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IMCAS Asia 2019
Program

FOCUS ON S019

Lasers & EBD: pigmentation - How to avoid the complication

Room: Room 3A
Date: Friday 5 July 2019 at 11:00 to 12:00
Format: FOCUS SESSION > lectures covering a major topic of the congress
Objectives: 1. Recognize the various forms of pigmented lesions and their implications for treatment and prognosis 2. Identify new intervention methods to treat pigmented lesions with lasers & EBD 3. Develop safe and effective treatment plans with lasers & EBD for hyperpigmentation

Chairs

Dr Teresita Santillan FERRARIZ

Dermatologist

Philippines

Prof Taro KONO

Plastic Surgeon

Japan

Lectures of the session

Hours	Speakers	Lecture title	Abstract	Number
11:00	Dr Michael BENZAQUEN	Clinical overview of pigmented lesions	View	84965
11:12	Dr Victor Gabriel CLATICI	Pigmented lesions - The danger of treatments	View	85648
11:24	Dr Ratna Maitri Dewi GONDOWARDOJO	How to get a good result and avoid complication in treating hyperpigmentation with lasers and EBDs	View	86998
11:36	Dr Sri Aryani SUDHARMONO	Safety and efficacy of the dual wavelength picosecond laser for the treatment of benign pigmented lesions in South East Asian morphology	View	84664
11:48		Questions and answers		88228

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Pigmentation

Lasers

Complications

Skin phototype (type I, etc)

Energy-based devices (EBD)

Dr Michael BENZAQUEN

Dermatologist

Switzerland

Other author(s) :

Clinical overview of pigmented lesions

Objectives: - We will present a clinical overview of pigmented lesions, from melasma and its differential diagnoses to lentigo, ephelides and café-au-lait spots.
- We will also detail the clinical characteristics of nevus spilus, Becker’s nevus, Ota/Ito/Hori’s nevi, and congenital nevus.

Conclusion: - Pigmented lesions represent a great chapter of dermatology, with several clinical diagnoses.
- There is a strong patient demand for treatment (Q-switched laser, IPL, bleaching agents, …). But, before any treatment, a careful clinical examination +/- dermoscopy +/- biopsy are absolutely necessary.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Victor Gabriel CLATICI

Dermatologist

Romania

Other author(s) :

Pigmented lesions - The danger of treatments

Objectives: Skin represent both the largest organ of the body (one-sixth of body weight) and the first line of defense against aggressions, and now is considered an endocrine gland which produces hormones and neurotransmitters. Also, skin health and skin influence directly self-esteem and mental status, social interactions and
quality of life.

Introduction: The face is the primary source of information in social perception and serves a key role in social perception, affecting people’s judgments of everything from trustworthiness and aggressiveness to competence and likeability in as little as 100 ms. The distribution of pigment color (blood and melanin) in the skin can affect the apparent health, age and attractiveness of human faces. Facial appearance, or perceived age, is composed of different facial features, including skin wrinkling, lip size, pigmented spots, skin texture, and sun damage.

Materials / method: During a lifetime, skin will change in appearance and structure not only because of chronological and intrinsic processes but also due to several external factors such as gravity, sun and ultraviolet exposure, and high levels of pollution; or lifestyle factors that have important and obvious effects on skin aging, such as diet, tobacco, illness, or stress.

The main signs of aging can be classified into four main categories of wrinkles/texture, lack of firmness, vascular disorders, and pigmentation heterogeneities.

Results: Visible skin color distribution appears to have major influence on the perception of female facial age and judgments of attractiveness, health, and youth, and the dynamic range of the estimated ages indicates that visible facial color distribution can account for up to 20 years of apparent age, independent of facial form and skin surface topography.
Hyperpigmentation (postinflammatory dark marks, melasma, or solar lentigines), increases the perception of an aged appearance to a greater degree than wrinkles.

Conclusion: The dangers associated with treatment of pigmented lesions are connected with the person which perform the treatment (respectively non medical peoples) and with specific side effects of EBD treatments, erythema and skin burns, infections and hyperpigmentation, and in the worst case scenario even with melanoma. Skin color homogeneity, driven by melanin and haemoglobin distribution, influences perception of age, health and attractiveness, și and accurate diagnosis of pigmented lesions is mandatory before laser treatment. For some pigmented lesions, laser treatment may be the only treatment.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Ratna Maitri Dewi GONDOWARDOJO

Dermatologist

Indonesia

Other author(s) : David Sudarto Oeiria, Christopher Toshihiro Wirya, Stephen Akihiro Wirya

How to get a good result and avoid complication in treating hyperpigmentation with lasers and EBDs

Objectives: Laser is a cutting edge technology which has dramatically improved the outcome of dermatologic and aesthetic treatments. However, laser may also cause side effects and complications, especially post inflammatory hyperpigmentation or in less frequent cases, post inflammatory hypopigmentation. Both of these conditions may be irreversible.

Introduction: There are four important aspects to ensure optimal results. Pre-treatment skin conditioning, correct laser and parameter decision, patients’ compliance in using high SPF broad spectrum sunscreen, and post-laser skin care are all equally important.

Materials / method: Asian skin is characterized by more active melanocytes compared to Caucasian skin. However, unlike other racial groups, Asians do not share the same skin phototype, with variation ranging from Skin Phototype 3 in Northern parts of Asia to 6 in the Southern parts. Asians with darker skin are more likely to develop complications.

Results: Laser treatment for Asian skin in tropical zone is challenging. Parameters should be tailored to each individual according to skin phototype and degree of sun exposure. These parameters are usually lower compared to Caucasian skin.
Melasma is one of the most common hyperpigmentation disorder. Treatment of melasma using laser is promising, but controversial as results are often temporary with high risk of rebound.
Tips and tricks will be discussed in the lecture.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Sri Aryani SUDHARMONO

Dermatologist

Indonesia

Other author(s) : Yudo Irawan, MD, Roger Aruan, MD,

Safety and efficacy of the dual wavelength picosecond laser for the treatment of benign pigmented lesions in South East Asian morphology

Objectives: To evaluate the safety and efficacy of the dual wavelength picosecond laser for the treatment of benign pigmented lesions in Indonesian patients.

Introduction: Pigmentary disorders are the commonest manifestation of photoageing in Asians, including lentigo, seborrheic keratosis, Hori’s naevus, naevus of Ota, melasma .etc
QS technology used in toning involves heating melanin in the epidermis and dermis. Although current treatments are used with a high degree of success, there are still concerns with these side effects especially in the darker skin types; patients with FST III-VI should be treated with caution. It has been anticipated that PS technology with shorter pulse duration could be used in a toning procedure when dealing with darker skin types

Materials / method: Twenty nine subjects with benign pigmentary disorders with fitzpatrick skin type III-V were observed in a retrospective clinical observation to examine the safety and efficacy of the dual wavelength picosecond laser. The patients were treated at approximately 1 - 6 weeks interval depending on the type of lesions (25 melasma, 1 café au lait, 2 nevus of Ota, 1 Hori’s nevus). The patients were treated in the Senopati Skin Center Clinic from december 2018 to may 2019. Improvement was evaluated by blinded dermatologists observers using post treatment photographs compared to baseline photographs.

Results: The pigmentary conditions treated included melasma, cafe au lait macules, Nevus of Ota and Hori’s Nevus. 1-8 weeks after treatment, 58.62% of all pigments achieved excellent response (76–100% lightening), 27.58% of pigments achieved good response (51–75% lightening) and 13.79% of pigments achieved both fair (26–50% lightening) and poor responses (0–25% lightening), respectively. Transient post inflammatory hyperpigmentation rate was 6.89% of subjects as a side effect of treatment.

Conclusion: The dual wavelength picosecond laser is a safe and effective treatment of benign pigmentary conditions in South East Asian skin.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

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IMCAS Asia 2019 Program

FOCUS ON S019

Lasers & EBD: pigmentation - How to avoid the complication

Chairs

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IMCAS Asia 2019
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