Effect of dual-optical pulses with temporal energy distribution on laser ablation performance in in vivo zebrafish model.

A Q-switched laser system has been used in a single-pulse mode for skin melasma treatments because of instant heat deposition in the target. Despite the efficient ablation of the melanophores in the skin, the single, high-fluence pulse often causes undesirable damage to the surrounding tissue, leading to high recurrence rates. This study aims to investigate the feasibility of dual-optical pulses with a temporal energy distribution on the melasma treatment in in vivo zebrafish models in comparison to that of the single optical pulse. Based on the optical detection, the dual-optical pulses had a temporal energy distribution ratio of 4:1 and an interval of 61 µs between the two consecutive pulses. According to the histological analysis, the dual pulses removed melanophores and induced a few apoptotic nuclei with minimal recurrence. This study demonstrated that the feasibility of dual-optical pulses (energy ratio = 4:1) could enhance the laser ablation performance in vivo.

A retrospective study of 1064-nm Q-switched Nd:YAG laser therapy for acquired bilateral nevus of Ota-like macules.

BACKGROUND: The therapeutic efficacy of laser treatments for acquired bilateral nevus of Ota-like macules (ABNOM) varies among studies, and few studies have evaluated the factors affecting therapeutic effects. AIMS: To evaluate the efficacy and safety of 1064-nm Q-switched Nd:YAG laser (QSNYL) therapy for ABNOM and to identify the factors influencing the outcome. METHODS: A total of 110 patients with ABNOM were retrospectively evaluated and received two-to-nine treatment sessions. The effects of different factors on the therapeutic effect were analyzed on the basis of the number of treatments, age at first treatment, skin type, lesion color, affected area, number of lesion sites, and presence of concomitant melasma. RESULTS: The curative effect was positively correlated with the treatment time and negatively correlated with the increasing age at first treatment (p < 0.05). The curative effect was better in patients with skin type III than those with type IV ( p < 0.05) and in patients with a lesion area of less than 10 cm2 than those with a larger affected area (p < 0.05). Additionally, the treatment effect was poorer in patients with concomitant melasma (p < 0.05). The treatment effect was not significantly correlated with the lesion color or number of affected sites (p > 0.05). Eleven patients (10%) developed postinflammatory hyperpigmentation (PIH). CONCLUSIONS: Early and repeated QSNYL therapy achieved satisfactory results for ABNOM. The risk of PIH after laser treatment is highest among patients with older age, darker lesion color, and darker skin color. For patients with ABNOM with concurrent melasma, low-energy laser therapy is recommended to reduce the risk of melasma aggravation.

Comparison of Picosecond and Nanosecond Nd:YAG 1064-nm Lasers in the Treatment of Melasma: A Split-Face Randomized Clinical Trial.

BACKGROUND: Melasma is a refractory pigmentary disorder. The picosecond Nd:YAG 1064-nm laser (PSNY) has promise as a better treatment for melasma with few side effects and favorable therapeutic efficacy. The authors evaluated the efficacy and safety of PSNY and the nanosecond Q-switched Nd:YAG 1064-nm laser (QSNY) in patients with melasma. METHODS: Eighteen patients were recruited to receive the two types of laser treatment on split faces. The modified Melasma Area Severity Index was assessed at baseline and the 3-month follow-up visit. The recurrence rate and the patients' self-satisfaction assessment were also evaluated. RESULTS: The two treated sides showed statistically significant decreases in modified Melasma Area Severity Index score after treatment at follow-up compared with baseline ( P < 0.001). There was no statistically significant difference between the modalities ( P = 0.873) or the patients' satisfaction assessment ( P = 0.287). The visual analogue scale pain assessment score showed that the QSNY was more painful than the PSNY counterpart ( P = 0.007). The recurrence rate was the same for the two treated sides (12.5%). CONCLUSION: PSNY is a better choice compared with QSNY with less treatment pain and postprocedure erythema as well as lower potential risk of exacerbation of melasma. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Neurosurgical management of patients with neurocutaneous melanosis: a systematic review.

OBJECTIVE: Neurocutaneous melanocytosis (NCM), also referred to as neurocutaneous melanosis, is a rare neurocutaneous disorder characterized by excess melanocytic proliferation in the skin, leptomeninges, and cranial parenchyma. NCM most often presents in pediatric patients within the first 2 years of life and is associated with high mortality due to proliferation of melanocytes in the brain. Prognosis is poor, as patients typically die within 3 years of symptom onset. Due to the rarity of NCM, there are no specific guidelines for management. The aims of this systematic review were to investigate approaches toward diagnosis and examine modern neurosurgical management of NCM. METHODS: A systematic review was performed using the PubMed database between April and December 2021 to identify relevant articles using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Search criteria were created and checked independently among the authors. Inclusion criteria specified unique studies and case reports of NCM patients in which relevant neurosurgical management was considered and/or applied. Exclusion criteria included studies that did not report associated neurological diagnoses and neuroimaging findings, clinical reports without novel observations, and those unavailable in the English language. All articles that met the study inclusion criteria were included and analyzed. RESULTS: A total of 26 extracted articles met inclusion criteria and were used for quantitative analysis, yielding a cumulative of 74 patients with NCM. These included 21 case reports, 1 case series, 2 retrospective cohort studies, 1 prospective cohort study, and 1 review. The mean patient age was 16.66 years (range 0.25-67 years), and most were male (76%). Seizures were the most frequently reported symptom (55%, 41/74 cases). Neurological diagnoses associated with NCM included epilepsy (45%, 33/74 cases), hydrocephalus (24%, 18/74 cases), Dandy-Walker malformation (24%, 18/74 cases), and primary CNS melanocytic tumors (23%, 17/74 cases). The most common surgical technique was CSF shunting (43%, 24/56 operations), with tethered cord release (4%, 2/56 operations) being the least frequently performed. CONCLUSIONS: Current management of NCM includes CSF shunting to reduce intracranial pressure, surgery, chemotherapy, radiotherapy, immunotherapy, and palliative care. Neurosurgical intervention can aid in the diagnosis of NCM through tissue biopsy and resection of lesions with surgical decompression. Further evidence is required to establish the clinical outcomes of this rare entity and to describe the diverse spectrum of intracranial and intraspinal abnormalities present.

Laser therapy in the treatment of melasma: a systematic review and meta-analysis.

Melasma is a highly prevalent and cosmetically disfiguring pigmented skin disease. The post-treatment results are often unsatisfactory. A large number of clinical trials have tried to prove the effectiveness of the combination therapy involving laser therapy, but the results have been indeterminate. This study aimed to evaluate the effectiveness of laser treatment for melasma via a systematic review and meta-analysis. We respectively searched 4 databases and clinicaltrials.gov as of June 8, 2021. Two researchers independently searched for literature and extracted data. Study outcomes were computed by weighted mean differences (WMD). All statistical analyses were performed by the Review Manager version 5.3, STATA version 14 software at 95% confidence interval. We obtained 22 eligible studies which involved a total of 694 patients. After the heterogeneity test and sensitivity analysis, we took a subgroup meta-analysis on the before and after treatment of different laser types. We found that most lasers and laser-based combinations were associated with reduced melasma area and severity index (MASI), such as low-fluence Q-switch 1,064-nm Nd: YAG laser (QSNYL) (WMD: - 2.76; 95% CI: - 3.53 to - 1.99), fractional ablative CO2 laser (WMD: - 9.36; 95% CI: - 12.51 to - 6.21), and fractional ablative 2940-nm Er: YAG laser (WMD: - 2,72; 95% CI: - 3.94 to - 1.49). Significant decrease was seen in neither MASI score of non-ablative 1550-nm fractional laser (WMD: - 1.29; 95% CI: - 2.80 to 0.21) and picosecond laser (WMD: - 0.58; 95% CI: - 1.43 to 0.27), nor melanin index (MI) of low-fluence QSNYL treatment (WMD: 10.17; 95% CI: - 4.11 to 24.46). When using laser to treat melasma, various adverse reactions may occur, most of which will resolve quickly without subsequent treatment, such as edema, erythema, scaling, and burning sensation after treatment. However, for patients with darker skin, there are risks of postinflammatory hyperpigmentation and hypopigmentation. The laser and laser-based combination treatment for melasma could significantly reduce the MASI score, which was showed by our systematic review and meta-analysis.

Oral tranexamic acid, hydroquinone 4% and low-fluence 1064 nm Q-switched Nd:YAG laser for mixed melasma: Clinical and dermoscopic evaluation.

BACKGROUND: Tranexamic acid (TA) can prevent melanocyte activation by various stimuli. Combining TA with either hydroquinone 4% or Q-switched Nd:YAG laser may be associated with greater improvement of melasma. OBJECTIVES: We aimed to evaluate the efficacy and safety of oral TA alone and combined with either topical hydroquinone 4% or low-fluence 1064 nm Q-switched Nd:YAG laser in treatment of mixed melasma. PATIENTS & METHODS: Patients were randomly divided into three groups of 20 patients each. Group A were treated with oral TA 250 mg twice daily for three months; group B were treated with TA similarly combined with topical hydroquinone 4% cream; group C were treated with TA combined with two sessions of 1064 nm low-fluence Q-switched ND:YAG laser (850-1200 mJ/cm2 , 4-5 Hz,spot size 4 mm) spaced 4 weeks apart. Patients were followed monthly for 9 months. RESULTS: After cessation of therapy, the mean mMASI score was lowest in group B (2.34 ± 2.37) followed by groups A (6.38 ± 4.04) and C (7.24 ± 4.95).Mean percentage of mMASI score improvement was 35.91 ± 24.13, 77.47 ± 19.07, and 24.94 ± 27.79 in groups A, B, and C (p < 0.001). There was a significant reduction of telangiectasia in the three groups. Reported side effects were itching & irritation, post-inflammatory hyperpigmentation, and gastritis. CONCLUSION: Oral TA is a tolerable effective treatment modality for melasma. Combining hydroquinone 4% with oral TA is associated with a relatively earlier and better cosmetic outcome.

[A Case of Esophageal Malignant Melanoma during Follow-Up of Esophageal Melanosis Metastasis].

Man 62-years-old as for the case. In 2019, he was diagnosed with right hypopharyngeal cancer, and esophageal melanosis was noted on upper gastrointestinal endoscopy before treatment. We did a follow-up upper gastrointestinal endoscopy every year. At a follow-up upper gastrointestinal endoscopy performed in February 2021, he was histologically diagnosed with an esophageal primary malignant melanoma. Computed tomography showed no metastatic lesions. He underwent esophagectomy. He is currently being followed on an outpatient basis and has had no recurrence. Careful follow-up for esophageal melanocytosis is important for early diagnosis of esophageal primary malignant melanoma.

Treating melasma with the 1064 nm Nd:YAG laser with a 650-microsecond pulse duration: A clinical evaluation.

BACKGROUND: The effective treatment of melasma remains a challenge that necessitates a multifaceted approach that includes strict sun protection, bleaching creams, chemical peels, and laser therapy. The 1064 nm Nd:YAG laser with a 650-microsecond pulse duration provides a safe option for all skin types. METHODS: We treated 10 patients with the 1064 nm Nd:YAG laser with a 650-microsecond pulse duration. Treatments were performed every 2-4 weeks. RESULTS: Using a conservative treatment protocol, lightening of melasma occurred as early as 3 weeks post-treatment, with all subjects requiring several treatment sessions to achieve adequate resolution of their melasma. The majority of subjects experienced up to 25% improvement after two treatments, and an even more noticeable improvement after the 3rd treatment session. None reported any associated pain or discomfort. CONCLUSIONS: Advantages of this laser modality include essentially no pain or downtime, lower risk of rebound, and the ability to safely treat all skin types with melasma. Therefore, the 1064 nm Nd:YAG laser with a 650-microsecond pulse duration serves as a treatment option for melasma.

Prospective randomized controlled trial comparing treatment efficacy and tolerance of picosecond alexandrite laser with a diffractive lens array and triple combination cream in female asian patients with melasma.

BACKGROUND: Recent evidence suggests melasma to be a photoaging disorder. Triple combination creams (TCC: fluocinolone acetonide 0.01%, hydroquinone 4% and tretinoin 0.05%) remain the gold standard treatment. Picosecond alexandrite laser treatment using a diffractive lens array (DLA) has been identified to be effective for improving photoaging conditions. OBJECTIVE: We aimed to compare the efficacy and tolerance of the picosecond alexandrite laser with those of DLA and TCC in female Asian patients with melasma. METHODS: Twenty-nine patients were randomly assigned to group A1 (3 laser sessions at 4-week intervals), A2 (5 laser sessions at 4-week intervals) or B (TCC daily for at least 8 weeks and then tapered until the final evaluation). The Melasma Area, Severity Index (MASI) score and VISIA were assessed at baseline, week 12 and week 20. By week 20, the follow-up periods for groups A1 and A2 were 3 months and 1 month, respectively. RESULTS: Nine, 11 and 6 participants in groups A1, A2 and B completed the study, respectively. MASI scores were significantly improved in all 3 groups at weeks 12 and 20. In groups A1, A2 and B, the improvement rates at week 20 were 53%, 38% and 50%, respectively. VISIA® analysis additionally revealed a significant improvement in spots, porphyria, pores and brown spots after 3 laser sessions (P < 0.05). Group A2 showed greater improvements than group A1 in terms of spots, wrinkles and pores; however, only red areas were significantly different (P < 0.001). All side-effects in the 3 groups were transient and gradually subsided after 1-3 months. CONCLUSION: Picosecond alexandrite laser treatment using DLA showed comparable efficacy with TCC for the treatment of melasma. Improvements in texture, spots, wrinkles and pores were observed in the laser groups. Patients with melasma lesions that exhibit telangiectasia may benefit from additional laser treatment sessions.

Gingival Melanin Depigmentation With Diode Laser - Case Report / Despigmentación Melánica Gingival con Láser de Diodo - Relato de Caso

ABSTRACT: The pigmented lesions of the oral cavity may be endogenous or exogenous. Endogenous lesions are benign and usually caused by melanin, and they are called gingival melanin pigmentations. Among the options for depigmenting these areas, laser therapy stands out for being a minimally invasive procedure. This study aims to report a clinical case of the gingival depigmentation technique using a high-power diode laser in the anterior maxillary region, for the ablation of the pigmented tissue to improve gingival aesthetics. The patient had an aesthetic complaint of the darkened aspect of the gingiva in the anterior maxillary and mandibular portions. After local anesthesia, we started depigmentation with high-power diode laser and performed ablation from the attached gingiva toward the free marginal gingiva. The patient returned after 30 and 180 days presenting healthy gingiva and absence of melanin repigmentation. Thus, we concluded that the diode laser was a good alternative for melanin depigmentation because it is a procedure with lower morbidity and satisfactory postoperative results.

RESUMEN: Las lesiones pigmentadas de la cavidad oral pueden ser endógenas o exógenas. Las endógenas son benignas y generalmente causadas por la melanina, denominándose pigmentaciones melánicas gingivales. Entre las opciones para la despigmentación de estas regiones, se destaca la laserterapia, por ser un procedimiento poco invasivo. Este trabajo tuvo como objetivo relatar un caso clínico de la técnica de despigmentación gingival utilizando láser de diodo de alta intensidad en la región anterior de los maxilares para ablación del tejido pigmentado con la finalidad de mejorar la estética gingival. El paciente presentaba como queja estética el aspecto oscurecido de la encía en la región anterior de la maxila y de la mandíbula. Tras aplicar anestesia local, se inició la despigmentación con láser de diodo de alta intensidad, siendo que la ablación se realizó a partir de la encía insertada hacia la encía marginal libre. El paciente regresó tras 30 y 180 días, presentando encía saludable y con ausencia de repigmentación melánica. Así fue posible concluir que el láser de diodo mostró ser una buena alternativa para la despigmentación melánica, ya que se presentó como un procedimiento con menor morbidad y buen resultado postoperatorio.

A Randomized, Controlled, Split-Face Study of the Efficacy of a Picosecond Laser in the Treatment of Melasma

Introduction: Melasma is a common disorder where patients develop hyperpigmented macules and patches on the face and is thought to be the result of sun exposure and hormonal contributions, although the pathogenesis is not completely understood. Lasers have been used for melasma treatment with varying degrees of success. Objectives: The objective of this study was to examine the safety and efficacy of a novel picosecond laser for the treatment of melasma. Materials and Methods: Ten subjects received nine weekly laser treatments with a picosecond laser to a randomized half of their face. A lightening cream was applied to the entire face to serve as a control. The primary outcome measure was clinical efficacy measured by a patient-reported outcome survey, the Melasma Quality of Life (MELASQOL) questionnaire, and physician assessment with the Global Aesthetic Improvement Scale (GAIS). The secondary outcome measure was safety, which was assessed by monitoring for adverse events. Photos were taken before every treatment and at a 1-week follow-up. Results: Ninety percent of subjects rated their melasma as at least slightly better, and 90% percent of subjects would recommend this laser treatment to others with melasma. MELASQoL questionnaire scores improved by an average of 5.7 points after laser treatment. Assessments by two board-certified dermatologists using the GAIS revealed an overall improvement in 80% of patients on the laser treatment side versus 20% on the control side. Side effects, including erythema and discomfort, were minimal and transient post-treatment. Conclusions: This study suggests that picosecond laser treatments are a safe and efficacious way to treat melasma. J Drugs Dermatol. 2019;18(11):1104-1107.

Clinical & ultrastructural evaluation of the effect of fractional CO2 laser on facial melasma.

Melasma represents the most obvious and disfiguring change of the face leading to psychological problems especially in females. Ablative lasers have also been used by many professionals to treat melasma, although there is few scientific data supporting this indication. The exact mechanism of action of ablative lasers in melasma is not yet clear enough. We aimed to evaluate the ultrastructural effect of fractional ablative CO2 (FrCo2) laser on facial melasma. Eleven melasma patients evaluated clinically by clinical modified area and severity index (MASI) score, treated by two sessions of fractional CO2 laser one month a part. Two punch biopsies of 2 mm diameter were obtained from all subjects one before and the other 3 months after treatment. All biopsies were analyzed by light and electron microscopy. Clinically, significant improvement of pigmentation and 48% reduction of (MASI) score were observed after two sessions of laser treatments. Light microscopic analysis of specimens revealed significant decrease in melanocyte count after treatment. Electron microscopic analysis of specimens after treatment revealed significant decrease in the number and size of melanocytes and significant decrease or complete absence of melanin granules in the surrounding keratinocytes compared to pre-treatment specimens. No scarring or post inflammatory hyper or hypopigmentation. We concluded that repeated application of Fractional CO2 laser on melasma skin may result in long lasting improvement due to its destructive effect on melanocytes.

Clinical efficacy of laser combined with menstrual regulation in the treatment of female melasma: a retrospective study.

The aim of this study was to evaluate the clinical efficacy of using a Medlite C6 Q-switch Nd:YAG laser combined with menstrual regulation-based traditional Chinese medicine (TCM) in the treatment of female melasma. Forty cases of female patients with melasma, who were treated between December 2013 and December 2015 at the Jiangsu Provincial Hospital of Traditional Chinese Medicine, were reviewed retrospectively. Twenty patients received Q-switch Nd:YAG 1064 nm laser treatments combined with menstrual regulation treatments (experimental group), and 20 patients were treated only with the laser (control group). All treatments lasted for 6 months. The patients' faces were photographed before, immediately, and 6 months after treatment. The therapeutic efficacy was assessed by the reduction in the Melasma Area and Severity Index (MASI) score and the total skin damage score, and this was then compared between the two groups. Immediately and 6 months after the treatment, both the MASI and total skin damage scores in the experimental group were significantly lower compared to those in the control group (P < 0.001). The experimental group had significantly higher basic recovery and effectiveness rates than the control group (P = 0.020 and P = 0.008, respectively) and had a significantly lower invalidity rate (P < 0.001). Results from Medlite C6 Q-switch Nd:YAG laser treatment combined with menstrual regulation are superior than those obtained using only a laser for the treatment of female melasma.

Shunt Surgery for Neurocutaneous Melanosis with Hydrocephalus: Case Report and Review of the Literature.

BACKGROUND: Neurocutaneous melanosis is a rare phakomatosis characterized by large or multiple pigmented nevi and melanosis of the leptomeninges. It is often complicated by hydrocephalus due to melanotic deposits interfering with cerebrospinal fluid reabsorption in the basal cisterns or causing foraminal or aqueductal obstruction. In 10% of cases, it will be associated with the Dandy-Walker complex. CASE DESCRIPTION: We present the case of a 6-year-old girl with multiple congenital hairy nevi presenting with generalized tonic-clonic seizures, headache, and vomiting. Neuroimaging showed a communicating hydrocephalus associated with the Dandy-Walker variant, melanotic deposits in the amygdalae, thalami, and cortical sulci, and abnormal leptomeningeal enhancement. After undergoing ventriculoperitoneal shunt insertion, the symptoms of increased intracranial pressure abated. However, she again showed deterioration 1 month postoperatively due to progressive leptomeningeal spread suspicious for malignant degeneration. CONCLUSION: The results of the present case and the findings from a review of related data suggest that shunt insertion (ventriculoperitoneal or cystoperitoneal) is an effective palliative measure for patients with neurocutaneous melanosis with associated hydrocephalus. Despite treatment, however, the prognosis of these patients remains poor owing to malignant progression and leptomeningeal spread of lesions, in particular, in cases associated with the Dandy-Walker complex.

Epidermal grafting for leukoderma resulting from 1064-nm quality-switched neodymium-doped yttrium aluminium garnet laser toning.

Leukoderma secondary to Q-switched 1064-nm neodymium-doped yttrium aluminium garnet laser is usually refractory to treatment. The pathogenesis was cumulative phototoxic damage to melanocytes and eventually resulted in melanocytopenia. Wood's light or UV imaging can help observe early leukoderma before it becomes apparent clinically and determine the degree of melanocytopenia before conducting a biopsy. NB-UVB phototherapy and 308-nm excimer laser can potentially worsen the pre-existing melasma lesions and may not be effective if the lesions have already become melanocytopenic. Epidermal grafting can replenish the hypopigmented area with melanocytes without worsening melasma.

Treatment of Digital Melanonychia with Atypia.

BACKGROUND: Melanonychia of the digit is uncommon in the Caucasian population and is concerning because of potential malignant transformation. Several histologic changes occur before malignant transformation, including melanocytic atypia. The authors evaluated patients with melanonychia with melanocytic hyperplasia to determine the risk factors for malignant transformation. METHODS: The authors retrospectively reviewed records for patients older than 18 years that underwent biopsy for melanonychia. They identified 22 patients with melanocytic hyperplasia with a median age of 61 years (interquartile range, 44 to 71 years). A bivariate analysis was performed to evaluate whether the degree of atypia was associated with malignant transformation and whether treatment choices by surgeons were based on melanocytic atypia. RESULTS: Following biopsy, patients were followed for a median of 41.0 months (interquartile range, 4.8 to 100.6 months). Melanocytic atypia was present in nine patients and transformed into a malignancy in three: in two patients it became a melanoma in situ, and in one it became an acral lentiginous melanoma. Moderate-severe and severe melanocytic atypia was associated with malignant transformation. After initial biopsy, 14 patients were monitored (11 without atypia and three with atypia). One patient with slight atypia, two patients with moderate-severe atypia, and two patients with severe atypia underwent additional treatment. Patients with melanocytic hyperplasia without atypia were monitored more often (78.6 percent versus 21.4 percent). CONCLUSIONS: Melanonychia presents a challenge to the hand surgeon, as some patients may be monitored and some should undergo additional resection. Patients with moderate-severe melanocytic atypia following biopsy should undergo resection, and those with mild to slight atypia can most often be monitored clinically. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.