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자연과학
공학
의약학
농수해양학
예술체육학
복합학
DBpia AI
AI 에이전트
AI 아이디어
AI 리더
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Citeasy
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커뮤니티
연구자들이 자신의 연구와 전문성을 널리 알리고, 새로운 협력의 기회를 만들 수 있는 네트워킹 공간이에요.
초록·키워드
I read with interest the work by Belzer et al1Belzer A. Swallow M.A. Gowen M. Suozzi K.C. Picosecond neodymium-doped yttrium-aluminum-garnet laser therapy for pigmentation due to lichen planus pigmentosus in a patient with skin of color.JAAD Case Rep. 2023; 34: 45-47https://doi.org/10.1016/j.jdcr.2023.01.029Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar reporting partial improvement of postinflammatory pigmentation (PIH) in a patient with clinical diagnosis of lichen planus pigmentosus (LPP) who was submitted to a series of 10 treatments of picosecond Q-switched Nd:YAG laser 1064 nm with the Zoom handpiece at 3- to 4-mm spot size (Picoway, Candela) with uncertain fluence range (minimal “mJ” energy parameters provided), followed by 4 treatments with titanium sapphire crystal 785-nm handpiece at 3 to 4 mm with additional improvement (uncertain fluence range). This letter aims to confirm the fluence range used and to point out terminology minutia for readership and future reference. Assuming the fluence range provided was “2.0 to 2.4 J/cm2” (high-fluence for picosecond 1064 nm) and 459 to 1212 were the total number of pulses (not “passes”), because that number of “passes” would likely be an extremely long session. I would comment that when treating melanophages/PIH vs dermal nevus, I avoid fluence ranges known to cause PIH by disrupting the basal layer, such as high-fluence 1064 nm, or utilizing wavelengths that cause epidermal frosting (532 nm or 785 nm). The authors could have described the “end point” aimed or achieved during the session with each parameter. I have been treating LPP for >10 years using mild settings, such as those for melasma and PIH, a method coined in literature as “laser toning,” which consists of 1064 nm low-fluence settings with a wide spot size, such as the photoacoustic twin pulse mode (8 mm) 2.8 J/cm2 in conventional nanosecond Q-switched lasers,2Kim J.Y. Choi M. Nam C.H. et al.Treatment of melasma with the photoacoustic twin pulse mode of low-fluence 1,064 nm Q-switched Nd:YAG laser.Ann Dermatol. 2016; 28: 290-296https://doi.org/10.5021/ad.2016.28.3.290Crossref Scopus (12) Google Scholar or “picotoning” (8 mm) 1 J/cm2 using PicoWay Zoom handpiece. In some patients with extreme dermal melanin deposits, severe pain may be elicited, such as a tattoo removal session, and dermal frosting (instant lightening of deep gray/blue pigment) can sometimes be noted, or just mild erythema and edema immediately after the session. When the photoacoustic feedback is too intense, lowering the parameters in the first session can avoid PIH. In my patients with frontal fibrosing alopecia, I combine antiandrogens (such as dutasteride) with low-dose isotretinoin, which was found to improve LPP.3Muthu S.K. Narang T. Saikia U.N. Kanwar A.J. Parsad D. Dogra S. Low-dose oral isotretinoin therapy in lichen planus pigmentosus: an open-label non-randomized prospective pilot study.Int J Dermatol. 2016; 55: 1048-1054https://doi.org/10.1111/ijd.13293Crossref PubMed Scopus (41) Google Scholar Although marketing teams in the picosecond laser industry have attributed the Q-switched terminology to refer to the “old” nanosecond devices, picosecond lasers are also Q-switched.4Ross V. Naseef G. Lin G. et al.Comparison of responses of tattoos to picosecond and nanosecond Q-switched neodymium:YAG lasers.Arch Dermatol. 1998; 134: 167-171https://doi.org/10.1001/archderm.134.2.167Crossref PubMed Scopus (214) Google Scholar When discussing previous literature, it is best to spell “nanosecond” or “picosecond” or specify the approximate duration of pulse (5 ns, 500 ps, etc). The authors have adopted a new term “Both Q-second and picosecond,” which emphasizes how the marketing was efficacious in imprinting Q-switching to “nano.” Because LPP is an orphan disease, I congratulate the authors for publishing the case report. I was particularly impressed by the improvement in the perioral area at 1064 nm. Through the looking-glass with the awareness by transcriptomic analysis that lichen planus is an interferon-driven disease and previous positive results of an open-label study,5Brumfiel C.M. Patel M.H. Severson K.J. et al.Ruxolitinib cream in the treatment of cutaneous lichen planus: a prospective, open-label study.J Invest Dermatol. 2022; 142: 2109-2116.e4https://doi.org/10.1016/j.jid.2022.01.015Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar we hope to see reports of the employment of topical Janus Kinase inhibitors in combination with low-fluence Q-switched 1064-nm lasers (picosecond or nanosecond) and tinted zinc-based sunscreens in LPP (cases are currently being followed). Dr Wambier has served as speaker for Cynosure; as an advisor for Vydence, Incyte, ChemistryRx, Young Pharmaceuticals, and Daniel Alain; and owner of Wambier Dermatologics, LLC. Response to “Commentary on picosecond neodymium-doped yttrium aluminum garnet laser therapy for pigmentation due to lichen planus pigmentosus in a patient with skin of color”JAAD Case ReportsPreviewTo the Editor: Thank you for your response to this single case report highlighting successful treatment of hyperpigmentation due to lichen planus pigmentosus. As you mention, this is an “orphan disease” and we are glad this report has stimulated a discussion as that was the intent. Full-Text PDF Open Access
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