Clinical Evaluation of Safety and Efficacy of a 670-nm Picosecond Laser for Treatment of Benign Pigmented Lesions in Asians.

BACKGROUND: Picosecond lasers are increasingly being investigated in treating pigmentation disorders because they may provide better treatment efficacy and comfort compared with nanosecond lasers. OBJECTIVE: This study aims to evaluate the efficacy and side effect of a novel 670-nm picosecond laser in the removal of benign pigmented lesions (BPLs) in individuals with Fitzpatrick skin types (FST) III and IV. MATERIALS AND METHODS: Fifteen subjects with solar lentigines and 7 subjects with ABNOMs received a single treatment with a 670-nm picosecond laser. Blinded physicians assessed the pigment clearance using a 5-category grading system scale. All subjects were evaluated at 1 month, 3 month, and 6 month after a single treatment. Adverse events were recorded at every follow-up visit. RESULTS: All subjects with lentigines had complete clearance (95%-100%) of lesions during 3-month follow-up after a single treatment session of 670-nm picosecond laser, whereas 75% of the subjects with ABNOMs noted fair lightning (25%-49%) of lesions. Mild hypopigmentation and hyperpigmentation were observed in 9% and 14% of the subjects, respectively, which resolved within 3 months after the treatment. CONCLUSION: The novel 670-nm picosecond laser is a safe and effective treatment for BPLs in subjects with FST III and IV with low rates of transient adverse effects.

The Use of Botanical Extracts in East Asia for Treatment of Hyperpigmentation: An Evidenced-Based Review.

Recent years have seen a growth in the Asian cosmeceutical industry and an expanding worldwide marketplace with increasing consumer use of plant-based skin care products. The rising prevalence of Asian cosmeceuticals has led to research studies assessing the safety and efficacy of these products. We seek to review current evidence on safety and efficacy of key ingredients used in Asian cosmeceuticals to treat disorders of hyperpigmentation. A comprehensive search on PubMed was conducted to identify hyperpigmentation-related research studies on eight popular ingredients used in Asian cosmeceuticals: green tea, soy, orchid, licorice, rice water, ginseng, bamboo, and aloe. Both in vitro studies and clinical trials involving human subjects were included. Of the ingredients reviewed, soy and licorice had the most clinical evidence supporting their efficacy, while all other ingredients were supported by in vitro studies. More research is needed to further evaluate the safety and efficacy of Asian cosmeceutical ingredients in treatment of hyperpigmentation. J Drugs Dermatol. 2020;19(7): doi:10.36849/JDD.2020.4776.

Should we biopsy melanonychia striata in Asian children? A retrospective observational study.

BACKGROUND AND OBJECTIVES: Melanonychia striata is common in children of darker-skinned Asian races, while subungual melanoma is extremely rare and it is difficult to make a diagnosis clinically. However, performing nail unit biopsies in children is particularly challenging and can result in permanent nail dystrophy. The aim of this study was to review the clinical and histologic characteristics of melanonychia striata in pediatric patients of Asian descent to aid in the clinical decision regarding nail biopsy. METHODS: Sixty-two pediatric patients presenting with melanonychia striata involving single or multiple nails at two tertiary pediatric dermatology clinics in Singapore between 2005 and 2015 were reviewed. Clinical and histopathological data were analyzed, including age at onset, age at presentation, location, color, width, presence of Hutchinson's sign, pseudo-Hutchinson's sign, nail dystrophy, length of follow-up, and clinical evolution. Histopathological assessment was performed by three senior dermatopathologists independently for cases that underwent a nail biopsy. RESULTS: No cases of subungual melanoma were detected in our series. Solitary melanonychia of the thumbnail with a single uniform color was the most common presentation. Pseudo-Hutchinson's sign was commonly observed. Consensus in histological diagnosis emerged amongst all three dermatopathologists in only half of the cases biopsied. CONCLUSION: The occurrence of melanoma in Asian children presenting with melanonychia is extremely rare. We recommend clinical follow-up and anticipatory guidance for these patients and nail unit biopsy only in the presence of high-risk clinical features.

A retrospective clinico-pathological study comparing lichen planus pigmentosus with ashy dermatosis.

BACKGROUND/OBJECTIVES: Controversy persists as to whether lichen planus pigmentosus and ashy dermatosis are separate clinical entities. This study was conducted to examine the clinicopathological features and treatment outcome of the two conditions. METHODS: A retrospective medical chart review of all patients who were diagnosed with lichen planus pigmentosus or ashy dermatosis was conducted. The information collected included the participants' age at onset, site of onset, duration of disease, presence of precipitating factors, distribution of disease, pigmentation and presence of symptoms. In patients from whom a biopsy was taken the histopathological reports were included. RESULTS: Altogether 26 patients with ashy dermatosis and 29 with lichen planus pigmentosus were included in the study. Compared with ashy dermatosis, lichen planus pigmentosus had a more localised distribution with a preponderance for facial involvement, compared with the truncal preponderance in ashy dermatosis. Ashy dermatosis tended to have a more stable clinical course than lichen planus pigmentosus, which was more likely to wax and wane. The utility of histopathology in differentiating between the two conditions is low. CONCLUSION: Ashy dermatosis and lichen planus pigmentosus, as defined in this study, appear to be two separate clinical entities with distinguishable clinical features and natural histories.

Facial skin photo-aging and development of hyperpigmented spots from children to middle-aged Japanese woman.

BACKGROUND/PURPOSE: Facial skin hyperpigmention caused by chronic sun exposure is a major skin complaint, however, its characteristics and influential factors are still limitedly known. METHODS: A cross-sectional survey in healthy Japanese women aged from 6 to 62 years (n=169) was conducted using a facial image analyzer VISIA™ for knowing onset age of hyperpigmented spot formation, its chronological changes, and influence of environmental factors. RESULTS: UV Pigmented Spot (PS) Score was positively correlated with age (R=.487, P=.000). Hyperpigmented spots appeared first around 18 years old in most subjects, and PS score remarkably increased at 20s then gradually increased by ages. The subjects with Skin Type I, one of the three grades of Japanese Skin Type (JST), whose melanin formation is genetically lower, showed higher PS score. A woman aged 31 years was subjected a weekly VISIA measurement for 2 years, and found no changes in the number, place, size and intensity of the pigment spots in this duration. CONCLUSION: Hyperpigmented spots developed in women over 20 years of age due to chronic sun exposure without sun protection during childhood and adolescent and it was stable afterwards, whose intensity was influenced by age and skin type.

Using a Low Fluence Q-Switched 532/1064-nm Nd: YAG Laser for Facial Skin Depigmentation in Asian Patients: Outcome and Complication Profile Analysis.

BACKGROUND AND OBJECTIVES: Low fluence Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers are widely applied for facial depigmentation. Nonetheless, few reports analyze the general outcome, complications, of single and combined therapy of 532/1064-nm Nd:YAG lasers in Asian patients with Fitzpatrick type IV skin. STUDY DESIGN/MATERIALS AND METHODS: We retrospectively reviewed all consecutive patients who completed 5 consecutive sessions at 1-month intervals of treatment with 1064-nm (spot size: 5-7 mm, 1.5-2.0 J/cm) or combined with 532-nm (spot size, 2-3 mm; 0.5-1.5 J/cm) Nd:YAG laser (Laseroptek, Korea) from October 2011 to March 2013. The patients, laser surgeon, and 3 blinded reviewers assessed the outcomes and complications. Improvement was graded as follows: 1, 0%-25%; 2, 26%-50%; 3, 51%-75%; 4, 76-90%; and 5, greater than 90%. Postinflammatory hyperpigmentation (PIH) was documented according to the severity (1, slight; 2, moderate; 3, severe; and 4, extreme). Other post-laser side effects were also documented (eg, scaling, dryness, erythema, and pruritus). RESULTS: Four male patients and 37 female patients were included with a mean age of 38.5 years (SD, 10.1 years). There were no significant differences on patients', surgeon's, or blinded reviewers' improvement gradings. (4.11 ± 0.62 vs 4.30 ± 0.46, P = 0.54; 3.88 ± 0.66 vs 3.89 ± 0.31, P = 0.50; 3.30 ± 0.69 vs 3.74 ± 0.38, P = 0.34). Transient minor side effect occurred as follows: erythema in 9 (22%), pruritus in 7 (17%), dryness in 6 (15%), and scaling in 6 (15%). There was no risk difference in these side effects between groups. The PIH scores were slight in 10 patients (4 in single and 6 in combined), severe in 4 (3 in single and 1 in combined), and extreme in 1 (single therapy). The PIH incidence also did not differ (33.3%, 35.3%; P = 0.58). CONCLUSIONS: We reported satisfactory outcomes after low-fluence Q-switched sole 1064-nm or combined 532/1064-nm therapy. The outcome and complication profiles did not differ between the groups. The PIH incidence was not low, but usually transient. The incidence of severe or extreme PIH was rare.

Prurigo pigmentosa: a clinical and histopathological study of nine Chinese cases.

BACKGROUND: Prurigo pigmentosa (PP) is a chronic and recurrent inflammatory skin disease with the distinctive and prominent feature of reticulate hyperpigmentation. Most known cases have been reported in Japan; here we report nine Chinese cases. OBJECTIVE: To determine the clinical manifestation of prurigo pigmentosa and its effects in Chinese individuals compared to patients of other ethnicities. METHODS: We retrospectively analysed nine cases of PP. For all cases, clinical information was collected and reviewed, and skin biopsies were performed. Furthermore, we followed all nine patients to determine the recurrence rate. RESULTS: All nine patients fulfilled the diagnostic criteria of prurigo pigmentosa. The mean age of the patients at diagnosis was 27.4 years, and the patients were predominantly female. Skin lesions at different stages commonly co-occurred in the same patient. The most commonly affected part of the body was the back, but the armpit was also often involved. Patients responded well to minocycline treatment for the short duration of 8.62 days, and a lower recurrence rate (28.3%) was recorded after treatment. Biopsy revealed classic neutrophil and/or lymphocyte infiltration, spongiosis and necrotic keratocytes. Abscesses occasionally occurred in the follicular orifice. The abnormal presentation of hair follicles was also discovered. All characteristics were found to co-exist in different stages. CONCLUSION: We conclude that PP is easy to misdiagnose. Histopathological characteristics can co-exist at different stages, consistent with the clinical finding that different stages of skin lesions presented concurrently, contributing to misdiagnosis. Oral administration of minocycline not only yields an excellent response, but also effectively reduces the recurrence rate.

Extrinsic skin ageing in German, Chinese and Japanese women manifests differently in all three groups depending on ethnic background, age and anatomical site.

BACKGROUND: It has been suggested that extrinsic skin ageing manifests differently in Caucasians versus East Asians. In particular, from previous studies it was concluded that Caucasians are more prone to develop wrinkles, whereas pigment spot formation is the hallmark of extrinsic skin ageing in East Asians. However, these assumptions are based on a very limited number of studies which did not include different East Asian populations. OBJECTIVE: We here compare the manifestation of extrinsic skin ageing signs in German, Japanese and Chinese women by specifically elucidating the age and anatomical site dependence of any potential ethnic difference. METHODS: In the present study, we assessed skin ageing in N=902 German, N=165 Japanese and N=1260 Chinese women ranging from 30 to 90 years by means of SCINEXA™. Linear regression analysis was used to test for ethnic differences and their age and site dependence adjusted for educational level, sun exposure, smoking and sun protection behaviours. RESULTS: Pigment spots and wrinkles on the face were present among all three ethnic groups and differences were influenced by age and anatomical sites independently of further influencing factors. Pigment spots on the forehead were most pronounced over the whole age range in Chinese and German women and least developed in Japanese. Pigment spots on cheeks were a typical extrinsic skin an ageing sign in the two East Asian populations in all age groups. However, in older German women they reach the same level as observed in the two East Asian populations. In contrast, pigment spots on arms and hands were significantly more pronounced in German women ≥45years of age. Wrinkles were not exclusively a skin an ageing sign of German women, but were also very pronounced in Chinese women on forehead, between the eyebrows and in the crow's feet area. CONCLUSION: These results corroborate the previous notion that the occurrence of pigments spots and wrinkles is different between Caucasians and East Asians. In addition, this study shows that this difference depends on age and anatomical site and that it also differs between different ethnic groups from East Asia.

Prevalence and clinical features of pigmented oral lesions.

BACKGROUND: To examine the relative prevalence, types, and clinical features of pigmented lesions of the oral mucosa in 1275 patients attending a university hospital for dental care. METHODS: Patients attending dental clinics at The University of Jordan Hospital over a 1-year period were examined for the presence of oral pigmentations. Histopathological examination was performed on focally pigmented lesions with a suspicious or uncertain clinical diagnosis. RESULTS: A total of 386 (30.2%) patients were found to have oral pigmentations. Of these, racial pigmentation (39.9%) and smokers' melanosis (32.9%) were the most common causes of oral pigmentations. Other causes included amalgam tattoo (18.9%), focal melanotic macules (5.7%), postinflammatory pigmentation (1.6%), pigmentation due to medications or systemic disease (0.52%), heavy metal deposits (0.26%), and oral nevus (0.26%). Gingivae and buccal mucosae were the most common sites for oral pigmentations. CONCLUSION: Pigmentations of the oral mucosa are common. Gingivae and buccal mucosae are the most common sites for oral pigmentations. Proper history and recognition of clinical features are important for effective management.

Lichen planus pigmentosus in linear and zosteriform pattern along the lines of Blaschko.

Lichen planus pigmentosus (LPP) is a variant of lichen planus (LP) reported in various ethnic groups. It occurs predominantly in the third or fourth decade of life and is characterized by the insidious onset of dark-brown macules in sun exposed areas and flexural folds. Rarely, has it been described in a linear or segmental distribution. Herein we describe a case of LPP with lesions lateralized to right side of body along the lines of Blaschko, in a linear and zosteriform pattern.

The sensitization potential of sunscreen after ablative fractional skin resurfacing using modified human repeated insult patch test.

BACKGROUND: Ablative fractional skin resurfacing has become popular and proven to be useful in treating scars, photoaging and wrinkles. Although post-inflammatory hyperpigmentation (PIH) is the most common complication especially in dark-skinned patients like Asian. Several modalities have been used to overcome the PIH. OBJECTIVE: To determine the sensitization potential of sunscreen applied immediately after ablative fractional skin resurfacing. MATERIAL AND METHODS: Sixty volunteers were recruited. Of these 30 subjects were from previous ablative fractional skin resurfacing study who applied broad-spectrum sunscreen containing anti-inflammatory agent starting on the first day after resurfacing and another 30 non-resurfacing subjects had applied the same sunscreen on the intact skin. All subjects were patch/photopatch tested for sensitization study by using modified human repeated insult patch test (HRIPT). RESULTS: There were significantly higher sensitization rate of UV-filter, octocrylene and the sunscreen in resurfacing group than in non-resurfacing group. CONCLUSION: Early application of sunscreen after ablative fractional skin resurfacing has increased the incidence of sensitization potential of sunscreen. The sunscreen is recommended to start using from D3 after fractional ablative skin resurfacing to ensure the complete recovery of skin barrier and minimize the risk of sensitization.

Basal cell carcinoma in Singapore: a prospective study on epidemiology and clinicopathological characteristics with a secondary comparative analysis between Singaporean Chinese and Caucasian patients.

BACKGROUND/OBJECTIVES: Susceptibility to and clinical presentation of basal cell carcinoma (BCC) differ in Asian and Caucasian populations. This study aims to evaluate the epidemiological and clinicopathological characteristics of BCC in a multiracial Singaporean population, with a secondary comparative analysis between Chinese and Caucasian patients. METHODS: We prospectively studied patients with newly diagnosed, histologically confirmed BCC at the National Skin Centre, Singapore from 2004 to 2008. RESULTS: In total, 274 BCC from 260 patients were studied, with 19 patients having two or more tumours. Their mean age was 67.5 years and 54% were male. Chinese comprised 80% and Caucasians 14%. The Chinese were 1.8-fold as likely as Caucasians to be older than 60 years, and experienced itch thrice more frequently. Caucasians developed multiple BCC threefold and truncal or upper limb BCC 2.9-fold more frequently than the Chinese. In terms of tumour subtype, morphoeic BCC was 2.7-fold more common in Caucasians. Pigmented BCC occurred 2.7-fold more often in the Chinese, most frequently on the head and neck of elderly Chinese. CONCLUSIONS: Compared to the Chinese, BCC occurred more often in younger Caucasians, with a predilection for the trunk and upper limb, suggesting a greater role for recreational sun exposure as a risk factor. Pigmented BCC more commonly occurred on the head and neck of elderly Chinese and may be reflective of cumulative sun exposure as a risk factor. Aggressive morphoeic BCC was more common in Caucasians than in Singaporean Chinese patients.

Topical corticosteroids minimise the risk of postinflammatory hyper-pigmentation after ablative fractional CO2 laser resurfacing in Asians.

Postinflammatory hyperpigmentation (PIH) is the most common adverse effect of laser treatment in dark-skinned individuals. Little is known whether PIH can be prevented or minimised. The objective of this study was to investigate the effect of short-term application of topical corticosteroids on the incidence of PIH after ablative fractional resurfacing in Asians. Forty subjects with skin phototype IV and atrophic acne scars were treated with a fractional CO2 laser on both sides of the face. Post-operatively, clobetasol propionate 0.05% ointment was applied to one randomly selected side of the face for the first 2 days, followed by an application of petrolatum jelly for the rest of the week (petrolatum was applied to the other side for 7 days). Assessments on the clinical outcome, the wound healing process and the occurrence of PIH were obtained once weekly for the first month and at 2 and 3 months post-treatment. The side of the face treated with petrolatum alone had significantly (p < 0.001) higher incidence of PIH (75%) after laser irradiation than the side of the face treated with topical corticosteroids and petrolatum (40%). The PIH occurring on the petrolatum-treated sides had significantly higher intensity (p < 0.001) and was spread over a significantly larger area (p < 0.001), compared with the corticosteroid- and petrolatum-treated sides. In conclusion, a short-term application of topical corticosteroids postoperatively is associated with a decreased risk of PIH after ablative fractional resurfacing.

What's new in objective assessment and treatment of facial hyperpigmentation?

Facial hyperpigmentation is common and challenging to treat in darker-skinned populations. A Medline literature search of articles published up to October 2013 reporting the objective assessment of and/or treatment for melasma, postinflammatory hyperpigmentation, dermatosis papulosa nigra, lichen planus pigmentosus, and erythema dyschromicum perstans was reviewed. Objective assessment was only reported for melasma and postinflammatory hyperpigmentation. Furthermore, randomized controlled trial evidence was only reported for melasma. Although progress has been made, there is a need to develop more objective outcome measures and effective treatments for hyperpigmentation.

The spectrum of HIV-associated infective and inflammatory dermatoses in pigmented skin.

HIV and AIDS patients often suffer from various skin infections of viral, bacterial, and fungal origin. In addition, parasitic infestations are prevalent. Common inflammatory dermatoses include seborrheic dermatitis, psoriasis, photodermatitis, and pruritic papular eruptions. This article discusses some of these conditions with an emphasis on clinical presentation. In patients with pigmented skin, diagnosis maybe challenging and complicated by dyspigmentation.

Evaluating the safety and efficacy of the 1,440-nm laser in the treatment of photodamage in Asian skin.

BACKGROUND AND OBJECTIVE: As the demand for diminished procedure-associated downtime continues to increase, nonablative fractional laser resurfacing is becoming a more popular intervention in the progression of photoaging. Patients with pigmented skin and a mild degree of photodamage may be particularly suited for a less intensive laser treatment. In this study, we have evaluated the safety and efficacy of a low energy, low density 1,440-nm fractional laser in the treatment of multiple signs of photoaging including dyspigmentation, wrinkling, tissue laxity, enlarged pores, and skin roughness in Asians. STUDY DESIGN/MATERIALS AND METHODS: Ten Chinese subjects with Fitzpatrick skin types III-V and visible signs of photodamage participated in this study. Patients received four treatments at 2-week intervals with a 1,440-nm diode-based fractional laser. Photographs were taken at baseline, 2 weeks after each of the first three treatments and 4 weeks after the final treatment. Images were evaluated independently by two physicians. Clinical improvement and adverse events were analyzed. Discomfort, heat sensation and overall patient satisfaction associated with the procedure were also quantified. RESULTS: In this prospective single-arm study, signs of photoaging were examined after treatment with the 1,440-nm laser. Here we show that a series of four treatments with this device produced a mild improvement in skin texture, pigmentation, and wrinkling. Changes in pore size and skin laxity failed to reach statistical significance. Immediate after-effects of the procedure included erythema and edema which were transient and left no permanent sequela. A significant proportion of patients reported some degree of discomfort during the procedure despite use of a topical anesthetic. One patient developed a discrete, localized area of post-inflammatory hyperpigmentation which completely resolved by the final follow up visit. CONCLUSION: The low energy, low density nonablative 1,440-nm fractional laser produces a mild improvement in select signs of photodamage after four treatments without any long-term adverse effects.

Facial hyperpigmentation: causes and treatment.

By midcentury, the U.S.A. will be more ethnically and racially diverse. Skin of colour will soon constitute nearly one-half of the U.S. population, and a full understanding of skin conditions that affect this group is of great importance. Structural and functional differences in the skin, as well as the influence of cultural practices, produce variances in skin disease and presentation based on skin type. In the skin of colour population, dyschromia is a growing concern, and a top chief complaint when patients present to the physician. A thorough understanding of the aetiology and management strategies of facial hyperpigmentation is of importance in caring for those afflicted and also in the development of new therapies.