Re-pigmentation of Hypopigmentation: Fractional Lasers vs Laser-Assisted Delivery of Bimatoprost vs Epidermal Melanocyte Harvesting System

Background: Hypopigmentation is a common cutaneous manifestation that frequently poses a therapeutic challenge for dermatologists. Current treatments have varying efficacies and rarely provide patients with long-term results. However, new treatments are emerging, and head-to-head studies comparing these treatments are warranted. Methods & Materials: In this prospective, Institutional Review Board (IRB)-approved, double-blinded study, 40 subjects with moderate to severe hypopigmentation were randomized into 1 of 4 treatment arms; non-ablative fractional laser, ablative fractional laser, ablative fractional laser with laser-assisted delivered bimatoprost, and an epidermal harvesting system. Results: All patients in this study showed improvement regardless of the treatment modality. The average improvement score was calculated on a 0 to 4 scale, and Group 3 (fractional ablative laser and bimatoprost) was found to have a significantly higher average improvement than all other treatments, with 76% of the patients exhibiting at least a grade 3 (over 50%) improvement over the treatment course. Group 1 (non-ablative fractional) also had a significantly higher average score compared with group 2 (fractional ablative laser). Conclusion: New and emerging therapies have shown promise in helping re-pigmentation of cutaneous hypopigmentation. In this head-to-head trial, it was shown that laser-assisted delivery of bimatoprost had a greater statistically significant improvement compared with 3 possible treatment modalities for stimulation of pigment in medical and cosmetic hypopigmentation. J Drugs Dermatol. 2019;18(11):1090-1096.

Nódulos múltiples hipopigmentados adquiridos en la cara anterior del tórax / Multiple Acquired Hypopigmented Nodules on the Anterior Chest

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Treatment of Facial Hypopigmented Scars by the Laser Hole Technique Using a Nonfractional Carbon Dioxide Laser in Asians.

BACKGROUND: Facial hypopigmented scars are usually characterized by white color and a glossy surface. To correct the two problems simultaneously, the authors attempted to induce persistent postinflammatory hyperpigmentation for color and to build multiple pitted scars like facial skin pores for texture. This study describes a laser hole method using a traditional nonfractional carbon dioxide laser for treatment of facial hypopigmented scars and evaluates the clinical results. METHODS: Forty-three facial hypopigmented scars in 27 patients were treated, excluding protruding or thick scars. A carbon dioxide laser was set in the superpulse mode by continuous delivery. Multiple small holes were made in the scar at a distance of 1 to 3 mm. Each laser hole was produced by continuously repeated shots at one point until the deep dermis was involved. All lesions were exposed without protection. At 1 or 2 months after initial treatment, the remaining hypopigmentation was treated by the same procedure. RESULTS: Treatment sessions were performed once for nine scars, twice for 22 scars, and three times for 12 scars. In most cases, postinflammatory hyperpigmentation was slightly diminished but maintained until the last follow-up. The fine irregular surface with multiple pitted scars was similar to that of normal skin. Scar improvement evaluation showed marked or excellent in 39 scars (90.7 percent) and minimal or partial in four deep or thick scars. CONCLUSION: The laser hole technique using a nonfractional carbon dioxide laser may be an excellent option for simultaneously treating the color and texture of superficial or thin hypopigmented facial scars in Asians.

Rare Variant of Agminated Spitz Nevi on a Hypopigmented Background and Segmental Distribution: Case Report and Review of Literature.

Spitz nevus is a type of melanocytic nevus that can arise as a solitary lesion or as multiple lesions either disseminated or agminated (grouped) in different skin backgrounds (eg, grossly normal, hyperpigmented, or hypopigmented). Agminated Spitz nevi have been rarely reported and are even rarer in a background of hypopigmented skin. We present the case of a 2-month-old girl with multiple, grouped, dome-shaped, red papules arising on a hypopigmented patch with a segmental distribution. Biopsy of 2 lesions showed findings characteristic of Spitz nevus, confirming the diagnosis. We also review 4 other cases of agminated Spitz nevi arising on hypopigmented skin reported in the literature.

[The 308 nm Excimer laser : Treatment of vitiligo and hypopigmentation]. / 308 nm-Excimerlaser : Therapie von Vitiligo und Hypopigmentierungen.

Use of the 308 nm Excimer laser to treat hypopigmentation and vitiligo is usually superior to conventional ultraviolet (UV) therapy with regard to results and safety. It is particularly advantageous because specific areas of skin can be targeted without burdening the rest of the skin. Fewer sessions with lower cumulative doses are required. Various combination therapies can improve the outcome; selection criteria such as early initiation of treatment and more frequent sessions with shorter intervals make it easier to decide which patients should be treated and how to achieve the greatest benefit.

Surgical management of leukoderma after burn: A review.

Burns are a common and sometimes devastating injury causing a significant amount of pain, disability, and occasionally death. Burns can have serious aesthetic and functional consequences such as pigmentary changes and formation of scar tissue. Hypopigmentation or depigmentation is often a result of partial- or full-thickness burns, which is referred to as leukoderma after burn. Thus, this study is aimed at systematically reviewing the surgical options for treating leukoderma after burn in order to gain insight into the advantages, disadvantages, and future implications of each surgical technique. The surgical procedures reviewed include dermabrasion with thin split thickness grafting, epidermal cell suspension spray, suction blister epidermal minigrafting, minigrafting, cultured epithelium, noncultured keratinocyte suspension, and chip skin grafting.

[Management of hypopigmented scars following burn injuries]. / Prise en charge des cicatrices hypopigmentées post-brûlure.

OBJECTIVE: Permanent hypopigmentation of burn scars is a common consequence after partial and full thickness burns that heal by secondary intent, and they can cause severe aesthetic issues. The surgical goals for effective treatment of postburn hypopigmentation are to remove scar tissues, and to produce healthy melanocytes, with minimal donor site morbidity. This article reviews the current literature about the different ways to treat hypopigmentation following burn injuries and discusses the indications. METHODS: The PubMed database was searched for articles published from 1985 and up to 2016. Papers with regards to the management of hypopigmented lesions were included only if scars were following burn injuries. The treatments were assessed according to body region treated, surface involved, skin color, effectiveness on restoring skin pigmentation. RESULTS: Sixteen studies were included in this review. Non-surgical treatments like makeup and tattooing, and surgical treatments including thin skin grafting, chip skin grafting, punch grafting, non-cultured keratinocyte-melanocyte cell suspension, and cultured epidermal cells were all compared. CONCLUSION: Thin skin grafting is a reliable treatment especially for patient who suffer from small hypopigmented lesions as this method requires a donor skin of the same size. The cell suspension procedure may be beneficial for larger scars. Moreover demarcation between skin graft and normal skin may exist and when a precise color match is required, particularly in the head, tattooing and chip skin grafting produce a good pigmentation outcome.

Our experience of carbon dioxide laser ablation of angiofibromas: Case series and literature review.

Angiofibromas are one of the dermatological hallmarks of tuberous sclerosis. Various ablative treatments have been trialled and more recently topical rapamycin has been proposed. We present our experience of treatment of angiofibromas using carbon dioxide (CO2) laser ablation and provide a timely literature review. Nine patients were retrospectively identified as being treated with CO2 laser between 2009 and 2015. Three patients were male, six were female, median age at first treatment was 28 (range 15-49) years and the median number of treatments was two (range 1-17). Four of these patients could be contacted for a post-treatment telephone interview. All reported an improvement in appearance of angiofibromas following treatment and that they would recommend CO2 laser ablation to others. Three of the four reported recurrence of some lesions following treatment. The only side effect reported by one patient was transient hyperpigmentation. CO2 laser ablation appears to be a well-tolerated, efficacious treatment for angiofibromas with few long-term side effects.

Dermabrasion and Thin Epidermal Grafting for Treatment of Large and Small Areas of Postburn Leukoderma: A Case Series and Review of the Literature.

Deep burn injuries can have serious aesthetic consequences as it often results in scar tissue and pigmentary changes of the skin. The focus of this article is to report our experience and results using dermabrasion and thin split-thickness skin grafting as a technique for restoring skin pigmentation after burn injuries. Patient records were obtained from a pediatric burn hospital medical record database from 1990 to 2007. Both charts and photographs were retrospectively reviewed. The treatment was evaluated for body region treated, surface area involved, effectiveness of treatment, and number of treatments required. Indications for the procedure included longstanding depigmentation, defined as greater than 1 year, and a patient wiling to have a donor site. The areas of vitiligo were marked and dermabraded with a mechanical dermabrader. Thin epidermal grafts with a thickness of 6 thousands of an inch were harvested with an air-powered dermatome. The grafts were affixed to the dermabraded bed and dressed open or with nonstick gauze for areas of the face and wrapped for areas in the extremities. Eleven patients underwent 16 procedures. The average size of the graft per procedure was 87 cm (4-500 cm). All results were consistent and long-lasting at follow-up. Postburn leukoderma of long duration is well treated by dermabrasion and thin split-thickness skin grafting. This study is unique in describing grafting on multiple occasions and for larger areas than previously described, with two patients undergoing grafting more than 200 cm.

Non-ablative fractional photothermolysis in treatment of idiopathic guttate hypomelanosis.

BACKGROUND: Idiopathic guttate hypomelanosis (IGH) is a common pigmentary disorder affecting a large number of individuals. Many patients seek medical attention due to aesthetic concern. However, no standard treatment is available. OBJECTIVES: To evaluate the efficacy and side-effects of non-ablative fractional photothermolysis (FP) as a treatment of IGH. MATERIALS AND METHODS: A total of 120 lesions from 30 patients with IGH were treated. In each patient, two lesions on the extremities were assigned to treatment group, while lesions from the other side served as control. The treatment was delivered by fractional 1550-nm ytterbium/erbium fibre laser for four times at 4-week intervals. Lesional skin colour was measured by colourimetry. Digital photographs and dermoscopic digital photographs were taken at weeks 0, 4, 8, 12 and 16. In addition, patient satisfaction score and side-effects were recorded. All clinical photographs were evaluated by three experienced dermatologists to determine clinical improvement using a quartile grading scale. RESULTS: Colourimetry of the treatment side showed normalization of skin colour at each visit and was statistically significant when compared with control after two treatments (week 8) and continued to decrease until 4 weeks' follow-up (week 16) (P = 0.047, 0.016 and 0.06 respectively). Physicians' improvement grading score showed that 83.34% of the lesions in treatment group vs. 18.34% in the control group showed some improvement. The difference was statistically significant (P < 0.05). Common side-effects were erythema and oedema in treatment area, which were mild and transient. No post-inflammatory hyperpigmentation was observed. CONCLUSION: Non-ablative FP appears to be an effective way to treat IGH. The improvements are documented by both objective and subjective measurements.

Desmoplastic hypopigmented hairless nevus: a variant with progressive depigmentation, induration, and overgrowth.

Large congenital melanocytic nevus rarely presents itself without hairs, with hardened skin and progressive depigmentation. We report a girl who presented with a large congenital melanocytic nevus in the left cheek. Over the years, the nevus became pruriginous, light brown, bumpy, and hard. Histology revealed nevus cells interspersed with dense fibrosclerotic collagen bundles. There are few reported cases of large congenital melanocytic nevus with this evolution, so-called desmoplastic hypopigmented hairless nevus.

Efficacy of 308-nm xenon chloride excimer laser in pityriasis alba.

OBJECTIVE: Pityriasis alba (PA) is the most common cause of facial hypopigmentation presenting to the dermatologist. The objective of the current study was to study the effect of the 308-nm excimer laser in the treatment of PA. MATERIALS AND METHODS: Twelve patients with 37 PA patches were enrolled in this study. The lesions were treated using the 308-nm excimer laser twice a week for 12 weeks. The hypopigmented areas were evaluated at baseline and at weeks 0, 3, 6, and 12 for scaling, hypopigmentation, and pruritus on a 4-point scale (0 = none to 3 = severe). All adverse effects were recorded. RESULTS: There were seven male and five female participants in (aged 5-21 years), with skin type III to V. After 1 month of laser therapy, the clinical scores were significantly lower than at baseline. Similar decreases were observed for the scaling and pruritus scores. Uneven skin color improved by the third week, and near-complete resolution was noticed by the end of 3 months. No serious or unpleasant side-effects were observed, and all patients completed the 12-week treatment. Patients were satisfied or very satisfied with the treatment. CONCLUSION: The 308-nm excimer laser is an effective therapeutic option for PA.