The Treatment of Solar Lentigo using Dr. Hoon Hur’s ... · the authors introduce the new...

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*Corresponding author email: sjimi@fukuoka-u.ac.jpSymbiosis Group

Symbiosis www.symbiosisonline.org www.symbiosisonlinepublishing.com

The Treatment of Solar Lentigo using Dr. Hoon Hur’s Optimal Melanocytic Suicide-2 Parameter with a High

fluence 1064nm Nd:YAG Laser without Postinflammatory Hyperpigmentation

*Hoon Hur, Yu Ri Kim.

Choice Dermatology Clinic, Pyeongchon, Korea

Clinical Research in Dermatology: Open Access Open AccessResearch Article

Received: April 05, 2017; Accepted: April 26, 2017; Published: May 05, 2017

*Corresponding author: Hoon Hur, Choice Dermatology Clinic, 1045, Hogye-dong, Dongan-gu, Anyang-si, Gyeonggi-do, Korea, Tel: 82-31-383-7533; E-mail: dermahur@naver.com

Introduction Asolarlentigoisaflat,sharplycircumscribedpatch.It

canberound,ovalorirregularinshape.Colorvariesfromskin-colored,browntodarkbrownorblack,andsizevariesfromafewmillimeterstoseveralcentimetersindiameter[1,2].Itresultsfromlong-termexposure toUltraviolet (UV) radiation,which causeslocalproliferationofepidermalmelanocytesandaccumulationofmelaninwithinthekeratinocytes[3].Solarlentigosorlentiginesareverycommon,especiallyinpeopleovertheageof40years.But the treatment of solar lentigos or lentigines without sideeffects such as postinflammatory hyperpigmentation (PIH),scars and recurrences are extremely difficult [4-6]. Thereforetheauthors introduce thenew treatmentof solar lentigousingDr.HoonHur’soptimalmelanocyticsuicide-2(OMS-2)parameterwith a high fluence 1064nmQ-switched Nd:YAG laser withoutsideeffectsorrecurrences.

Abstract Asolarlentigoisasmall,well-circumscribed,pigmentedmacule

surrounded by normal-appearing skin. Histopathlogic findingsmayshow epidermal hyperplasia and increased melanin pigmentationof the basal layer. A variable number of melanocytes are present;these melanocytes may be increased in number, but they do notform nests. In themost cases, treatment is not necessary for solarlentigo.Howevertreatingthesolarlentigowithoutpostinflammatoryhyperpigmentation is very difficult and treatment for solar lentigowithout side effects such as postinflammatory hyperpigmentation,scarsandrecurrencescannotbefoundinanyliteratureyet.Thereforethe authors introduce the new treatment of solar lentigo usingoptimalmelanocyticsuicide-2parameterwithahighfluence1064nmQ-switchedNd:YAGlaserwithoutsideeffectsorrecurrences.

Report of Cases Fifty two Korean patients with solar lentigo or solar

lentigines (age range: 40-72 years old, mean age: 52.6 years)participatedinthisstudy.Allpatientswereclinicallydiagnosedwithsolarlentigoorsolarlentigines(Fig.1,3,5,7,9,12,15).

Figure 1: Asinglelargeroundbrownpatchontheleftlateralorbitalrimarea(Beforetreatment:2017/1/17)

dermahur@naver.com

Figure 2: Acompleteclearanceofsolarlentigo(AftertreatmentwithDr.HoonHur’sOMS-2Parameter:2017/3/2)

of5Citation:JimiS,SatoK,KimuraM,SuzumiyaJ,HaraS,etal.(2017)G-CSFAdministrationAcceleratesCutaneousWoundHealingAccompaniedWithIncreasedPro-HypProductionIndb/dbMice.ClinResDermatolOpenAccess4(1):1-5.

G-CSF Administration Accelerates Cutaneous Wound Healing Accompanied With Increased Pro-Hyp Production In db/db Mice

Figure 5: A single round well-circumscribed brown patch with twosmallrounddarkbrownmacules(Beforetreatment:2017/2/1)

Figure 9: Multiplesmallroundwell-circumscribedbrownmaculesontherightzygomaareaandcheek(Beforetreatment:2015/8/24)

Figure 4: Acompleteclearanceofsolarlentigos(AftertreatmentwithDr.HoonHur’sOMS-2Parameter:2017/3/2)

The Treatment of Solar Lentigo using Dr. Hoon Hur’s Optimal Melanocytic Suicide-2 Parameter with a High fluence 1064nm Nd:YAG Laser without Postinflammatory Hyperpigmentation

Citation: HoonHur,YuRiKim.(2017)TheTreatmentofSolarLentigousingDr.HoonHur’sOptimalMelanocyticSuicide-2Param-eterwithaHighfluence1064nmNd:YAGLaserwithoutPostinflammatoryHyperpigmentation.ClinResDermatolOpenAccess4(2):1-5.

Figure 3: Multiple small well-circumscribed brown macules on therightzygomaarea(Beforetreatment:2017/1/12)

Figure 6: Acompleteclearanceofsolarlentigo(AftertreatmentwithDr.HoonHur’sOMS-2Parameter:2017/2/17)

Figure 7: AMultiple smallwell-circumscribedbrownmaculeson theleftzygomaarea(Beforetreatment:2017/1/5)

Figure 10: Thereisnorecurrenceat6monthsfollow-upaftertheendofthetreatment(2016/4/18)

Figure 13: MAcompleteclearanceofsolarlentigos(AftertreatmentwithDr.HoonHur’sOMS-2Parameter:2017/3/2)

Discussion Asolarlentigo(plural,solarlentigines),alsoknownasasun-inducedfreckleorsenilelentigo,isabrowntodarkbrownlesioncausedbynaturalorartificialultravioletlight.Solarlentigo

Figure 12: Multiplesmallroundwell-circumscribedbrownmaculesontheleftzygomaareaandcheek(Beforetreatment:2015/8/24)

Figure 15: Multiplesmallroundwell-circumscribedbrownmaculesontheleftzygomaareaandcheek(Beforetreatment:2015/12/31)

Otherwise, the patients had no significant medical or familialhistory.After obtainingwritten informed consent, all of the52patients were subjected to 8 treatment sessions of a 1064nmQ-switchedNd:YAG laser (QX-MAXLaser,Fotona,Slovenia)at aone-weekintervalwithaspotsizeof3mm,afluenceof5J/cm2and a pulse rate of 10Hz with pulse stacking technique for 3secondstothesolarlentigo.Icepackswereimmediatelyappliedto the entire face after laser treatment sessions, and patientswereinstructedtouseabroad-spectrumsunscreendaily.Patientphotoswereobtainedonthedayoftreatmentand4weeksafterthefinalsession.Theevaluationwasperformedbystandardized

digitalphotographyusingaCanonCameraG11(Japan).Patientswereaskedtoreportanysideeffects,painordiscomfortduringthe treatment. All patientswere satisfiedwith the results, andnoany significant sideeffects, includingpurpura,PIHand scarexceptslightpainduringthelasertreatment(Fig.2,4,6,8,10,13,16).

TheauthorsthinkthatthemechanismofDr.HoonHur’sOMS-2ParameterTherapy is todestroy theepidermalmelano-cytes and minimize the epidermal damage without petechiaeand crusts because awavelength of 1064nm result in less ab-sorptionbyepidermalmelanin.Then,weeklyOMS-2ParameterTherapydestroysmelanocytescompletelyandacceleratesapop-toticmelanocyte cell death, thus the endproducts of damagedmelanocytes suchas thedispersedmelanosomesandmelaninsareeitherremovedbythetransepidermaleliminationorarere-movedbydermalmelanophages through the lymphatic system[10,11].Eventually,completeclearanceofsolarlentigowithoutsideeffectsandrecurrencescanbeachieved.Inthesecases,ourpatientswithsolarlentigoweretreatedwith8sessionsofahighfluence1064nmQ-switchedNd:YAGlaser(QX-MAXLaser,Fotona,Slovenia)ataone-weekintervalwithaspotsizeof3mm,afluenceof5J/cm2andapulserateof10Hzwithpulsestackingtechniquefor3secondstothesolar lentigo.Thepulsestackingtechniquefor3secondstothesolarlentigoisveryimportanttodestroytheepidermalmelanocyteswithminimizingtheepidermaldamage.If thepulse stacking technique formore than3 seconds to thesolarlentigowasperformed,theepidermaldamagesmighthaveoccurred and the damaged keratinocytes might have secretedthekeratinocyticinjury-inducedcytokinessuchasendothelin-1,α-MSH,ACTH,bFGF,andprostaglandin(PGE2,PGF2α)whichac-tivatemelanocytesandincreasemelaninsynthesisinthemelano-somes,thereforecausingPIHandworseningsolarlentigo[7-11].Incaseof solar lentigoon face,8sessionsofOMS-2ParameterTherapyareperformedonceaweek.Butincaseofsolarlentigoonotherpartsofbody(arms,legs,andtorso),morethan8ses-sionsofOMS-2ParameterTherapyshouldbeperformedonceaweekregardlessofthelesionalsize.ThemeritofOMS-2Param-eterTherapyisthatitminimizestheepidermaldamagewithoutpetachiae and crusts. This parameter can deliver the sufficientenergytodestroyepidermalmelanocytesandalsosalvagenor-malbackgroundtissueduetolessabsorptionbyepidermalmela-

maybesingleormultiple[1,2].Thistypeoflentigoisdifferentfroma simple lentigo (lentigo simplex)because it is causedbylong-termexposuretoUVlight.Solarlentigoisbenign,butitmayindicateexcessivesunexposure,ariskfactorforthedevelopmentofskincancer[1,2].Histopathlogicfindingsofsolarlentigomayshow epidermal hyperplasia and increased melanin pigmen-tation in thebasal layer.Avariablenumberofmelanocytesarepresent;thesemelanocytesmaybeincreasedinnumber,buttheydonotformnests[3].Inthemostcases,treatmentisnotneces-saryforsolarlentigo.HowevertreatingthesolarlentigowithoutPIH isverydifficult [4-6].AlthoughtheprecisepathogenesisofPIH is idiopathic, there are possible several reasons of occur-renceofPIHwhentreatingsolarlentigowithconventionallasertherapy.Generally515-755nmofintensepulsedlight,532nmofQ-SwithchedNd:YAG laser,694nmofruby laserand755nmofalexandritelaserareabsorbedinmuchmoremelanincomparedto1064nmofQ-SwithchedNd:YAGlaser.Thus,thelaserenergywhichdestroysepidermalmelanocytesinjuriesthesurroundingkeratinocytes, and the damaged keratinocytes secrete interleu-kin-1 (IL-1). IL-1 stimulates keratinocytes to secrete endothe-lin-1,α-MelanocyteStimulatingHormone(MSH),Adrenocortico-tropicHormone(ACTH)andProstaglandin(PGE2,PGF2α).Thesekeratinocyticinjury-inducedcytokinesactivatemelanocytesandincreasemelaninsynthesisinthemelanosomes,thereforecaus-ingPIHandworseningsolarlentigo[7-11].Thedamgedkerati-nocytesalsosecretethesingle-chainurokinasetypeplasminogenactivator(sc-uPA).Thesc-uPAconvertsplasminogentoplasmin,which stimulates the keratinocytes to secrete basic fibroblastgrowthfactor(bFGF).AgainbFGFactivatesthemelanocytesandincreasesmelaninsynthesisinthemelanosomes,thereforecaus-ingPIHandworseningsolarlentigo[7-11]. Whentheconventionallasertherapycausespetechiaeandcrusts, laserenergymay injury fibroblasts,mastcells, lym-phocytes, macrophages, and vascular endotheliums. Then, thefibroblastsmainlysecreteStemCellFactor(SCF)andHepatocyteGrowth Factor (HGF)which activatemelanocytes and increasemelanin synthesis in themelanosomes, eventually causing PIHandworseningsolarlentigo[7-11].Finally,reactiveoxygenspe-ciessuchasnitricoxide,freeradicaloxygenandperoxide,gener-atedfromthedamagedkeratinocytesalsoactivatemelanocytesandincreasemelaninsynthesis inthemelanosomes,eventuallycausingPIHandworseningsolarlentigo[7-11].ToavoidthesideeffectssuchasPIH,scarringandworseningsolar lentigoof theconventional laser therapy, the authorsdevisedDr.HoonHur’soptimalmelanocyticsuicide-2(OMS-2)parametertherapywithahigh fluence1064nmQ-switchedNd:YAG laserwithoutsideef-fectsorrecurrences. Dr.HoonHur’sOMS-2Parameter therapywith a high1064nmQ-switchedNd:YAGlasermaydestroyepidermalmela-nocyteswithout keratinocytedamage, and the endproducts ofdamagedmelanocyteswillberemovedthroughtransepidermalelimination[10,11].Alsotheendproductsofdamagedmelano-cytesdrop into theupperdermis.Thedispersedmelanosomesandmelaninsareremovedbydermalmelanophagethroughthelymphaticsystem[10,11]. The authors suggest that the name of this therapy is

“Dr.HoonHur’sOMS-2ParameterTherapy”.Becausewebelievesthatitcannotonlydestroyepidermalmelanocyteswithminimalepidermaldamagebutalsoaccelerateapoptoticmelanocyticcelldeath program and can improve various skin diseaseswithoutsideeffectssuchasPIHandscarring(Table1).

Table1:IndicationofDr.HoonHur’sOMS-2Parametertherapy

SolarlentigoorSolarlentigines

Multiplelentiginesorfaciallentiginosis

Macularseborrheickeratosis

AcquiredbilateralnevusofOta-likemacules(ABNOM)

Melanocyticnevus

Verrucaplana

nin.Therefore this therapydoesnotprovokePIHandscarring.ButOMS-2ParameterTherapyrequires8treatmentsessionsfor8weeks.Inthesecases,52patientswithasolarlentigoorsolarlentigines(Fig.1,3,5,7,9,12,15)weretreatedwithOMS-2Param-eterofahighfluence1064nmQ-switchedNd:YAGlaser.Atotalof52patientswithasolarlentigoorsolarlentigineswasachievedcompleteclearanceofthepigmentedlesionswithoutPIH(Fig.2,4,6,8,10,13,16).Therearenorecurrencesat18monthsfollow-up(Fig.11,14).AllpatientsweresatisfiedwiththeresultsofDr.Hoon Hur’s OMS-2 Parameter Therapy, and no any significantsideeffects,includingPIHandscarring.

Conclusion TheparameterforeachDr.HoonHur’sOMS-2Param-eterTherapywasaspotsizeof3mm,afluenceof5J/cm2andapulserateof10Hzwithpulsestackingtechniquefor3seconds.Thistherapydoesnotcausesideeffectssuchaspetechiae,crustsandPIHduringthelasertreatment.Thereisnorecurrenceat18months follow-up. Therefore,Dr.HoonHur’sOMS-2ParameterTherapyisthoughtthatmoreeffectiveandsaferesultsoftreat-mentthanconventionallasertreatmentcanbeexpected.

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