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Beneficial Effect of Low Fluence 1,064 Nm Q-Switched Neodymium:Yttrium-Aluminum-Garnet Laser in the Treatment of Senile Lentigo

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Beneficial Effect of Low Fluence 1,064 Nm Q-Switched Neodymium:Yttrium-Aluminum-Garnet Laser in the Treatment of Senile Lentigo 1,064 nm QS Nd:YAG Laser Treatment for Lentigo pISSN 1013-9087ㆍeISSN 2005-3894 Ann Dermatol Vol. 29, No. 4, 2017 https://doi.org/10.5021/ad.2017.29.4.427 ORIGINAL ARTICLE Beneficial Effect of Low Fluence 1,064 nm Q-Switched Neodymium:Yttrium-Aluminum-Garnet Laser in the Treatment of Senile Lentigo Jae-Hui Nam*, Han-Saem Kim*, Ga-Young Lee, Won-Serk Kim Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea Background: Low fluence 1,064 nm Q-switched (QS) near total improvement, and three of 12 (25.0%) reached Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser moderate improvement. No side effects occurred. Conclusion: treatment, also known as laser toning, is widely used for pig- Repetitive low fluence 1,064 nm QS Nd:YAG laser treatment mentary disorders. There has been no reliable evaluation of may be an effective and safe optional modality for senile the effect of low fluence 1,064 nm QS Nd:YAG laser for se- lentigo. (Ann Dermatol 29(4) 427∼432, 2017) nile lentigo. Objective: To investigate the beneficial effect of low fluence 1,064 nm QS Nd:YAG laser in the treatment of -Keywords- senile lentigo on the face. Methods: A retrospective review Lasers, Laser therapy, Lentigo, Pigmentation, Skin was conducted on patients treated only with repetitive low fluence 1,064 nm QS Nd:YAG laser. Among them, 12 pa- tients with multiple senile lentigines before treatment were INTRODUCTION included. All side effects were recorded to assess the safety of the modality. Results: Mean age was 56.1±7.8 years old Senile lentigo is a benign and common discoloration in and male-to-female ratio was 1:11. Mean treatment fluence older people. Clinically, senile lentigo demonstrates a 2 was 1.62±0.16 J/cm and mean total treatment session was well-defined, annular or ovoid, uniform tan to brown, 8.8±2.6. Mean interval period between each session was small macule or patch, which presents on sun-exposed 28.0±11.4 days and mean treatment session to reach skin, such as the face, dorsal hands, and extensor forearms. marked and near total improvement was 8.7±2.8. At the fi- Aged skin in Asians is characterized by striking pig- nal visit, seven of 12 (58.3%) patients reached marked and mentary changes rather than the wrinkles apparent in Caucasian skin with aging1. Exposure to sunlight has been suggested to be the major cause of various pigmentary dis- Received July 11, 2016 Revised August 30, 2016, Accepted for publication September 21, 2016 orders in aged skin. For the development of senile lenti- *These authors have equally contributed to this work. gines, chronic sun exposure is necessary in pathogenesis. A draft version of this paper was first presented at the 67th autumn Prior studies suggested that keratinocytes and melanocytes meeting of Korean Dermatological Association. play a role in the formation of senile lentigo in response to Corresponding author: Won-Serk Kim, Department of Dermatology, 2 Kangbuk Samsung Hospital, Sungkyunkwan University School of Me- ultraviolet irradiation . dicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea. Tel: 82-2- Senile lentigines are not harmful to health, but may cause 2001-2228, Fax: 82-2-2001-2236, E-mail: [email protected] cosmetic problems in elderly individuals with wide- spread and disfiguring features. Q-switched (QS) lasers, in- This is an Open Access article distributed under the terms of the Creative cluding 532 nm QS Neodymium:Yttrium-Aluminum-Garnet Commons Attribution Non-Commercial License (http://creativecommons. org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, (Nd:YAG), QS ruby and QS alexandrite lasers, have be- distribution, and reproduction in any medium, provided the original work come popular in treating senile lentigo. However, post-in- is properly cited. flammatory hyperpigmentation can occur in 10%∼25% Copyright © The Korean Dermatological Association and The Korean of irradiated patients3. Society for Investigative Dermatology Vol. 29, No. 4, 2017 427 JH Nam, et al Use of a low fluence 1,064 nm QS Nd:YAG laser, also Laser treatment termed laser toning, has been introduced to improve a va- riety of benign pigmentary disorders, including melasma All 12 patients were treated in 5 to 12 sessions with and nevus of Ota4,5. Laser toning has become a mainstay low-fluence QS Nd:YAG laser (Spectra VRMIIIⓇ; Lutronic in the treatment armamentarium for the management of Corp., Seoul, Korea) at a wavelength of 1,064 nm, pulse benign pigmented lesions by achieving successful out- duration of 5∼10 nsec, spot size of 8 mm, and fluence of comes and lowering side effects accompanied with con- 0.8∼2.0 J/cm2. The entire face was covered as a treatment ventional QS laser therapy5. field, since general facial brightening was the goal Although the efficacy of laser toning has been proven throughout the treatment period. The laser fluence was ad- through diverse experience with various skin lesions, no justed based on patients’ response to the previous studies have addressed the efficacy of laser toning in the treatment. No topical anesthesia and pre-procedure proc- treatment of solar lentigo. Here, we describe laser treat- esses were used. The treatment endpoint was immediate ment using a low fluence 1,064 nm QS Nd:YAG laser to moderate erythema. reduce senile lentigo on the face. Clinical assessment MATERIALS AND METHODS Clinical response after laser treatment was independently scored by two dermatologists with clinical photographs Study participants taken at each visit. A quartile scale was used: minimal im- A retrospective review was conducted on patients treated provement (＜25% response), moderate improvement at least four times with low fluence 1,064 nm QS Nd:YAG (26%∼50% improvement), marked improvement (51%∼ laser for skin brightening between 2009 and 2015. The 75% improvement), and near total improvement (＞75% participants were older than 40 years of age and had mod- response). Physicians’ scores were confirmed only if the erate to severe grade of multiple senile lentigines on the ratings of the two dermatologists were consistent. All cuta- face. To clarify the extent of disease, other pigmentary le- neous adverse events were recorded to assess the safety of sions, such as melasma, freckle, and obvious seborrheic the laser modality; these included hyperpigmentation, hy- keratosis, were excluded. In addition, any patients who popigmentation, persistent erythema, crust, and burning had undergone previous laser or cosmetic procedures on and itching sensation. the face within 3 weeks of the first treatment session were Statistical analysis excluded. The study protocols have been approved by the institutional review board (IRB) of Kangbuk Samsung To compare treatment-related factors between two groups Hospital, Seoul, Korea (KBSMC IRB no. 2016-02-028). classified with clinical response rate, a Mann-Whitney test Twelve individuals (one male and 11 females) were was performed on the number of treatment session, mean included. The mean age at the first visit was 56.1 years treatment fluence, and mean treatment interval. All analy- (range, 43∼69 years) (Table 1). ses were conducted using PASW Statistics ver. 18.0 (IBM Co., Armonk, NY, USA). Statistical significance was de- fined as p＜0.05. RESULTS Table 1. Demographics of study participants (n=12) The demographics of the study participants are presented Demographics Result in Table 1. The male-to-female ratio was 1:11. The in- No. of patients 12 dividual clinical data are summarized in Table 2. The Sex (male/female) 1/11 mean number of treatment sessions was 8.8±2.6, the Age (yr) 56.1±7.8 mean interval between sessions was 28.0±11.4 days, and 40 to ＜50 2 2 50 to ＜60 6 the mean treatment fluence was 1.62±0.16 J/cm . The ≥60 4 mean number of treatment sessions required to reach Fitzpatrick skin type marked and near-total improvement was 8.7±2.8. At the III 7 final visit, all patients showed an improved response com- IV 5 pared to pre-treatment status. Seven of 12 (58.3%) patients Values are presented as number only or mean±standard achieved marked and near-total improvement, and three deviation. of 12 (25.0%) patients achieved moderate improvement 428 Ann Dermatol 1,064 nm QS Nd:YAG Laser Treatment for Lentigo Table 2. Overall results of patients with low fluence 1,064 nm Q-switched Neodymium:Yttrium-Aluminum-Garnet laser treatment (n=12) Patient Age Total Final Session number to marked Mean Mean treatment Adverse Sex no. (yr) session (n) improvement* and near total improvement fluence (J/cm2) interval (d) events 1 F 69 5 2 - 1.56 50.0 - 2 F 64 10 3 10 1.53 29.3 - 3 F 56 9 4 9 1.80 23.3 - 4 F 58 9 3 9 1.60 43.1 - 5 F 66 9 4 3 1.82 41.1 - 6 F 62 10 2 - 1.64 18.2 - 7 M 58 11 3 9 1.55 15.6 - 8 F 50 10 1 - 1.37 22.2 - 9 F 50 11 2 - 1.60 18.3 - 10 F 43 10 4 10 1.50 14.7 - 11 F 47 7 2 - - 23.3 - 12 F 50 12 4 12 1.89 36.7 - F: female, M: male, -: no data was available. *1: minimal, 2: moderate, 3: marked, 4: near total improvement. ment fluence (1.67 J/cm2 vs. 1.54 J/cm2, p＞0.51), and mean treatment interval (29.1 days vs. 26.4 days, p＞ 0.69). DISCUSSION Senile lentigo can occur with 90% of people older than 60 years of age and is generally regarded as an early sign of aged skin1,3.
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