Treatment of flat and elevated pigmented disorders with a 755-nm alexandrite picosecond laser: clinical and histological evaluation

Abstract

The novel picosecond lasers, initially developed for faster tattoo removal, have also shown great efficacy in endogenous pigmentary disorders. To describe the efficacy and safety profile of an alexandrite (755-nm) picosecond laser in a wide range of pigmented flat and elevated cutaneous lesions. A retrospective study was performed in which we collected all the clinical images of patients treated with the 755-nm alexandrite picosecond laser for 12 months (November 2016-November 2017). Clinical features were obtained from their medical charts. Patients treated for tattoo removal were excluded. All the images were analyzed by three blind physicians attending to a visual analogue scale (VAS) from 0 to 5 (0, no change; 1, 1-24% clearance; 2, 25-49% clearance; 3, 50-74% clearance; 4, 75-99% clearance; 5, complete clearance). Patient satisfaction was obtained from a subjective survey including four items: very satisfied, satisfied, non-satisfied, and totally dissatisfied. Thirty-seven patients were included (12 males; 25 females). The mean age of the study was 42.35 years. Twenty-five patients (68%) were treated for different pigmented flat disorders such as solar and mucosal lentigines (5), stasis dermatitis (4), or nevus of Ota (4), among other diagnoses. Twelve patients (32%) were treated for epidermal elevated lesions such as warts (5), epidermal nevi (2), and seborrheic keratosis (3), among other elevated lesions. Mean number of laser treatment was 3.02 sessions while mean follow-up after last laser treatment was 4.02 months. Mean VAS score of the three observers was 3.44 (61% of clearance) for pigmentary flat disorders and 3.60 (67%) for elevated lesions. Adverse effects reported were mild blistering in the first 2-5 days following laser treatment in some of the patients. Overall satisfaction among the patients included was high. The novel 755-nm picosecond alexandrite laser is effective not only for the resolution of pigmented flat lesions of different nature but also for the treatment of the more difficult elevated pigmented lesions.

A Systematic Review of Picosecond Laser in Dermatology: Evidence and Recommendations

“…Picosecond lasers with wavelengths of 532, 755, and 1064 nm have been reported to be safe and effective in the treatment of a wide range of discrete pigmented lesions including solar lentigines, freckles, verrucus epidermal nevus, café au lait macules (CALM), nevus of Ota, and Hori's macules. A total of five case reports/series; five retrospective reviews; three prospective open-label trials; and four split-face/lesion randomized comparison trials involving a cumulative 320 subjects have documented these findings [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29].…”

Recent advances in managing and understanding seborrheic keratosis

“…The CO 2 laser is an effective alternative option but with a slightly higher risk of scarring and pigmentary changes 51, 52 . Small case series have used intense pulsed light 53 , pulsed-dye laser 54 , Nd:YAG (neodymium-doped yttrium aluminum garnet) laser 55 , or the 755-nm alexandrite picosecond laser 56 for SK removal. Larger trials, however, are missing.…”

Successful Treatment of Pigmentary Disorders in Asians With a Novel 730‐nm Picosecond Laser

“…Dyspigmentation of the face is a concern of many patients but is difficult to treat, especially in patients with darker skin types because of an increased adverse event profile [5]. Novel ps-lasers were initially developed for faster tattoo removal but have also shown great efficacy in endogenous pigmentary disorders, even in darker-skinned patients [6][7][8][9][10][11].…”