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      Efficacy of 532-nm Q-switched Nd:YAG Laser in the Treatment of Lip Melanosis

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          Abstract

          Introduction:

          Lip pigmentation is frequently encountered in the Dermatology outpatient department. No effective treatment is available so far. Topical treatment requires longer time and is often unsatisfactory.

          Aim:

          The aim of this work was to study the efficacy of 532-nm Q-switched Nd:YAG laser in the treatment of lip melanosis.

          Settings and Design:

          This was a prospective interventional study.

          Materials and Methods:

          Twenty patients in the age group 27–53 years were included in the study. Eight patients had diffuse pigmentation and twelve patients had focal pigmentation. Test spot was done. After topical anesthesia, Q-switched Nd:YAG laser was used. Treatment interval was 4 weeks. Follow-up was done at 1 week and then monthly.

          Statistical Analysis Used:

          Wilcoxon signed ranks test and P value.

          Results:

          Seven patients (35%) showed an excellent response with more than 75% of pigment clearance. Seven patients (35%) showed a good response, two patients (10%) moderate response, and two patients (10%) had a mild response. Two patients had recurrence after 3 months follow-up. The average number of sessions required for clearance of pigmentation was 2.5. No scarring was seen.

          Conclusion:

          532-nm Q-switched Nd:YAG laser is safe and effective in the management of lip pigmentation and gives rapid results.

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          Most cited references11

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          Approaches to the evaluation of lip hyperpigmentation.

          Hyperpigmentation of the lips is a common condition. It is associated with a wide variety of conditions that include physiologic changes, genodermatoses, inflammatory diseases, endocrinologic disorders, drugs and chemicals, benign and malignant neoplasm, and other non-melanotic conditions. The aim of this article is to provide a clinical approach to hyperpigmented lesions on the lips based on the extent of lesions, the age of onset, and associated systemic involvements. In this review, we present an algorithm to guide the diagnosis of and plan for therapeutic intervention for pigmented lesions of the lips. The algorithm is based on the typical clinical presentation of each entity and should not be taken as an absolute indicator of diagnosis. Although the differences in color can help to differentiate among pigmented lesions, the interpretation of color can be subjective and is influenced by the amount and location of the pigment within the mucosa. The limitations of this review are that some data are based on case reports and small case series that may not reflect true association.
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            Irradiation of pigmented melanoma cells with high intensity pulsed radiation generates acoustic waves and kills cells.

            Photokilling of pigmented mouse melanoma cells (B-16) was investigated using pulsed high intensity visible radiation. Melanin acts as an endogenous chromophore, and 694 nm radiation with 40 nsec pulse duration and 0.5-3 X 10(7)w/cm2 intensity causes cell death. Irradiation of non-pigmented human melanoma cells (U1) or human squamous carcinoma cells (FaDu) under similar conditions did not kill the cells. Also, irradiation of B-16 cells with 300 microsec laser pulses (10(3)W/cm2) or with continuous wave (CW) radiation (10(-3)W/cm2) did not kill the cells. These data indicate that pigmented cell killing is due to absorption of radiation by melanin and that the pulsewidth and intensity of radiation play important roles in cell killing. The generation of acoustic waves due to absorption of the pulsed radiation by pigmented cells and by isolated melanosomes was demonstrated at 532 and 625 nm and 8.5 nsec pulse duration (10(7)-10(8) W/cm2); the amplitudes of the acoustic signals were approximately 2.5-3.0-fold higher at 532 nm compared with 625 nm, and they increased with increasing fluence. In contrast, irradiation of U1 or FaDu cells with comparable fluences and intensities did not generate acoustic waves. A possible correlation between the generation of photoacoustic waves and pigment cell death is proposed. Since the thermal relaxation time of melanosomes is 0.5-1.0 microsec, the mechanism proposed is that thermal confinement of high intensity, short-pulse visible radiation generates acoustic waves by thermal expansion, leading to mechanical damage to the cells.
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              Q-switched alexandrite laser treatment of facial and labial lentigines associated with Peutz-Jeghers syndrome.

              The Q-switched alexandrite laser used at 752 nm, a wavelength well absorbed by melanin relative to other optically absorbing structures in skin, causes highly selective destruction of pigment-laden cells. In addition, the 75-nanosecond pulse duration produced by this laser approximates the thermal relaxation time for melanosomes, thereby confining the energy to the target. Facial and labial dark brown macules quickly identify patients with Peutz-Jeghers syndrome. These lentigines may be cosmetically disfiguring. The Q-switched alexandrite laser produces clinically significant fading of mucocutaneous melanosis in association with Peutz-Jeghers syndrome without complications often seen with other therapeutic modalities.
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                Author and article information

                Journal
                J Cutan Aesthet Surg
                J Cutan Aesthet Surg
                JCAS
                Journal of Cutaneous and Aesthetic Surgery
                Wolters Kluwer - Medknow (India )
                0974-2077
                0974-5157
                Apr-Jun 2021
                : 14
                : 2
                : 203-207
                Affiliations
                [1]Department of Dermatology, Bangalore Medical College and Research Institute (BMCRI) Bengaluru, Karnataka, India
                Author notes
                Address for correspondence: Dr. Sulaksha Kerkar, Department of Dermatology, Victoria Hospital, OPD B Block, Bangalore Medical College and Research Institute (BMCRI), Bengaluru 560002, Karnataka, India. E-mail: sulaksha292@ 123456gmail.com
                Article
                JCAS-14-203
                10.4103/JCAS.JCAS_7_20
                8423207
                c2a0d8b8-31ae-43f2-99e5-d978ced34be6
                Copyright: © 2021 Journal of Cutaneous and Aesthetic Surgery

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                Categories
                Original Article

                Surgery

                dark lips, laser, lip pigmentation, nd, yag, q-switched

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