Agminated nevi are rare, grouped lesions, which are confined to one anatomic area. Herein, we report a case of successful cosmetic treatment of bilateral, acquired agminated nevi with a picosecond 532 nm Nd:YAG laser device.
Literature search was completed on acquired agminated nevi. A healthy 21-year-old woman presented with numerous, grouped 1-mm brown-to-dark brown macules in the axillae bilaterally. Biopsies revealed lentiginous junctional nevi with mild atypia, leading to the diagnosis of agminated nevi. She was referred for laser treatment to improve cosmetic appearance. Two different laser devices were utilized initially, a picosecond 532 nm Nd:YAG laser on the left axilla and a millisecond domain 532 nm laser on the right. Greater improvement was noted with the picosecond 532 nm device. Three additional treatments were completed with the picosecond laser with significant improvement in pigmentation of melanocytic nevi.
Various pigmented and melanocytic lesions have been noted to occur in an agminated pattern although their pathway of development remains unknown. While various devices have demonstrated efficacy for pigmented lesions, treatment of agminated nevi specifically is less reported or established. Our patient's presentation is novel because of the axillary location and bilateral distribution of multiple acquired agminated nevi, neither of which have been previously reported in the literature. We also report successful treatment utilizing a picosecond 532 nm laser. While laser can help improve the cosmetic appearance of pigmented lesions, most lasers do not remove all melanocytes, highlighting the need for close monitoring, as atypia and melanoma have been reported to develop in acquired agminated nevi.
Thus, we present a case of acquired agminated nevi in a novel bilateral distribution in a healthy female successfully treated with a picosecond 532 nm laser.
Pigmented actinic keratoses (PAKs), a pigmented variant of actinic keratosis, present diagnostic challenges due to their resemblance to both benign and malignant lesions. Conventional therapies have inconsistent outcomes and may cause undesirable side effects. This study investigates the efficacy of the Alexandrite laser, a pulsed laser with selective melanin absorption, for PAK treatment. Through dermoscopic analysis pretreatment, it aims to identify predictive patterns for better treatment outcomes.
Patients with PAKs were enrolled in a multicenter study, receiving standardized Alexandrite laser therapy. Detailed dermoscopic evaluations were conducted pretreatment. The Physician's Global Assessment (PGA) and Target Lesion Pigmentation (TLP) scales measured treatment efficacy.
The study included 50 patients with 60 PAKs. Following treatment, there was a statistically significant reduction in TLP scores, particularly in lesions with pigmented pseudo-networks and gray-brownish dots, which were linked to improved outcomes. No adverse effects were reported, suggesting the safety and tolerability of the laser treatment.
The Alexandrite laser emerges as a promising modality for the management of PAK pigmentation, with specific dermoscopic patterns being indicative of a favorable response. This study reinforces the critical importance of dermoscopic expertise in the selection and optimization of treatment for PAKs. Future research should focus on comparative studies with different lasers or combination therapies to develop a more comprehensive treatment framework for PAKs.
This study aimed to evaluate the efficacy and safety of nanosecond laser treatment of pigmented lesions in silico using a model of melanosome disruption threshold fluence (MDTF) based on skin optical properties.
Particle size analysis and scanning electron microscopy were performed to determine the threshold fluence for melanosome disruption using a nanosecond laser. By inputting the obtained threshold fluence into the MDTF model and considering the variability in skin optical properties, irradiation parameters were calculated and compared with the results from clinical studies.
The threshold fluences for 532 and 755 nm nanosecond laser irradiation were determined to be 3.0 and 15.0 J/cm2, respectively. In silico analysis showed that the incident fluence for moderately pigmented skin should be 1.2 times that for lightly pigmented skin, whereas it should be 50% lower than that for lightly pigmented skin to achieve the same level of energy deposition. Clinically applied fluences for moderately pigmented skin are at the low end of the calculated range of values, suggesting that the clinical fluence is chosen to minimize energy deposition in normal tissues.
Our results showed that the MDTF model can be used to evaluate nanosecond laser treatments and provide clinical guidance on fluence settings based on laser–tissue interactions in moderately pigmented skin. The in silico method can, therefore, provide a robust and quantitative retrospective evaluation of the treatment effects that accounts for variation in irradiation parameters among patients by combining the MDTF model with the in vivo optical properties of individual skin types.
Scalp inflammation and alopecia are distressing conditions for which patients regularly present to dermatology. Although some diagnoses can be made clinically, others require biopsy, which carries the risk of pain, infection, bleeding, and scarring. This review examines the existing literature regarding noninvasive in vivo imaging techniques and their evidence and utility in evaluating scalp pathology, with a focus on the diagnostics of hair conditions.
A systematic literature search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines without timeframe restrictions. The PubMed and Clarivate (Web of Science) databases were searched using the terms (“imaging” OR “in-vivo imaging” OR “non-invasive imaging” OR “non-invasive in vivo imaging” “imaging,” “in-vivo imaging) AND (“human scalp disorders” OR “scalp” OR “hair loss” OR “alopecia”). Peer-reviewed randomized control trials (RCTs), prospective studies, retrospective studies, and case series or reports discussing in vivo imaging of the scalp published before 2022 were selected.
Forty-two studies were included and discussed; modalities included laser devices (n = 27), ultrasound (US) (n = 13), infrared thermography (n = 1), skin capacitance imaging (SCI), and ultraviolet light–enhanced visualization (ULEV) (n = 1). The most common laser devices used were reflectance confocal microscopy (RCM), multiphoton microscopy (MPM), and optical coherence tomography (OCT). US techniques included high-frequency US (HFUS) and US biomicroscopy (UBM).
Quality imaging of the scalp in the setting of alopecic, neoplastic, and inflammatory diseases is highly sought after. Many of these noninvasive imaging techniques show promise, each with individual advantages and disadvantages in imaging-specific conditions. Ultimately, noninvasive imaging techniques may be used to optimize patient management and minimize morbidity associated with scalp biopsies.
To characterize the properties of cutaneous defects created by energy-based devices using optical coherence tomography.
Radiofrequency (RF) microneedling and non-ablative fractional laser (NAFL) treatment were performed in vivo with various parameters. Following treatment, optical coherence tomography (OCT) was used to image and measure cutaneous defects at multiple time points over a 24 h period.
Channel-like cutaneous defects were visible with OCT following bipolar RF microneedling and NAFL treatment. Using a double pulse technique with RF microneedling yielded a greater number of defects visible with OCT, as well as defects that were deeper and more durable over time. Following treatment with 1927 nm thulium fiber laser, the average diameter of the defects was greater when the energy level was 20 mJ as compared to 10 mJ (0.33 mm vs. 0.27 mm, p < 0.01).
Cutaneous defects were observed following both RF microneedling and NAFL treatment. Properties of the cutaneous defects varied based on device, treatment setting, and technique, which may be useful in guiding further study of device-assisted drug delivery.
Acne scarring results from the inflammation associated with acne papules, which alters dermal collagen, typically producing depressed scars. Lasers have been used to remodel skin improving the texture and appearance of acne scars. Herein, we investigate a new 2910 nm, erbium-doped, fluoride glass, fiber laser for improving acne scars. This novel laser delivers up to 5000 Hz low-energy pulses, providing a unique treatment modality.
Fourteen subjects with rolling and/or boxcar acne scars were enrolled in this study. Thirteen subjects completed the final visit and received three treatments with the 2910 nm fiber laser at 6–8-week intervals. Eight subjects were Fitzpatrick type II and five were Fitzpatrick type III. Digital images were taken pre- and 1- and 3-months posttreatment and evaluated by two blinded reviewers in a randomized fashion for improvement. Subjects and the treating physician completed a Global Aesthetic Improvement Scale (GAIS) before treatment and at each visit to subjectively evaluate treatment effect. Histological analysis was performed on ex vivo lower eyelid skin samples. Side effects were evaluated by the treating physician and included erythema, edema, and pinpoint bleeding.
Evaluation of blinded digital images revealed a mean improvement of 47.3% ± 14.2% (mean ± SEM) 3 months following the final treatment. GAIS scores demonstrated improvement as evaluated by both the subjects and the treating physician. Side effects averaged trace-to-mild erythema, edema, and pinpoint bleeding.
This study shows that the 2910 nm, erbium-doped, fluoride glass, fiber laser is safe and effective for improving the appearance of acne scars.
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