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Objectives: Diode laser represents a practical clinical strategy for treating gingival hyperpigmentation. However, its effectiveness remains controversial. The aim of this meta-analysis was to evaluate the quantitative effects of diode laser therapy on gingival hyperpigmentation., Method and Materials: PubMed, Embase, Web of Science, and Cochrane Library were systematically searched for the use of diode laser in gingival hyperpigmentation. The primary outcomes assessed were the Dummett-Gupta Oral Pigmentation Index (DOPI), visual analog scale pain scores, and the Wound Healing Index (WHI) for overall evaluation. The I2 index was calculated to identify heterogeneity, and sensitivity analyses were performed to identify sources of heterogeneity. Funnel plots and the Egger test were utilized to evaluate publication bias., Results: Thirteen randomized controlled trials involving a total of 233 participants were included in the study. The analysis demonstrated that diode laser had a significant effect on DOPI (standard mean difference [SMD] = -0.245, 95% CI -0.451 to -0.040, P = .019) and pain (SMD = -0.809, 95% CI -1.332 to -0.285, P = .002), with no significant effect on WHI (SMD = -0.224, 95% CI -1.100 to 0.653, P = .617). Despite the significant heterogeneity in VAS and WHI indicated by the I2 index statistic, the sensitivity analyses' results demonstrated the main findings' reliability. While no significant publication bias was detected for DOPI and WHI, the pain results exhibited notable publication bias., Conclusion: The study demonstrated that diode laser prolongs gingival repigmentation time and reduces pain compared to other treatments. However, efficacy in wound healing was not significantly affected.

Objective: This study aimed to investigate the effectiveness of prophylactic photobiomodulation (PBM) in reducing postinflammatory hyperpigmentation (PIH) induced by carbon dioxide (CO 2 ) laser resurfacing in a patient with periorbital syringomas. Background: PIH is a common condition characterized by abnormal skin pigmentation after an inflammatory process occurring in up to 20-30% of patients undergoing CO 2 laser resurfacing. Methods: The patient was treated with PBM using a pulsed home-use device at 630 nm before and after CO 2 laser treatment. The patient was asked to treat the right periorbital area before and after the CO 2 laser treatment, which was continued once a day for 2 consecutive weeks. Results: At 12 weeks, PIH was significantly reduced on the treated side compared with the contralateral untreated side (leading to persistent erythema at 6 months). Conclusions: This is the first report of prophylactic treatment of CO 2 laser-induced dyschromia using PBM.

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., (© 2023 The Authors. Skin Research and Technology published by John Wiley & Sons Ltd.)

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 cm 2 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., (© 2023 The Authors. Skin Research and Technology published by John Wiley & Sons Ltd.)

Background: Conventional high fluence Q-switched (HFQS) Alexandrite 755-nm are widely used in clinical café-au-lait macules (CALMs) treatment. There have been recent concerns regarding the efficacy and safety of low fluence Q-switched (LFQS) Nd: YAG 1064-nm lasers., Objective: To evaluate the efficacy and safety of the conventional HFQS and LFQS laser in the treatment of CALMs., Methods: Within 3 months, 20 patients underwent prospective self-controlled split-lesion treatments with HFQS once or twice depending on the recovery rate, and with LFQS six times biweekly. Then the more effective laser was selected for continued treatments. Efficacy outcomes were evaluated by a visual analog scale (VAS) biweekly during the comparative trail. Recovery process, side effects and recurrence were recorded during the trial and follow-up visit. Patient and physician preferences for laser selection were also recorded., Results: The average VAS scores of areas treated with HFQS and LFQS were 2.92 ± 0.86 and 2.93 ± 1.13, respectively (p > 0.05). The most significant efficacy change of LFQS was after the fourth laser treatment (VAS score: 1.82-2.37, p < 0.001). 11 lesions treated with LFQS and 7 with HFQS achieved an optimal treatment response (3.67 ≤ VAS ≤ 4). Three patients relapsed on one side (one on LFQS, two on HFQS) and five on both sides. Adverse effects included temporary hypopigmentation, hyperpigmentation, uneven pigmentation, and mottled hypopigmentation. Doctors thought 80% of patients were suitable for LFQS. 70% of patients preferred LFQS posttreatment., Conclusions: The efficacy difference between the LFQS 1064-nm laser and HFQS 755-nm laser in treating CALMs in a 3-month comparative trial was statistically insignificant. LFQS is preferred by doctors and patients and is likely to help more patients achieve treatment efficacy than the HFQS within a short time, with fewer temporary adverse reactions, and a more even pigmentation. But it can cause mottled hypopigmentation. The LFQS had obvious lesion clearance after the fourth treatment., (© 2022 Wiley Periodicals LLC.)

Purpose: This article attempted to describe the efficacy and safety of 1064QNYL in combination with other treatments for refractory melasma., Methods: Two researchers independently retrieved randomized controlled trials (RCTs) according to inclusion and exclusion criteria. Primary outcome was evaluated with MASI and mMASI scores in control group and experiment group. The secondary outcome was evaluated with MI scores. We calculated 95% CI of standardized mean difference (SMD) and heterogeneity of the included literature by Higgins I 2 test, and assessed publication bias by Funnel plots, Egger's, and Begg's tests., Results: A total of 12 articles including 322 subjects were analyzed. Experiment group was treated with 1064QNYL combined with single treatment (e.g., PDL, IPL, RF, and TA). Control group was treated with 1064QNYL alone. A greater reduction of Melasma Area and Severity Index (MASI)/modified Melasma Area and Severity Index (mMASI) scores were shown in experiment group than that in control group at the end of the treatment (SMD, -0.37; 95% CI -0.70 to -0.04, p = 0.03, I 2  = 33%). The SMD of MI scores further supported this conclusion by -0.32 (95% CI -0.63 to -0.02, p = 0.04, I 2  = 27%). As for adverse events (AEs), combined treatment gave rise to more mild burning, stinging, and erythema that resolved spontaneously. Several studies reported focal purpura, punctate leukoderma, hyperpigmentation, hypopigmentation, and so on., Conclusion: Combined 1064QNYL treatment was better than single laser treatment, with the highest short-term benefit and long-term follow-up to maintain the effect in favor of combined treatment., (© 2022 Wiley Periodicals LLC.)

Chloasma is a prevalent clinical hyperpigmentation skin disorder that causes symmetrical brown to tan patches on the cheeks, as well as the neck and forearms on rare occasions. The pathophysiology of this condition is complicated, and there is now no cure. Under the light microscope, the full-thickness melanin of the epidermis in the skin lesions was increased, and the dermal chromophages increased. At present, the treatment of melasma mainly includes topical drugs, chemical peels, systemic drugs, laser therapy, and traditional Chinese medicine. With the development of medical technology, intense pulsed light and Q-switched laser have been widely used in the treatment of melasma, which can emit laser beams to penetrate the dermis uniformly to treat deep pigmented lesions in the dermis. After a stable treatment outcome for melasma is achieved, it is important to minimize side effects such as postinflammatory hyperpigmentation and skin irritation. Therefore, this paper uses a reflection confocal microscope to establish an evaluation index system and then uses a neural network to evaluate the treatment effect. The work of this paper is as follows: (1) this paper introduces various methods of treating melasma at home and abroad and focuses on the application of intense pulsed light therapy and low-energy Q-switched Nd: YAG laser in the treatment of melasma. (2) In this paper, the case data samples are trained with the designed BP network to obtain a reliable evaluation network model. (3) The results and mistakes of the evaluation are produced by training the genetic algorithm optimized backpropagation (GA-BP) network structure model to evaluate the treatment effect of chloasma. Finally, it has been demonstrated that the GA-BP network has great accuracy and stability., Competing Interests: The authors declare that they have no conflict of interest., (Copyright © 2022 Jiali Xu and Yijing Pu.)

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., (© 2022. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Background: Physiological lip hyperpigmentation (PLH) is a common cosmetic concern in the Middle East and Asia. It is characterized by homogeneous symmetric diffuse hyperpigmentation affecting both lips. There is no satisfactory treatment for this condition. The aim of this study is to evaluate the efficacy and safety of Q-switched (QS) 532 nm Nd:YAG laser for PLH., Methods: A total of 30 patients with clinical diagnosis of PLH were retrospectively reviewed and included in the study. Patients underwent at least one laser treatment using QS 532 nm with a minimum follow up of six months. Laser parameters were as follows: spot size 2-3 mm, pulse duration 20 ns, fluence 2-4 J/cm 2 . One to three sessions were performed depending on clinical response. Two methods were used for assessment: patient satisfaction and independent physician assessment. PLH was classified as grade 1 (upper lip fully affected plus only border of lower lip), grade 2 (upper lip fully affected plus most of lower lip), and grade 3 (majority of both lips hyperpigmented)., Results: Excellent (>75% improvement) response was achieved in 30% of patients. Good (51-75% improvement) response was seen in 37% and 43% of patients according to patient satisfaction and independent physician assessment, respectively. Majority of patients required only one treatment session. Reactivation of herpes labialis occurred in two patients, and mottled hypopigmentation in three patients. None of the patients developed persistent hyperpigmentation or scarring., Conclusions: PLH can be effectively treated with QS 532 nm Nd:YAG laser and is well tolerated by patients.

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., (© 2021 Wiley Periodicals LLC.)

Background: Isobutylamido thiazolyl resorcinol (ITR) is a novel anti-tyrosinase recently shown to be effective in the treatment of hyperpigmentation. Low-fluence Q-switched Nd:YAG 1064-nm laser (LFQS) has proven to be effective for various hyperpigmentary conditions. However, there is no study on the efficacy and safety of combined ITR and LFQS treatment., Objectives: To compare the efficacy and safety of combined ITR and LFQS with LFQS monotherapy for facial hyperpigmentation., Materials and Methods: Patients with symmetrical facial hyperpigmentation were treated with five sessions of once weekly LFQS on the whole face. One side was randomly treated with ITR and the other side received a placebo cream for 12 weeks. Patients were followed for 8 weeks after the last laser treatment. Relative lightness index (RL*I), Facial Hyperpigmentation Severity Score on the malar area (FHSS m ), patient satisfaction, recurrence, and adverse events were recorded., Results: Twenty-four patients completed the study. Both sides demonstrated significant reductions of mean RL*I and mean FHSS m from baseline (P < .01). At the 4th week, the ITR-treated side showed more improvement of mean RL*I than the placebo-treated side (62.5% vs 47.3% improvement, P < .05). The mean FHSS m on the ITR-treated was reduced at a significantly higher percentage than the placebo-treated side (54.4% vs 40.2% reduction, P < .05). Partial recurrence was observed on both sides. No serious side effects were noted., Conclusion: Combined ITR and LFQS therapy was more superior than LFQS monotherapy in the treatment of facial hyperpigmentation. ITR may serve as adjuvant for patients with such condition., (© 2020 Wiley Periodicals LLC.)

Background: Awareness of accidental tattoos after iron injections with paravenous leakage is low. No larger patient cohorts have been analyzed. The lesions are a burden to the patients. The only known treatment is laser therapy., Objective: To characterize the clinical appearance and development of iron-induced tattoos and to demonstrate safe and efficient removal with quality-switched (QS) and picosecond lasers., Materials and Methods: The authors conducted a retrospective systematic analysis on patients who presented at the Dermatology Department of the University Hospital of Zurich between Year 2008 and 2017 with accidental hyperpigmentations after iron injections. From 29 collected patients, 13 received laser treatment and were analyzed with reference to the lasers used, including wavelength, fluence, spot size, intervals, number of sessions, and overall success. The authors defined the latter as a complete removal or as patients' satisfaction., Results: The authors treated 13 patients and completed the treatment in 8 patients, with an average of 5.6 sessions. No complications occurred., Conclusion: Spontaneous regression of iron-induced tattoos is possible within 1 to 2 years, but not guaranteed. Removal with QS ruby, Nd:YAG, and picosecond lasers can be achieved within a mean number of 5.6 sessions. Assuring a valid indication before intravenous iron administration is important.

Background and Objectives: Post inflammatory hyperpigmentation (PIH) can be difficult to treat especially in patients with darker skin types as darker skin carries increased epidermal melanin content. Various treatments available to improve the appearance of PIH may incite further pigmentation thus making treatment extremely difficult and frustrating. The purpose of this study was to perform a retrospective chart and photographic review to evaluate the efficacy and safety profile of a low energy low density non-ablative fractional1927 nm wavelength laser treatment for PIH in patients with Fitzpatrick skin types IV-VI., Study Design: A retrospective evaluation of 61 patients with PIH treated with a 1927 nm laser was conducted at a single center. Inclusion criteria required at least 2 treatment sessions so that before and after treatment photographs would be available for comparison and study purposes. Two blinded physician-evaluators using a visual analog scale for percentage of pigmentary clearance in standard photographs assessed treatment efficacy., Results: The mean percent improvement after treatment, evaluated by two dermatologists was 43.24%. The correlation between raters was statistically significant (Pearson's correlation coefficienct of r = 0.59, p < 0.0001). No side effects were observed in the patients treated with the 1927 nm laser., Conclusion: The low energy low density non-ablative fractional 1927 nm wavelength laser is a safe and effective modality for improving post inflammatory hyperpigmentation in patients with darker skin types. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc., (© 2019 Wiley Periodicals, Inc.)

Traumatic tattoos can be treated with several methods, including mechanical and chemical devices. However, they are rarely used due to the high risk of permanent side effects such as scarring and depigmentation. Recently, laser devices, especially the Q-switched (QS) laser and the pulsed dye laser (PDL), applied in combination, have achieved complete clearance of the lesions without any risk of side effects. Herein, we reported three cases of traumatic facial tattoos successfully treated with combined PDL and QS Nd:YAG laser., (© 2019 Wiley Periodicals, Inc.)

Patients with a history of intravenous drug usage (IVDU) often develop pathognomonic linear hyperpigmented dermatoses near injection sites. This drug use-related pigmentation can be very distressing for patients as they persist for life, are very difficult to treat, and remain a constant reminder of prior drug usage. The difficulty of treatment is due to the location of the deposited material and its exogenous nature. This article reports two cases of linear hyperpigmentation due to IVDU successfully treated using the Q-switched Alexandrite laser.

Postinflammatory hyperpigmentation (PIH) and erythema are the most common adverse effects associated with laser treatment, particularly in dark-skinned individuals. Several methods have been used to prevent or minimize these adverse effects; however, to date, no definitive precautions/strategies are known to prevent post-laser PIH and erythema. We investigated whether the topical application of the α-adrenergic receptor agonist brimonidine could reduce laser treatment-related complications such as erythema and PIH.

Background: The fractional radiofrequency (fRF) technique is a recently emerged technique. However, the exact outcomes of fRF for treating atrophic acne scar in Asians are still unclear., Objective: To compare the clinical outcomes of fRF with the fractional laser technique in Asians with atrophic acne scar., Materials and Methods: The databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Chinese National Knowledge Infrastructure (CNKI) were searched. Main clinical outcomes were participant-reported scar improvement, investigator-reported scar improvement, post-inflammatory hyperpigmentation (PIH), erythema duration, scab duration, and the pain level., Result: Six randomized controlled trials were included in this meta-analysis. The scar improvement was similar in both groups regarding participant-reported scar improvement (p = 0.48) and investigator-reported scar improvement (p = 0.89). However, the incidence of PIH in fRF group was lower in comparison with the laser group (p < 0.001). The average duration of erythema was shorter in fRF group than in the laser group (p < 0.001). The mean time for debridement was shorter in fRF group than the carbon dioxide fractional laser system (p = 0.02). The pain level did not differ significantly in the two groups (p = 0.53)., Conclusion: Although some bias exists in our study, fRF appears to be a superior alternative for the treatment of atrophic acne scar in Asians.

Three hundred and eight nanometer excimer light therapy has recently been reported to be effective against patchy alopecia areata (AA) in several clinical studies. However, these studies only included a few patients with severe forms of AA, and all of them exhibited poor outcomes. We further investigated the use of excimer light as a therapeutic option for cases of alopecia universalis (AU) that are resistant to other treatments. Eleven treatment-resistant AU patients were treated with a 308-nm excimer light at 2-week intervals for more than 16 sessions. Four patients achieved good responses and two patients exhibited poor responses. Three patients had Japanese skin type 1 and all of them achieved good responses. The radiation dose was increased until the patients exhibited marked erythema. The patients with Japanese skin type 3 who achieved good responses exhibited strong pigmentation at the irradiated sites. In conclusion, 308-nm excimer light therapy has significant effects on some AU patients who are resistant to other treatments and may be an alternative therapeutic option for AU. During the treatment of AU, high doses of radiation should be administrated until a strong inflammatory skin reaction is seen., (© 2016 Japanese Dermatological Association.)

Background: Intense pulsed light (IPL) has a well-recognized role in the treatment of photodamaged skin., Objective: To assess the safety and efficacy of a novel single-band IPL handpiece versus dual-band IPL handpiece in the treatment of photodamage., Study Design/materials and Methods: This was a prospective, single-center split-face study with 20 enrolled participants. Three treatments, 21 days apart, were administered to the subjects and follow-up was performed for 20 weeks. The left side of the face was treated with the single-band handpiece. The right side of the face was treated with the dual-band handpiece. Blinded investigators assessed the subjects' skin texture, pigmented components of photodamage, and presence of telangiectasia both before and after treatment, utilizing a five-point scale., Results: Pigmented components of photodamage, skin texture, and presence of telangiectasias on the left and right side of the face were improved at the end of treatment. At 20-week follow-up, the side treated with single-band handpiece showed improvement in telangiectasia and pigmentation that was statistically superior to the contralateral side treated with the dual-band handpiece. Both devices equally improved textural changes. No adverse effects were noted with either device., Conclusion: Both single-band and dual-band IPL technology are safe and effective in the treatment of photodamaged facial skin. IPL treatment with a single-band handpiece yielded results comparable or superior to dual-band technology.

Objective: The objective of this retrospective review is to investigate the long-term effect of skin rejuvenation by the intense pulsed light (IPL) source for the treatment of photoaging., Methods: From 5300 clinical cases that our department has treated with the IPL, the first 2534 were chosen for this study. Each patient received a minimum of 3 IPL treatments during this time-many were yearly treatments. Clinical photographs were taken on a yearly basis for up to 12 years and sent to a blinded independent panel to study the effects of continuous IPL treatments., Results: Results showed that the effective rate for the IPL was between 88.24% and 96.45%., Conclusions: IPL therapy is an effective treatment for photoaging and can truly have an effect on reversing the signs of photodamage on skin.

Background: There is a paucity of studies investigating laser resurfacing in Fitzpatrick skin phototypes (SPT) IV to VI., Objective: To assess the efficacy and safety of fractional nonablative laser resurfacing in the treatment of acne scarring in patients with SPT IV to VI., Methods and Materials: The authors conducted a randomized, investigator-blinded and rater-blinded, split-face comparative study of adults with SPT IV to VI and facial acne scars treated with 2 different density settings and the same fluence., Results: Quantitative global scarring grading system (QGSGS) scores were significantly improved from baseline at 16 and 24 weeks (p = .0277). Improvements in QGSGS scores after higher and lower density treatments were statistically similar (p = .96). The live-blinded dermatologist, the blinded dermatologist photoraters, and the patients rated scars as being significantly more improved by visual analog scale at weeks 16 and 24 compared with baseline (p < .001) for both treatment densities. Five of 7 and 3 of 7 patients in the higher and lower density group, respectively, experienced mild or moderate hyperpigmentation as an investigator observed site reaction., Conclusion: The nonablative 1550-nm fractional laser is safe and efficacious in treating acne scaring in Fitzpatrick skin types IV to VI. Self-limited postinflammatory hyperpigmentation was a common occurrence, especially with higher treatment densities.

A 64-year-old female presented with facial hyperpigmentation. She had dyed her hair monthly with pure henna powder for the past seven months. After patch tests, the patient was diagnosed as post-inflammatory hyperpigmentastion due to allergic contact dermatitis to pure henna that has rarely been reported. The patient underwent Q-switched Nd:YAG laser treatment and was treated with oral tranexamic acid for 10 weeks. The hyperpigmentation on her forehead demonstrated substantial improvement.

Background: Nevus of Ota, caused by dermal melanocytosis, is cosmetically troublesome in Asian patients. The destruction of dermal melanocytosis using Q-switched laser systems carries a high risk of postinflammatory hyperpigmentation/hypopigmentation., Methods: To determine the usefulness, safety, and adverse problems of low fluence 1064 nm Q-switched Nd:YAG laser in the treatment of nevus of Ota, 19 Korean patients (five male and 14 female; Fitzpatrick skin type IV) who were clinically diagnosed as having nevus of Ota were enrolled in the present study. Low fluence laser treatments were performed with a collimated Q-switched Nd:YAG laser at intervals of two weeks. The fluence of laser treatments was set at 2.5 J/cm(2) and adjusted based on patient response to the previous treatment session and sensitivity to pain. Treatment was applied until the lesions showed mild erythema., Results: The mean number of total treatment sessions was 17.1 (range 6-32). Among the 19 patients, 18 reached near total improvement, while one patient failed to reach near total improvement after 11 treatment sessions. The mean fluence of treatment was 2.5 J/cm(2) (range 2.0-5.0 J/cm(2) ). Five patients complained of delayed eyelid response. Post-therapy hyperpigmentation was observed in one patient., Conclusion: Low fluence 1064 nm Q-switched Nd:YAG laser is an effective modality for the treatment of nevus of Ota with a low incidence of side effects. It is an easy to perform treatment with low downtime., (© 2013 The International Society of Dermatology.)

Background and Objective: As the demand for diminished procedure-associated downtime continues to increase, nonablative fractional laser resurfacing is becoming a more popular intervention in the progression of photoaging. Patients with pigmented skin and a mild degree of photodamage may be particularly suited for a less intensive laser treatment. In this study, we have evaluated the safety and efficacy of a low energy, low density 1,440-nm fractional laser in the treatment of multiple signs of photoaging including dyspigmentation, wrinkling, tissue laxity, enlarged pores, and skin roughness in Asians., Study Design/materials and Methods: Ten Chinese subjects with Fitzpatrick skin types III-V and visible signs of photodamage participated in this study. Patients received four treatments at 2-week intervals with a 1,440-nm diode-based fractional laser. Photographs were taken at baseline, 2 weeks after each of the first three treatments and 4 weeks after the final treatment. Images were evaluated independently by two physicians. Clinical improvement and adverse events were analyzed. Discomfort, heat sensation and overall patient satisfaction associated with the procedure were also quantified., Results: In this prospective single-arm study, signs of photoaging were examined after treatment with the 1,440-nm laser. Here we show that a series of four treatments with this device produced a mild improvement in skin texture, pigmentation, and wrinkling. Changes in pore size and skin laxity failed to reach statistical significance. Immediate after-effects of the procedure included erythema and edema which were transient and left no permanent sequela. A significant proportion of patients reported some degree of discomfort during the procedure despite use of a topical anesthetic. One patient developed a discrete, localized area of post-inflammatory hyperpigmentation which completely resolved by the final follow up visit., Conclusion: The low energy, low density nonablative 1,440-nm fractional laser produces a mild improvement in select signs of photodamage after four treatments without any long-term adverse effects., (© 2014 Wiley Periodicals, Inc.)

Objective: This study evaluates a topical oxygen emulsion (TOE) to reduce adverse effects after skin rejuvenation with a fully ablative CO2 laser alone and in combination with a fractional ablative CO2 laser., Materials and Methods: Patients (n = 100) seeking skin rejuvenation underwent CO2 laser resurfacing. Group A patients (n = 34) received a single deep fractional laser treatment followed by application of Aquaphor immediately after treatment for 24 h and TOE every 6 h for the next 6 days. Group B patients (n = 66) underwent both deep fractional and fully ablative laser resurfacing followed by application of TOE every 6 h for 7 consecutive days., Results: Patients in both groups showed clinical improvement and a 7.1% overall incidence of adverse effects which included milia (5.1% overall) and hyperpigmentation (3.1% overall). For milia, Group A and Group B individual adverse effect rates were 11.8% and 1.5%, respectively; for hyperpigmentation, individual rates were 0.0% and 3.1%, respectively., Conclusion: The elimination of petrolatum products in the post-skin care regimen has significantly reduced the incidence of post-procedure complications when compared with the use of TOE, resulting in the lowest incidence of complications in fully ablative or fractional resurfacing published thus far.

Postinflammatory hyperpigmentation (PIH) developing after cosmetic procedures such as lasers and chemical peels is always a concern, especially in darker skin types. We report two cases of laser-related PIH of the face successfully treated by combined therapy with 578-/511-nm copper bromide laser and light-emitting diodes (LED). Good cosmetic results were achieved in both patients. The side effects during and after treatment included a mild stinging and redness, but these were resolved within several days without any treatment. Combined 578-/511-nm copper bromide laser with LED provided safe and effective treatment for post-laser pigmentation in Korean patients., (© 2013 Wiley Periodicals, Inc.)

Becker's nevus is cosmetically bothersome both due to the hyperpigmentation and due to the hypertrichosis which can accompany it, particularly in males. Laser hair removal can be considered, but the pigmented background of the Becker's nevus makes the treatment more challenging. Fifteen patients with Becker's nevus underwent eight sessions of hair removal with low-fluence high-repetition-rate diode lasers (808-810 nm). All participants experienced significant hair reduction at 6 and 12 months. No adverse events were reported. The study supports the use of low fluence with high-repetition-rate diode laser hair removal as a safe and effective method for the management of hypertrichosis in Becker's nevus.

Background: Discoid lupus erythematosus (DLE) is restricted to the skin, mostly the face, often chronic and disfiguring. Standard medical therapies include topical corticosteroids and antimalarials. This is a retrospective long-term follow-up of refractory DLE treated with different lasers and intense pulsed light (IPL)., Methods and Materials: Sixteen patients with histologically confirmed DLE participated in this study. Two men and fourteen women, aged 28-69 years, mean age 54 years, were treated at the laser units of the Departments of Dermatology at the University Hospital of Örebro from 2001 and at Skåne University Hospital in Malmö, Sweden from 1999. Several therapies, including first- and second-line treatments and even cryotherapy, had been used without response. Many patients had marked scarring. Pulsed dye laser (PDL) and IPL were used with low fluencies., Results: Of 16 patients, 14 were improved regarding itching, erythema, scaling, scarring and pain. There was no scarring as a side effect of laser therapy or IPL. Two patients were not satisfied: one because of long healing time, and the other because of post inflammatory hyper pigmentation., Conclusion: IPL and PDL is a safe adjunctive therapy to conventional treatment of DLE. In the effort to prevent severe scarring and disfigurement it should be used as early as possible.

Background: Although many Asian atopic patients have orbital darkening symptom and the demand to treat this condition is increasing, little has been reported in the literature on the treatment of infraorbital dark circles in atopic dermatitis., Objective: To evaluate the clinical efficacy and safety of 2790-nm erbium:yttrium scandium gallium garnet (Er:YSGG) laser therapy for reducing infraorbital dark circles in atopic dermatitis patients., Materials and Methods: Ten Korean patients over 21 year with mild atopic dermatitis and infraorbital dark circles were enrolled in this study. Patients who need active atopic dermatitis treatments are excluded because of the possibility of aggravation after laser treatment. They were treated for dark circles using a 2790-nm Er:YSGG laser. The treatment parameters were 1.8-2.2 J/cm² fluence, 6-mm spot size, and 0.3-ms pulse width with 10% overlap over the infraorbital areas once with a 4-week interval between treatments. Efficacy was assessed with a quartile grading score ranging from 0 to 5 by a blinded investigator, and the patients also documented their degree of satisfaction with the same grading score. All possible side effects were evaluated., Results: The clinical assessment showed 74.5% (2.7) and 72.5% (2.5) improvements, and the patient satisfaction scale scores improved an average of 74% (2.4) and 71.5% (2.3) at 2 months and 4 months after treatment, respectively. There were no severe side effects or aggravation of atopic dermatitis., Conclusion: Our study suggests that 2790-nm Er:YSGG laser therapy can be effectively and safely used in the treatment of infraorbital dark circles in atopic dermatitis patients.

Lasers are a very effective approach for treating many hyperpigmented lesions. They are the gold standard treatment for actinic lentigos and dermal hypermelanocytosis, such as Ota nevus. Becker nevus, hyperpigmented mosaicisms, and lentigines can also be successfully treated with lasers, but they could be less effective and relapses can be observed. However, lasers cannot be proposed for all types of hyperpigmentation. Thus, freckles and café-au-lait macules should not be treated as the relapses are nearly constant. Due to its complex pathophysiology, melasma has a special place in hyperpigmented dermatoses. Q-switched lasers (using standard parameters or low fluency) should not be used because of consistent relapses and the high risk of post-inflammatory hyperpigmentation. Paradoxically, targeting the vascular component of the melasma lesion with lasers could have a beneficial effect. However, these results have yet to be confirmed. In all cases, a precise diagnosis of the type of hyperpigmentation is mandatory before any laser treatment, and the limits and the potential side effects of the treatment must be clearly explained to patients., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Fractional photothermolysis (FP) therapy and chemical peels have been reported to be effective in patients with recalcitrant melasma. However, there is little information to compare the efficacy of single treatment session in Asian women. The aim of this study was to examine the efficacy, long-lasting outcomes and safety of a single session of 1550-nm erbium-doped FP in Asian patients, compared with trichloroacetic acid (TCA) peel with a medium depth. Eighteen Korean women (Fitzpatrick skin type III or IV) with moderate-to-severe bilateral melasma were randomly treated with a single session of 1550-nm FP on one cheek, and with a 15% TCA peel on the other cheek. Outcome measures included an objective melasma area severity index and subjective patient-rated overall improvement at 4 and 12 weeks after treatment. Melasma lesions were significantly improved 4 weeks after either treatment, but melasma recurred at 12 weeks. Post-inflammatory hyperpigmentation developed in 28% of patients at 4 weeks but resolved in all but one patient by 12 weeks. There was no difference between FP treatment and TCA peeling with respect to any outcome measure. FP laser and TCA peel treatments were equally effective and safe when used to treat moderate-to-severe melasma, but neither treatment was long-lasting. We suggest that multiple or periodic maintenance treatments and/or supplemental procedures may be required for the successful treatment of melasma in Asian women.

Postinflammatory hyperpigmentation (PIH) developing after cosmetic procedures, such as chemical peeling and laser therapies, are always a concern, especially in Asians. Some cases of PIH tend to be spontaneously regressed; however, certain forms of PIH need to be treated with several therapeutic attempts, including bleaching creams, several kinds of Q-switched lasers, and erbium-doped fractional photothermolysis system, with various treatment outcomes. A 1064-nm Q-switched Nd:YAG laser with low-fluence therapy is easily applicable, and the therapeutic trial in our case was revealed to have minimal downtime without post-therapy bleeding or crust formation; the post-therapy erythema spontaneously resolved within a few hours. The 1064-nm Q-switched Nd:YAG laser with low-fluence treatment should be considered in the treatment of PIH caused by procedures like laser surgery and chemical peeling in Asian patients., (© 2010 Wiley Periodicals, Inc.)

Laser treatments using 532-/1064-nm Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers are popular non-ablative and selective photothermolysis therapies for pigmentary disorders. We treated three male Korean patients (aged 23, 27 and 24 years) for smoker's gingival hyperpigmentation using a 532-nm Q-switched Nd:YAG laser. At each treatment session, the laser was delivered at 1.2 J/cm(2) with a 5-mm spot size and appropriate overlap. Clinical improvement as well as complete healing of the treated gingiva was noted within 2 weeks after each treatment. We also observed that the therapeutic effects lasted more than 6 months.

Background and Objective: Laser treatment of cutaneous pigmentation is one of the most interesting areas in cutaneous surgery. Our purpose was to study the efficacy of Q-switched Nd:YAG at 1064 nm and 532 nm for the treatment of some pigmented lesions in our locality in Egypt., Methods: A total of 60 subjects were treated with the Q-switched Nd:YAG laser with fluences ranging from 8 to 10 J/cm(2) for dermal lesions and 2.5-5 J/cm(2) for epidermal lesions. The number of sessions ranged from one to six sittings for epidermal lesions, four to six sessions for dermal lesions, while the mixed group required two to three sessions., Results: A total of 34 patients (56.7%) showed excellent response, seven patients (11.7%) showed good response, nine patients (15%) showed fair response, and 10 (16.6%) showed poor response. Transient postinflammatory hyperpigmentation occurred in five patients (8.33%) and erythema in seven patients (11.66%). Complications were common in darker skin types V and VI., Conclusion: The Q-switched Nd:YAG laser is an effective and safe technique for the treatment of pigmented skin lesions. Adverse hyperpigmentation can occur but is transient.

This is a case report of a 27-year-old Korean woman with Fitzpatrick skin type IV presenting with refractory arcuate hyperpigmentation, which developed after non-ablative 1450-nm diode laser therapy. The refractory arcuate hyperpigmentation was unresponsive to the use of Q-switched lasers, vitamin C iontophoresis, and a bleaching agent, but was responsive to fractional photothermolysis system treatment.

The development of skin hyperpigmentation in patients with end-stage renal disease (ESRD) on hemodialysis (HD) have been well documented. However, the cosmetic concern was neither valued seriously nor treated effectively in the past. We report a female case who suffered from facial hyperpigmentation (FH). She was treated by large-spot sized, 1064-nm Q-switched Nd:YAG laser (QSNYL). A significant improvement was found after three treatment sessions at a fluence of 3.9 J/cm(2) with 8-day intervals, but spotted leucoderma developed at the fourth visit. Neither residual FH nor spotted leucoderma subsequently improved following two additional sessions of 1064-nm QSNYL at a lower fluence with topical hydroquinone and HeNe laser, and it persisted at the 1-year follow-up. This clinically specific round-shaped leucoderma suggested laser-induced damage to melanocytes due to unsuitable application. The 1064-nm QSNYL with a large spot size and an appropriate parameter may become an effective therapeutic modality if properly utilized.

Melasma is difficult to treat. Vitamin C, topical and by iontophoresis, has been shown to be useful. When lasers are used, there is a significant incidence of post-laser hyperpigmentation. There is no single established treatment for the latter. The case history of a 51-year-old Chinese woman is presented. Intravenous vitamin C appears to be useful in treating this complication.

Background/objective: Hyperpigmentation occurs in more than 37% of dark-skinned subjects treated with a fully ablative CO2 laser device. This study assessed the risk of postinflammatory hyperpigmentation (PIH) in subjects with skin types 4 and 5 treated once with a specific protocol of treatment using a fractional CO2 laser., Methods: Seven subjects with photodamaged skin received a single facial treatment using a fractional CO2 laser. Anesthesia was limited to a lidocaine and prilocaine cream for 1 hour before the single-pass treatment. Subjects were evaluated for improvement and PIH on alternate days for 14 days, and at 1 month, 3 months, and 6 months posttreatment., Results: All subjects achieved improvement in their specific skin conditions and in skin texture. Postinflammatory hyperpigmentation was not observed in any subject. Four subjects experienced no pain during treatment, while 3 reported mild pain. Recovery was associated with minimal pain and itching., Conclusion: In dark-skinned subjects, fractional CO2 laser treatment and topical anesthesia subjectively improves common skin conditions without PIH.