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• W2072474863 abstract "Editor Pigmented lesions result from excessive or abnormally deposited melanin and can be treated with pigment specific lasers from the concept of selective photothermolysis. Pigment-specific lasers include quality-switched (Q-switched) lasers operating with melanin-absorbing wavelengths, high peak powers and ultrashort pulse durations in the nanosecond range in order to target melanosomes selectively by a photoacoustic effect.1 The Q-switched YAG laser at 532-nm (green light) and 1064-nm wavelengths (infrared light) is reported to clear epidermal, dermal and mixed epidermal/dermal pigmented lesions successfully.1 However, side-effects may occur such as textural changes and pigmentary alterations due to unspecific thermal damage and disruption of melanosomes and melanocytes, which may lead to hypopigmentation.2 We report three children of fair skin types responding with unexpected postoperative hyperpigmentation from Q-switched YAG laser treatment of pigmented skin lesions, which we consider a paradoxical response to a pigment-specific laser, designed to clear pigmented lesions. A 10-year-old boy with skin type II and a histopathologically confirmed benign congenital pigmented naevus of 10 × 8 cm on his forearm was treated on January 2006 with the Q-switched YAG laser, 532/1064 nm (Q-YAG 5 Nd:YAG laser, Palomar Medical Technologies, Burlington, MA, USA), using 4-mm spot, one pass with two test fluencies of 2.55 and 2.75 J/cm2, both of which resulted in the desired endpoint of immediate skin whitening. Two months after the treatment, both test areas appeared distinctly darker than the untreated part of the naevus, and laser treatment was not resumed (Fig. 1). Hyperpigmentation in two test areas seen 2 months after Q-switched YAG laser treatment with combined 532/1064 nm. A 10-year-old girl with skin type II and a disfiguring café-au-lait macule (CALM) of 14 × 12 cm on her abdomen was treated on June 2006 with the Q-switched YAG laser at 532/1064 nm, using a 4-mm spot, one pass with test fluencies of 2.4–2.55–2.75 J/cm2, resulting in immediate skin whitening. Four months after the treatment, the test areas appeared darker than the rest of the lesion, and laser treatment was not resumed. A 15-year old boy with skin type II and a CALM of 3 × 1.8 cm on his lower cheek was treated on December 2007 with the Q-switched YAG laser at 532/1064 nm, using a 4-mm spot, one pass, 1.85 J/cm2 test dose, resulting in erythema and immediate darkening of the lesion. Four months after the treatment the test area appeared darker than the rest of the lesion, and laser treatment was not resumed. Q-switched nanosecond lasers are considered highly specific for clearing pigmented lesions due to photomechanical shock waves, which target melanosomes selectively with a secondary lethal injury to the melanocytes. Hypopigmentation is a well-known side-effect from pigment destroying lasers due to too intensive pigment removal, whereas hyperpigmentation is more related to skin types and darker complexions being generally more likely to hyperpigment.3 Moreover, it is well known that exposure to sunlight increases the risk of post-inflammatory hyperpigmentation.4 The three cases presented here were all Caucasians with fair skin complexions, and none of the children were predisposed to develop post-inflammatory hyperpigmentation in terms of skin type or sun exposure since none of the children were exposed to sunlight before treatment or for several months after treatment. The observed hyperpigmentation was therefore highly unexpected. The increased pigmentation may be caused by deposition of melanin or haemosiderin as well as melanocyte stimulation is observed in guinea pigs after Q-switched laser irradiation.5,6 However, the precise mechanism is unknown. We recommend that test treatments are performed before Q-switched YAG laser treatment of pigmented lesions and that patients are preoperatively informed of the risk of hyperpigmentation, which may also occur in patients of fair complexions." @default.
• W2072474863 created "2016-06-24" @default.
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• W2072474863 date "2009-07-01" @default.
• W2072474863 modified "2023-09-25" @default.
• W2072474863 title "Paradoxical postoperative hyperpigmentation from Q-switched YAG laser treatment of pigmented lesions in children with fair skin types" @default.
• W2072474863 cites W2000389316 @default.
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• W2072474863 doi "https://doi.org/10.1111/j.1468-3083.2008.03059.x" @default.
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