In vivo trial comparing patients' tolerance of Q-switched Alexandrite (QS Alex) and Q-switched neodymium:yttrium-aluminum-garnet (QS Nd:YAG) lasers in the treatment of nevus of Ota

Lasers for cutaneous lesions: An update

There are several types of medical settings which use lasers. Dermatologists use lasers as it is non-invasive with preferential cosmetic outcomes and finer wound healing. The types of lasers are relying on their wavelengths and delivery systems. Over time, by using several distinct devices and strategies, new lasers have been generated; as a consequence, they are manipulated in a wide range of dermatological settings. In this review, laser applications in various vascular, infectious, and hyperpigmented cutaneous lesions were framed. We aimed to represent the fitness of phototherapy for each condition as well as the overall challenges that face laser. In addition, low-level laser therapy, and laser resurfacing were noted as the marketable line of lasers in the current time for cosmetic purposes.

Laser treatment of medical skin disease in women

Laser treatment is a relatively new and increasingly popular modality for the treatment of many dermatologic conditions. A number of conditions that predominantly occur in women and that have a paucity of effective treatments include rosacea, connective tissue disease, melasma, nevus of Ota, lichen sclerosus (LS), notalgia paresthetica and macular amyloidosis, and syringomas. Laser therapy is an important option for the treatment of patients with these conditions. This article will review the body of literature that exists for the laser treatment of women with these medical conditions.

Comparison of clinical efficacy and complications between Q-switched alexandrite laser and Q-switched Nd:YAG laser on nevus of Ota: a systematic review and meta-analysis

Although the application of Q-switched lasers on nevus of Ota (OTA) is well demonstrated, debates about clinical option between Q-switched alexandrite laser (QSA) and Q-switched Nd:YAG laser (QSNY) still remain. This systematic review and meta-analysis estimated the overall successful rate of OTA pigment clearance and complication rate of QSA and QSNY and evaluated which laser could produce a better result. English articles evaluating pigment clearance and complications of QSA and/or QSNY on OTA were screened through predetermined inclusion and exclusion criteria and analyzed. The successful rate of pigment clearance and complication rate of QSA and QSNY were respectively calculated using a random-effects or fixed-effects model, depending on the heterogeneity of the included studies. The successful rate and complication rate of QSA and QSNY were compared statistically. Of the 140 articles searched, 13 met inclusion criteria. Totally, 2153 OTA patients treated by QSA and 316 patients treated by QSNY were analyzed. In QSA and QSNY groups, respectively, the successful rate of OTA pigment clearance was 48.3% (95% confidence interval (CI) 19.9-76.8%) and 41% (95% CI 9.7-72.2%), while the complication rate was 8.0% (95% CI 3.9-12.2%) and 13.4% (95% CI 7.7-19.0%). When compared with QSNY, QSA had a significantly higher successful rate (P = 0.017), and a lower complication rate (P = 0.000). According to this review, QSA may surpass QSNY in treatment for OTA as it had a superior successful rate of pigment clearance and a lower complication rate than QSNY did.

Melanoma in situ: Part II. Histopathology, treatment, and clinical management

Melanoma in situ (MIS) poses special challenges with regard to histopathology, treatment, and clinical management. The negligible mortality and normal life expectancy associated with patients with MIS should guide treatment for this tumor. Similarly, the approach to treatment should take into account the potential for MIS to transform into invasive melanoma, which has a significant impact on morbidity and mortality. Part II of this continuing medical education article reviews the histologic features, treatment, and management of MIS.

A randomized, split-face clinical trial of Q-switched alexandrite laser versus Q-switched Nd:YAG laser in the treatment of bilateral nevus of Ota

Different types of Q-switched (QS) lasers have been used successfully to treat nevus of Ota. The purpose of this study was to compare the clinical efficacy and complication of QS alexandrite (QS Alex) laser versus QS neodymium:yttrium aluminum garnet (Nd:YAG) (QS Nd:YAG) laser for bilateral nevus of Ota. Seventeen patients with bilateral nevus of Ota were treated randomly with QS Alex in one half of face and QS Nd:YAG in the other half with an interval of at least 3 months between each. Subjective assessment was made by both patients and dermatologists. Patients were also examined for evidence of complications. All patients experienced improvement (p < 0.05). There was no statistically significant difference between the two sides (p > 0.05). The pain after a short period of laser therapy was more severe for QS Alex than for QS Nd:YAG laser. Vesicles developed in 1 patient after QS Alex therapy. Both QS Alex laser and QS Nd:YAG laser were equally effective at improving bilateral nevus of Ota. Patients tolerate QS Nd:YAG laser better than QS Alex laser.

A retrospective analysis of the clinical efficacies of Q-switched Alexandrite and Q-switched Nd:YAG lasers in the treatment of nevus of Ota in Korean patients

BACKGROUND

While the Q-switched Alexandrite laser (QSAL) and the Q-switched neodymium: yttrium-aluminum-garnet (QSNY) laser have been widely used in treating nevus of Ota, few studies compared them.

OBJECTIVE

To compare the efficacies of the QSAL and the QSNY laser in the treatment of nevus of Ota in Korean patients.

METHODS AND MATERIALS

A retrospective multicenter study was conducted in 76 patients with nevus of Ota. Thirty-one patients were treated with a QSAL (5.5-8.0 J/cm(2), 4-mm spot size) and 45 patients were treated with QSNY laser (6.0-12.0 J/cm(2), 2-mm spot size). Treatment outcomes were categorized into five grades and the results were compared with the relevant variables taken into account using multivariate logistic regression analysis.

RESULTS

QSAL treatment was more likely to achieve a better response compared with that with QSNY laser treatment. The odds ratio of achieving an excellent response, compared with the odds ratio of having a poor response, was 12.213-times more likely when a QSAL was used than when a QSNY laser was used (p = 0.026).

CONCLUSION

The QSAL tends to be more efficient than the QSNY laser in the treatment of nevus of Ota in Korean patients. Further controlled, prospective comparison studies are needed.

A retrospective study on laser treatment of nevus of Ota in Chinese children--a seven-year follow-up

OBJECTIVE

To retrospectively study laser treatment of nevus of Ota in children.

METHODS

Clinically analyzing characteristics, effects, side effects, and recurrence of a 104 cases of nevus of Ota in children under 12 years, including 32 boys and 72 girls.

RESULTS

After seven treatments, cure rate of lesion color fading and area reducing were 79.81% and 75.96%, respectively. After 10 treatments, both of the two cure rates were 96.15%. Later the cure rate was constant with even more treatments. The younger the first treating age, the lesser the treatments are. The younger the age of onset, the higher the relapse after clearance.

CONCLUSION

Nevus of Ota should be treated as early as possible to reach better efficacy with less treatments. The younger the onset age, the easier it recurs.

'Nevi of Ota: the unusual birthmarks': a case review

Nevi of Ota are usually characterised by unilateral, mottled, slate blue or dark brown macules on the forehead and face around the eye area. These are unusual skin discolorations in which melanocytes are found deeper than normal. Ota's nevus is usually congenital but may appear in early childhood or in puberty. We summarise a case report along with histological and management aspects of this cosmetically unappealing condition.

QYAG5 Q-switched Nd:YAG Laser Treatment of Nevus of Ota: An Indian Study of 50 Patients

Background:

Nevus of Ota is very common in Asian patients. The condition is more common in females, with a male-female ratio of 1:4.8. Most patients seek treatment early in life due to the psychological trauma and cosmetic disfigurement. The Q-switched lasers have changed the way we approach the condition and have become the mainstay of therapy.

Aims and Objectives:

To evaluate long-term safety and efficacy of pigmented lesion laser Palomar QYAG5 Q-switched Nd:YAG in 50 Indian patients.

Materials and Methods:

Fifty patients of nevus of Ota underwent multiple treatments (average 6 sessions) carried out over a period of 1year with a Q-switched Nd:YAG laser (QYAG5, Palomar, USA). Of the 50 patients, 2 were males; and the rest, females. Five patients had a bilateral involvement. Skin types treated included phototypes 4 and 5. The response after subsequent treatments was documented through serial photographs that were taken before and after the completion of treatments. Patients were followed up for a period of 1 year after the last session. Response to treatment was graded based on physician’s global assessment.

Results:

Excellent improvement was noted in a majority of the patients at the end of the treatments. Greater-than-60% improvement was seen in 66% of the patients. The remaining patients had moderate clearing of pigmentation (30%-60% improvement). No significant adverse effects were seen immediately after the treatments and on long-term follow-up. Transient post-inflammatory hyperpigmentation was observed in 5 (10%) patients, which cleared with use of sunscreens and bleaching agents within 2 months. No textural change or scarring was seen. Hypopigmentation (guttate type) was observed in 1 (2%) patient, which resolved within 3 months. No recurrence was observed after 1 year of follow-up.

Conclusion:

This study validates the superior efficacy of Q-switched Nd:YAG laser when compared to conventional methods for treatment of nevus of Ota.

Comparing the effectiveness of Q-switched Ruby laser treatment with that of Q-switched Nd:YAG laser for oculodermal melanosis (Nevus of Ota)

BACKGROUND AND OBJECTIVE

The objective of this study was to compare the efficacy and safety of Q-switched Ruby laser versus Q-switched neodymium:yttrium-aluminium-garnet (Nd:YAG) laser for oculodermal melanosis (Nevus of Ota) birthmarks in a large group of patients.

STUDY DESIGN/MATERIALS AND METHODS

A retrospective review was conducted of 94 patients with Nevus of Ota treated with a Q-switched Ruby laser and a Q-switched Nd:YAG laser over a 3-year period. The subjects' ages ranged from 3 to 64 years; there were 70 females and 24 males, all of whom were of Asian descent. The number of treatments ranged from 1 to 8. Duration of treatment ranged from 6 months to 3 years and 10 months, with a mean of 14 months. Patients (n=47) received Q-switched Ruby laser treatment (694 nm) using light dosages of 7-10 J cm(-2). Subsequent patients (n=47) received Q-switched Nd:YAG laser treatment (1064 nm) using light dosages of 7-10 J cm(-2). The primary efficacy measurement was the quantitative assessment of clearing and fading response using the DermaSpectrometer for the Q-switched Ruby laser group versus the Q-switched Nd:YAG laser group.

RESULTS

Based on a paired t-test, clinical and statistically significant differences in clearing and fading response were observed amongst the Q-switched Ruby laser-treated subjects as preferred to the appearance of Q-switched Nd:YAG laser-treated group (P<0.05). In both groups, transient hyperpigmentation resolved in all subjects within 6 months. Permanent hyperpigmentation or scarring was not observed in either group.

CONCLUSION

Use of a Q-switched Ruby laser resulted in better clearing and fading as compared with Q-switched Nd:YAG laser.

The Asian dermatologic patient: review of common pigmentary disorders and cutaneous diseases

The Asian patient with Fitzpatrick skin types III-V is rarely highlighted in publications on cutaneous disorders or cutaneous laser surgery. However, with changing demographics, Asians will become an increasingly important group in this context. Although high melanin content confers better photoprotection, photodamage in the form of pigmentary disorders is common. Melasma, freckles, and lentigines are the epidermal disorders commonly seen, whilst nevus of Ota and acquired bilateral nevus of Ota-like macules are common dermal pigmentary disorders. Post-inflammatory hyperpigmentation (PIH) occurring after cutaneous injury remains a hallmark of skin of color. With increasing use of lasers and light sources in Asians, prevention and management of PIH is of great research interest. Bleaching agents, chemical peels, intense pulsed light (IPL) treatments, and fractional skin resurfacing have all been used with some success for the management of melasma. Q-switched (QS) lasers are effective for the management of epidermal pigmentation but are associated with a high risk of PIH. Long-pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers and IPL sources pose less of a PIH risk but require a greater number of treatment sessions. Dermal pigmentary disorders are better targeted by QS ruby, QS alexandrite, and QS 1064-nm Nd:YAG lasers, but hyper- and hypopigmentation may occur. Non-ablative skin rejuvenation using a combination approach with different lasers and light sources in conjunction with cooling devices allows different skin chromophores to be targeted and optimal results to be achieved, even in skin of color. Deep-tissue heating using radiofrequency and infra-red light sources affects the deep dermis and achieves enhanced skin tightening, resulting in eyebrow elevation, rhytide reduction, and contouring of the lower face and jawline. For management of severe degrees of photoaging, fractional resurfacing is useful for wrinkle and pigment reduction, as well as acne scarring. Acne, which is common in Asians, can be treated with topical and oral antibacterials, hormonal treatments, and isotretinoin. Infra-red diode lasers used with a low-fluence, multiple-pass approach have also been shown to be effective with few complications. Fractional skin resurfacing is very useful for improving the appearance of acne scarring. Hypertrophic and keloid scarring, another common condition seen in Asians, can be treated with the combined used of intralesional triamcinolone and fluorouracil, followed by pulsed-dye laser. Esthetic enhancement procedures such as botulinum toxin type A and fillers are becoming increasingly popular. These are effective for rhytide improvement and facial or body contouring. We highlight the differences between Asian skin and other skin types and review conditions common in skin of color together with treatment strategies.

Laser Treatment of Congenital Nevi

Congenital nevi are benign proliferations present at birth that consist of cells normally present in the skin. Many of these lesions are disfiguring and a source of psychosocial impairment. Because of location or extent of the lesion, surgical excision of the nevus may leave a defect without favorable reconstructive options. Laser ablation of such lesions has been used by several clinicians. A review of laser terminology is presented along with a review of nevus of Ota, nevus of Ito, café-au-lait macules, lentigines, and congenital melanocytic nevi. Although good results may be achieved with laser ablation of these lesions, laser treatment modalities for congenital melanocytic nevi remain controversial because of the potential for malignancy.

Comparison of characteristics of acquired bilateral nevus of Ota-like macules and nevus of Ota according to therapeutic outcome

Both acquired bilateral nevus of Ota-like macules (ABNOM) and nevus of Ota are characterized by the presence of dermal melanocytes. There are no differences in the method of treatment, however, postinflammatory hyperpigmentation (PIH) develops more often in ABNOM than in nevus of Ota following treatment. We investigated the differences in the development of PIH after treatment between ABNOM and nevus of Ota, and the histopathologic differences in the PIH. A total of 82 patients with ABNOM (n=47) and nevus of Ota (n=35) were treated with Q-switched alexandrite laser and followed up 2 weeks and 3 months later. Biopsies were performed on lesional skin before treatment. The distribution and the amount of melanin pigments were visualized with Fontana-Masson stain, and the distribution and the depth of melanocytes were measured by GP-100 (NK1-beteb) stain. Clinically, there was more erythema and PIH in ABNOM than in nevus of Ota. Histopathologically, intradermal melanocytes were clustered in groups and dispersed perivascularly in ABNOM, while melanocytes were scattered evenly throughout the dermis in nevus of Ota. Both groups show that when there is a statistically significant number of melanocytes in the perivascular area, erythema and PIH occur after laser therapy. In conclusion, indirect vessel injury in addition to perivascular clustering melanocytes might be considered the cause of increased PIH after treatment in ABNOM.

Laser surgery: an approach to the pediatric patient

Revolutionary advances in laser research and technology have led to expanded dermatologic laser applications. With the wide range of lasers now available, a large spectrum of skin conditions in the pediatric population can be successfully treated or, in some cases, completely eradicated. Laser treatment of the pediatric population poses a unique challenge for the clinician on a variety of levels. Physically, the composition of many vascular and pigmented lesions changes as children age making them more resistant to laser therapy. Thus, in many cases, treating lesions at an early age has resulted in clearing in fewer sessions and with decreased complications. Mechanically, lasers and laser settings used for the treatment of adult lesions may have to be adjusted for the smaller vessels and the unpredictable nature of scarring with children's skin. For vascular lesions, the pulsed dye laser is considered the laser of choice for its efficacy and low-risk profile, whereas the Q-switched, pigment-specific lasers are ideal for most childhood pigmented lesions, allowing for single pigment cell destruction. Other conditions such as acne and acne scars, psoriasis, keloids, warts and hypertrichosis that traditionally have been treated with a variety of modalities are now being managed safely with laser surgery. Other issues specific to the pediatric population include the determination of suitable anesthesia, the provision of size-appropriate safety equipment, and the assessment and management of patient and parent anxiety. The use of lasers specifically designed for structural differences in pediatric lesions and the recognition of emotional issues surrounding a young patient during laser surgery are critical components of successful treatment.

LEARNING OBJECTIVE

At the conclusion of this learning activity, participants should be familiar with the mechanism of laser technology, current trends in the use of lasers for skin lesions in the pediatric population, and the issues specific to treating a patient with laser surgery.

Use of Q-switched ruby laser in the treatment of nevus of ota in different age groups

BACKGROUND AND OBJECTIVES

Nevus of Ota is a form of dermal melanocytic hamartoma that appears as a bluish discoloration in the trigeminal region. Although Q-switched lasers provide effective treatment, the appropriate age at which to start that treatment is not known. Our aim is to compare the clinical efficacy and safety of Q-switched ruby laser (QSRL) in the treatment of nevus of Ota in different age groups.

STUDY DESIGN/MATERIALS AND METHODS

Our study included 46 children and 107 adults with nevus of Ota, which had been treated with QSRL that achieved excellent (75% or more) to complete response. The laser parameters were 694-nm wavelength, 30 nanoseconds pulse duration, 4-mm spot size, and 5-7 J/cm2 fluence at 3-4 month intervals. We assessed the mean number of treatment sessions and the degree of complications in the two age groups of patients.

RESULTS

The mean number of treatment sessions to achieve significance to complete clearing was 3.5 for the younger age group and 5.9 for the older age group (P = 0.0001). The complication rate for the younger age group was 4.8% as compared to 22.4% for the older age group.

CONCLUSIONS

The use of QSRL for the treatment of nevus of Ota in children can achieve an excellent result in fewer sessions and at a lower complication rate than later treatment. The risk of recurrence is a concern, however, and further long-term study is necessary to address this issue.

Role of skin cooling in improving patient tolerability of Q-switched Alexandrite (QS Alex) laser in nevus of Ota treatment

BACKGROUND

The development of a high-energy laser device with very short pulse duration has revolutionized the treatment of nevus of Ota. Nevertheless, patients still suffer from complications that range from the pain and swelling that occur immediately after laser surgery to post-operative pigmentary changes and scarring. However, the simultaneous use of skin surface cooling and laser surgery may limit the damage of non-target tissue.

OBJECTIVES

To assess whether epidermal cooling reduces the pain and swelling that commonly occur after laser treatment for nevus of Ota.

STUDY DESIGN/PATIENTS AND METHODS

Thirty-seven patients with nevus of Ota were recruited from a dermatology outpatient clinic. Before treatment, the research nurse used an ink pen to divide the lesions into two halves. Half of each lesion was treated with a Q-switched Alex laser system that had a cool sapphire plate in contact as a mean of skin cooling. The other half was treated with the same laser, but with the cooling device switched off. Immediately after treatment, and again 1 week later, the patients answered a questionnaire, which assessed the symptoms that are associated with laser surgery. Dose assessment was performed in each half of the nevus to obtain the optimal fluence that could be used for the treatment of nevus of Ota before the entire half was treated.

RESULTS

There was no difference in terms of the optimal fluence that was used, but in terms of immediate pain the patients associated the side that was treated with the cooling plate with a significantly lesser degree of pain than the non-cooled side (P = 0.001). Eighty two percent of the patients preferred the cooled side to the non-cooled side.

CONCLUSIONS

Pre- and post-operative skin cooling is effective in improving the tolerability of nevus of Ota patients to Q-switched laser treatment. However, the use of cooling during laser treatment of nevus of Ota did not allow the use of higher fluence.

Lasers in dermatology: four decades of progress

Advances in laser technology have progressed so rapidly during the past decade that successful treatment of many cutaneous concerns and congenital defects, including vascular and pigmented lesions, tattoos, scars, and unwanted hair-can be achieved. The demand for laser surgery has increased substantially by patients and dermatologists alike as a result of the relative ease with which many of these lesions can be removed, combined with a low incidence of adverse postoperative sequelae. Refinements in laser technology and technique have provided patients and practitioners with more therapeutic choices and improved clinical results. In this review, the currently available laser systems with cutaneous applications are outlined, with primary focus placed on recent advancements and modifications in laser technology that have greatly expanded the cutaneous laser surgeon's armamentarium and improved overall treatment efficacy and safety.

Nevus of Ota: clinical aspects and management

Nevus of Ota, or nevus fuscoceruleus ophthalmomaxillaris, is a dermal melanocytic hamartoma that presents as bluish hyperpigmentation along the first or second branches of the trigeminal nerve. Extra-cutaneous involvement has been reported, especially ocular involvement. Nevus of Ota affects between 0.014%-0.034% of the Asian population. Clinical differential diagnoses include facial cafe-au-lait patch, spilus nevus, and acquired bilateral nevus of Ota-like macules. Previous treatment modalities, including cryotherapy and microsurgery, can be associated with scarring. In the last decade, the use of Q-switched lasers has revolutionized the treatment of this condition. This review summarizes the clinical, histologic, and management aspects of this dermal melanocytic hamartoma.

Lasers in dermatology. An overview of types and indications

Advances in laser technology have been so marked over the past two decades that successful eradication of many cutaneous pathologies and congenital defects, including vascular and pigmented lesions, tattoos, scars, and unwanted hair, can now be fully realized. Because of the relative ease with which many of these lesions can be removed, coupled with a low incidence of adverse postoperative sequelae, demand for laser surgery has increased substantially. In this review, the currently available laser systems with cutaneous application are outlined, with special reference to recent advancements and modifications in laser technology that have greatly expanded the laser surgeon's armamentarium and improved upon overall treatment efficacy.

A retrospective study looking at the long-term complications of Q-switched ruby laser in the treatment of nevus of Ota

BACKGROUND AND OBJECTIVE

Despite the extensive use of QS Ruby, there is no report looking at its long-term complication in the treatment of nevus of Ota. To look at the long-term complications of nevus of Ota patients treated with QS Ruby laser.

STUDY DESIGN/MATERIALS AND METHODS

A teaching hospital in Japan where over 400 patients with nevus of Ota had been treated since 1984. Hundred and one nevus of Ota patients that had been treated with QS Ruby laser, but had not received treatment for 12 months prior to the study, were called back for further assessment. Patients were called back to the hospital where they were interviewed and examined by two independent clinicians.

RESULTS

Hypopigmentation was the most common complication, affecting 16.8% of the patients and 5.9% had hyperpigmentation. One patient that had complete clearance post-laser surgery developed recurrence.

CONCLUSION

QS Ruby laser is effective in the treatment of nevus of Ota. Recurrence is rare, but hypopigmentation is common and can be permanent. Further prospective study comparing its use with other Q-switched lasers is necessary.

Treatment of nevus of Ota with the Q-switched alexandrite laser

BACKGROUND AND OBJECTIVE

Q-switched laser systems have been shown to be useful for removal of nevus of Ota, a pigmented lesion on the face. The purpose of this study was to evaluate the efficacy of Q-switched alexandrite laser in the treatment of nevus of Ota in 13 patients.

STUDY DESIGN/MATERIALS AND METHODS

A spot test was made at 6.0, 7.0, and 8.0 J/cm(2) energy fluence, and the best energy fluence was selected after a 2-month postoperative evaluation. Q-switched alexandrite laser with a mean fluence of 7.290.46 J/cm(2) was used at 8-week intervals. Total treatment ranged from 1 to 15 sessions (mean 7.1 +/- 5.1 sessions). The single shot technique was used.

RESULTS

More than 75% lightening was achieved in seven patients, between 51% and 75% in three, less than 50% in one, and less than 25% in one. In two patients with excellent clearance, a very light gray macula in the lower eyelid persisted after 8 and 14 treatment sessions, respectively. Mild transient hypopigmentation that subsided spontaneously after 2 months was observed in one patient. No repigmentation was seen.

CONCLUSIONS

The Q-switched alexandrite laser seems to be an effective and safe modality for the treatment of nevus of Ota.

Nevus of Ota: a new classification based on the response to laser treatment

BACKGROUND AND OBJECTIVE

For 60 years, Tanino's classification has been used to classify the extent of nevus of Ota. However, such classification not only fails to address variants such as phacomatosis pigmentovascularis but also cannot be used to predict the therapeutic outcome. Our objective is to retrospectively study our series of laser-treated patients with the aim of re-classifying nevus of Ota, so that such important issues can be taken into account.

STUDY DESIGN/MATERIALS AND METHODS

One hundred nineteen patients that had received Q-switched laser treatment were recruited into the study. They were recalled for interview and examination for evidence of coexisting birthmarks and extracutaneous involvement. Two observers assessed the pre- and posttreatment clinical photographs for evidence of periorbital under-response (panda's sign), defined as the degree of periorbital laser clearing significantly less than clearing in the other area.

RESULTS

A total of 47.8% of the patients with periorbital pigmentation were considered by the observers to have significant periorbital under-response (panda's sign). Additionally, 10.1% had other birthmarks, and extracutaneous involvement was seen in 31.4% of the patients.

CONCLUSION

Periorbital under-response is commonly seen in patients with periorbital pigmentation. Taking this and other factors into consideration, we have proposed a new classification for nevus of Ota that allows for the prediction of the clinical outcome of laser treatment.

Q-switched Nd:YAG laser treatment for acquired bilateral nevus of ota-like maculae: a long-term follow-up

BACKGROUND AND OBJECTIVE

Acquired bilateral nevus of Ota-like maculae (ABNLM) is not an uncommon dermal melanosis in Asian people. It is known for its recalcitrance to conventional treatment. We proposed Q-switched Nd:YAG laser for the treatment of this entity.

STUDY DESIGN/PATIENTS AND METHODS

Seventy female patients with ABNLM, who were 25-40 years old (mean, 37 years), were included in a prospective clinical study. Q-switched Nd:YAG laser at fluence of 8-10 J/cm(2), spot size 2 or 4 mm, and a repetition rate of 10 Hz was used to treat the lesions.

RESULTS

Two patients were lost to follow-up. In the remaining 68 cases, all lesions attained a 100% clearance after two to five treatment sessions (mean, 2.8 sessions). The results had persisted at 3-4 years follow-up (mean, 42 months). Temporary hyperpigmentation was found in 50% of patients; there was no scarring or changing of skin texture.

CONCLUSION

Q-switched Nd:YAG laser is a safe and effective noninvasive alternative treatment for ABNLM.

Treatment of Hori's nevus with the Q-switched Nd:YAG laser

BACKGROUND

Hori's nevus is an acquired pigmented lesion involving bilateral blue-brown facial macules. There has been a dearth of reported treatment modalities for this condition.

OBJECTIVE

The purpose of this study was to evaluate the efficacy of the Q-switched Nd:YAG laser for the treatment of Hori's nevus.

METHODS

The Q-switched Nd:YAG laser was used to treat Hori's nevus in 66 Asian patients. Patients were treated up to seven times. The follow-up time after the final treatment ranged from 3 to 44 months.

RESULTS

Twenty six percent of patients showed good to excellent clearing after one to two treatments. Fifty percent of patients who underwent more than two treatments received good to excellent results.

CONCLUSION

The Q-switched Nd:YAG laser can be used to treat Hori's nevus. Results are not as good as those seen with nevus of Ota.