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Hyperpigmentation
Kinds of Hyperpigmentation Selected AbstractsOutcomes of Childhood Hemangiomas Treated with the Pulsed-Dye Laser with Dynamic Cooling: A Retrospective Chart AnalysisDERMATOLOGIC SURGERY, Issue 12 2009CARINA RIZZO MD BACKGROUND Laser treatment of childhood hemangiomas remains controversial. Previous studies have used outdated technology, resulting in a potential overrepresentation of adverse outcomes. OBJECTIVE To evaluate outcomes of hemangiomas treated with the most current laser technology. METHODS A retrospective chart analysis of 90 patients with a median age of 3.0 months and a total of 105 hemangiomas were enrolled over a 2.5-year period. All were treated with the 595-nm long-pulse pulsed-dye laser (LP-PDL) with dynamic epidermal cooling at 2- to 8-week intervals depending on the stage of growth. Exclusion criteria were previous laser, surgical, or corticosteroid treatment. Three reviewers assessed outcomes. RESULTS Near-complete or complete clearance in color were achieved for 85 (81%) and in thickness for 67 (64%) hemangiomas. There was no scarring or atrophy. Ulceration occurred in one case and resolved during treatment. Hyperpigmentation and hypopigmentation occurred in 4% and 14% of hemangiomas, respectively. CONCLUSION Early treatment of childhood hemangiomas with the 595-nm LP-PDL with dynamic cooling may reduce the proliferative phase and result in excellent rates of clearing and few adverse events. [source] Phenol-Castor Oil: Modified Peel for Dermal MelasmaDERMATOLOGIC SURGERY, Issue 5 2006THADA PIAMPHONGSANT MD BACKGROUND Deep type of melasma is difficult to treat. Various compositions for peeling have been formulated to accomplish this. OBJECTIVE Our purpose was to determine the safe use of the new formula, which was composed of phenol and castor oil. METHODS Different concentrations of phenol and castor oil were mixed in five formulations, and the solutions were tested on the forearms of 10 volunteers. The application time was 1 minute, different from that of the original phenol-croton oil. Formula 4 was found to cause a high effect of peeling with least side effects and was used to treat deep facial melasma in 30 patients. RESULTS Higher concentrations of castor oil produced more inflammation when mixed with phenol. Formula 4 was used to clear two cases of melasma in 1 week despite no effect from prior use of a modified antimelasma cream, while some degree of fading was noted in other cases. The total number of different melasma indices was reduced from 206.4 to 91.2 in 30 patients. Hyperpigmentation was noted in five cases and hypopigmentation in one case. Neither scar formation nor cardiac arrhythmia was observed. CONCLUSION A phenol-castor oil peel with an application time of 1 minute reduces pigments in the deep type of melasma with least side effects and a high efficiency when combined with an antimelasma cream. The safe formula and the technique of application are introduced. [source] Minocycline-Induced Hyperpigmentation Treated with a 755-nm Q-Switched Alexandrite LaserDERMATOLOGIC SURGERY, Issue 9 2004Tina S. Alster MD Background. Cutaneous pigmentation associated with minocycline therapy is an unusual adverse effect for which few successful treatments have been described. The pigment changes may persist for years, despite cessation of therapy, and is often cosmetically disfiguring, causing significant embarrassment and psychological depression in those affected. Few safe and effective treatments have been described in the past; however, recent pigment-specific laser technology has shown promise in the treatment of this condition. Objective. The objective was to describe a series of patients with minocycline-induced hyperpigmentation who were successfully treated with a 755-nm Q-switched alexandrite laser. Methods. Six patients with minocycline-induced hyperpigmentation on the face or legs were treated with a Q-switched alexandrite laser on a bimonthly basis until pigmentation was eradicated. Results. Cutaneous pigmentation resolved completely in all patients in an average of four laser sessions. Side effects were limited to transient purpura and mild desquamation without scarring or dyspigmentation. Conclusion. Minocycline-induced cutaneous pigmentation can be effectively cleared without risk of adverse sequelae by Q-switched alexandrite (755-nm) laser irradiation. [source] Minocycline-Induced Hyperpigmentation of the Tongue: Successful Treatment with the Q-Switched Ruby LaserDERMATOLOGIC SURGERY, Issue 3 2002Ilyse S. Friedman MD background. Minocycline-induced hyperpigmentation (MIH) is a benign condition that may persist for years despite abrogation of therapy. The Q-switched ruby laser (QSRL) has been successful in removing such lesions from the skin. To date there is no documentation of QSRL or any laser being used to treat lingual hyperpigmentation associated with minocycline therapy. objective. Long-term follow-up results are reported for the use of QSRL to treat lingual hyperpigmentation. The literature is reviewed comparing the use of different laser systems on MIH. methods. A 26-year-old woman with pigment changes of the tongue and buccal mucosa due to long-term minocycline therapy was treated with four consecutive sessions with QSRL (694 nm, 20-nsec pulse duration, and 6.5 mm spot size) at 3.6,4.0 J/cm2. results. A 90% resolution was achieved after three treatments. After the final treatment the lesions were completely gone. There were no side effects reported. No new pigment was detected at follow-up. conclusion. Treatment with the QSRL is a safe and effective strategy for treating hyperpigmentation of the tongue associated with minocycline therapy. [source] Q-Switched Ruby Laser Treatment for Postsclerotherapy HyperpigmentationDERMATOLOGIC SURGERY, Issue 7 2000Alireza Tafazzoli Background. One of the most common adverse sequelae of sclerotherapy is cutaneous hyperpigmentation. Objective. We used the Q-switched ruby laser to treat postsclerotherapy hyperpigmentation. Methods. Eight patients developed pigmentation lasting more than 1 year (1,2 years on average) after sclerotherapy treatment for reticular and telangiectatic veins in the legs ranging in size from 0.2 to 4 mm in diameter. All patients were treated with a Q-switched ruby laser at 694 nm, 4 mm beam size, and fluence range of 5.6,10.5 J/cm2. Results. Ninety-two percent of lesions lightened after treatment. There was significant (75,100%) resolution of hyperpigmentation in 58% of treated areas, 25% improvement in 33% of treated areas, and no improvement in the remaining areas. Conclusion. Our impression is that given a choice of lasers, the Q-switched ruby laser provides the greatest efficacy for treating postsclerotherapy hyperpigmentation. [source] Effect of copper on hatching and development of larvae of the estuarine crab Chasmagnathus granulata (Decapoda, Brachyura)ENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 7 2001Valeria Zapata Abstract Ovigerous females of the estuarine crab Chasmagnathus granulata were exposed to 0.05, 0.1, 0.5, and 3 mg/L of copper during the egg incubation period. Regarding egg loss, a higher effect was observed at higher copper concentrations: 80% of the females lost their eggs at 0.5 mg/L, whereas no hatching was seen in those exposed to 3 mg/L. A significant decrease was found in the number of hatched larvae in females exposed to 0.5 mg/L, as was a significant decrease in the duration of the incubation period. In addition, several morphological abnormalities were seen and observed. Hydropsy and atrophy of the dorsal spine, pleon, and maxillipeds occurred at the higher copper concentrations, as found in previous studies with other pollutants. Hyperpigmentation of the cephalothorax and pleon was the only abnormality observed at every concentration assayed. Hypopigmented eyes were also evident. This pathology showed that among all defects observed at 0.5 mg/L, hypopigmented eyes had the highest incidence and might be a specific response to copper. [source] Transdermal Clonidine Skin ReactionsJOURNAL OF CLINICAL HYPERTENSION, Issue 2 2002L. Michael Prisant MD The clonidine transdermal therapeutic system is being used as a therapy for blood pressure treatment. Systemic side effects seem to be fewer than with oral clonidine. However, localized skin reactions occur frequently and the incidence increases with the dose and duration of use. Common signs include erythema, scaling, vesiculation, excoriation, and induration. Allergic contact dermatitis is less frequent but common. Hyperpigmentation and depigmentation also occur. Pretreatment with 0.5% hydrocortisone is associated with less skin irritation and higher blood levels. Although oral clonidine is no longer widely used in the management of hypertension, awareness of these reactions to the transdermal delivery of this agent is important. [source] Chloracne: histopathologic findings in one caseJOURNAL OF CUTANEOUS PATHOLOGY, Issue 4 2002Maria Antonia Pastor Background: Chloracne is an acneiform eruption due to poisoning by halogenated aromatic compounds having a specific molecular shape. This condition is always a symptom of systemic poisoning by chemical chloracnegens and not just a cutaneous disorder. Methods: We have studied a patient with severe chloracne who showed cutaneous lesions involving mostly the face and the axillae. Results:, Histopathologic study of the facial lesions demonstrated that almost every vellus hair follicle was involved, showing a dilated infundibulum filled by a keratotic plug. This keratotic material was mostly composed of orthokeratotic basket-weave basophilic corneocytes, namely infundibular keratin, although there were also some dilated infundibula containing eosinophilic laminated or granular sebum at their center. Small infundibular cysts were more numerous than comedones. Mature and well-developed sebaceous glands were seen at the base of many of the dilated infundibula and no squamous metaplasia of the sebaceous glands or ducts could be demonstrated. Hyperpigmentation of the lesions resulted from hyperproduction of melanin by a normal number of melanocytes along the basal layer of the epidermis and infundibular epithelium. Abundant melanin granules also impregnated the corneocytes of the infundibular plugs. Conclusions:, Our findings support the notion that tiny infundibular cysts rather than comedones represent the basic lesions of chloracne. [source] Discoid Lupus Erythematosus in Children: Clinical, Histopathologic, and Follow-Up Features in 27 CasesPEDIATRIC DERMATOLOGY, Issue 2 2003Celia Moises-Alfaro, M.D. During a mean follow-up period of 36 months, seven patients (26%) developed systemic lupus erythematosus (SLE). Four of these patients were less than 10 years of age. No correlation was found between localized and disseminated lesions and evolution to SLE. Three of four patients with a positive family history for rheumatoid disease developed SLE (p < 0.05). Hyperpigmentation was significantly more frequent (p < 0.04) in children less than 10 years of age. There was a female predominance of 5:1 among patients less than 10 years of age. Our findings suggest that onset of DLE prior to 10 years of age does not indicate a greater risk of developing SLE. The occurrence of localized or disseminated lesions does not seem to influence the outcome. [source] Treatment of Superficial Infantile Hemangiomas of the Eyelid Using the 595-nm Pulsed Dye LaserDERMATOLOGIC SURGERY, Issue 5 2010CHRISTOPHER M. HUNZEKER MD BACKGROUND Despite the proven effectiveness of the 595-nm pulsed dye laser (PDL) in treating superficial infantile hemangiomas, many physicians are reluctant to treat such lesions involving the eyelid. OBJECTIVE To examine the safety and efficacy of the 595-nm PDL for the treatment of superficial infantile hemangiomas of the eyelid. MATERIALS & METHODS Records were reviewed for patients with superficial infantile hemangiomas of the eyelid treated with 595-nm PDL. Pre- and post-treatment photographs were compared. Reviewers rated the degree of improvement of the hemangioma as excellent (76,100%), good (51,75%), moderate (26,50%), or poor (0,25%) and indicated whether the hemangioma was 100% clear. Side effects of scarring, atrophy, hyperpigmentation, and hypopigmentation were assessed. RESULTS Twenty-two patients met the study criteria. Eight (36.4%) demonstrated complete clearance of their hemangioma, 17 (77.3%) received an improvement rating of excellent, and five (22.7%) received a rating of good. No scarring, atrophy, or hypopigmentation was noted. Two patients (9.1%) were noted to have hyperpigmentation in the treated area. CONCLUSION Early treatment with the 595-nm PDL can safely and effectively diminish proliferative growth and hasten resolution of superficial infantile hemangiomas of the eyelid. Roy G. Geronemus, MD, is on the Medical Advisory Board for Candela Laser Corp. [source] Review of Fractional Photothermolysis: Treatment Indications and EfficacyDERMATOLOGIC SURGERY, Issue 10 2009EMILY P. TIERNEY MD BACKGROUND Fractional photothermolysis (FP) is one of the most significant milestones in laser technology and resurfacing. METHODS Review of the Medline English literature and recent international conferences regarding FP technology, applications, and indications. RESULTS Successful conditions treated with nonablative FP reported in the literature include acne scarring; dyschromia and fine wrinkling of photoaging on the face, chest, neck, and hands; melasma; poikiloderma of Civatte; nevus of Ota; scars; minocycline hyperpigmentation; telangiectatic matting; residual hemangioma; granuloma annulare; colloid milium; and disseminated superficial actinic porokeratosis. An advance in 2007 was the introduction of ablative FP (AFP), which results in significantly greater improvement in skin laxity and textural abnormalities. Most recently, AFP has demonstrated significantly greater improvement than nonablative FP in reducing acne scarring and skin redundancy and laxity associated with photoaging. CONCLUSIONS Through the induction of microthermal zones of injury, FP technology stimulates a robust and rapid wound healing response resulting in improvement in a diversity of aesthetic, inflammatory, and preneoplastic skin disorders. Further investigation into the technology and diverse array of cutaneous conditions that can benefit from FP is highly needed. [source] Eyelid Tightening and Improved Eyelid Aperture through Nonablative Fractional ResurfacingDERMATOLOGIC SURGERY, Issue 11 2008SEAN A. SUKAL MD BACKGROUND AND OBJECTIVE The effects of fractional resurfacing on eyelid tightening and aperture are unknown. Our purpose was to retrospectively examine the potential for eyelid tightening and eye-aperture opening in patients treated with nonablative fractional resurfacing for facial photorejuvenation. STUDY DESIGN/MATERIALS AND METHODS Fractional laser treatments using a 1,550-nm erbium-doped fiber laser system on the upper and lower eyelids were given at a pulse energy of 17 to 20 mJ at 125 micro-thermal zones (MTZ)/cm2 to a final density of 500 to 750 MTZ/cm2. Each patient had 3 to 7 treatments. Standard pre- and post-treatment photographs were taken at each visit. Physicians who graded 31 preselected patient photographs using a 4-point scale evaluated eyelid tightening. Increase in eyelid aperture was also evaluated. RESULTS All patients had some degree of eyelid tightening; 19% achieved 1% to 25% tightening, 26% achieved 25% to 50%, 26% achieved 50% to 75%, and 29% achieved 75% to 100%. Increase in eyelid aperture was seen in 55.9% of patients. Postoperative wounding, hypopigmentation, hyperpigmentation, persistent erythema, and scarring were not observed. All patients experienced mild or no edema for a few days after treatment. CONCLUSION Fractional resurfacing tightens and increases eyelid aperture without wounding, downtime, or long-term complications. [source] Side Effects and Complications of Fractional Laser Photothermolysis: Experience with 961 TreatmentsDERMATOLOGIC SURGERY, Issue 3 2008EMMY M. GRABER MD BACKGROUND A novel 1,550-nm erbium-doped laser (Fraxel, Reliant Technologies Inc.) has been shown to be effective in the treatment of photodamaged skin and scars with minimal postoperative recovery; however, studies evaluating its side effects and complication rates have been limited. PURPOSE The purpose was to determine the frequency and range of side effects and complications associated with fractional photothermolysis treatment. METHODS A retrospective evaluation of 961 successive 1,550-nm erbium-doped laser treatments in patients of various skin phototypes (I,V) was conducted in a single center. Side effects and complications of treatment, including time of onset and duration, were identified and tabulated. Patient demographics and laser parameters were also assessed. RESULTS Seventy-three treatments (7.6%) resulted in development of complications. The most frequent complications were acneiform eruptions (1.87%) and herpes simplex virus outbreaks (1.77%). Side effects and complications were equally distributed across different ages, skin types, body locations, laser parameters, and underlying skin conditions, except for postinflammatory hyperpigmentation, which occurred with increased frequency in patients with darker skin phototypes. CONCLUSIONS Fractional laser skin treatment is associated with a relatively low complication rate. Side effects and complications observed in this study were temporary and did not result in long-term or significantly severe sequelae (e.g., scarring). [source] Regression of Atypical Nevus: An Anecdotal Dermoscopic ObservationDERMATOLOGIC SURGERY, Issue 10 2006MARIA A PIZZICHETTA MD BACKGROUND Clark nevi (atypical melanocytic nevi) can be considered as risk markers and potential precursors of melanoma. The authors report on the morphologic changes of an atypical nevus by dermoscopic follow-up examination over a 7-year period. CASE REPORT A 43-year-old man had a brown macule on his back, sized 5 mm, with an irregular shape, clinically and dermoscopically diagnosed as an equivocal melanocytic lesion. Dermoscopically during the initial examination, a predominant reticular pattern with peripheral eccentric hyperpigmentation in the lower portion of the lesion could be seen. After 7 months, the area of peripheral eccentric hyperpigmentation had regressed, and after 4.5 years the atypical pigment network had almost disappeared. After 7 years of follow-up, a diffuse area of hypopigmentation and a residual light brown pigmentation were detectable. The histopathologic diagnosis was consistent with an atypical junctional nevus with regression with features of a Clark nevus. CONCLUSION Based on our observation, even a dermoscopically atypical nevus may undergo regression as documented by long-term dermoscopic follow-up. [source] Photoepilation Results of Axillary Hair in Dark-Skinned Patients by IPL: A Comparison Between Different Wavelength and Pulse WidthDERMATOLOGIC SURGERY, Issue 2 2006JONG HEE LEE MD BACKGROUND Recently, intense pulsed light (IPL) sources have been shown to provide long-term hair removal. OBJECTIVE This study examined the photoepilatory effects of different wavelengths and pulse width application in the same device and compared their efficiencies in Asian skin. METHODS Twenty-eight Korean women were treated using HR (600,950 nm filter) and 27 using HR-D (645,950 nm filter) in the axillar area. Four treatments were carried out at intervals of 4 to 6 weeks; follow-ups were conducted 8 months after the last treatment. Mean energy settings were 14.9±2.0 J/cm2 for HR and 17.1±0.6 J/cm2 for HR-D. Longer pulse widths were applied in case of HR-D treatment. Hair counts and photographic evaluation of skin sites were made at baseline and at the last follow-up. Final overall evaluations were performed by patients and clinicians. RESULTS Average clearances of 52.8% and 83.4% were achieved by HR and HR-D, respectively. No significant adverse effects were reported after HR-D treatment. One case each of hypopigmentation and hyperpigmentation was reported for HR. CONCLUSION An IPL source by removing 45 nm of the emitted spectra and applying longer pulse width was found to provide a safer and more effective means of photoepilation in Asian patients. [source] Variable-Pulse Nd:YAG Laser in the Treatment of Facial TelangiectasiasDERMATOLOGIC SURGERY, Issue 1 2006AVERY A. BEVIN MD BACKGROUND Variable-pulse 1,064 nm wavelength lasers have been used with good effectiveness on leg telangiectasias and reticular veins and have shown promising results on facial telangiectasias as well. OBJECTIVE To investigate the effectiveness of a variable-pulse neodymium:yttrium-aluminum-garnet (Nd:YAG) laser using a small spot size in the treatment of facial telangi-ectasias. METHODS Eight male patients (mean age 75 years) underwent a single treatment session using a variable-pulse 1.5 mm spot size Nd:YAG laser with epidermal cooling. Telangiectasia diameters were 0.3 to 2.0 mm. Test sites were performed using three pulse widths (3, 20, and 60 ms), with fluences varying depending on vessel size and response. Full treatments were per-formed using test parameters giving the best response. Thirteen weeks later, the patients returned for final evaluation and satisfaction rating. RESULTS Fluences ranged from 226 to 425 J/cm2, with smaller vessels requiring larger energies. Pulse duration was equally divided between the 20 and 60 ms settings. The shortest pulse width (3 ms) was inferior in all patients. Longer pulse durations achieved superior vessel elimination with minimal immediate purpura and no postinammatory hyperpigmentation. The average mean vessel clearance was 26 to 50% in half of the patients and 51 to 75% in the other half as evaluated by three unbiased dermatologists with extensive laser experience. CONCLUSION A small,spot size Nd:YAG laser using a pulse width of 20 ms or higher appears to be effective in clearing a significant percentage of facial telangectasias with a single pass. The side effects were minimal. [source] The Treatment of Melasma with Fractional Photothermolysis: A Pilot StudyDERMATOLOGIC SURGERY, Issue 12 2005Cameron K. Rokhsar MD Background. Melasma is a common pigmentary disorder that remains resistant to available therapies. Facial resurfacing with the pulsed CO2 laser has been reported successful but requires significant downtime, and there is a risk of adverse sequelae. Objective. To determine if melasma will respond to a new treatment paradigm, fractional resurfacing. Methods. Ten female patients (Fitzpatrick skin types III,V) who were unresponsive to previous treatment were treated at 1- to 2-week intervals with the Fraxel laser (Reliant Technologies, Palo Alto, CA, USA). Wavelengths of 1,535 and 1,550 nm were both used, and 6 to 12 mJ per microthermal zone with 2,000 to 3,500 mtz/cm2 were the treatment parameters. Four to six treatment sessions were performed. Responses were evaluated according to the percentage of lightening of original pigmentation. Two physicians evaluated the photographs, and each patient evaluated her own response. Results. The physician evaluation was that 60% of patients achieved 75 to 100% clearing and 30% had less than 25% improvement. The patients' evaluations agreed, except for one patient, who graded herself as 50 to 75% improved as opposed to the physician grading of over 75%. There was one patient with postinflammatory hyperpigmentation and no patient with hypopigmentation. No downtime was necessary for wound healing. Conclusions. Fractional resurfacing affords a new treatment algorithm for the treatment of melasma that combines decreased risk and downtime with significant efficacy. This treatment modality deserves further exploration to maximize benefits. RELIANT technologies LOANED THE FRAXEL LASER FOR THE STUDY. RICHARD E. FITZPATRICK, MD, IS A PAID CONSULTANT FOR RELIANT AND A STOCKHOLDER. [source] Short-Term Side Effects of Fractional PhotothermolysisDERMATOLOGIC SURGERY, Issue 2005Galen H. Fisher MD Objective:. To ascertain the immediate and short-term side effects of fractional photothermolysis for the treatment of a variety of skin disorders involving the face, neck, chest, and hands. Methods. Physician-administered questionnaires were given during 60 follow-up visits for fractional photothermolysis treatment for a variety of facial skin disorders in patients with skin types ranging from I to IV. The questionnaire addressed 14 possible side effects, pain, and limitation of social activities. In addition, all patients were asked about any additional side effects not mentioned in the survey. An analysis of the data was performed once 60 surveys had been collected. Results. All patients (100%) undergoing fractional photothermolysis had transient post-treatment erythema. Other frequently reported post-treatment side effects were transient and included facial edema (82%), dry skin (86.6%), flaking (60%), a few (one to three) small, superficial scratches (46.6%), pruritis (37%), and bronzing (26.6%). Other more rarely reported effects included transient increased sensitivity (10%) and acneiform eruption (10%). Most patients reported that the pain level was easily tolerated, with an average pain score of 4.6 on a scale of 10. Most patients (72%) reported limiting social engagements for an average of 2 days after treatment. There were no long-lasting adverse events noted in our survey. Conclusion. Fractional photothermolysis to treat dermatologic conditions on the face, neck, chest, and hands is a well-tolerated and safe procedure with several immediate, and slightly delayed, post-treatment side effects. In our experience, these side effects were transient and limited to erythema, edema, dry skin, flaking skin, superficial scratches, pruritis, increased sensitivity, and acneiform eruption. Importantly, we did not see the development of post-treatment scarring, herpetic activation, hypopigmentation, hyperpigmentation, persistent erythema, persistent edema, or infection. [source] Long-Pulsed Dye Laser Treatment for Facial Telangiectasias and Erythema: Evaluation of a Single Purpuric Pass versus Multiple Subpurpuric PassesDERMATOLOGIC SURGERY, Issue 8 2005Shilesh Iyer MD Background and Objective. Subpurpuric treatments with the pulsed dye laser can be effective for treatment of vascular lesions, although less so than when purpuric fluences are used. Increased efficacy may be achieved by performing multiple passes at the time of treatment. We performed a split-face bilateral paired comparison of multiple low-fluence subpurpuric passes compared with a single high-fluence purpuric pass in the treatment of facial telangiectasias. Materials and Methods. Nine patients were included in the study. One cheek was chosen to be treated with four passes of a nonpurpuric fluence, and the contralateral cheek was treated with a single purpuric pass. Reductions in vessel density, diameter, arborization, and background erythema were evaluated 3 weeks after treatment. Results. We found a 43.4% reduction in surface area covered by telangiectasias on the cheek treated with a single purpuric pass compared with 35.9% on the cheek treated with four subpurpuric passes. The purpuric fluences produced greater reduction in vessel diameter and arborization, whereas the subpurpuric protocol was more effective in reducing background erythema. Purpuric fluences were also noted to produce more significant edema and transient hyperpigmentation in one patient. Conclusion. The multipass subpurpuric approach to treatment with the pulsed dye laser is both cosmetically acceptable and effective, although purpuric treatments may be required to effectively eliminate larger-caliber, more highly networked vessels. [source] Novel Approach to the Treatment of Hyperpigmented Photodamaged Skin: 4% Hydroquinone/0.3% Retinol versus Tretinoin 0.05% Emollient CreamDERMATOLOGIC SURGERY, Issue 2005Zoe Diana Draelos MD Background. Mild to moderately photodamaged skin is characterized by dyspigmentation, fine wrinkles, and tactile roughness. An optimal approach to the topical treatment of photoaging would simultaneously address all appearance issues. Objective. This study was undertaken to evaluate the effect of 4% hydroquinone and 0.3% retinol in photoaging. Materials and Methods. A 16-week study was designed to evaluate the efficacy and tolerance of a single cream containing prescription topical 4% hydroquinone for dyspigmentation and the cosmeceutical 0.3% retinol for fine wrinkles in an emollient vehicle for tactile roughness. This novel formulation was compared with 0.05% tretinoin emollient cream, the standard against which all other topical photoaging treatments are compared. Investigator assessments, subject assessments, and photography represented the evaluation end points. Results. The cosmeceutical emollient 4% hydroquinone/0.3% retinol cream more effectively diminished the collective signs of photodamage than 0.05% tretinoin emollient cream in terms of dyspigmentation, fine wrinkles, and tactile roughness in 16 weeks. Conclusion. Combination therapy of hydroquinone and retinol may improve photoaging-associated hyperpigmentation. THIS STUDY WAS CONDUCTED AS PART OF A RESEARCH GRANT FROM MEDICIS THE DERMATOLOGY COMPANY, PHOENIX, ARIZONA. DR. DRAELOS HAS NO FINANCIAL INTEREST IN ANY OF THE MEDICATIONS DISCUSSED IN THIS RESEARCH. [source] Nonablative 1450-nm Diode Laser in the Treatment of Facial Atrophic Acne Scars in Type IV to V Asian Skin: A Prospective Clinical StudyDERMATOLOGIC SURGERY, Issue 10 2004Sze-Hon Chua MRCP (UK) Background. There is presently little published data on the clinical effectiveness of nonablative lasers in the treatment of atrophic acne scars and the safety of their use in patients with darker skin types. Objective. This study aims to determine the clinical effectiveness and safety of the nonablative 1450 nm diode laser with cryogen cooling spray in the treatment of facial atrophic acne scars in Type IV-V Asian skin. Methods. This is a prospective non-comparative open study. 4 to 6 laser treatment sessions were performed on patients with atrophic acne scars. Final clinical assessment was performed 6 months after the last treatment. Results. 57 patients were evaluated. Patient's self-assessment of scar improvement as compared with doctor's assessment was as follows: patients who completed 4 treatments (15.7% vs 6.6%), patients who completed 5 treatments (20% vs 7.9%) and patients those who completed 6 treatments (17.3% vs 5.0%). Main side effects were mild to moderate pain during the procedure, transient erythema, and hyperpigmentation which occurred in 39% of treated patients. Conclusion. The nonablative 1450 nm diode laser may be effective in achieving mild to moderate gradual clinical improvement in the treatment of facial atrophic acne scars. The procedure is associated with minimal downtime and is safe for use in darker skin types IV and V. [source] Combination Surgical Lifting with Ablative Laser Skin Resurfacing of Facial Skin: A Retrospective AnalysisDERMATOLOGIC SURGERY, Issue 9 2004Tina S. Alster MD Background. Cutaneous aging is manifested by rhytides, dyschromias, and skin laxity. Ablative laser skin resurfacing can effectively improve many signs of skin aging; however, the photoaged patient with facial laxity often requires a surgical lifting procedure in order to obtain optimal results. Concerns with delayed or impaired wound healing has led to reluctance to perform both procedures simultaneously. Objective. To report the clinical results and side effect profiles after concomitant surgical facial lifting procedures and ablative carbon dioxide or erbium:YAG laser resurfacing in a series of patients. Methods. A retrospective analysis and chart review was performed in 34 consecutive patients who underwent combination CO2 or erbium:YAG laser skin resurfacing and surgical lifting procedures, including S-lift rhytidectomy, blepharoplasty, and brow lift. Side effects and complication rates were tabulated. Results. The side effect profile of the combined surgical-laser procedures was similar to that reported after a laser-only procedure. The most common side effect was transient hyperpigmentation which occurred in 20.6% of treated patients. None of the patients experienced delayed reepithelialization, skin necrosis, or prolonged healing times. Conclusions. Concurrent laser skin resurfacing and surgical lifting of facial skin maximizes aesthetic results without increased incidence of adverse effects. Patients benefit from the consolidation of anesthesia and convalescent times as well as enhanced global clinical outcomes. [source] Intense Pulsed Light for the Treatment of Refractory Melasma in Asian PersonsDERMATOLOGIC SURGERY, Issue 9 2004Chia-Chen Wang MD Background. Patients with dermal or mixed-type melasmas are often refractory to various treatments. Intense pulsed light has been used to treat melanocytic lesions with promising results. Objective. The purpose of this study was to clarify the effectiveness of intense pulsed light for refractory melasma in Asian persons. Methods. Seventeen patients were treated with intense pulsed light, during four sessions at 4-week intervals. The patients were also given 4% hydroquinone cream and broad-spectrum sunscreens to prevent and treat postinflammatory hyperpigmentation. Sixteen patients in the control group were treated with hydroquinone cream and sunscreens. The treatment efficacy was evaluated using reflectance spectrophotometer and patient satisfaction questionnaire. Results. Patients in the intense pulsed light group achieved an average of 39.8% improvement in relative melanin index, compared to 11.6% improvement in the control group (p<0.05) at Week 16. Six (35%) patients in the intense pulsed light group had more than 50% improvement, compared to two (14%) patients in the control group. Two patients in the intense pulsed light group, however, experienced transient postinflammatory hyperpigmentation, and partial repigmentation was noted 24 weeks after the last treatment session. Conclusion. Intense pulsed light is a safe and effective treatment for refractory melasma in Asian persons, with minimal side effects. Further treatment sessions are required for maintenance therapy. [source] Minocycline-Induced Hyperpigmentation Treated with a 755-nm Q-Switched Alexandrite LaserDERMATOLOGIC SURGERY, Issue 9 2004Tina S. Alster MD Background. Cutaneous pigmentation associated with minocycline therapy is an unusual adverse effect for which few successful treatments have been described. The pigment changes may persist for years, despite cessation of therapy, and is often cosmetically disfiguring, causing significant embarrassment and psychological depression in those affected. Few safe and effective treatments have been described in the past; however, recent pigment-specific laser technology has shown promise in the treatment of this condition. Objective. The objective was to describe a series of patients with minocycline-induced hyperpigmentation who were successfully treated with a 755-nm Q-switched alexandrite laser. Methods. Six patients with minocycline-induced hyperpigmentation on the face or legs were treated with a Q-switched alexandrite laser on a bimonthly basis until pigmentation was eradicated. Results. Cutaneous pigmentation resolved completely in all patients in an average of four laser sessions. Side effects were limited to transient purpura and mild desquamation without scarring or dyspigmentation. Conclusion. Minocycline-induced cutaneous pigmentation can be effectively cleared without risk of adverse sequelae by Q-switched alexandrite (755-nm) laser irradiation. [source] Intense Pulsed Light Treatment of Photoaged Facial SkinDERMATOLOGIC SURGERY, Issue 8 2004Douglas E. Kligman MD Background. It has been reported that intense pulsed light is efficacious for rejuvenation of photoaged skin, specifically the improvement of appearance of telangiectases and solar lentigines. Objective. The objective was to define the treatment variables for photodamaged facial skin using a newer intense pulsed light system. Methods. Twenty-three female subjects received three treatments using double-stacked pulses with fluences of 24 and 30 J/cm2. Response to treatment was evaluated using digital photography. Three signs of photoaging were evaluated: surface texture/roughness, mottled hyperpigmentation, and erythema/telangiectases. Results. There was a shift in clinical grading from more to less severe on all three measures of photoaging. Conclusion. Intense pulsed light therapy was efficacious in ameliorating the clinical signs of photoaging. The device was well tolerated with minimal side effects. [source] Improvement of Dermatochalasis and Periorbital Rhytides With a High-Energy Pulsed CO2 Laser: A Retrospective StudyDERMATOLOGIC SURGERY, Issue 4 2004Tina S. Alster MD Background. Upper eyelid dermatochalasis is typically treated with excisional blepharoplasty. The role of the CO2 laser previously had been confined to that of a vaporizing, incisional, or hemostatic tool. Over the past several years, however, ablative CO2 laser skin resurfacing has been popularized as an adjunctive treatment to blepharoplasty to minimize periorbital rhytides through its vaporizing as well as skin-tightening action. Objective. To evaluate the safety and efficacy of a high-energy pulsed CO2 laser as a stand-alone treatment for dermatochalasis and periorbital rhytides. Methods. Sixty-seven patients (skin phototypes I,IV) with mild-to-severe upper eyelid dermatochalasis and periorbital rhytides received periocular CO2 laser skin treatment. Global assessment scores of dermatochalasis and rhytides were determined by a side-by-side comparison of periocular photographs preoperatively and 1, 3, and 6 months postoperatively. In addition, caliper measurements of upper eyelids before and 1, 3, and 6 months after treatment were obtained. Results. Both dermatochalasis and periorbital rhytides were significantly improved after periocular CO2 laser skin resurfacing. Patients with more severe dermatochalasis and rhytides showed greater improvement after CO2 laser treatment than did those with mild or moderate involvement. Side effects were limited to erythema and transient hyperpigmentation. No scarring, hypopigmentation, or ectropion were observed. Conclusions. Periocular skin resurfacing with a CO2 laser can safely and effectively improve upper eyelid dermatochalasis and periorbital rhytides. [source] Combined Excimer Laser and Topical Tacrolimus for the Treatment of Vitiligo: A Pilot StudyDERMATOLOGIC SURGERY, Issue 2 2004Adam Z. Kawalek BA Background. Vitiligo is an acquired skin disorder that is characterized by well-defined, often symmetric white patches. Although current therapeutic modalities are directed toward increasing melanocyte melanin production, few treatment modalities address the immunologic nature of the disease. Objective. To determine whether excimer laser, a known therapeutic modality, in combination with tacrolimus, a topical immunomodulator, accelerate response time and/or improve the degree of response in patients with this disorder. Methods. Eight subjects diagnosed with vitiligo were recruited to participate in this institutional review board,approved double-blind, placebo-controlled study. Twenty-four symmetric vitiliginous patches (elbows, knees) from eight subjects received excimer laser treatment three times per week for 24 treatments or 10 weeks. Additionally, topical tacrolimus 0.1% ointment (Protopic) and placebo (Aquaphor) were applied to randomized patches (left or right) twice daily throughout the length of the trial. Vitiliginous patches were monitored with photographs at baseline, every 2 weeks, and 6 months after treatment. Biopsies were performed on subjects with significant results. Results. Twenty vitiliginous patches from six subjects qualified for evaluation. Fifty percent of patches treated with combination excimer laser and tacrolimus achieved a successful response (75% repigmentation) compared with 20% for the placebo group. Subjects who responded successfully repigmented faster (19%) with combination therapy compared with excimer laser alone. Additionally, three subjects experienced transient hyperpigmentation in lesions treated with combination therapy. Conclusion. Combining topical immunomodulators with known phototherapeutic modalities may represent a key advancement in the treatment of disease. [source] Combined Therapy Using Q-Switched Ruby Laser and Bleaching Treatment With Tretinoin and Hydroquinone for Acquired Dermal MelanocytosisDERMATOLOGIC SURGERY, Issue 10 2003Akira Momosawa MD Background and objective. Acquired dermal melanocytosis (ADM; acquired bilateral nevus of Ota-like macules) is known for its recalcitrance compared with Nevus of Ota, and we assume that one of the reasons is a higher rate and degree of postinflammatory hyperpigmentation (PIH) seen after laser treatments. Methods. Topical bleaching treatment with 0.1% tretinoin aqueous gel and 5% hydroquinone ointment containing 7% lactic acid was initially performed (4 to 6 weeks) to discharge epidermal melanin. Subsequently, Q-switched ruby (QSR) laser was irradiated to eliminate dermal pigmentation. Both steps were repeated two to three times until patient satisfaction was obtained (usually at a 2-month interval for laser sessions). This treatment was performed in 19 patients with ADM. Skin biopsy was performed in six cases at baseline, after the bleaching pretreatment, and at the end of treatment. Results. All patients showed good to excellent clearing after two to three sessions of QSR laser treatments. The total treatment period ranged from 3 to 13 (mean of 8.3) months. PIH was observed in 10.5% of the cases. Histologically, epidermal hyperpigmentation was observed in all specimens and was dramatically improved by the topical bleaching pretreatment. Conclusion. QSR laser combined with the topical bleaching pretreatment appeared to treat ADM consistently with a low occurrence rate of PIH and lessen the number of laser sessions and total treatment period and may also be applied to any other lesions with both epidermal and dermal pigmentation. [source] Combined Ultrapulse CO2 Laser and Q-Switched Alexandrite Laser Compared with Q-Switched Alexandrite Laser Alone for Refractory Melasma: Split-Face DesignDERMATOLOGIC SURGERY, Issue 1 2003Suhattaya Angsuwarangsee MD Background. Melasma is common and can cause major psychological impact. To date, the mainstay of treatment, including various hypopigmenting agents and chemical peels, is ineffective and can cause adverse effects. Laser is a new approach and is yet to be explored for its efficacy and safety. Objective. To compare combined Ultrapulse CO2 laser and Q-switched alexandrite laser (QSAL) with QSAL alone in the treatment of refractory melasma. Methods. Six Thai females were treated with combined Ultrapulse CO2 laser and QSAL on one side of the face and QSAL alone on the other side. The outcome was evaluated periodically for up to 6 months using the modified Melasma Area and Severity Index score and the modified Melasma Area and Melanin Index score. Results. The side with combination treatment had a statistically significant reduction of both scores. On the QSAL side, the score reduction was not significant. Two cases developed severe postinflammatory hyperpigmentation and were effectively treated with bleaching agents. Transient hypopigmentation and contact dermatitis were observed with the combination treatment side. Conclusions. Combined Ultrapulse CO2 laser and QSAL showed a better result than QSAL alone but was associated with more frequent adverse effects. Long-term follow-up and a larger number of cases are required to determine its efficacy and safety for refractory melasma. [source] Cosmetic Color Improvement of the Nipple-Areola Complex by Optimal Use of Tretinoin and HydroquinoneDERMATOLOGIC SURGERY, Issue 12 2002Kotaro Yoshimura MD background. A successful treatment to improve the color of nipple-areola complex (NAC) has never been reported, although the number of women seeking the more attractively colored NAC is not small. objective. To determine the effectiveness of our bleaching protocol for cosmetic improvement of the NAC. methods. The protocol was composed of two phases: bleaching phase (4,8 weeks) and healing phase (4,6 weeks). 0.2,0.4% tretinoin aqueous gel was applied concomitantly with 5% hydroquinone, 7% lactic acid ointment for bleaching twice a day. Tretinoin was applied to the NAC with a small cotton applicator, while hydroquinone was widely applied beyond the NAC area. After obtaining sufficient improvement in NAC color, the application of tretinoin was discontinued and hydroquinone alone was continually applied in the healing phase until the reactive erythema was eliminated. Fifteen female patients were involved in this study. results. The average treatment period was 16.6 weeks. Improvement of NAC color was obtained in 12 patients (80%) by the physician's estimation, and 11 patients (73%) satisfied with their final results. The treatment was repeated after a 1-month interval of tretinoin application in 4 patients: 2 desired further improvement in color, and 2 had the second course conducted to treat the postinflammatory hyperpigmentation on the surrounding mound induced by the first course. conclusion. This approach appeared to be most effective for cosmetic improvement of NAC color among treatments available so far. [source] | |||||||||||||