Recurrence rate of oral melanotic macule treated with Q-switched alexandrite laser versus surgical excision: a retrospective cohort study / 口腔疾病防治

Objective@#To compare the recurrence rates between 755 nm Q-switched alexandrite laser (QSAL) treatment and surgical excision of oral melanotic macules (OMM).@*Methods@#This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. A retrospective cohort study was designed to collect demographic and clinical characteristics and follow-up data from patients with OMM. Patients who received QSAL or surgical excision in the Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2019 to August 2021 were included. The one-year recurrence rate was investigated as the primary outcome. Long-term adverse reaction rates were investigated as safety indicators. Kaplan-Meier analyses were performed to analyze the recurrence-free rates between the groups.@*Results@#A total of 57 patients were enrolled in this study. 16 patients underwent surgical excision, and 41 underwent QSAL. The baseline demographic and clinical characteristics between the groups were not significantly different. No recurrence (0%) of OMM was observed in the surgical excision group, while in the QSAL group, the macule recurred in 12 patients (29.27%). The average duration of recurrence was 6.08 months after treatment. Recurrence was not found to be associated with smoking (P = 1.000), gastrointestinal polyps (P = 1.000), longitudinal melanonychia (P = 0.187), family history (P = 0.552), treatment sessions (P = 0.567) or multiple macule lesions (P = 0.497). Compared with treatment with surgical excision, the odds ratio of recurrence for treatment with QSAL was 4.41, with a 95% confidence interval of 1.27-15.24 (P = 0.020). In the surgical excision group, 3 patients (18.75%) reported depressions and scars on the lesion, while no long-term adverse reactions (0%) were reported in the QSAL group (P = 0.019).@*Conclusion@#Compared with surgical excision, the advantage of QSAL is the low long-term adverse reaction rate, while the disadvantage is the relatively high one-year recurrence rate. It is necessary to communicate the advantages and disadvantages of the two methods with OMM patients to assist in clinical decision-making.

Tratamiento de Nevus de Ota con Láser Q-Switched Alexandrita de 755 nm / Treatment Of Nevus De Ota With 755 Nm Alexandrite Q-Switched Laser

Introducción: El nevus de Ota es un hamartoma melanocítico dérmico benigno de aspecto macular, mal delimitado y en parche de color negrogrisáceo que generalmente afecta unilateralmente la primera y segunda rama del trigémino. Objetivo: Evaluar la eficacia, seguridad y los eventos adversos ocasionados por la aplicación de láser Alexandrita de 755 nm para el tratamiento del nevus de Ota. Métodos: Serie de casos de 10 pacientes de fototipo IV con Nevus de Ota unilateral atendidos entre enero 2017 y diciembre 2018, los cuales fueron tratados con esta energía lumínica y con parámetros definidos. Resultados: La media de edad fue de 29 años., Los pacientes que completaron el tratamiento no presentaron repigmentación en la lesión tratada y el índice de satisfacción fue aceptable. Se observó que el promedio de sesiones para obtener resultados favorables varió entre 8 y 10 aplicaciones. Dentro de los efectos adversos más importantes resalta la hiperpigmentación postinflamatoria y la eliminación del estrato superficial de la piel post láser. Todos fueron controlados sin dejar lesiones residuales permanentes. Conclusión: El láser Q-switched Alexandrita de 755 nm es una tecnología efectiva para lograr un alto grado de despigmentación en el tratamiento del nevus de Ota y puede ser considerado como un tratamiento de primera línea para el manejo de esta patología.

Introduction: Ota nevus is a benign dermal melanocytic hamartoma with a macular appearance, poorly defined and in a gray-black patch that generally affects the first and second branches of the trigeminal unilaterally. Objective: To evaluate the efficacy, safety and adverse events caused by the application of 755 nm Alexandrite laser for the treatment of Ota nevus. Methods: Case series of 10 phototype IV patients with unilateral Ota Nevus treated between January 2017 and December 2018, which were treated with this light energy and with defined parameters. Results: The mean age was 29 years. The patients who completed the treatment did not show repigmentation in the treated lesion and the satisfaction index was acceptable. It was observed that the average of sessions to obtain favorable results varied between 8 and 10 applications. Among the most important adverse effects, post-inflammatory hyperpigmentation and the removal of the superficial layer of the post laser skin stand out. All were controlled without leaving permanent residual lesions. Conclusion: The 755 nm Alexandrite Q-switched laser is an effective technology to achieve a high degree of depigmentation in the treatment of Ota nevus and can be considered as a first-line treatment for the management of this pathology.

Safety and efficacy of picosecond Alexandrite laser with a diffractive lens array for treatment of facial photoaging / 中华医学美学美容杂志

Objective To evaluate the efficacy and safety of a 755 nm picosecond Alexandrite la-ser with a diffractive lens array in the treatment of facial photoaged skin .Methods Twenty-six pa-tients with facial photoaging were recruited and received 3 treatments at 4-week intervals .Laser energy was applied over the entire face at a fixed spot size of 6 mm ,with a fluence of 0 .71 J/cm2 and 5Hz . Blinded clinical assessment was performed by 2 independent dermatologists on a 5-point global pho-toaging scale (GPS) .Patients were also questioned on the extent of improvement of rhytides ,skin tightening ,and complexion with a 4-point global aesthetic improvement scale (GAIS) and satisfaction . Adverse events were also evaluated .Results Twenty-six patients completed the treatment .Compared with the baseline ,there was a significant improvement in facial photoaged skin after 3 treatments ,and these positive outcomes were maintained up to the 3-month follow-up ,according to the GPS and GAIS scores .Moderate pain and transient erythema were observed as the two main discomforts associated with the treatment .Most patients were satisfied with the treatment .Conclusions This 755 nm pico-second Alexandrite laser with a diffractive lens array optic is effective in the treatment offacial pho -toaged skin ,and the therapy also seems safe and well tolerated .

Efficacy and safety of picosecond Alexandrite laser in treatment of nevus of Ota / 中华医学美学美容杂志

Objective To analyze the efficacy,safety and the correlative influencing factors of picosecond Alexandrite laser in the treatment of nevus of Ota.Methods 49 patients with nevus of Ota receiving picosecond Alexandrite laser in our department from October 2015 to October 2017 were retrospectively analyzed,and grouped according to patient gender,age of onset,age of first treatment,Tanino classification of skin lesions and color grading.Clinical characteristics,treatment effects,adverse reactions,influencing factors and other factors were analyzed.Results 49 patients with nevus of Ota were treated 1-4 times,and 9 cases were cured.After one treatment,the significant effective rate was 28.6 ％,the effective rate was 53.1 ％,and the effective rate was 100 ％ after 3 treatments,and the effective rate was 100％ after 4 treatments.No significant difference was found in the first treatment efficacy between different genders,age of onset,Tanino classification and color grading (P＞0.05).There was a significant difference in the first treatment effect between different first treatment age groups (P＜0.05).The inverse relationship between age and efficacy was found.The younger the age,the better the first treatment effect.Pigmentation appeared in 2 patients after treatment and subsided after 6 months.No adverse reactions such as scars and hypopigmentation appeared.Conclusions Picosecond Alexandrite laser is a safe and highly effective therapy for nevus of Ota.

Prospective Comparison of Dual Wavelength Long-Pulsed 755-nm Alexandrite/1,064-nm Neodymium:Yttrium-Aluminum-Garnet Laser versus 585-nm Pulsed Dye Laser Treatment for Rosacea

BACKGROUND: Rosacea treatments including oral/topical medications and laser therapy are numerous but unsatisfactory. OBJECTIVE: To compare the effectiveness of the dual wavelength long-pulsed 755-nm alexandrite/1,064-nm neodymium: yttrium-aluminum-garnet laser (LPAN) with that of 585-nm pulsed dye laser (PDL) for rosacea. METHODS: This was a randomized, single-blinded, comparative study. Full face received four consecutive monthly treatments with LPAN or PDL, followed-up for 6 months after the last treatment. Erythema index was measured by spectrophotometer, and digital photographs were evaluated by consultant dermatologists for physician's global assessment. Subjective satisfaction surveys and adverse effects were recorded. RESULTS: Forty-nine subjects with rosacea enrolled and 12 dropped out. There were no significant differences between LPAN and PDL in the mean reduction of the erythema index (p=0.812; 3.6% vs. 2.8%), improvement of physician's global assessment (p=1.000; 88.9% vs. 89.5%), and subject-rated treatment satisfaction (p=0.842; 77.8% vs. 84.2%). PDL showed more adverse effects including vesicles than LPAN (p=0.046; 26.3% vs. 0.0%). No other serious or permanent adverse events were observed in both treatments. CONCLUSION: Both LPAN and PDL may be effective and safe treatments for rosacea.

Efficacy of Q-switched Alexandrite laser on the nevus of Ota / 中华医学美学美容杂志

Objective To observe the clinical efficacy of Q-switched Alexandrite laser at 752 nm in the treatment of nevus of Ota. Methods A total of 1985 cases of nevus of Ota were treated with the Q-switched Alexandrite laser PhotoGenica HT10, and then the ages, frequency of treatment and interval of treatment were analyzed. Results The excellent effective rate was 97.88 %, and the total effective rate was 100 % in 1985 cases. Most patients in all age group received the excellent effects, however, there was no significant difference between the groups. Most patients acheived the excellent effect after 4 to 5 treatments, and very few patients (0.8 %) needed over 10 treatments; the rate ofpatient who needed 1-3 treatments or 6-10 treatments was 18. 2 % and 25.8 %, respectively. The patients had the most excellent efficacy in the group that the interval of two treatments was 4 to 6months, however, there was no significant difference between the group of the interval of two treatments over 6 months. In our study, there were only a few cases (4.48 %) with slight side reaction,such as temporary pigmentation and hypopigmentation and scar. Conclusions 752 nm Q-switched Alexandrite laser is one of effective and safe treatments for nevus of Ota.

Prevention and treatment of the complications caused by long-pulsed alexandrite laser on hair removal / 中华医学美学美容杂志

Objective To investigate the causes and treatment methods of complications induced by the long-pulsed alexandrite laser on hair removal. Methods A total of 2 562 patients (3 279 sites) with unwanted hairs were treated by the long-pulsed alexandrite laser. Wave length was 755 nm. With 20 msec pulse width. 12. 5 mm spot size, 12. 0-16. 5 J/cm2 treatment energy, and 50-60 days intermitted between each treatment. Results There were 242 patients with complications such as erythema, eruption, blister, bulla, hyperpigmentation, hypopigmentation, and scar. Conclusion The long-pulsed alexandrite laser on hair removal is effective and safe, and the correct procedures of treatment can reduce the complications.

Hemifacial Rejuvenation Effect after Treatment of Nevus of Ota with the Q-switched Alexandrite Laser

Q-switched(QS) Lasers have been successfully used to treat nevus of Ota with a few complications. A 51 year old woman had nevus of Ota affecting the left half of her face from birth. During childhood and adolescence, her nevus enlarged and has remained stable since her late teens. She was treated with Q- switched Alexandrite Laser (fluences: 5.5J/cm2, spot size: 3mm, repetition rate: 10Hz). After 7 sessions(interval 6 weeks), complete clearance was achieved. She complained that the treated side of her face looked much younger than the other side. Alexandrite Laser therapy and post- treatment therapies might be considered to cause this problem. First, she applied 0.025% retinoid and 4% hydroquinone ointment on her treated area every night. Second, laser treatment for intradermal pigmented lesion tightened dermal collagens. In cases of middle aged women with dermal pigmented lesions (nevus of Ota), collagen tightness of dermal layer is considered to cause rejuvenation effect. In order to balance the two sides of her face, we made her apply the same post-treatment therapies on the normal side. After 18months, the effect of rejuvenation of the treated area still lasted and the normal side also improved. This case implies that skin care on the entire face pre- and post-treatment is important in a laser therapy for nevus of Ota. Especially when it comes to middle aged women, rejuvenation therapies are recommended.

Axillary Hair Removal Using Long Pulse Alexandrite Laser

The goal of this study was to prospectively assess the long-term results of long pulse alexandrite laser depilation in 13 patients who underwent axillary hair removal initially since February 2000. Thirteen patients underwent laser therapy, four times every 2 months. The last follow up was 21 months later. The patients were treated with alexandrite laser, with 20J/cm2 energy density, 20ms pulse duration. Percentage of hair removal (clearance rate) was assessed by an average hair count in 1cm2 of the same treated area. The clearance rates were respectively 38%, 44%, 70%, 74% according as the therapy was repeated. There were no significant complications except for temporary erythema and vesicle formation. The long pulse alexandrite laser can safely remove unwanted axillary hair in a Fitzpatrick skin type IV.

Histopathologic, Immunohistochemical, and Electron Microscopic Findings of Pigmented Skin Lesions Immediately after Q-switched Alexandrite Laser Treatment / 대한피부과학회지

BACKGROUND: There have been only a few electron microscopic studies after laser treatment of pigmented skin lesions. OBJECTIVE: The purpose was to investigate the pathologic, immunohistochemical, and electron microscopic changes following Q-switched alexandrite laser treatment of pigmented skin lesions. METHODS: Three patients with acquired bilateral nevus of Ota-like macules, and 2 patients with cafeau lait macule were irradiated with Q-switched alexandrite laser. Forty biopsies were taken before and immediately after laser treatment. Hematoxylin-eosin, Fontana-Masson, and gp100 staining were performed for the evaluation of the histopathologic and immunohistochemical findings of the specimens. Electron microscopic findings were also evaluated. RESULTS: Histopathologically, suprabasilar separations were observed immediately after laser treatment. Vacuolar alterations of pigment-containing cells were frequently found in the epidermis and/or in the dermis. Fontana-Masson and gp100 staining positivity changed to negative or decreased in the epidermis immediately after laser treatment, while they changed to negative in the dermis. Ultrastructurally, epidermal pigment-containing cells frequently showed severe vacuolar changes in the cytoplasm, pyknotic nuclei, and vacuolated and/or fragmented melanosomes immediately after laser treatment. Dermal melanocytes frequently revealed vacuolated and/or fragmented melanosomes immediately after laser treatment. CONCLUSION: Histopathologic, immunohistochemical, and electron microscopic examination of pigmented skin lesions immediately after Q-switched alexandrite laser treatment demonstrated vacuolated or fragmented melanosomes and vacuolar alteration of pigment-containing cells in the epidermis and/or in the dermis, which suggested selective photothermolysis of melanosomes.

A Case of Piebaldism Treated by Combination Therapy with Suction Blister Epidermal Graft and the Alexandrite Laser / 대한피부과학회지

Piebaldism is a rare, autosomal dominant inherited disorder, characterized by inborn hypopigmented skin and hair. It is characterized by stable leukoderma with white forelock and vitiligo like amelanotic macules usually containing hyperpigmented macules at the periphery. As the leukodermic lesions in piebaldism are unresponsive to any form of topical or systemic medical treatment, several methods for autologous transplantation of melanocytes and epidermal transplantation methods have been developed and there are no specific treatment methods for hyperpigmented patch in piebaldism. A 12-year-old female had piebaldism from birth. Suction blister epidermal graft was tried at hypopigmented patches on the posterior aspects of both lower legs and the Q-switched Alexandrite laser was used at the site of the hyperpigmented patches. Combination therapy with suction blister epidermal graft and a Q-switched Alexandrite laser on piebaldism may be effective method.

The Removal of Eyebrow Tattoos by the Q-switched Alexandrite Laser / 대한피부과학회지

BACKGROUND: Women sometimes have eyebrows tattooed for cosmetic purpose. But until recently, the removal of tattoos has been difficult. Several laser techniques have been proposed for the removal of tattoos. The lasers that have been used most successfully are the Q-switched systems because of their ability to target tattoo pigment selectively with minimal risk of adverse tissue response. OBJECTIVE: The objective of this study was to determine the clinical effectiveness of the newest Q-switched system, the alexandrite laser, in removing both eyebrow tattoos and to observe side effects such as scarring or permanent pigmentary changes. METHODS: Forty seven patients with both eyebrows tattooed were treated with the Q-switched alexandrite laser (755 nm, 100 ns) at eight week intervals and clinically evaluated.

Successful Treatment of Mucosal Melanosis of the Lip with Q-switched Alexandrite Laser / 대한피부과학회지

Mucosal melanosis such as labial and vulvar pigmented macules is common as well as cosmetically disfiguring benign pigmented lesions. Until the recent development of laser treatments, it was impossible to remove a mucosal melanosis without leaving a scar. The Q-switched Alexandrite laser, which has a wavelength of 755 nm and a short pulse duration of 100 nanoseconds, has been used for the treatment of dermal pigmentary disorders such as Nevus of Ota and tattoos. We treated two patients with labial melanosis by the Q-switched Alexandrite laser using a 2,4 mm spot size and energy fluences of 4.5 to 7 J/cm2. Their mucosal pigmentations were completely cleared without adverse sequelae or recurrence after one session of the treatment. We report that Q-switched Alexandrite laser might be a highly effective and safe modality for the treatment of mucosal melanosis and suggest it as the treatment of choice.

Effects of Treatment According to Tattoo Color, Site and Duration with the Q-Switched Alexandrite Laser / 대한피부과학회지

BACKGROUND: After the development of the Q-switched lasers, it was possible to remove tattoos without causing scarring. Currently, Q-switched ruby lasers, Q-switched Nd: YAG lasers and Q-switched alexandrite lasers are used selectively to treat tattoos. The objective of this study was to determine the difference of effectiveness aceording to color, site and duration in removing tattoo pigments by the alexandrite laser. MATERIALS AND METHODS: 30 tattoos were treated with a Q-switched alexandrite laser(model IL-l, Candela Laser Corporation. Wayland. U.S.A.). Pretreatment evaluation included a clinical desrviption of the site, color, duration and photographs were taken. The effects were examined by fether photo graphs and telephone follow-up. The response was expressed as the percentage area cleared of the tattoo. The clearance was graded as follows: clear, >95%; excellent, 76-95%; good, 51-75%; fair, 26-50%; poor < 25%. The occurence of adverse events were also examined. RESULTS: 1""he results are summarized as follows: 1. Treatment with fluences that ranged from 6.0-8.0J/cm2 was given on average 1.7 times and better results were achived than expected in 80% of all patients with tattoo. 2. The effectiveness of laser therapy correlated with the number of treatments. 3. After 1 laser session, tattoos of black and darkblue showed better results than light blue in terms of color. 4. After 1 laser session, the sites of tattoos on upper extremitise showed better results than those of the eyebmw, eyeline and face. 5. Differences in duration after 1 laser session were not seen. 6. Hyperpigmentation in 2 cases and bulla formation in 1 case occurred and all complications had ceased after a few months. CONCLUSION: The alexandrite laser is an effective treatment for cosmetic, general and traumatic tattoos with a low incidence of significant adverse effects and provides excellent cosmetic results.

A Case of Ota's Nevus Treated by Combination Therapy with Cryosurgery and the Q-Switched Alexandrit Laser / 대한피부과학회지

Ota's nevus is a mongolian spot-like macular blue-black or gray-brown patchy pigmentation that most commonly occurs unilaterally in areas innervated by the first and second division of the trigeminal nerve. We report a case of Ota's nevus treated by combination therapy with cryosurgery and a Q-switched Alexandrite laser. A 48-year-old female had had a type III Ota's nevus from birth. Cryosurgery was tried at first using hard chalk dry ice on the lesion of the forehead and cheek. After that, The Q-switched Alexandrite laser was used three times at twelve week intervals at the site of the eyelid. Good therapeutic effects were gained and our patient was very satisfied. There were no complications or scarring. A Biopsy of the area treated revealed a similar histological pattern with significantly less melanin indicating melanin removal. Combination therapy with cryosurgery and an Alexandrite laser on the Ota's nevus may be cheaper, more effective and a safer method. It may also reduce the limitation of the two methods when used individually.

Acropigmentation Symmetrica of Dohi Treated with the Q-switched Alexandrite Laser

A few cases of reticulate acropigmentary disorders have been reported in Korea. Most of them were reticulate acropigmentation of Kitamura, but not acropigmentation symmetrica of Dohi. A 21 year-old male patient diagnosed as acropigmentation symmetrica of Dohi had been previously treated with various treatment methods unsuccessfully. Re-treatment with the Q-switched alexandrite laser(755 nm, 100nsec) showed a temporary improvement but a relapse of the lesion was experienced again. We describe a case of acropigmentation symmetrica of hi treated with the Q-switched alexandrite laser.

The Effect of the Alexandrite Laser for The Removal of Tattoos / 대한피부과학회지

BACKGROUND: Until the recent development of the Q-switched lasers, it was impossible to remove tattoos without causing scarring and sometimes disfiguring. Variations in wavelengths and pulse widths may result in different clinical effects or risks. OBJECTIVE: The purpose of this study was to investigate the therapeutic effects of the alexandrite laser in removing tattoos clinically, histologically and ultrastructually. METHODS: Fourty-two patients with gray, black, and blue-black colored tattoos were treated with fluences ranging from 6.5 to 8.0 J/cm2 at a minimal interval of 6 weeks. We took pictures of each tattoo prior to treatment and each treatment session in order to evaluate clinical irnprovement. Biopsy specimens were obtained from 8 patients, on prearranged times: before, immediately after, one week after and 6 weeks after irradiation. RESULTS: The results if the treatment of 42 patients with tattoos were analyzed. After two treatment sessions, 89% of patients showed 51% to 95% improvement. Transient hyperpigmentation and hypopigmentation occurred in 7 patients. However, skin atrophy, hypertrophic scar or infection did not occur. Ir a biopsy specimen taken 6 weeks after irradiation on light microscopy, most of tattoo granules disappeared without collagen fiber change. However, macrophage engulfing tattoo granules and a minute amount of tattoo granules still remained in the dermis on electron microscopy. CONCLUSION: The .alexandrite laser is considered to be a safe and effective treatment rnodality for removal of gray, black, and blue-black tattoo pigments.

Treatment of Ota's nevus with the Alexandrite Laser / 대한피부과학회지

BACKGROUND: Recently, Q-switched lasers have been reported to be successful in treating Ota's nevus without scarring. Utilizing the principle of selective photothermolysis, the Alexandrite laser has been developed for dermal pigmented lesions and tattoos. OBJECTIVE: In this study, we evaluated the clinical, histopathological and ultrastructual effect of the Alexandrite laser in the tretment of Nevus of Ota. METHODS: Forty-seven patients with nevus of Ota were treated with energy densities ranging from 5.0 to 8.0 J/cm2 at a miriimum of 6 week intervals. Sequential skin biopsy specimens were processed for the light microscope with H&E and Fontana-Masson stains and the electron microscope. RESULTS: The average number of treatments were 2.8 per patient. After two treatment sessions, 93 % patients 26 to 75% imprivement was seen. After three treatments 50 to 95% improvement was seen. No patients had permanent textual changes or scarring. On light microscop most of the dendritic melanocytes in the upper dermis were not observed in biopsy specimens taken after clinical improvement. Electron microscopy revealed damaged melanosomes in the upper dermis immediately after irradiation. CONCLUSION: Treatment with the Alexandrite laser for nevus of Ota is considered to be a safe and effective method.