The Asian Dermatologic Patient

Objective To compare the effect of Q-switch Nd∶YAG laser and intensive pulsed light on freckles. Methods 80 patients with freckles were divided into 2 groups randomly. One group of patients were treated with Q-switch Nd∶YAG 532 nm frequency-doubled laser, the interval was 8 weeks. The other group of patients were treated with 570 nm intensive pulsed light, the interval was 8 weeks. Results We used Mann-Whitney U test to compare the curative effect of the two groups (P <0.05), and the mean rank (34.00) of the Q-switch Nd∶YAG laser treatment group was greater than that (47.00) of the intense pulsed light treatment group. Conclusions The curative effect of Q-switch Nd∶YAG laser is better than that of intensive pulsed light on freckles. Key words: Laser; Intensive pulsed light; Freckle

Nonablative skin rejuvenation using laser, intense pulsed lights (IPLs), or radiofrequency techniques are becoming increasingly popular. In this paper, a novel protocol that integrates IPL sessions, low intense light and vitamin C, low-weight hyaluronic acid, betaglucan dermal injection versus IPL photorejuvenation as monotherapy is compared. A group of 100 patients, all women, with ages ranging from 35 to 65 years old (median age 56.3) with different degrees of photodamage was considered. A blinded control study was done. The patients were divided not randomly into two groups. These groups are similar for ages, skin types, and degrees of photoaging distribution. A first group of 40 patients had monotherapy consisting of seven sessions of IPL only. A second group of 60 patients had triple therapy consisting of seven sessions of IPL as well as nine sessions of low intense diode light and also biostimulation by drugs. Considering only the improvement in hyperpigmentations and teleangectasias, the monotherapy and the triple therapy show good results with no significant statistical difference between the two groups. Considering the improvement in skin texture and firmness in the group treated only with monotherapy, 30% (12 patients) had positive results, and 70% (28 patients) had poor results. In the group treated with triple therapy, 70% (42 patients) had positive results, and 30% (18 patients) had poor results, with the main differences in skin silicone negative imprints. On the basis of the data presented, the new technique of IPL, low intensity diode light, and multidrugs biostimulation seems to be a safe and effective method for skin rejuvenation and upgrades the effects of IPL in the fibroblasts' stimulation.

The color of skin: gray diseases of the skin, nails, and mucosa

Non-ablative skin rejuvenation treatments that involve the use of laser/light sources together with cooling devices have gained much popularity in recent years due to the lack of down time that is associated with them. One important but neglected issue is long-term safety. Does the repeated use of non-ablative skin rejuvenation lead to photoaging? Are we creating another sun-bed phenomenon? Recently, we performed an in vitro study to examine the effect of sub-lethal QS 755 nm lasers on the expression of p16INK4a on melanoma cell lines, and found that sub-lethal laser damage could increase DNA damage, which led to an increase in p16 expression. Our objective was to assess the cutaneous effect of repeated exposure to high-energy lasers and intense pulsed light sources on male Institute of Cancer Research (ICR) mice. Twenty-eight male ICR mice were divided into four groups. Other than the control group, all groups received either laser (585 nm pulsed dye laser or 1,320 nm Nd:YAG laser) or intense pulsed light (IPL) treatment. All four groups were anesthetized with a mixture of Hypnorm/Dormicum before treatment. The animals were irradiated twice a week for 6 months. Signs of toxicity such as mortality and weight loss were checked once a week. Skin tumor formation was evidenced by lesions of greater than 1 mm in diameter that persisted for 2 weeks. At the end of the 6 months, the expression of proliferating cell nuclear antigen (PCNA) and p16 in the mouse skin was determined by immunohistochemical staining and immunoblotting using specific monoclonal antibodies for mouse PCNA and p16. The results were expressed as mean +/- standard error of the mean (SEM). Statistical difference was assessed by multiple ANOVA. A P-value of <0.05 was considered to be significant. At the end of the 6 months, none of the animals had developed any signs of toxicity such as mortality or weight lost. There was no evidence of tumor formation. There were significant elevations of p16 and PCNA in all treated groups as compared to the control group (ANOVA P < 0.05). This particularly applied to the group that was treated with the 1,320 nm Nd:YAG laser. The repeated use of high-energy laser and intense pulsed light source did not cause any toxicity in mice. The changes in p16 and PCNA imply that further studies are necessary to consider the implications of repeated exposure to longer wavelength radiation in human skin.

Patients commonly complain about the appearance of acne scars. While various lasers and energy-based devices can offer clinical improvement, many of them are limited in treating patients with skin of color. Concerns exist regarding efficacy and safety, including risks of scarring, prolonged dyspigmentation, necrosis, and burns. To examine the utility of a 755-nm picosecond laser with fractionated lens array in improving the clinical appearance of acne scars in patients with Fitzpatrick skin types V and VI. A prospective clinical study investigated this laser using up to 5 monthly treatments. Twenty-four subjects were enrolled, while 17 subjects completed a 3-month follow-up. The mean age was 33.9 years, and 95.8% of the subjects were women. Fitzpatrick skin types V and VI were represented. Assessments compared baseline to 3-month follow-up. Two of the 3 blinded reviewers agreed on identifying pretreatment and post-treatment photographs for 82.4% of the cases. For physician Global Aesthetic Improvement Scale, 100% of the subjects had clinical improvement. Overall, 94.1% of subjects were satisfied with their treatment. No serious or unanticipated adverse events occurred. A 755-nm picosecond laser with fractionated lens array can safely and effectively improve acne scars in patients with Fitzpatrick skin types V and VI.

Laser procedures in skin of color (SOC) patients are challenging due to the increased risk of dyspigmentation and scarring. A novel 755 nm alexandrite picosecond laser has demonstrated effectiveness for tattoo removal and treatment of acne scars. No studies to date have evaluated its applications in pigmentary disorders. The purpose of this retrospective study was to evaluate the safety profile and efficacy of the picosecond alexandrite laser compared to the current standard treatment, Q-switched ruby and neodynium (Nd):YAG nanosecond lasers, for pigmentary disorders in SOC patients. A retrospective photographic and chart evaluation of seventy 755 nm alexandrite picosecond, ninety-two Q-switched frequency doubled 532 nm and 1,064 nm Nd:YAG nanosecond, and forty-seven Q-switched 694 nm ruby nanosecond laser treatments, in forty-two subjects of Fitzpatrick skin types III-VI was conducted in a single laser specialty center. The picosecond laser was a research prototype device. Treatment efficacy was assessed by two blinded physician evaluators, using a visual analog scale for percentage of pigmentary clearance in standard photographs. Subject assessment of efficacy, satisfaction, and adverse events was performed using a questionnaire survey. The most common pigmentary disorder treated was Nevus of Ota (38.1%), followed by solar lentigines (23.8%). Other pigmentary disorders included post-inflammatory hyperpigmentation, congenital nevus, café au lait macule, dermal melanocytosis, Nevus of Ito, and Becker's nevus. Clinical efficacy of the Q-switched nanosecond lasers and picosecond laser treatments were comparable for lesions treated on the face with a mean visual analog score of 2.57 and 2.44, respectively, corresponding to approximately 50% pigmentary clearance. Subject questionnaires were completed in 58.8% of the picosecond subjects and 52.0% of the Q-switched subjects. Eighty four percent of subjects receiving Q-switched nanosecond laser treatments and 50% of the subjects receiving alexandrite 755 nm picosecond laser treatments felt satisfied to completely satisfied. Side effects observed in subjects treated with the alexandrite 755 nm picosecond laser were similar to those commonly observed and reported with the nanosecond Q-switched technology. All side effects were temporary, resolving within one month, and no long-term complications were noted. All patients who were very satisfied with their picosecond laser treatment for Nevus of Ota noted a delayed improvement only after 3 months. The 755 nm alexandrite picosecond, 694 nm ruby, 532 nm, and 1064 nm neodynium:YAG nanosecond lasers appear to be safe and effective modalities for removal of pigmentary disorders in skin of color patients with no long-term complications if used appropriately. This study demonstrates the potential of the 755 nm alexandrite picosecond laser in further clinical applications beyond tattoo removal. While the Q-switched lasers were effective, promising results were also observed using an early version of the novel picosecond laser for the removal of pigmentary lesions in SOC patients. As we continue to improve our understanding of the 755 nm picosecond laser, this device may prove to be a safe and effective alternative to the Q-switched lasers for the treatment of facial pigmented lesions in patients with skin of color.

To compare efficacy and side effects of CO(2) laser resurfacing and intense pulsed light (IPL) rejuvenation for treatment of perioral rhytides. Twenty-seven female subjects with perioral rhytides (class I-III) were randomly treated with either CO(2) laser or IPL (three monthly treatments). Efficacy was evaluated by patient self-assessments and blinded photographs up to 12 months postoperatively. Side effects were assessed clinically. Non-invasive measurements included: trans epidermal water loss (TEWL), skin reflectance, skin elasticity, and ultrasound. CO(2) laser resurfacing resulted in higher degrees of patient satisfaction and clinical rhytide reduction compared to IPL rejuvenation up to 12 months postoperatively (patient evaluations, P < 0.05) (observer evaluations, P < 0.008). Laser-induced side effects included erythema, dyspigmentation, and milia whereas no side effects were observed after IPL rejuvenation. Non-invasive measurements showed a significant higher reduction of the subepidermal low-echogenic band in CO(2) laser treated areas versus IPL treated areas (12 months postoperatively, P < 0.001). Skin elasticity (expressed as Young's modulus) increased in both groups (P = ns). One month postoperatively a significant increase in TEWL values (P < 0.009) and skin redness% (P < 0.02) was found in CO(2) laser treated patients versus IPL treated patients. No significant differences were seen in skin pigmentation% during the observation period. CO(2) laser resurfacing induces a significantly higher degree of clinical rhytide reduction followed by considerably more side effects compared to IPL rejuvenation in a homogeneous group of patients.

Ethnic skin or 'skin of colour', which is characterized by increased epidermal melanin, labile melanocytes and reactive fibroblast responses, poses special challenges for the use of laser and light-based therapies. These therapies are associated with a greater risk of dyspigmentation and scarring in ethnic skin and therefore require careful selection of device and treatment parameters to minimize complications. Whereas early-generation lasers for hair removal and resurfacing were generally contraindicated for individuals with Fitzpatrick skin phototypes (SPT) IV-VI, advances in the past decade have given rise to a range of devices that can be safely used in ethnic skin. Longer wavelength lasers such as the 810 and 1064 nm Nd:YAG; intense pulsed light and monochromatic excimer light (308 nm); fractional lasers; and radiofrequency devices have all been used safely for hair removal, pigmentary abnormalities, resurfacing and skin tightening in ethnic skin, respectively. Notwithstanding these advances, nuances in the laser or light treatment of darker skin types remain and must be considered to ensure safe therapeutic outcomes. The vast majority of published data pertaining to lasers and light treatments in nonwhite skin involve patients of East Asian ethnicity (e.g. Korean, Japanese, Chinese, Thai). By contrast, there is a paucity of studies involving individuals of African ancestry or those with SPT V or VI. This article will review laser and light-based modalities that are considered safe and effective for individuals with richly pigmented skin.

This study examines whether intense pulsed light (IPL) treatment has a carcinogenic potential itself or may influence ultraviolet (UV)-induced carcinogenesis. Secondly, it evaluates whether UV exposure may influence IPL-induced side effects. Hairless, lightly pigmented mice (n=144) received three IPL treatments at 2-week intervals. Simulated solar radiation was administered preoperatively [six standard erythema doses (SED) four times weekly for 11 weeks] as well as pre- and postoperatively (six SED four times weekly up to 26 weeks). Skin tumors were assessed weekly during a 12-month observation period. Side effects were evaluated clinically. No tumors appeared in untreated control mice or in just IPL-treated mice. Skin tumors developed in UV-exposed mice independently of IPL treatments. The time it took for 50% of the mice to first develop skin tumor ranged from 47 to 49 weeks in preoperative UV-exposed mice (p=0.94) and from 22 to 23 weeks in pre- and postoperative UV-exposed mice (p=0.11). IPL rejuvenation of lightly pigmented skin did not induce pigmentary changes (p=1.00). IPL rejuvenation of UV-pigmented skin resulted in an immediate increased skin pigmentation and a subsequent short-term reduced skin pigmentation (p<0.002). Postoperative UV radiation resulted in re-pigmentation of IPL-induced pigment reduction (p=0.12). No texture changes were observed. Postoperative edema and erythema were increased by preoperative UV exposure (p<0.002). IPL rejuvenation has no carcinogenic potential itself and does not influence UV-induced carcinogenesis. UV exposure influences the occurrence of side effects after IPL rejuvenation in an animal model.

As the number of dermatologists offering cosmetic procedures continues to increase, so does the need for hands-on exposure to cosmetic dermatology during residency. A resident cosmetic clinic (RCC) model presents as a mutually beneficial opportunity for trainees to obtain first-hand experience, while patients have access to more affordable pricing. (1) To assess volume and variety of cosmetic dermatological procedures during residency. (2) To compare Loma Linda University (LLU) Dermatology RCC data with national residency program data. (3) To provide guidance for other dermatology residency programs who wish to incorporate cosmetic training into their educational curriculum. In this cross-sectional, retrospective, chart review study, resident training in cosmetic procedures at the LLU RCC was quantified and compared with that of national program averages, minimums, and maximums as reported by the Accreditation Council for Graduate Medication Education. LLU RCC residents performed more nonablative skin rejuvenation, intense pulsed light, and soft tissue augmentation procedures as the resident surgeon compared with other dermatology residents across the nation. Institutional review highlights an unmet need for greater exposure to and training in a variety of dermatologic cosmetic procedures during residency. Practical considerations for achieving optimal learning experiences were provided through the implementation of a resident cosmetic clinic.

Removal of benign pigmented skin lesions and tattoos in individuals regretting their tattoo is performed using Q-switched nanosecond lasers and the recently introduced picosecond lasers. In some dermo-epidermal pigmented lesions, only for specific applications, also the long-pulse lasers find indication. Melanin is the target in all the benign pigmented lesions and it adsorbs a wide range of laser wavelengths. However, every wavelength has specific indications on the basis of the lesion depth and the patient phototype. In view of the various tattoo pigments with different absorption spectra specific laser wavelengths are needed. The type of laser wavelength chosen for removal largely depends on the patient’s tattoo color and skin type. Q-switched (QS) lasers such as the QS Ruby, QS Nd: YAG, and QS Alexandrite until recently were the most effective devices for tattoo removal. However, picosecond lasers have quickly become the mainstay of treatment due to their superior efficacy and decreased treatment durations.

A split-face, single-blinded, randomized controlled comparison of alexandrite 755-nm picosecond laser versus alexandrite 755-nm nanosecond laser in the treatment of acquired bilateral nevus of Ota–like macules

Acquired bilateral nevus of Ota-like macules (ABNOM) are a common form of hyperpigmentation in Asian populations, character-ized by small, bilateral, blue-brown and/or slate-gray patches on the forehead, temples, eyelids, malar areas, and alae and roots of the nose [1]. As reported in other studies, several treatment modalities, including cryotherapy and dermabrasion, have been tried for ABNOM Based on the principles of selective photothermolysis, nevus of Ota has been successfully treated with Q-switched (QS) ruby lasers, QS alexandrite lasers, and QS neodymium-doped yttrium aluminium garnet lasers (QS-Nd:YAG) ABNOM and nevus of Ota, are histologically similar, which suggested to us that laser therapy may also be successful for treating ABNOM. We therefore assessed the efficacy and complications of a fractional QS ruby laser (QSRL) in the treatment of ABNOM. The purpose of this study was to evaluate the efficacy and complications of QSRL in the treatment of ABNOM.

Melasma is a common dermatological disorder characterized by hyperpigmented facial patches, which significantly impacting patients' quality of life and imposing substantial economic burdens. Given the multifaceted impact of melasma, there is a pressing need for effective therapeutic strategies. This meta-analysis evaluates the efficacy and safety of combining Q-switched (QS) laser with intense pulsed light (IPL) vs. monotherapy for melasma. A systematic literature search of relevant databases was conducted to identify controlled trials comparing the combination therapy with monotherapy. Primary outcomes included changes in the Melasma Area and Severity Index (MASI) score and adverse reactions. Secondary outcomes comprised clinical efficacy rate, recurrence rate, and patient satisfaction rate. Data were pooled using a fixed-effects model. A total of 31 studies involving 2,801 patients were included. Results showed that the combination therapy demonstrated a significantly greater reduction in MASI scores than monotherapy (standardized mean difference: 1.20, 95% CI: -1.36 to -1.05; p < 0.001). The pooled efficacy rate was also higher for the combination group (92.0% vs. 77.4%; risk ratio: 1.10, 95% CI: 1.03-1.17; p < 0.05). Moreover, the combination group exhibited a lower recurrence rate (8.5 vs. 17.8%; risk ratio: 0.54, 95% CI: 0.32-0.90; p < 0.05). However, no significant difference in patient satisfaction was observed between the two groups. The incidence of adverse events was comparable between the treatments. This meta-analysis indicates that Q-switched laser combined with intense pulsed light results in greater objective improvement in melasma than monotherapy, without an increased risk of adverse events. In contrast, patient satisfaction shows no significant improvement, suggesting that patient-reported outcomes should be considered alongside clinician-assessed measures. Additional longitudinal studies are needed to establish sustained efficacy and clarify patient-perceived benefits to further refine clinical protocols. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251170319, identifier: CRD420251170319.

BackgroundThe wide wavelength spectrum of intense pulsed light (IPL) provides an opportunity for a versatile array of clinical applications in dermatology.MethodsKey randomized clinical trials which took place in the past 20 years were summarized, focusing on skin rejuvenation, including pigmented and vascular lesions. We searched Pubmed using the key words intense, pulsed, light, and skin, then filtered results for randomized clinical trials.Results and ConclusionsStudies uniformly showed improvement in pigmented and vascular lesions with IPL. Efficacy in treating rhytides was only observed in some studies. IPL was also effective as a light source in treating actinic keratosis with photodynamic therapy. Rare cases of post‐inflammatory hyperpigmentation were observed.