Alejandro Camps-Fresneda

Necrobiosis lipoidica diabeticorum treated with the pulsed dye laser.

BACKGROUND AND OBJECTIVE : Different treatment modalities have been advocated for necrobiosis lipoidica diabeticorum but clinical response is unpredictable. The purpose of this study was to evaluate the usefulness of pulsed dye laser (Candela SPTLÁ, Irvine, MA, USA) in the treatment of an area of necrobiosis lipoidica of 4 cm in diameter on the anterior aspect of the leg in a non-diabetic patient. MATERIALS AND METHODS : A spot test was made at 6.0, 6.5 and 7.0 J/cm 2 energy fluences and the best energy fluence was selected after a 2-month postoperative evaluation. The patient received three treatment sessions with a fluence of 6.5 J/cm 2 , 585-nm wavelength, 5-mm spot size, and 450 µs pulse duration at 8-week intervals. The patient was given routine skin care advice with emollient cream and sunscreen (SPF 15) until the following session. RESULTS : Overall cosmetic improvement was achieved, with a decrease of erythema and telangiectasis, and stabilization in terms of progression (size) in the left half of the lesion, with no modification of atrophy or pigmentary changes. The right upper quadrant of the lesion showed an erythematous peripheral halo with minimal reduction in the erythema and telangiectasia, and discrete size increase. CONCLUSION : Pulsed dye laser may be a useful treatment for improving the telangiectasia and erythematous component of necrobiosis lipoidica.

Use of the Q-switched alexandrite laser (755 nm, 100 nsec) for eyebrow tattoo removal

Permanent tattooing for cosmetic reasons has increased in recent years; as a consequence, there has been an increase of requests for pigment removal due to complications or undesired results. The Q‐switched alexandrite laser has been found useful in removing black exogenous pigment, which is the most popular color in eyebrow enhancement. We report the case of a patient with black‐pigment eyebrow cosmetic tattoo after treatment with the Q‐switched alexandrite laser.

Long‐term hypopigmentation induced by diode laser photo‐epilation

To the Editors, In reply to Drs Mahaffey and Dave’s comments on our recent publication, we think some observation and clarification about hypopigmentation induced by hair removal systems, either lasers or intense pulsed light (IPL) sources, should be brought into consideration. During the last 5 years we have had the opportunity to use different hair removal systems: long-pulsed lasers such as alexandrite (Cyanosure Inc., USA), neodimio:YAG (Candela Corp., USA; CoolGlide Vantage, Altus Medical, USA), diode (LightSheer, Lumenis, USA) and diverse IPL sources such as EpiLight (ESC, Israel), Quantum HR (ESC, Israel), and Ellipse Flex (Danish Dermatologic Development, Denmark). Throughout these 5 years of experience in photo-epilation, in which more than 15 000 treatment sessions have been performed, we have had excellent clinical results with all the above-mentioned systems. Of course, side effects have also been observed with all of these systems, as have already been published in different periodicals. However, long-lasting hypopigmentation – by this we mean a hypopigmentation that lasts for more than 6 months – has been extremely rare: only one case, the patient that reported in our original article. Nevertheless, other colleagues have referred to our clinic additional cases affected by long-lasting hypopigmentation after alexandrite, diode and IPL (data not published) laser treatment. We completely agree with Drs Mahaffey and Dave’s appreciation that hypopigmentation is less common than hyperpigmentation and it is fortunately a reversible event; however, complete clinical recovery may need a variable length of time. In fact, our patient recovered completely after 18 months of follow-up. We also agree with the other point raised by Drs Mahaffey and Dave. Certainly, ‘pepper pot’ appearance due to widely separate circular treatment zones is always distressing for both patient and physician. However, overlapping of laser or IPL pulses may increase local thermal damage to the epidermis, especially in dark-skinned individuals. It is accepted that a 10–30% overlapping will circumvent this situation. Some manufacturers have developed laser units with a scanner that allows perfect delivery of side-by-side pulses; however, if treatment leads to hypopigmentation, whatever the cause, this situation will be of much concern for both the patient and physician, no matter how close together the round white spots are. In our routine work we carefully mark all areas to be depilated, especially in those patients with uneven hirsute areas, thus decreasing the possibility of skipping areas during the treatment. However, when treatment is carried out some areas may inadvertently be skipped, giving the final appearance of more widely spaced treated areas. This situation is corrected in following treatment sessions. Returning to our patient, after one single treatment session no clinical response was observed and fluence energy was increased; however, this increase appears to have been erroneous and this circumstance should be considered as the reason for the development of longlasting hypopigmentation. While most published articles and case reports discuss the excellence of a specific technique fewer communications are dedicated to complications, side effects or even errors, which, if published, may be of help to other colleagues. However, communication of bad results should be a question of honesty more than courage. The positive point, in our opinion, is that one will probably learn much more from a bad experience than from the excellent results obtained in everyday practice.

The use of Q-switched alexandrite laser (755 nm, 100 ns) for eyeliner tattoo removal

BACKGROUND Eyelid tattooing for cosmetic reasons has increased in the past few years, and unsatisfied customers may request pigment removal. Q-switched laser systems have been useful in these cases. OBJECTIVE To evaluate the clinical result of a patient with a bluish-black eyelid tattoo treated with Q-switched alexandrite laser. METHODS Threshold fluence was determined and a spot test made on the first visit. Treatment was with QSAL, with a fluence range of 6.75-7.50 J/cm2 (mean fluence 7.125 +/- 0.26) and overlapping +/- 10% at 4-week intervals. RESULTS The eyeliner tattoo was not completely removed after five treatments with QSAL, but noticeable pigment lightening was obtained. No side effects were seen. CONCLUSIONS Q-switched alexandrite laser may be a useful device to remove the bluish-black pigment used in cosmetic eyeliner tattoo.

Cosmetic tattoo refractive to Q-switched alexandrite laser

BACKGROUND Lip tattooing is a common cosmetic technique not exempt from certain risks and which may lead an unsatisfied customer to seek tattoo elimination. OBJECTIVE To assess the clinical outcome of a patient with a brownish-colored cosmetic lip tattoo after treatment with the Q-switched alexandrite laser (QSAL). METHODS Two sites were tested using the pigment lesion dye laser (PLDL) and QSAL. The patient received 10 monthly sessions with QSAL, with an average fluence of 6.925 J/cm2. The double and triple shot technique was applied. RESULTS The brownish pigmentation turned black after the PLDL and QSAL tests. Epidermal splattering and bleeding made a fluence increase with QSAL inadvisable. Treatment was unsuccessful. CONCLUSIONS PLDL and QSAL may induce a photochemical alteration in brownish pigment. Factors that may contribute to the poor response of a cosmetic lip tattoo to QSAL treatment are related to pigment characteristics and laser parameters.