Advancements in Laser Therapies for Dermal Hyperpigmentation in Skin of Color: A Comprehensive Literature Review and Experience of Sequential Laser Treatments in a Cohort of 122 Indian Patients.

The heightened awareness of ethnic dermatology aligns with the growing prevalence of skin of color communities globally, where hyperpigmentation disorders pose a common dermatological challenge. Effectively addressing dermal pigmentation is challenging due to its resistance to conventional therapies and its association with impaired quality of life. This underscores the need for effective treatments and a thorough grasp of laser advancements. A relevant literature search spanning the last 7 years across the PubMed database reveals core studies, challenges, and the evolution of laser technologies tailored for various forms of congenital and acquired dermal hyperpigmentation in skin of color. This comprehensive review explores the mechanisms, applications, and recommendations for pigmentary laser technologies, highlighting the key role of Q-switched lasers in their established millisecond/ nanosecond forms and emerging picosecond lasers, fractional non-ablative and ablative lasers, Intense Pulsed Light, etc. The summary of evidence includes studies on dermal melanocytosis (nevus of Ota and Hori's nevus), tattoos, acquired dermal macular hyperpigmentation, etc., and also entities with mixed epidermal-dermal components, such as melasma and post-inflammatory hyperpigmentation. The review offers valuable insights for clinicians to make informed decisions based on diagnosis, skin type, and the latest technologies to optimize results and minimize complications, especially in darker Fitzpatrick skin types. In their five-year study with 122 Indian patients, the authors applied specific laser combinations for diverse dermal melanoses, including tattoos, dermal/mixed melasma, acquired dermal macular hyperpigmentation, and dermal nevi. Substantial pigmentation reduction, subjectively assessed by both physicians and patients, was observed across all groups. A one-way ANOVA indicated a significant difference in mean improvement scores across various pigmentary conditions (F = 3.39, p = 0.02), with melasma patients exhibiting a significantly higher improvement score than tattoos (p = 0.03). The results affirmed the safety and efficacy of sequential laser therapy for dermal pigmentation in skin of color, advocating for flexibility in approach while maintaining the rationale behind the laser sequences. Despite advancements, challenges persist, and gaps in the current literature are identified. In conclusion, this summary highlights the ongoing pursuit of optimal protocols in dermatological laser treatments for dermal melanoses, offering valuable insights for future research and clinical practice.

Monopolar radiofrequency for reposing drooping fat planes and facial rejuvenation: A prospective study on 30 subjects towards true antiaging.

BACKGROUND: Monopolar radiofrequency (MRF) for facial rejuvenation works by diffusely heating the dermis and subdermal fibro-septal network. Immediate collagen contraction and long-term neo-collagenesis produce antiaging effects. AIM: To lift and repose drooping fat planes along their vectors of descent to restore natural, youthful contours using MRF and to objectively measure, quantify, and analyze the antiaging effects of MRF on the backdrop of functional facial anatomy. METHODS: This was a prospective study on 30 subjects aged 25-65 years who underwent three sessions of MRF (Exilis, BTL Aesthetics) with a modified protocol at weekly intervals. Clinical evaluation at baseline and 4 weeks after the final session was done according to the global drooping and wrinkles classification and scoring system (GDWCSS) and statistically evaluated. Two patients were analyzed with Ultrasound and Vectra-H1 imaging for change in subcutaneous fat depth and volume over different facial areas, respectively. RESULTS: There was improvement in all parameters (volume alteration and wrinkles) of the GDWCSS, of which improvement in cases that had baseline severe (grade-4) temporal fat loss, malar fat loss, periorbital hollowing, and puffiness was statistically significant. The results of imaging supported the clinical findings. CONCLUSION: Monopolar radiofrequency targets facial collagen as deep as the facial fat, thereby achieving "reversal" of the grooves and bulges of aging with volume re-distribution and favorable "remolding" of fat pads. The result is simultaneous skin tightening, lifting and contouring in manner that is natural, regenerative, and corrective. Given its versatility, efficacy, safety, and tolerability, it is emerging as a power-player in the dermatologist's antiaging armamentarium.

A prospective randomized comparative study on 60 Indian patients of melasma, comparing pixel Q-switched NdYAG (1064 nm), super skin rejuvenation (540 nm) and ablative pixel erbium YAG (2940 nm) lasers, with a review of the literature.

Background: Treating melasma is a challenge due to suboptimal efficacy and recurrence encountered with most modalities. There is inadequate literature regarding the use of lasers for melasma in Indian skin. We compared three modalities SSR (Super Skin Rejuvenation 540 nm), PQSNDY (pixel Q-switched Nd: YAG 1064 nm), and ablative pixel-Er: YAG (2940 nm) laser in melasma, amongst Indian patients. Materials/Methods: Sixty patients of recalcitrant melasma were enrolled and randomized into three groups with 20 patients each. These were treated with SSR, low fluence PQSNDY, and pixel-Er: YAG, respectively, for five sessions at 3-week intervals. Results were evaluated using Modified melasma area severity index (mMASI) by blinded comparison of digital photographs at baseline, each visit and 6 months (i.e. 2 months after the last session). Results: All groups showed a highly significant reduction in the mMASI score (p < .001). Pixel-Er: YAG maximally reduced mMASI and homogeneity (p < .001), while the other groups showed a more uniform fading. Epidermal melasma had best results with SSR and PQSNDY (p < .001), while recalcitrant cases of dermal and mixed melasma with pixel-Er: YAG laser (p < .001). There was no persistent or rebound pigmentation observed. Conclusions: All three modalities are effective and safe for melasma in Indian patients. Fractional technology, low fluences, adequate recovery time between sessions and a sound maintenance plan ensure efficacy and safety.

Subcutaneous Panniculitis-Like T-Cell Lymphoma with Hemophagocytic Syndrome in a Child.

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) characterized by subcutaneous infiltration of pleomorphic T-cells of the α/ß phenotype rarely affects children. Development of hemophagocytic syndrome (HPS) leads to a poor prognosis with this otherwise indolent lymphoma. We report a case of SPTCL in a 5-year-old child complicated by HPS treated successfully with combination chemotherapy. We discuss the potential pitfalls in reaching an early diagnosis and challenges in its management. Previously reported cases of SPTCL with HPS in children are briefly reviewed.