Unveiling the potential: Enhancing caregiver knowledge through video education to address topical corticosteroid concerns in children with eczematous dermatitis.

BACKGROUND: Concerns about the use of topical corticosteroids (TCS) in pediatric eczematous dermatitis management often hinder effective treatment. Limited data exist regarding the prevalence of these concerns and the effectiveness of interventions. This study aimed to assess the prevalence of TCS concerns among caregivers and determine the effectiveness of video education in mitigating these concerns. METHODS: A single-center prospective study was conducted from 2022 to 2023, involving caregivers of children under 18 years with eczematous dermatitis. Baseline and post-intervention questionnaires were administered after a 4-week period. Caregivers received video education on TCS use, and the TOPICOP score was evaluated before and after viewing the video. RESULTS: The study included 150 caregivers, 85.3% female and 74% had a child with atopic dermatitis. The prevalence of TCS concerns among Thai caregivers was 62%. Following video education, the prevalence of TCS concerns significantly decreased to 10.7%. Mean belief score decreased from 43.81 ± 13.45 to 31.85 ± 16.56, mean worry score decreased from 56.22 ± 18.27 to 40.41 ± 18.55 and mean total TOPICOP score decreased from 50.02 ± 12.65 to 36.13 ± 13.52 (p-value <.001). The intervention also resulted in reduced disease exacerbations, duration of the rash, and duration of TCS use. The optimal TOPICOP cut-off score to predict TCS concerns was identified as 43.06. CONCLUSION: Video education effectively alleviated TCS concerns among caregivers, addressing beliefs, worries, disease exacerbations, and side effects. Integration of this intervention into the management of pediatric eczematous dermatitis can yield optimal outcomes.

The attitudes and expectation of caregivers of febrile child receiving medical services: a multicenter survey in Thailand.

BACKGROUND: Most caregivers may visit pediatric outpatient clinics with high concern of fever and improper antipyretic use. However, studies of concern about fever in Asian countries are still limited. OBJECTIVES: This study aimed to explore caregivers' attitudes, management of their child's fever, factors associated with their high concern, and expectation from medical services. METHODS: A cross-sectional 26-item self-administered questionnaire was used to survey caregivers of 1-month to 15-year-old febrile infants/children/teenagers visiting outpatient clinics in 9 government hospitals from July 2018 to August 2019. RESULTS: One thousand two hundred and six caregivers (67% response rate) completed self-administered questionnaire. The median age of the caregivers and the pediatric patients were 34 years (interquartile range [IQR] 28-40) and 3.3 years (IQR 1.8-6.1), respectively. Approximately 70% of them believed that fever could harm a child, resulting in brain damage or death. Also, 2% managed high doses of acetaminophen and overdosed the child. The high level of concern was significantly associated with acetaminophen overdose (P < 0.001, Kruskal-Wallis test). Caregivers of nonhealth care providers and children's history of febrile seizure were factors related to higher score of concern. Most caregivers expected definite diagnosis (70.7%), antipyretic drugs (67.4%), and blood tests (48.9%). CONCLUSION: Caregivers' high concern of fever existed in Thailand. This may lead to unnecessary high doses of antipyretics. In clinical practice, the high concern of fever is a challenge for caregivers and pediatric health care providers. A better understanding of fever and its consequence should be advocated for proper management of the child's fever.

Topical corticosteroid phobia in adolescents with eczema and caregivers of children and adolescents with eczema: A cross-sectional survey.

Steroid phobia is an increasing phenomenon that affects treatment adherence. The purpose of this study was to assess the prevalence and associated factors of steroid phobia among adolescents with eczema and the caregivers of children and adolescents with eczema by using questionnaires and TOPICOP© scale. The prevalence of steroid phobia is approximately 12% and 37% in the adolescent and caregiver groups, respectively. Caregivers who obtained information about topical corticosteroid (TCS) from dermatologists and whose children had fewer number of flares, demonstrated less concern about using TCS.

Prevalence of skin diseases in school-age children.

BACKGROUND: The prevalence of community-based skin diseases, especially among school-age children, depends on topography, climate, and age of population. OBJECTIVE: We determined the prevalence of skin diseases among community-based primary school-age children and identified demographic characteristics in relation to particular skin conditions. METHODS: This was a cross-sectional descriptive survey study of a subproject school cohort in children aged 5-14 years of 2 community-based primary schools. Demographic data and whole-body skin examination were collected. The association of individual skin conditions was analysed by using bivariate and multivariable binary logistic regression. RESULTS: A total of 556 children were enrolled in this study. Of these, 90.2% had at least 1 skin disease. The most common skin disease was postinflammatory hyperpigmentation (PIH) (58.3%), followed by nevus/mole (40.1%), insect bite reaction (28.0%), acanthosis nigricans (20.0%), acne (13.7%), and pityriasis alba (12.9%). There was an increase of body mass index (BMI) in PIH and acanthosis nigricans with the adjusted odds ratios of 2.01 (95% confidence interval [CI] 1.40-2.87, P < 0.001) and 1.93 (95% CI 1.49-2.49, P < 0.001), respectively. Insect bite reaction was related to PIH with the adjusted odds ratio of 5.66 (95% CI 3.15-10.17, P = 0.001). CONCLUSIONS: The most common skin disease in community-based primary school-age children is PIH which related to acanthosis nigricans and insect bite reaction. A decrease of BMI may lower the risk for PIH and acanthosis nigricans. Education on common skin diseases is recommended for both community-based schools and school-age children.

Toxic epidermal necrolysis after first dose of Pfizer-BioNTech (BNT162b2) vaccination with pharmacogenomic testing.

Toxic epidermal necrolysis (TEN) is a rare and acute life-threatening condition and one of the severe cutaneous adverse drug reactions. There are limited data on TEN from the COVID-19 vaccine regarding its pathogenesis, treatment, and prognosis, particularly in children. We report a case of COVID-19 vaccine-induced TEN and the patient's human leukocyte antigen pharmacogenomic profile.

Drug-Induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Call for Optimum Patient Stratification and Theranostics via Pharmacogenomics.

The Global Genomic Medicine Collaborative, a multinational coalition of genomic and policy experts working to implement genomics in clinical care, considers pharmacogenomics to be among the first areas in genomic medicine that can provide guidance in routine clinical practice, by linking genetic variation and drug response. Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe life-threatening reactions to medications with a high incidence worldwide. Genomic screening prior to drug administration is a key opportunity and potential paradigm for using genomic medicine to reduce morbidity and mortality and ultimately eliminate one of the most devastating adverse drug reactions. This review focuses on the current understanding of the surveillance, pathogenesis, and treatment of SJS/TEN, including the role of genomics and pharmacogenomics in the etiology, treatment, and eradication of preventable causes of drug-induced SJS/TEN. Gaps, unmet needs, and priorities for future research have been identified for the optimal management of drug-induced SJS/TEN in various ethnic populations. Pharmacogenomics holds great promise for optimal patient stratification and theranostics, yet its clinical implementation needs to be cost-effective and sustainable.

Dermatologic manifestations in pediatric patients after liver and HSCT: A 20-year retrospective cohort study.

LT and HSCT are now potentially curative treatments for many medical conditions. Dermatologic manifestations are one of the sequelae after transplantation. To study the prevalence and associated risk factors of dermatologic manifestations after pediatric LT and HSCT. A 20-year retrospective cohort study was conducted in children, aged ≤15 years, who received LT or HSCT from January 1, 1997, to December 31, 2017. Medical records were reviewed for data collection until December 31, 2018. A total of 70 LT and 51 HSCT recipients were included. The percentages of overall dermatologic manifestations after LT and HSCT were 64.3% and 64.7%, respectively. Viral infection was the most common manifestation in both groups, with mucocutaneous HSV infection as the most prevalent. One HSCT recipient developed leukemia cutis. GVHD was revealed in 27.5% of HSCT recipients. Impetigo and xerosis were significantly observed in patients using azathioprine and prednisolone. Approximately two-thirds of pediatric LT and HSCT recipients experienced dermatologic manifestations, potentially associated with immunosuppressive agents. Thus, regular skin examination and optimized immunosuppression would be beneficial in these recipients.

Efficacy of 1064-nm Nd:YAG picosecond laser in lichen amyloidosis treatment: clinical and dermoscopic evaluation.

Lichen amyloidosis (LA) is a type of primary localized cutaneous amyloidosis characterized by multiple localized, hyperpigmented, grouped papules, in which the deposition of amyloid materials from altered keratinocytes usually resists to current treatments. We presented two LA patients with non-satisfactory results of topical treatments. After the first treatment using 1064-nm Nd: YAG picosecond (ps-Nd:YAG) laser, there was an improvement with persistence up to 3-month follow up after five sessions of 4-week interval, as well as a decrease in number, thickness, and darkness of lesions from clinical and dermoscopic evaluation. Thus, the ps-Nd:YAG laser could be efficacious for LA treatment.

Adherence to Screening for Anemia in 9-Month-Old Full-Term Infants in Bangkok, Thailand.

OBJECTIVES: To determine adherence to the screening for anemia in 9-month-old full-term infants and factors associated with non-adherence to the screening for anemia. METHODS: A descriptive cross-sectional study was conducted in 9-month-old full-term healthy infants who visited the General Pediatric and Well Child Care Clinic, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Demographic data, adherence to the screening, and factors associated with non-adherence to the screening were analyzed using percentage, χ2 test, and bivariate logistic regression. RESULTS: A total of 234 full-term infants, aged 9 months, were included in the study between January and December 2019. The prevalence of adherence to the screening for anemia was 76.1% (95% CI 0.70-0.81). The most common cause of non-adherence to the screening was the waiting time for laboratory results (39.3%). Factors associated with non-adherence to the screening were low education of caregiver (AOR 2.684; 95% CI 1.451-4.966), low socio-economic status (AOR 2.26; 95% CI 1.568-3.258), and inadequate complementary food (AOR 1.961; 95% CI 1.107-3.473). CONCLUSION: The most common cause of non-adherence to the screening for anemia is the waiting time for laboratory results. Pediatricians and general practitioners should ensure the importance of anemia screening in infants and plan on anemia screening with parents.

Genetic and clinical risk factors associated with phenytoin-induced cutaneous adverse drug reactions in Thai population.

OBJECTIVE: This study aimed to describe the genetic and clinical risk factors associated with phenytoin-induced cutaneous adverse drug reactions (PHT-induced cADRs) in Thai patients. METHOD: A retrospective case-control study was conducted among 88 PHT- cADRs (25 SJS/TEN, 37 DRESS/DIHS and 26 MPE) compared to 70 PHT-tolerant controls during 2008-2017. Genotyping was performed by Taqman RT-PCR (EPHX1 337 T > C, EPHX1 416A > G and CYP2C9*3), pyrosequencing (UGT1A1*28, UGT1A1*6) and polymerase chain reaction-sequence-specific oligonucleotide probe (HLA-B). Chi-squared test and binary logistic regression were used to identify factors associated with PHT-cADRs. RESULTS: Multivariate analysis showed that HLA-B*46:01 was significantly associated with all PHT-induced cADRs (OR 2.341; 95% CI, 1.078-5.084; P = .032). Age of ≥60 years showed a significant association with PHT-induced SJS/TEN (OR 3.600; 95% CI, 1.214-10.672; P = .021). CYP2C9*3 was almost reaching statistically associated with an increased risk of PHT-induced SJS/TEN (OR 4.800; 95% CI, 0.960-23.990; P = .056). While HLA-B*56:02/04 was found to have a significant association with PHT-induced DRESS/DIHS (OR 29.312; 95% CI, 1.213-707.994; P = .038). Moreover, female gender and HLA-B*40:01 were associated with an increased risk of PHT-induced MPE at OR 5.734; 95% CI, 0.910-58.351; P = .042 and OR 3.647; 95% CI, 1.193-11.147; P = .023, respectively. CONCLUSION: Both clinical (advanced age, female gender) and genetic factors (HLA-B*46:01, CYP2C9*3, HLA-B*56:02/04 and HLA-B*40:01) contributed to the risk of PHT-induced cADRs. Further studies with larger sample size may be warranted to confirm these findings and also the influence of EPHX1 gene.

The 24-hr, 28-day, and 7-day post-moisturizing efficacy of ceramides 1, 3, 6-II containing moisturizing cream compared with hydrophilic cream on skin dryness and barrier disruption in senile xerosis treatment.

Direct replacement of decreased ceramides in the stratum corneum can be efficacious for skin hydration, skin barrier function, and skin pH. Our study aimed to evaluate the 24-hr, 28-day, and 7-day post-moisturizing efficacy of ceramide-containing moisturizer in senile xerosis treatment. A split site, double-blinded, randomized, controlled study was conducted in 24 senile subjects (91.7% females, mean age 54.83 ± 5.45 years) with mild to moderate xerosis, who were randomized to receive ceramide-containing moisturizer or hydrophilic cream, daily applied on each side of the shin. A single application of ceramide-containing moisturizer increased skin hydration, while improving transepidermal water loss (TEWL) and skin pH for up to 24 hr, with statistically significant difference. After 28 days of twice-daily application, more significant improvement on skin hydration, barrier function, and skin pH was observed in those with ceramide-containing moisturizer at all-time points. At day 28, there was a statistically significant decrease of hemoglobin index, wrinkle, and texture on the ceramide treated side. The 7-day post-moisturizing efficacy on the ceramide treated side was superior for skin hydration, TEWL, skin pH, and wrinkle. Thus, the ceramide-containing moisturizer can be a novel promising treatment for senile xerosis.

Sun protection behavior and knowledge of patients attending laser clinic to prevent adverse events of laser: A cross-sectional, single-center, tertiary care study.

BACKGROUND: Limited data of sun protection knowledge in laser treatment patients exists therefore, preventative information should be provided by dermatologists to minimize harmful effects. OBJECTIVE: To assess sun protection knowledge-behavior and knowledge to prevent adverse events from laser therapy among patients who visited a laser clinic at a tertiary university hospital in Bangkok, Thailand. METHODS: This is a self-reported questionnaire, cross-sectional survey. All participants from the Laser Clinic in KCMH were recruited into the study. RESULTS: A Total of 385 patients were enrolled into the study; 80.5% female participants. Patients who never received laser treatment significantly lacked proper sun protection knowledge to prevent adverse events of lasers when compared to those who previous received laser treatments regarding the application of sunscreen after laser treatment (56.6% vs 17.4%, P < .001), consistent application of sunscreen 4-6 weeks prior to receiving laser treatment (60.5% vs 18.9%, P < .001), application of topical corticosteroid after laser (67.1% vs 54.1%, P = .048), and sun protection in the post laser area (41.9% vs 20.4%, P < .001). CONCLUSION: The attitude and knowledge of sun protection to prevent adverse events were significantly different among the group of educational levels and previous history of laser treatment.

Topical Botulinum Toxin Type A Liposomal Cream for Primary Axillary Hyperhidrosis: A Double-Blind, Randomized, Split-Site, Vehicle-Controlled Study.

BACKGROUND: Despite its effectiveness in treating primary axillary hyperhidrosis (PAH), topical botulinum toxin type A (BTX-A) is highly resistant to transdermal absorption. Topical BTX-A liposomal cream is recommended as a novel, noninvasive modality to enhance skin penetration. OBJECTIVE: To evaluate the efficacy and safety of topical BTX-A liposomal cream in comparison with liposomal vehicle cream alone in the treatment of PAH. MATERIALS AND METHODS: A prospective, randomized, double-blinded, split-site study was conducted in 20 subjects, aged 18 to 50 years, all of whom had symmetrical axillary sweating with Hyperhidrosis Disease Severity Scale scores between 2 to 4. All subjects were double-blinded to treatment regimens and randomly given 2 bottles, one containing topical BTX-A liposomal cream and one containing the vehicle cream without BTX-A, to be applied consistently to the same axilla nightly for 7 consecutive days. Clinical improvement and adverse reactions were evaluated at every follow-up visit. RESULTS: Axillary skin treated with topical BTX-A demonstrated superior sweat reduction and patient satisfaction to vehicle cream-treated axillary skin, with clinical and statistical significance, at baseline, weeks 2, 4, 6, and 8 of follow-up, without adverse effects. CONCLUSION: Topical BTX-A liposomal cream pharmaceutically enhances drug delivery, is painless, cost-effective, and overall an innovative treatment of PAH.

Dapsone-induced severe cutaneous adverse drug reactions are strongly linked with HLA-B*13: 01 allele in the Thai population.

OBJECTIVES: A previous publication in Chinese leprosy patients showed that the HLA-B*13:01 allele is a strong genetic marker for dapsone-induced drug hypersensitivity reactions, however there are no data describing whether HLA-B*13:01 is a valid marker for prediction of dapsone-induced drug hypersensitivity reactions in other ethnicities or nonleprosy patients. The aim of this study is to investigate whether there is an association between HLA genotypes and dapsone-induced severe cutaneous adverse reactions (SCARs) in Thai nonleprosy patients. PATIENTS AND METHODS: HLA-B genotypes of 15 patients with dapsone-induced SCARs (11 drug reaction with eosinophilia and systemic symptoms, 4 Stevens-Johnson syndrome/toxic epidermal necrolysis), 29 control patients, and 986 subjects from the general Thai population were determined by the reverse PCR sequence-specific oligonucleotides probe. RESULTS: The HLA-B*13:01 allele was significantly associated with dapsone-induced SCARs compared with dapsone-tolerant controls (odds ratio: 54.00, 95% confidence interval: 7.96-366.16, P=0.0001) and the general population (odds ratio: 26.11, 95% confidence interval: 7.27-93.75, P=0.0001). In addition, HLA-B*13:01 associated with dapsone-induced SJS-TEN (OR: 40.50, 95% confidence interval: 2.78-591.01, P=0.0070) and DRESS (OR: 60.75, 95% confidence interval: 7.44-496.18, P=0.0001). CONCLUSION: This study demonstrated an association between HLA-B*13:01 and dapsone-induced SCARs including Stevens-Johnson syndrome/toxic epidermal necrolysis and drug reaction with eosinophilia and systemic symptoms in nonleprosy patients. Moreover, these results suggest that the HLA-B*13:01 allele may be a useful genetic marker for prediction of dapsone-induced SCARs in Thai and Han-Chinese populations.

Influence of genetic and non-genetic factors on phenytoin-induced severe cutaneous adverse drug reactions.

PURPOSE: The purpose of this study was to investigate the association of genetic factors including variants in HLA-B and CYP2C genes and non-genetic factors with phenotype-specific phenytoin (PHT)-induced severe cutaneous adverse reactions (SCARs) in Thai patients. METHODS: Thirty-six PHT-induced SCAR cases (15 Stevens-Johnson syndrome (SJS) and 21 drug rash with eosinophilia and systemic symptoms (DRESS)/drug hypersensitivity syndrome (DHS)) and 100 PHT-tolerant controls were studied. Variants in HLA-B, CYP2C9, and CYP2C19 genes were genotyped. Fisher's exact test and multiple logistic regression analysis were performed to test the association of genetic and non-genetic factors with specific type of SCARs. RESULTS: Multiple logistic regression models showed that genetic and non-genetic factors associated with PHT-induced SCARs were specified to its phenotype. HLA-B*13:01, HLA-B*56:02/04, CYP2C19*3, and omeprazole co-medication were strong risk factors of DRESS/DHS (adjusted OR = 13.29, p = 0.0001; adjusted OR = 56.23, p = 0.0007; adjusted OR = 6.75, p = 0.0414; and adjusted OR = 9.21, p = 0.0020, respectively). While CYP2C9*3 and having Chinese ancestry were significant risk factors of SJS (adjusted OR = 10.41, p = 0.0042 and adjusted OR = 5.40, p = 0.0097, respectively). Combined genetic and non-genetic risk factors optimized sensitivity and increased specificity for predicting PHT-induced SCARs. CONCLUSION: This study showed that distinct genetic markers were associated with phenotype-specific PHT-induced SCARs. Non-genetic factor, omeprazole co-medication, was strongly associated with PHT-induced DRESS/DHS in addition to variants in HLA-B and CYP2C genes. Combined markers may be better predictors for PHT-induced SCARs.

Nail Scabies: An Unusual Presentation Often Overlooked and Mistreated.

Nail scabies is an interesting clinical presentation of scabies. Although it is usually found concomitant with characteristic dermatologic manifestations, it may present as an isolated finding in the immunocompromised host. This condition is commonly mistaken with other diseases such as nail dystrophy, nail psoriasis and onychomycosis. We report two cases of unusual nail presentations that provide clues to diagnosis. Also, literature on unusual nail and dermatologic presentations was reviewed to recognize dermatologist consideration for appropriate treatment options.

A Comparative Study of 3 Different Methods of Temperature Measurement in Children.

BACKGROUND: The accuracy of body temperature measurement is very important in children. The accuracy and reliability of the forehead skin thermometer (FST) and infrared tympanic thermometer (TT) are inconclusive. OBJECTIVES: To determine: 1) the mean difference, agreement, and accuracy of body temperature detected in children by FST and ITT, as compared with the gold standard rectal mercury-in-glass thermometer (RMT); and, 2) the cut-off level for FST and ITT in the detection of fever MATERIAL AND METHOD: Children ≤ 2 years old with the chief complaint of "fever" were recruited for this study. Body temperature (BT) was measured by 3 different methods, including FST 5 times; ITT 3 times; and, RMT, 1 time, for each patient. Each measurement method was performed by 3 well-trained staff members, all of whom were blinded to the recorded data of the other methods. The mean difference in body temperature, agreement by Bland-Altman method, and the verified performance of FST and ITT by diagnostic test were assessed. RESULTS: A total 312 children were recruited. Body temperatures measured by FST and ITT were lower than those measured by RMT, with a mean difference of 1.04°C (p < 0.001) and 1.03°C (p < 0.001), respectively. In subgroup analysis by levels of fever the mean differences between rectal temperature and both forehead and ear temperature were statistically significantly different (p < 0.001) for all levels of fever. Regarding the diagnostic test to verify performance, the data revealed the most practical cut-off point to be 37.0°C for both FST and ITT as compared to the gold standard RMT. CONCLUSION: Both FST and ITT were found to be accurate temperature screening methods for daily clinical use. However, the cut-off points to detect fever should be lowered to 37.0°C to be consistent with gold standard measurement.

The natural course of childhood atopic dermatitis: a retrospective cohort study.

BACKGROUND: Atopic dermatitis (AD) is generally considered to be the initial step of the so-called atopic march, which following steps are allergic rhinitis (AR) and asthma. There are few data about the progression of AD, including factors associated with the remission of AD in Asians and further research is needed. OBJECTIVE: To study the progression and factors associated with the remission of childhood AD diagnosed by pediatric dermatologists. METHODS: This study included 303 AD patients who visited the pediatric dermatology unit at King Chulalongkorn Memorial Hospital, Thailand, between 2002 and 2010. An interview, performed by a physician via telephone using a preformed questionnaire, was completed for 205 children. RESULTS: A total of 205 children were observed, with a median observation time of 5.2 (3.5-8.0) years, and an initial AD severity score of mild (61.0%), moderate (29.3%) and severe (9.7%). The prevalence of AD during the first two years of life was 64.4%. AD completely disappeared in 102 cases (49.8%) by the median age of 3.5 (1.5-7.8) years. Early onset and severity of AD were major determinant of prognosis. The prevalence of AR and asthma was 36.6%, and 9.3%, respectively. The risk factors associated with respiratory allergy were the onset of AD after aged two years, a family history of atopy, increased serum IgE level, and sensitization to inhalant allergens. CONCLUSIONS: Half of AD had completely disappeared at preschool age. Good prognosis was mostly determined by early onset AD and mild severity. Late onset, family history of atopy and increased serum IgE level are associated with respiratory allergy.

Arborescent vascular dilatation mimicking Lichtenberg figures from lightning.

The clinical presentation of arborizing vascular dilatation can resemble Lichtenberg figures from lightning. Both have a feather-like or ferning pattern. We report an interesting case of pressure-induced vasodilatation (PIV) caused by temporary vascular occlusion from jeans buttons.

Efficacy of 532-nm Nd: YAG Fractional Picosecond Laser with 9 mm High Coverage Handpiece Micro Lens Array in the Treatment of Facial Partial Unilateral Lentiginosis: A Case Report.

Introduction: Facial partial unilateral lentiginosis (PUL) is an infrequent skin pigmentation disorder characterized by multiple lentigines. Despite the availability of various treatment modalities, there is no standard treatment for PUL. This study reports a successful treatment of facial PUL in a female patient using a novel 532-nm Nd:YAG fractional picosecond laser (FPL). Case Report: The patient underwent four treatment sessions at four-week intervals. The treatments were administered using a 9 mm high coverage handpiece micro lens array (MLA), with a fluence of 0.2-0.4 J/cm2, a frequency of 2 Hz for 2-3 passes, and approximately 10% overlap. The treatment was well-tolerated by the patient, with significant improvement in pigmentation and no significant side effects observed. The outcomes confirmed the efficacy of the 532-nm Nd:YAG FPL in treating facial PUL. Conclusion: The 532-nm Nd:YAG FPL appears to be an effective and well-tolerated treatment for facial PUL, offering significant improvement in pigmentation without notable side effects.