*Corresponding author email: [email protected]Symbiosis 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 Access Research 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: [email protected]Introduction A solar lentigo is a flat, sharply circumscribed patch. It can be round, oval or irregular in shape. Color varies from skin- colored, brown to dark brown or black, and size varies from a few millimeters to several centimeters in diameter [1, 2]. It results from long-term exposure to Ultraviolet (UV) radiation, which causes local proliferation of epidermal melanocytes and accumulation of melanin within the keratinocytes [3]. Solar lentigos or lentigines are very common, especially in people over the age of 40 years. But the treatment of solar lentigos or lentigines without side effects such as postinflammatory hyperpigmentation (PIH), scars and recurrences are extremely difficult [4-6]. Therefore the authors introduce the new treatment of solar lentigo using Dr. Hoon Hur’s optimal melanocytic suicide-2(OMS-2) parameter with a high fluence 1064nm Q-switched Nd:YAG laser without side effects or recurrences. Abstract A solar lentigo is a small, well-circumscribed, pigmented macule surrounded by normal-appearing skin. Histopathlogic findings may show epidermal hyperplasia and increased melanin pigmentation of the basal layer. A variable number of melanocytes are present; these melanocytes may be increased in number, but they do not form nests. In the most cases, treatment is not necessary for solar lentigo. However treating the solar lentigo without postinflammatory hyperpigmentation is very difficult and treatment for solar lentigo without side effects such as postinflammatory hyperpigmentation, scars and recurrences cannot be found in any literature yet. Therefore the authors introduce the new treatment of solar lentigo using optimal melanocytic suicide-2 parameter with a high fluence 1064nm Q-switched Nd:YAG laser without side effects or recurrences. Report of Cases Fifty two Korean patients with solar lentigo or solar lentigines (age range: 40-72 years old, mean age: 52.6 years) participated in this study. All patients were clinically diagnosed with solar lentigo or solar lentigines (Fig.1, 3, 5, 7, 9, 12, 15). Figure 1: A single large round brown patch on the left lateral orbital rim area (Before treatment: 2017/1/17) [email protected]Figure 2: A complete clearance of solar lentigo (After treatment with Dr. Hoon Hur’s OMS-2 Parameter: 2017/3/2)
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.
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).
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
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
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-
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
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).
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
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.
