Vitamin C mesotherapy versus diode laser for the esthetic management of physiologic gingival hyperpigmentation: a randomized clinical trial.

BACKGROUND: Physiologic gingival hyperpigmentation is a common esthetic concern that affects individuals of various ethnicities, and can have a significant impact on individual's self-confidence and overall quality of life. Thus, this study aimed to clinically assess the effectiveness of intra-mucosal injection of vitamin C versus 980 nm diode laser for the management of physiologic gingival hyperpigmentation. METHODS: Twenty-six healthy non-smoker individuals with physiologic gingival hyperpigmentation were randomly assigned to two groups. Group I received intra-mucosal injection of vitamin C (L-Ascorbic acid 1000 mg/5 ml), and group II was managed using diode laser (980 nm, 1.5 W, continuous wave mode). Clinical evaluation of pigmentation intensity and distribution was performed preoperatively, and at 1, 2 and 3 months postoperatively using two different color assessment indices; Dummett-Gupta Oral Pigmentation Index (DOPI), and Gingival Pigmentation Index (GPI). Additionally, the study assessed pain intensity and patients' satisfaction. RESULTS: Pigmentation scores decreased significantly between pre-operative visit and different follow-up visits for both treatment modalities (p < 0.0001*). When compared to the vitamin C mesotherapy group, the laser group demonstrated significantly lower gingival pigmentation scores (p < 0.0001*). However, both treatment modalities were equally satisfying for the patients. CONCLUSIONS: Vitamin C mesotherapy and diode laser are both effective in the management of physiologic gingival hyperpigmentation. While diode laser yields better and earlier results, vitamin C mesotherapy offers a cost-effective, safe and minimally invasive approach that is equally satisfying for the patients seeking esthetic enhancements. TRIAL REGISTRATION: The study was registered on ClinicalTrials.gov (NCT05608057) on (01/11/2022).

Clinical application of 675 nm laser therapy for dorsal hand skin hyperpigmentation.

BACKGROUND: Noninvasive skin rejuvenation treatment is growing in recognition to aesthetic medicine. AIM: The objective of the study was to assess the efficacy and the safety of the 675-nm laser source treatment of photodamaged hands. MATERIALS AND METHODS: The study included 21 patients (6 males and 15 females) with a mean age of 63 (± 9) years. Patients were treated with -two to three sessions of the 675-nm laser with a 1-month interval between sessions. Photos of each patient were collected at baseline, and 3 months after the last laser session. The 5-point Global Aesthetic Improvement Scale (GAIS) was recorded with their final assessment session (3 months). RESULTS: The total GAIS scores showed satisfactory results: 15 patients (71%) experienced 4 score (excellent improvement) changes and 6 patients (29%) experienced 3 score (good improvement) changes. Clinical images showed good efficacy and visible aesthetic results for the management of photodamaged skin. No serious adverse effects were recorded. CONCLUSION: This study demonstrates the safety and efficacy of for the aesthetic improvement of skin pigmentation and texture for photodamaged hands.

Treatment of facial pigmented disorders with a 785-nm picosecond Ti:sapphire laser in Asians: A report of three cases.

Since the advent of the theory of selective photothermolysis, the importance of targeting the chromophore and minimizing the surrounding damage has been extensively discussed. Picosecond-domain laser (ps-laser) treatment with a wide range of wavelengths is an emerging option for various pigmented lesions; however, no definitive treatment choice has been confirmed. The authors aimed to investigate the efficacy and safety of a ps-laser with a 785-nm wavelength for the treatment of facial pigmented lesions in Asians. Three Korean patients with facial pigmented lesions were recruited for the study. A 785-nm ps-laser with a fractionated and an unfractionated handpiece was utilized to administer the treatment. The clinical outcome was evaluated by a clinician by comparing pre- and post-treatment photographs. All patients exhibited a significant improvement in pigmented lesions including freckles, lentigines, and melasma, after three to four sessions of treatment. No adverse events, including post-inflammatory hyperpigmentation or hypopigmentation were observed. In conclusion, this novel 785-nm Ti:sapphire ps-laser may be an effective and safe modality for treating pigmented lesions in skin of color.

Identification of the fate and regenerative mechanism of zebrafish melanocyte progenitor cells and melanocytes after laser-induced pigment ablation.

BACKGROUND AND OBJECTIVES: Lasers are known to be the most effective treatment modality for pigmentary skin diseases. However, melanocytes and melanin pigment often recur or leave post-inflammatory hyperpigmentation after the laser procedure. Studies have reported on the role of progenitor cells in pigment cell regeneration, which can be constantly replenished through mitosis. However, the response of unpigmented melanocyte progenitor cells to laser treatment is poorly understood. In this study, we used adult zebrafish skin as the melanocyte regenerative system and examined the response of melanocyte progenitor cells to laser photothermolysis. MATERIALS AND METHODS: The two groups of adult zebrafish were irradiated with 1064 nm wavelength laser system of Q-switched neodymium:yttrium-aluminum-garnet (Nd:YAG) laser with 0.3 or 0.7 J·cm-2 . We compared the regeneration of pigment at different energy levels by measuring new melanocyte counts and pigment area. We traced and quantitatively compared the melanocyte lineage cells by immunohistochemical staining using specific markers such as sox10, mitfa, and dct during the regeneration process. Three repetitive laser ablations were also held to test the postinflammatory hyperpigmentation. RESULTS: After the laser ablation of melanocytes, most of the new melanocytes appeared between Days 5 and 10. In high-energy irradiation of 0.7 J·cm-2 , the unpigmented mitfa-expressing cells showed significant decrease (p < 0.05) and showed delay in the differentiation process of melanocyte lineage cells. After repeated laser irradiation, hyperpigmentation did not appear and the final recovery ratio of the pigmented area was 87.5% and 75.3% at the 0.3 and 0.7 J·cm-2 energy levels, respectively. CONCLUSION: We suggest that laser treatment overcoming the recurrence should be planned based on the adequate energy level targeting the melanocyte progenitor cells. High-energy irradiation may induce apoptosis of progenitor cells and delay their process of differentiation. Short-term repetitive sessions of laser therapy can reduce the pigmentation in the long-term observation.

Comparison of Nd:YAG Laser and Surgical Stripping for Treatment of Gingival Hyperpigmentation: A Clinical Trial.

OBJECTIVE: The objective of this study is to evaluate and compare surgical stripping and neodymium-doped: yttrium, aluminum garnet (Nd:YAG) laser techniques for gingival depigmentation and to evaluate their effect on repigmentation. BACKGROUND DATA: Gingival depigmentation is often associated with repigmentation. Recurrence of pigmentation differs according to different treatment modalities. MATERIALS AND METHODS: In this study, 40 maxillary sites from 20 patients presenting bilateral melanin gingival hyperpigmentation were selected. Contralateral quadrants in the maxilla were randomly assigned to receive Nd:YAG laser at 3 W, 30 mJ per pulse, with contact mode, and with a handpiece with a 300 µm diameter optic fiber and surgical stripping. Plaque index, Dummett Oral Pigmentation Index (DOPI), Hedin melanin index, size of pigmented area, time interval and extent of repigmentation, time taken for each of the procedures, assessment of pain, intraoperative bleeding index, and patient preference were compared from baseline to 6 months. RESULTS: Comparison between Nd:YAG laser and surgical stripping group for plaque index, DOPI, Hedin index, size of pigmented area, time interval, and extent of repigmentation, at 6 months was statistically nonsignificant. Intergroup comparison for time taken, pain, and patient preference was statistically significant. Intragroup comparison for Nd:YAG laser and surgical stripping at 6 months for DOPI, Hedin index, and size of pigmented area was statistically significant. CONCLUSIONS: From the present study it can be concluded that Nd:YAG laser can be used as an alternative technique for gingival depigmentation. However, surgical stripping continues to remain as a cost-effective procedure.

New tattoo approaches in dermatology.

Tattoos have fascinated mankind for centuries. Although these body marks were once considered to be permanent, technical and scientific progress in recent years has made it possible to remove tattoos by various treatment modalities. Contemporary technology involves the use of nonablative quality-switched lasers, which are considered to be the gold-standard treatment option for the removal of unwanted tattoo ink. Current research in the field of tattoo removal is focused on faster lasers and more effective targeting of tattoo pigment particles including picosecond laser devices, multi-pass treatments, dermal scatter reduction, application of imiquimod, and the use of microencapsulated tattoo ink.

Periocular hyperpigmentation: a review of etiology and current treatment options.

BACKGROUND: Periocular "dark circles" fall among the most difficult chief complaints to address. In most cases, we have little information regarding etiology and no gold-standard treatment option. The extent of the problem is reflected in the sheer number of products on the market advertised to either lighten or cover the pigmentation. OBJECTIVE/METHODS: To present dermatologists with a complete review of the literature with regard to anatomy, definition, etiology, and treatment of periocular hyperpigmentation. CONCLUSIONS: Our understanding of the causes and treatment of periocular hyperpigmentation continues to advance. Nevertheless, we are in need of additional controlled clinical trials and novel therapeutic options. Individual patients will likely benefit most from a combination of approaches. Although more randomized clinical studies are necessary, Pfaffia paniculata/Ptychopetalum olacoides B./Lilium candidum L.-associated compound cream seems to be a promising option, with 90% improvement. For patients with increased melanin deposition, quality-switched ruby laser therapy could offer a better treatment option. In the hands of experienced professionals, a surgical option might be suitable, either by autologous fat transplantation or hyaluronic acid filler.

Laser therapy in black skin.

This article provides a systematic overview of laser, light, and other energy devices for patients of African descent. It also reviews complications in skin of color and some treatment options for these adverse events.

The use of lasers in darker skin types.

The demographics of the US population continue to change at an extremely rapid pace. As of 2008, Asians, Hispanics, and African Americans accounted for 31% of the US population, and it is estimated that by the year 2050 half of the population of America will be represented by darker ethnic skin types. With the increase in the total number of individuals of skin of color, the demand for safe and effective laser therapy in darker skin types continues to increase. However, despite the increase in demand, the current literature regarding the use of lasers in darker skin remains limited. Most of the treatment parameters defined for laser platforms have been established primarily through extensive testing on skin phototypes I to III, and those studies that have been conducted on darker skin phototypes have been overwhelmingly conducted on Asian skin. Nevertheless, it has become clear that effective cutaneous laser surgery in darker skin types can be accomplished despite a relative overall greater risk for complications. Therefore, as the diversity of America continues to grow, the laser surgeon needs to maintain a clear understanding of the complexities associated with treating ethnic skin and remain mindful of the current, and ever-changing, therapeutic modalities available. This will allow the conscientious physician to maximize outcome and minimize risk when performing laser surgery on darker skin types.

Tratamento da hipercromia cutânea idiopática da região orbital com Erbium Laser: uma avaliação retrospectiva / Treatment of idiopathic cutaneous hyperchromia of the orbital region (ICHOR) with Erbium Laser: a retrospective assessment

Introdução: a hipercromia cutânea idiopática da região orbital dá um aspecto cansado à face. Sua etiologia ainda não é bem entendida. Causas primárias incluem hiperpigmentação da derme, por depósitos de melanina, ou pela vascularização superficial visível através da pele palpebral inferior. Causas secundárias são associadas com doenças sistêmicas e autoimunes. As opções de tratamento são muito vastas, com o laser sendo relativamente recente. Objetivos: o objetivodesteestudo é avaliar os resultados, a longo prazo, com o uso do Er:YAG(erbium) laser, nadiminuiçãodahiperpigmentação periorbital. Métodos: dez pacientes, incluindo oito mulheres e dois homens, foram submetidos ao tratamento da região periorbital usando Erbum:YAG laser, entre 2003 e 2006. Os pacientes foram avaliados comA e B períodos após o procedimento. Os critérios de avaliação incluíram a redução da pigmentação periorbital e a satisfação do paciente. Resultados: o tratamento com Er:YAG laser mostrou redução da hipercromia periorbital efetiva, com significativa melhora precoce e tardia, além da manutenção dos resultados, durante o período de avaliação, com satisfação dos pacientes. Discussão: a ablação com o Er:YAG laser mostrou-se efetiva na redução da hipercromia idiopática periorbital, com resultados duradouros. Complicações menores e raras incluíram hiperpigmentação transitória, pigmentação residual e leve hipocromia, em alguns casos.

Introduction: idiopathic Cutaneous Hypercromia of the Orbital Region (HCIRO),give a sad, tired aspect to face. Its etiopathology is to date still not well understood. Primary causes include hyperpigmentation from dermal deposits of melanin, or from superficial vascularization that is visible through the lower palpebral skin. Secondary causes are associated with systemic and autoimmune disorders. Treatment for HCIRO varies greatly, with laser treatment being relatively recent. Objectives: theobjective of this study was to clinically evaluate the long-term results of treatment using the Er:YAG (erbium)laser to diminish idiopathic periorbital hyperpigmentation. Methods: ten patients, eight females and two males underwent treatment of the periorbital region using ablative Erbium: YAG laser treatment between 2003 and 2006. The patients were evaluated at 2 and 6 month and 2-5 years post-procedure. The evaluation criteria included clinical reduction of periorbital pigmentation and patient satisfaction. Results: the treatment with Er:YAG laser, reduction of idiopathic periorbital hyperchromia was effective at early and long-term evaluation points, with the results being maintained during the period of evaluation with good patient satisfaction. Discussion: ablative treatment with Er:YAG laser was found to be effective in reduction of idiopathic periorbital hyperchromia, with a long-lasting result. Complications were minorandrare, and included mild hyperpigmentation, residual pigment, and hipopigmentation.

A randomized, double-blind comparison of two topical anesthetic formulations prior to electrodesiccation of dermatosis papulosa nigra.

BACKGROUND: Liposomal lidocaine 4% (L.M.X.4 cream, Ferndale Laboratories Inc., Ferndale, MI, USA) has been proposed as a more rapidly acting topical anesthetic than the eutectic mixture of lidocaine 2.5% and prilocaine 2.5% (EMLA cream, AstraZeneca LP, Wilmington, DE, USA) for venipuncture and laser procedures. However, their anesthetic efficacy has not been previously compared for electrosurgical destruction of superficial skin lesions. OBJECTIVE: To test the hypothesis that L.M.X.4 and EMLA differ in anesthetic efficacy when applied under occlusion for 30 minutes prior to electrodesiccation of papules of dermatosis papulosa nigra. METHODS: Forty adults were randomly assigned to treatment with either agent for 30 minutes under Tegaderm. The study drug was administered for an additional 30 minutes if the electrodesiccation of the first few papules was too painful. RESULTS: One subject treated with EMLA versus none treated with L.M.X.4 experienced complete anesthesia after a single 30-minute application. Nineteen of 20 (95%) subjects treated with EMLA versus 18 of 20 (90%) subjects treated with L.M.X.4 required only a single application (p = .49). Pain scores after the initial 30-minute application (scale: 0 = none to 10 = very severe) were EMLA 3.3 +/- 2.2 (mean +/- SD) versus L.M.X. 4 2.9 +/- 2.0 (p = .46). CONCLUSION: EMLA and L.M.X.4 provide comparable levels of anesthesia after a single 30-minute application under occlusion prior to electrodesiccation of superficial skin lesions.

The effect of combination treatment of the recalcitrant pigmentary disorders with pigmented laser and chemical peeling.

BACKGROUND: The pigmentary disorders including melasma, freckles, postinflammatory hyperpigmentation, or acquired bilateral nevus of Ota-like macules, etc. are usually resistant to all treatment modalities, and are therefore very frustrating to the patient and clinician. OBJECTIVE: The purpose of this study was to demonstrate the effect of the combination treatment of recalcitrant pigmentary disorders with pigmented laser and chemical peeling and to observe any side-effects. METHODS: Twenty-four patients with recalcitrant facial pigmentary disorders were treated with the Q-switched alexandrite laser at fluences of 7.0-8.0 J/cm2 or the pigmented lesion dye laser (PLDL) at fluences of 2.0-2.5 J/cm2, and at the same session, 15-25% trichloroactic acid (TCA) with or without Jessner's solution were used for the chemical peeling. And the results were clinically analyzed. RESULTS: In the assessment by the patients, 63% of them considered the result as "clear, excellent, or good" in respect to the color and 54% of them assessed that the size of the lesion had cleared more than 50%. In the assessment by a clinician, 67% of the patients were categorized into the grade of clear, excellent, or good. There were no significant complications with this combination method. CONCLUSIONS: The combination treatment with pigmented laser and chemical peeling is effective, safe, and relatively inexpensive treatment modalities in the recalcitrant pigmentary disorders.

Treatment of nevus spilus with the Q-switched ruby laser.

BACKGROUND: Q-switched lasers have shown to be effective in the removal of unwanted cutaneous pigmentation. Benign cutaneous pigmented lesions represent a heterogeneous group. Nevus spilus is a relatively uncommon pigmented lesion characterized by dark, hyperpigmented dots scattered over a tan-colored macule. OBJECTIVE: A cohort of patients with nevus spilus was studied to determine the effects of Q-switched ruby and Q-switched Nd:YAG laser treatment on clearance of pigment and to evaluate potential side effects. METHODS: Six patients with nevus spilus were treated with the Q-switched ruby laser (QSR). In addition, three lesions received a test treatment with the Q-switched Nd:YAG (QSYAG) laser at 532 or 1064 nm. The results of treatment were documented during follow up visits. RESULTS: Most lesions showed a near-complete or complete response to laser treatment. In one case partial hyperpigmentation occurred after treatment and in one case no follow-up could be obtained. In the three cases that received both QSR and QSYAG laser treatment, the QSR laser was shown to be the most effective in removing pigment. CONCLUSION: Nevus spilus can be treated effectively with the Q-switched ruby laser.

The removal of cutaneous pigmented lesions with the Q-switched ruby laser and the Q-switched neodymium: yttrium-aluminum-garnet laser. A comparative study.

BACKGROUND: The Q-switched ruby laser (QSRL) (694 nm) has been used successfully in the removal of tattoos and a variety of cutaneous pigmented lesions. The frequency-doubled Q-switched neodymium:yttrium-aluminum-garnet laser (QSNd:YAG) (1064 and 532 nm) has also been shown to be effective in the treatment of tattoos, however, little has been published regarding the QSNd:YAG laser in the removal of cutaneous pigmented lesions. OBJECTIVE: The purpose of this study is to compare the efficacy and side effect profile of the QSRL and the frequency-doubled QSNd:YAG lasers in the removal of cutaneous pigmented lesions, including lentigines, café-au-lait macules, nevus of Ota, nevus spilus, Becker's nevus, postinflammatory hyperpigmentation, and melasma. METHODS: Twenty patients with pigmented lesions were treated with the QSRL and the frequency-doubled QSNd:YAG lasers. Clinical lightening of the lesion was assessed 1 month after a single treatment. Side effects and patient satisfaction were also evaluated. RESULTS: A minimum of 30% lightening was achieved in all patients after only one treatment with either the QSRL or the frequency-doubled QSNd:YAG laser. The QSRL seems to provide a slightly better treatment response than the QSNd:YAG laser. Neither laser caused scarring or textural change of the skin. Most patients found the QSRL to be more painful during treatment, but the QSNd:YAG laser caused more postoperative discomfort. CONCLUSION: Both the QSRL and the frequency-doubled QSND:YAG laser are safe and effective methods of treatment of epidermal and dermal pigmented lesions.