John Z.S. Chen

Efficacy and Safety of Intense Pulsed Light in Treatment of Melasma in Chinese Patients

BACKGROUND Melasma is commonly seen in the Asian population. Traditional therapies are less effective and may cause adverse effects. OBJECTIVE The objective was to study the efficacy and safety of a new intense pulsed light (IPL) device in the treatment of melasma in Chinese patients. METHODS Eighty-nine women with melasma were enrolled in this open-labeled study. Subjects received a total of four IPL treatments at 3-week intervals. Changes in facial hyperpigmentation and telangiectasis were evaluated using an objective, skin colorimeter (Mexameter, Courage & Khazaka), the melasma area and severity index (MASI), and a global evaluation by the patients and blind investigators. RESULTS Sixty-nine of 89 patients (77.5%) obtained 51% to 100% improvement, according to the overall evaluation by dermatologists. Self-assessment by the patients indicated that 63 of 89 patients (70.8) considered more than 50% or more improvement. Mean MASI scores decreased substantially from 15.2 to 4.5. Mexameter results demonstrated a significant decrease in the degree of pigmentation and erythema beneath the melasma lesions. Patients with the epidermal-type melasma responded better to treatment than the mixed type. Adverse actions were minimal. CONCLUSION IPL treatment is a good option for patients with melasma. Adverse actions of IPL were minimal and acceptable.

Immunohistological evaluation of skin responses after treatment using a fractional ultrapulse carbon dioxide laser on back skin.

BACKGROUND AND OBJECTIVE Fractional photothermolysis (FP) lasers have been widely used in treating photo‐aged skin, acne scars, and other skin conditions. Although plenty of clinical data have demonstrated the efficacy of the FP laser, only limited histologic studies have been available to observe serial short‐ to long‐term skin responses. METHODS Seven healthy Chinese women received one pass of fractional carbon dioxide laser treatment on the left upper back. Biopsies were taken at the baseline and 4 hours, 1 day, 5 days, 1 month, 3 months, 6 months, and 1 year after the procedure for hematoxylin and eosin stains, immunohistochemical evaluation (for heat shock proteins and elastin), and Verhoeff‐iron‐hematoxylin stains (for collagen and elastic fiber). RESULTS Remarkably greater expression of heat shock protein (HSP)70 could be observed 4 hours after the procedure, which diminished significantly by 3 months, 6 months, and 1 year after the procedure. HSP47 reached its peak expression 1 month after the procedure, especially around microscopic thermal zones, and maintained its high level of expression 3 and 6 months after the procedure. Distinct new formation and remodeling of collagen and elastic fibers could be observed 3 and 6 months after procedure. CONCLUSION FP‐induced HSP expression and new formation of collagen and elastic fibers lasted as long as 6 months, longer than the previously acknowledged 3 months. The authors have indicated no significant interest with commercial supporters.

Application of a New Intense Pulsed Light Device in the Treatment of Photoaging Skin in Asian Patients

BACKGROUND Intense pulsed light (IPL) technology has long been used in the treatment of photoaging skin. OBJECTIVE To evaluate the efficacy and safety of a new IPL device in the treatment of photoaging skin in Asian patients. METHODS One hundred fifty-two Chinese women with photoaging skin were enrolled in this open-labeled study. Subjects received four IPL treatments at 3- to 4-week intervals. Changes of photoaging were evaluated using a global evaluation, an overall self-assessment, a Mexameter, and a Corneometer. RESULTS One hundred thirty-nine of 152 patients (91.44%) experienced a score decrease of 3 or 2 grades, according to the dermatologist. One hundred thirty-six of 152 patients (89.47%) rated their overall improvement as excellent or good. The mean skin melanin index (MI) and erythema index values deceased with each session. MI on forehead and EI on cheilion decreased most significantly. Adverse effects were limited to mild pain and transient erythema. CONCLUSION IPL treatment is a safe and effective method for photoaging skin in Asian patients. Adverse effects were minimal and acceptable.

A Split-Face Study of Intense Pulsed Light on Photoaging Skin in Chinese Population

Intense pulsed light (IPL) is regarded as the gold standard of nonablative photorejuvenation. Yet there is still a need to observe its efficacy and safety on dark skin using a split‐face module.

A Retrospective Study of Q-Switched Alexandrite Laser in Treating Nevus of Ota

BACKGROUND The Q‐switched alexandrite laser (QSAL) has been clinically proven to be effective in treating nevus of Ota, but a large‐scale retrospective study with long‐term follow‐up has never been performed. OBJECTIVE To evaluate the efficacy of the QSAL in treating nevus of Ota, the lasers long‐term side effects, complications associated with the treatments, and the recurrence rate. MATERIALS AND METHODS Eight hundred six patients (651 female, 155 male) with a diagnosis of nevus of Ota who had received a series of QSAL (wavelength 755 nm) treatments were recruited. The typical settings were fluences of 3.8 to 4.8 J/cm2 and a spot size of 3 mm. Follow‐ups were conducted via questionnaire with 590 patients who had completed the treatment at least 3 years earlier. RESULTS Overall, 93.9% of patients achieved complete clearance after an average of 5.2 sessions. All recurrences (0.8%) appeared beyond the previously treated sites. No long‐term adverse effects, including hypopigmentation, hyperpigmentation, textural changes, and malignant transformation, were observed. CONCLUSION The QSAL is a safe and effective modality for treating nevus of Ota. Recurrence was rare and appeared beyond the previously treated sites. The authors have indicated no significant interest with commercial supporters.

A Pilot Study of Intense Pulsed Light in the Treatment of Riehl's Melanosis

&NA; The authors have indicated no significant interest with commercial supporters.

Treatment of Infraorbital Dark Circles Using a Low-Fluence Q-Switched 1,064-nm Laser

OBJECTIVE To evaluate the efficacy and safety of the low-fluence 1,064-nm Q-switched neodymium-doped yttrium aluminium garnet (QSNY) laser in treating infraorbital dark circles. PARTICIPANTS AND METHODS Thirty women with infraorbital dark circles (predominant color dark brown) participated in this open-label study. Participants underwent eight sessions of low-fluence QSNY laser treatment at 4.2 J/cm(2) at 3- to 4-day intervals. A spot size of 3.5 mm was used, with a pulse duration of 8 ns. The melanin deposition in the lesional skin was observed in vivo using reflectance confocal microscopy (RCM). Morphologic changes were evaluated using a global evaluation, an overall self-assessment, a narrow-band reflectance spectrophotometer, and a skin hydration measurement instrument. RESULTS Twenty-six of 30 patients showed global improvement that they rated as excellent or good. Twenty-eight rated their overall satisfaction as excellent or good. The melanin index indicated a substantial decrease, from 225.84 at baseline to 182.65 (p < .05). RCM results showed a dramatic decrease of melanin deposition in the upper dermis. Adverse effects were minimal. CONCLUSIONS The characteristic finding for dark-brown infraorbital dark circles is melanin deposition in the upper dermis. Treatment of infraorbital dark circles using low-fluence 1,064-nm QSNY laser is safe and effective. The authors have indicated no significant interest with commercial supporters.

Treatment of Erythromelanosis Follicularis Faciei et Colli Using a Dual-Wavelength Laser System: A Split-Face Treatment

A 20-year-old man developed redness and roughnesson the cheek at the age of 12. Physical examinationrevealed well-defined but irregular areas of erythemawith telangiectasia and mild hyperpigmentation in-volving the preauricular and submandibular areas ofthe neck. The skin texture was rough and dry, withmany follicular papules (Figure 1A and B). Promi-nent keratosis pilaris was appreciated on the shoul-ders, lateral arms, and thighs, with mild erythemaaround the hair follicles.The patient was initially treated using intense pulsedlight (IPL) on both sides of the face at intervalsof 3 to 4 weeks. The settings for Lumenis One(Lumenis Co., Santa Clara, CA) were single pass,560/590-nm filters, double or triple pulse, 3.0-mspulse width, 30-ms pulse delay, a starting fluenceof 15J/cm