONCLUSIONS: We suggest that chlorophyll-a photodynamic therapy for the treatment of acne vulgaris can be effective and safe with minimal side effects.

Concomitant use of an infrared fractional laser with low-dose isotretinoin for the treatment of acne and acne scars.

BACKGROUND: Acne scarring has lifelong sequelae. Fractional photothermolysis (FP) has been shown to provide fast recovery from acne within a short period, thereby aiding skin rejuvenation. Isotretinoin is a well-known, effective drug for the treatment of severe recalcitrant acne. This study investigated the safety and the efficacy of infrared fractional laser treatment in conjunction with low-dose isotretinoin for the treatment of acne and acne scars. MATERIALS: A 1550 nm Erbium-doped fiber laser was used to treat 35 patients with acne scarring. All the patients had taken isotretinoin (10 mg/day) for more than one month prior to the commencement of the fractional laser treatment. RESULTS: There was no aggravation of acne scars, hypertrophic scars, or keloids. Most of the patients (33 patients) received reduced microthermal damage zone (MTZ) treatment. Eighty percent of the treated patients (28 patients) demonstrated more than a fair improvement. The total average score on the global acne scarring classification before treatment was 13.5, and the score after treatment was 11.2. CONCLUSION: Acne and acne scars can be treated more effectively by concomitant use of an infrared fractional laser with low-dose isotretinoin with reduced MTZ densities. Most patients showed more than a fair improvement, and there was no aggravation of the scars.

Effect of intense pulsed light on rat skin.

BACKGROUND: Intense pulsed light (IPL) is widely used in treating skin conditions and has been reported to increase collagen and elastic fibers without damaging the epidermis. OBJECTIVE: To evaluate the effect of variation in the number of passes and intervals of IPL treatments on photorejuvenation in rats. MATERIALS AND METHODS: Groups of two rats each were exposed to two or four passes of an IPL source using a fluence of 30 J/cm(2) and a cut-off filter of 560 nm at 1- or 3-week intervals. The collagen and elastic fiber content in stained tissue biopsies and the thickness of the collagen fibers of IPL-irradiated and unexposed skin regions were compared. RESULTS: Collagen distribution and collagen fiber diameter was in IPL-irradiated than in control regions. The number of passes did not significantly affect the collagen fiber thickness, but the collagen fibers from the 3-week-interval groups were thicker than those of the 1-week-interval groups (p < .001). CONCLUSION: IPL increased dermal collagen fibers and collagen fiber diameter, suggesting efficacy in photorejuvenation and wrinkle reduction.

Recovery from tanning induced by narrow-band UVB phototherapy in brown-skinned individuals with psoriasis: twelve-month follow-up.

BACKGROUND: Pigmentation induced by narrow-band UVB (NBUVB) phototherapy can cause complaints by psoriasis patients, especially those with brown skin. Nevertheless, the recovery process from tanning after the completion of NBUVB treatment is not known. OBJECTIVE: The purpose of this study was to evaluate the extent of tanning recovery after the end of NBUVB treatment and determine the time required to recover from the fully tanned state. METHOD: Sixteen psoriasis patients with brown skin were observed. The skin color changes on the lower back were measured before beginning phototherapy, upon completion of NBUVB treatment, and subsequently every month for the first one-half year, then bimonthly for the second one-half year, using two different reflectance spectrophotometers. The results are presented as the erythema index (EI) and melanin index (MI), L*a*b* values as recommended by the Commission Internationale de l'Eclairge, and the individual typology angle (ITA degrees). RESULTS: The mean L* value reached 64.4 by the 10th month after the end of NBUVB treatment, with no significant difference from the value before beginning phototherapy. The mean ITA degrees approximated the initial angle at the 8th month after completing NBUVB treatment with no significant difference, thus representing recovery to the original intermediate skin color. The MI recovered to the initial values earlier than the L* value and ITA degrees. The EI appeared the earliest recovery value. CONCLUSION: Understanding the recovery process from tanning induced by NBUVB treatment will improve the patient's compliance for treatment and bring higher efficacy and safety to the retrial of phototherapy in brown-skinned individuals with psoriasis.

A retrospective review of 20% vs. 10% incremental narrowband UVB regimens to treat psoriasis in skin phototypes III-V Koreans.

BACKGROUND: The optimal incremental dose regimen of narrowband UVB (NBUVB) phototherapy that will provide maximal efficacy and safety has not been determined for patients with brown skin and psoriasis. OBJECTIVE: To compare 20% and 10% incremental dose regimens of NBUVB phototherapy with respect to efficacy and safety in Korean patients with brown skin and psoriasis whose Fitzpatrick skin phototypes (SPT) are III-V. METHOD: A retrospective study was designed to compare the 20% and 10% incremental dose groups with respect to the number of sessions, duration of treatment, maximum dose, cumulative dose until response, and adverse effects. RESULTS: The mean number of sessions was significantly lower, the duration of treatment was significantly shorter, and the maximum dose was significantly higher in the 20% incremental dose group. The cumulative dose was not significantly different between the two groups, and there was no statistically significant difference between the groups with respect to the percentage of total adverse effects. CONCLUSION: Use of a 20% incremental dose regimen could be advantageous over a 10% incremental dose regimen in patients with brown skin and psoriasis because of a faster treatment response and higher efficacy without a significant increase in the risk of adverse effects.