Journal of Clinical and Aesthetic Dermatology

AUG 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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operated at a fluence of 0.7J/cm 2 , spot size 12mm, 15hz. a single full-face pass with 10- percent overlap was performed. subsequent second and third passes were performed over the freckled areas until a clinical endpoint of skin whitening was achieved; no wiping was performed between the passes. care was taken to keep the skin cool during the laser irradiation with cryogen spray cooling. post- laser treatment, patients applied a topical antibiotic (fusidic acid) for three days and wore sunscreen during the daytime for the study duration. photographs were taken pretreatment and one month after laser treatment. Three independent physicians evaluated these photographs using the grading system shown in Table 1. 4 patients were followed clinically for a total of six months post-laser treatment to monitor for post-inflammatory hyperpigmentation and recurrence. RESULTS during the procedure, all patients tolerated mild-to-moderate pain without use of anesthesia. For 5 to 7 days post-laser treatment, there was notable erythema and scaling of the skin. all five patients noted lightening of their freckles at the end of 5 to 7 days, along with resolution of the skin peeling. at one month post-laser treatment, all five patients were evaluated. The three independent physicians agreed that all five patients had greater than 90-percent clearance of their freckles (Figures 1 and 2). during the subsequent follow-up visits (up to 6 months post-laser treatment), no post-inflammatory hyperpigmentation, hypopigmentation, or recurrence was observed. DISCUSSION super ficial pigmented lesions, such as freckles, respond to a variety of lasers. 1 The most commonly used lasers are the pigment lasers, namely the frequency-doubled Qs nd:YaG, Qs ruby, Qsal, and pulsed dye green laser. These lasers work by targeting melanin. by having wavelengths in the 400 to 600nm range and a shor t pulse duration, these lasers cause melanosome rupture, hence freckle lightening. 4–6 conversely, ablative lasers, such as the co 2 laser, have been used to nonspecifically damage the epidermis to remove pigmented lesions. 7 The advantage of co 2 is that it achieves a ver y good clearance rate with one or two sessions. however, the downtime thereafter can stretch up to two weeks or more post-laser treatment. There is also a risk of textural changes or scarring. 7 To the best of our knowledge, treatment of freckles with the fractional 2940nm nonablative erb:YaG laser has not been described. moreover, minimal data on the treatment of freckles in asian Type iii/iV skin exist. Limitations. we acknowledge that this study is too small to draw firm conclusions. a prospective study with a greater number of subjects is needed. it is impor tant to replicate the results on a larger scale. more studies are needed to validate the proposed mechanism of action. more studies are also necessar y to determine the optimal settings and techniques to be applied. CONCLUSION we demonstrated the erb:YaG laser to be an emective treatment option for treatment of freckles using a single treatment session, which carries less risk and shorter down time compared to co 2 lasers. by using nonablative fractional settings, the 29 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY august 2017 • Volume 10 • number 8 b r i e F r e p o r T TABLE 1. Grading system GRADE PERCENT CLEARANCE NUMBER OF PATIENTS 1 (poor) 0–25 0 2 (fair) 26–50 0 3 (good) 51–75 0 4 (excellent) 76–95 3 (all >90% clearance) 5 (clear) >95 2 FIGURE 1. appearance of freckles prior to laser treatment FIGURE 2. one-month post-laser treatment

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