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Background: Melasma on the face is difficult to treat and is often refractory to multiple treatment modalities., Objectives: To investigate the safety and efficacy of fractional photothermolysis (FP) for the treatment of melasma and to determine recurrence rates with this treatment method., Materials and Methods: Eight female patients (Fitzpatrick skin type II-IV) with clinically diagnosed melasma on the face were treated using FP (1,550 nm Fraxel SR laser). Two to seven treatments were performed at 3- to 8-week intervals. Treatment levels ranged from 3 to 10, corresponding to 9% to 29% surface area coverage (8-10 passes per treatment). Energies used ranged from 6 to 40 mJ. Physician and patient assessments were recorded at each visit and at a follow-up visit 7 to 36 months (mean 13.5 months) after the last treatment session., Results: At the last treatment, assessments revealed greater than 50% clinical improvement in melasma in five of eight patients. Follow-up assessments by the evaluating physician revealed sustained efficacy in five patients. Recurrence was reported in three patients. No significant adverse effects were noted., Conclusions: FP is a safe and effective treatment for refractory melasma, with long-term remission.

Background: Nonablative fractional photothermolysis has revolutionized the way we treat a number of common skin conditions with laser technology., Objective: A comprehensive guide is needed for clinicians using this technology to treat specific skin conditions in various skin types., Materials and Methods: Recommendations were made from a recent round table discussion among experienced physicians and a review of recent literature findings., Results: Optimal laser parameters are dependent on patient skin type and condition. We recommended guidelines for the successful treatment of several common skin conditions on and off the face using nonablative fractional photothermolysis. Specific conditions were dyschromia, rhytides, acne scars, surgical scars, melasma, and striae distensae., Conclusions: We developed reproducible guidelines to most effectively treat a variety of skin types and conditions using nonablative fractional photothermolysis. Future large, multicenter trials are indicated for further optimization of treatment parameters.

Background: Keratinocyte carcinoma (KC) is the most common type of nonmelanoma skin cancer. Currently, prophylactic treatment options are limited. Nonablative fractional lasers (NAFL) have received the Food and Drug Administration approval for the treatment of actinic damage; however, their role in KC prophylaxis is not known., Objective: The aim of this study is to determine whether NAFL treatment is associated with a decrease in subsequent facial KC development., Materials and Methods: A retrospective cohort study of patients with a history of facial KC treated at the Massachusetts General Hospital Dermatology Laser and Cosmetic Center between 2005 and 2021 was conducted., Results: Forty-three NAFL-treated patients with a history of facial KC and 52 matched control subjects were included in the study. The rate of subsequent facial KC development was 20.9% in NAFL-treated patients and 40.4% in control subjects (RR 0.52, p = .049). Control subjects developed new facial KC significantly sooner than NAFL-treated patients (p = .033). When controlling for age, gender, and skin type, control subjects were more likely to develop new facial KC than NAFL-treated patients (hazard ratio 2.65, p = .0169)., Conclusion: NAFL treatment was associated with a decreased risk of subsequent facial KC development and may have a benefit for KC prophylaxis., (Copyright © 2022 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

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: The Fraxel Dual laser system (Solta Medical, Inc., Bothell, WA) contains a 1,550 and 1,927 nm wavelength single handpiece with different indications for each wavelength., Objective: To discuss treatment setting recommendations and best practices for select on-label and investigational applications of the 1,550 and 1,927 nm dual laser system., Materials and Methods: Eight board-certified dermatologists with 10 or more years of experience with the 1,550 and 1,927 nm laser system completed an online survey about their clinical experience with the system and then participated in a roundtable to share clinical perspectives and best practices for using the laser system., Results: For all Fitzpatrick skin types, treatment recommendations were described for selected approved indications for the 1,550 and 1,927 nm laser system, including both lasers in combination. Treatment recommendations were also reached for investigational applications with the 1,550 nm laser and 1,927 nm laser. Best practices for using the lasers during the treatment session to achieve optimal outcomes and decrease the post-treatment recovery time were compiled., Conclusion: The 1,550 and 1,927 nm dual laser system is effective for a wide range of aesthetic and therapeutic applications, on and off the face and across all Fitzpatrick skin types., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society for Dermatologic Surgery, Inc.)

Background: Dermatosis papulosa nigra (DPN) is characterized by the presence of multiple, small, hyperpigmented, warty papules affecting the face, neck, and trunk that bear to histological semblance to seborrheic keratosis. Although the lesions are benign tumors, they can cause distress for cosmetic reasons., Objective: We, herein, report the cases of three female Japanese patients (mean age, 46 years) with DPN who were treated using a carbon dioxide (CO 2 ) laser with a computerized scanner. The patients were all suffering from an increased number of brown asymptomatic papules (size, 1-5 mm), which were located all over the trunk. Histological examinations revealed acanthosis, hyperkeratosis and horn cyst formation in the epidermis., Methods: We performed CO 2 laser (LASER 30C; Lumenis Inc) treatment (settings: 8-10 W; pulse duration, 0.05-seconds; rest duration, 0.36 seconds; laser spot size, 1.2 mm) for 5-10 months., Results: With CO 2 laser treatment, were could completely remove the lesions and achieve excellent cosmetic results without scar formation in all cases. The treated lesions did not relapse for more than 1 year., Conclusion: In our opinion, CO 2 laser treatment with a computerized scanner is an effective therapeutic option for DPN., (© 2020 Wiley Periodicals, Inc.)

Background: Studies investigating the efficacy of lasers to minimize early surgical scars are low powered and report variable results. To further examine the evidence, the authors performed a systemic review and meta-analysis., Objective: To present the evidence of randomized controlled trials investigating the efficacy of laser modalities in minimizing surgical scars when applied <1 month after operation., Materials and Methods: A literature search of PubMed, EMBASE, Northern Light Life Sciences Conference Abstracts, and Cochrane Library was performed between November 6, 2015, and November 20, 2015. After assessing for inclusion, data extraction used the PRISMA checklist. Assessment for quality, validity, and risk of bias applied a scale devised by Jadad and colleagues, the Oxford Pain Validity Scale, and the RevMan risk of bias assessment tool, respectively. The GRADEpro application graded overall quality, and statistical analysis was performed with RevMan., Results: Approximately 4,373/4,397 abstracts and 16/24 full articles were excluded using predefined criteria, leaving 8 articles in the systematic review and 4 in the meta-analysis. The primary outcome reached statistical significance favoring the intervention group with standardized mean difference 0.39 (95% confidence interval, 0.05-0.74) and p = .03., Conclusion: The outcome supports the efficacy of lasers in minimizing primarily closed surgical scars when treated <1 month after surgery.

The aim of this study was to assess and compare the efficacy of fractional CO2 laser, Q-switched Nd:YAG laser (1064 nm), and their combined use in treatment of keratosis pilaris. The study included twenty female patients. For each patient, three areas were randomly assigned to treatment by either fractional CO2 laser (area A) or Q-switched laser (1064 nm) (area C), or both types of laser (area B). All patients were assessed by digital photography at baseline and 1 month after the last session. Assessment was done by two non-blinded and two blinded investigators (blinded investigators do not know which area is treated with which machine and non-blinded knows). Patients reported the degree of satisfaction or any adverse effects also after 1 month from the last session. The three treatment modalities led to overall improvement in the KP lesions. According to patients' score and investigator two, area B showed statistically significant improvement compared to areas A and C (p=0.001 and p=0.039, respectively). The first blinded investigators' assessment revealed that there was statistically significant improvement in area C compared to A and B (p = 0.023). The assessment of both investigator one and the second blinded investigator revealed that there was improvement in the three areas with no statistically significant difference between them. Both fractional CO2 and Q-switched Nd:YAG laser (1064 nm) proved to be safe and effective in the treatment of keratosis pilaris regarding not only pigmentation but also follicular prominence; their combination may have an additive effect. [ABSTRACT FROM AUTHOR]

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Background Low-fluence Q-switched Nd: YAG 1064 nm laser ( LFQS) and intense pulsed light ( IPL) have been shown to be effective in the treatment of melasma. LFQS can target deeper pigment, while IPL can target a wide range of cutaneous structures. However, there is limited information on efficacy and side-effects of the combined treatment. Objective To compare the efficacy and safety of combined LFQS and IPL therapy with LFQS monotherapy in the treatment of melasma. Methods Twenty female patients with mixed-type melasma on both cheeks were treated with LFQS on full face for five sessions at 1-week intervals. One side of the face was randomly assigned to receive additional three sessions of IPL treatments at 2-week intervals. Patients were evaluated 12 weeks after the last treatment. Outcome measures include the assessment by colorimeter and calculated as relative lightness index (R*LI), modified Melasma Area and Severity Index ( mMASI), patient satisfaction and adverse effects. Results Eighteen patients completed the study. Both sides of the face showed significant improvement of R*LI and mMASI. A more rapid improvement of R*LI and mMASI was observed on combined side. At the end of treatment, 55% improvement and 37% improvement of R*LI was observed on combined side and monotherapy side respectively. The overall patients' satisfaction was in favour of the combined side. Recurrence occurred on both sides but there was still a significant decrease compared to baseline. No serious side effect was noted. Conclusion The combination of LFQS and IPL results in faster clearance of melasma and is more effective than LFQS alone for melasma treatment. However, recurrence is still inevitable. [ABSTRACT FROM AUTHOR]

Background: Striae Distensae (SD) is a very common dermatologic condition. We evaluated the effectiveness and safety of a novel non-ablative fractional 1565 nm laser (ResurFX) on the appearance of SD. Materials and methods: Twelve Caucasian subjects with various stages of SD received three non-ablative laser treatments. Each treatment consisted of two different laser settings, in order to achieve a demarcated dense impact together with a diffused deep impact. Three months after the last treatment, SD improvement was assessed by blinded and non-blinded reviewers using clinical images and 3D image analyses. Results: Good clinical improvement (between 51% and 75%) was observed in all patients. Most patients showed improvement of > 50% in the volume of depressions and in lesion color (91.7% and 83.3% of patients, respectively). The average pain during treatment was generally defined as tolerable and the average downtime was 4 days. Transient erythema and severe edema were noted immediately after the procedure, but long-lasting or severe adverse effects were not observed. All patients noted a good improvement and were satisfied with the treatment and the results. Conclusions: The treatment with the 1565 nm ResurFX laser resulted in improved pigmentation, volume, and textural appearance of SD. [ABSTRACT FROM AUTHOR]

Striae distensae are atrophic dermal scars associated with psychosocial stress. Several treatments have been used but there is no gold standard until now. Fractional photothermolysis has been described as a successful and safe method to treat scars. In this description, we report 4 patients (Fitzpatrick phototype IV) who developed striae distensae after long-term use of topical corticosteroids and were successfully treated with fractional nonablative 1540 nm Erbium: glass laser. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Hyperpigmentary disorders, especially melasma and post-inflammatory hyperpigmentation (PIH), cause significant social and emotional stress to the patients. Although many treatment modalities have been developed for melasma and PIH, its management still remains a challenge due to its recurrent and refractory nature. With the advent of laser technology, the treatment options have increased especially for dermal or mixed melasma. To review the literature on the use of cutaneous lasers for melasma and PIH. We carried out a PubMed search using following terms "lasers, IPL, melasma, PIH". We cited the use of various lasers to treat melasma and PIH, including Q-switched Nd:YAG, Q-switched alexandrite, pulsed dye laser, and various fractional lasers. We describe the efficacy and safety of these lasers for the treatment of hyperpigmentation. Choosing the appropriate laser and the correct settings is vital in the treatment of melasma. The use of latter should be restricted to cases unresponsive to topical therapy or chemical peels. Appropriate maintenance therapy should be selected to avoid relapse of melasma. [ABSTRACT FROM AUTHOR]

Dermatosis papulosa nigra (DPN) is a common condition of pigmented skin. Whilst lesions are benign, they may be symptomatic or cosmetically disfiguring. Ablative lasers have previously been reported as a useful therapeutic modality in DPN. We report the largest case series to date of patients with DPN ablated with the carbon dioxide (CO2) laser. A retrospective case note review was conducted of all patients with DPN treated in our laser clinic in the last five years, and a post-treatment telephone survey was undertaken to assess patient satisfaction. Forty-five patients were identified, with a median age of 41 years (range 25-74 years), of whom 37 (82%) were female. The median number of treatments undertaken was three (range 1-10). Of the 18 respondents to the telephone survey, when asked to grade their satisfaction with the procedure out of 10, median response was 9.5 (range 6-10) with nine patients citing the maximum score of 10. All patients replied that their confidence had improved following the procedure and that they would recommend the treatment to other patients. Five respondents (28%) reported recurrence of a few lesions following CO2 laser ablation; the remaining 13 respondents (72%) reported no recurrence of DPN. No respondents reported any other post-procedural complications (including scarring, hypopigmentation and hyperpigmentation). We advocate use of the CO2 laser as a safe, convenient means of treating DPN, with a high degree of patient satisfaction, low recurrence rate and few complications. [ABSTRACT FROM AUTHOR]

Dermatosis Papulosa Nigra (DPN) is a common skin condition observed in black people and considered a benign epithelial tumor, and more specifically, a particular topographic form of seborrheic keratosis. We treated five female patients affected by DPN with 10,600-nm CO2 laser. We propose the 10,600-nm CO2 laser as a valid therapeutic option in patients affected by DPN, since the treatment is well tolerated, causes no major side effects, and is effective and long lasting. [ABSTRACT FROM AUTHOR]