Advancing Treatment of Solar Lentigines Through the Vasculature Salvage Laser Surgery System

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Although solar lentigines pose minimal health risks, their presence can significantly affect patients’ aesthetic concerns and, in turn, their overall quality of life. Solar lentigines are benign epidermal hyperpigmented lesions that develop in sun-exposed areas, primarily due to melanocyte proliferation and melanin accumulation.¹ Traditional interventions, including topical agents, cryotherapy, and laser therapies, particularly Q-switched (QS) Nd:YAG lasers, have long been employed in clinical practice. However, these modalities frequently come with challenges such as prolonged erythema, postinflammatory hyperpigmentation (PIH), and the risk of recurrence, which can undermine patient satisfaction and deter further treatment.² These complications underscore the need for safer, more effective alternatives to deliver reliable results without compromising skin integrity. Recent advancements in laser technology, particularly the development of the Vasculature Salvage Laser Surgery (VSLS) system, may offer a significant leap forward in managing solar lentigines.³ VSLS, which utilizes a 532-nm nanosecond Nd:YAG laser, has shown promise in minimizing complications while providing effective clearance of these lesions.³

Safety and Efficacy

A recent case series assessed 6 Korean patients diagnosed with refractory solar lentigines who had previously undergone various unsuccessful treatments, including multiple sessions of traditional Nd:YAG laser therapy.³ Using VSLS, all patients received a single treatment session, with follow-up evaluations ranging from 3 to 10 weeks post procedure. Results included complete removal of the pigmented lesions in all patients after a single session. In this case series, the only observed adverse effect was mild erythema, which resolved naturally over time.³ This outcome suggests that VSLS may provide effective results while maintaining a favorable safety profile. This advancement is particularly significant in addressing patient concerns regarding adverse effects such as PIH, which can limit the acceptance and success of other laser treatments.

Innovations in VSLS

VSLS incorporates significant technological advancements that distinguish it from traditional laser treatments. First, the system features a contact cooling mechanism that maintains epidermal temperatures between –10 °C and 0 °C, reducing thermal damage to surrounding tissues and potentially lowering the risk of complications such as PIH and prolonged erythema.³ This cooling technology may enhance safety and improve patient comfort, contributing to greater satisfaction with the treatment process. Second, VSLS employs an autoderm lesion recognition algorithm, enabling precise targeting of pigmented lesions and ensuring uniform energy delivery.⁴ This innovation minimizes exposure to healthy skin, reducing the risk of collateral damage and promoting faster recovery times. Additionally, this precision allows for more effective outcomes in a single session, making it a valuable tool for busy clinical settings.

Case Studies: Real-World Applications

The efficacy of VSLS was demonstrated in 6 patients with refractory solar lentigines, each achieving successful outcomes. A woman aged 70 years who previously failed intense pulsed light and laser toning treatments saw complete pigmentation clearance after 1 VSLS session. A woman aged 67 years whose lesions darkened after carbon dioxide laser treatments showed significant improvement within 4 weeks. A woman aged 65 years achieved total resolution of a cheek lesion after 10 weeks. A man aged 56 years achieved clearance of a brown orbital patch within 4 weeks, whereas a woman aged 41 years had a large eyelid patch resolved in 3 weeks. Lastly, a woman aged 47 years achieved total clearance of her residual lesion after 4 weeks. These cases highlight the potential for VSLS to effectively treat difficult-to-manage solar lentigines, offering a promising tool for dermatologists.

Clinical Implications

These findings highlight key implications for dermatologists looking to enhance patient care through innovative treatments. First, it is crucial to educate patients on the advantages of VSLS, supported by recent literature demonstrating its favorable safety profile and efficacy in managing refractory solar lentigines. Addressing common concerns about adverse effects such as PIH may encourage more patients to pursue treatment. The ability of VSLS to provide clinically significant results in a single session, coupled with faster recovery times, may improve patient satisfaction and adherence to treatment plans, especially for those who have previously experienced limited success with conventional therapies.

The efficacy of VSLS, demonstrated through successful outcomes in 6 patients with refractory lesions, highlights its potential value for dermatologists. By integrating VSLS into their practices, dermatologists can expand their treatment options and better meet their patients’ diverse needs. This approach enhances patient care and encourages open discussions about cosmetic interventions, contributing to improved treatment outcomes and higher patient satisfaction.

Furthermore, the system’s precision targeting and cooling mechanisms make it particularly suitable for patients with darker skin tones, who are at greater risk for complications associated with traditional laser treatments, such as PIH.⁵ Providing safer and more effective options for diverse populations is essential as dermatology practices increasingly encounter varied demographics. Staying informed about innovative technologies such as VSLS empowers dermatologists to address evolving patient needs and offer innovative solutions.

Although the current findings are encouraging, additional research is necessary to evaluate the long-term efficacy and safety of VSLS, particularly for solar lentigines and other pigmentary disorders. By continually assessing new therapies, dermatologists can refine treatment strategies, ensuring optimal care while upholding high standards in an ever-evolving field. Incorporating advancements like VSLS into practice broadens treatment possibilities and enables clinicians to provide more personalized and effective care, ultimately improving patient outcomes across diverse populations.

Conclusion

The introduction of VSLS marks an advancement in the treatment of solar lentigines. With its innovative cooling mechanism and precise targeting capabilities, VSLS demonstrates safety and efficacy in this cohort and has the potential to enhance patient satisfaction in dermatology practices. As further research establishes its long-term efficacy, dermatologists are encouraged to consider this technology as a valuable addition to their therapeutic arsenal for managing challenging refractory cases of solar lentigines.

Isabella J. Tan is a third-year medical student at Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey.

References

1. Praetorius C, Sturm RA, Steingrimsson E. Sun-induced freckling: ephelides and solar lentigines. Pigment Cell Melanoma Res. 2014;27(3):339-350. doi:10.1111/pcmr.12232
2. Kang HJ, Na JI, Lee JH, Roh MR, Ko JY, Chang SE. Postinflammatory hyperpigmentation associated with treatment of solar lentigines using a Q-switched 532-nm Nd: YAG laser: a multicenter survey. J Dermatolog Treat. 2017;28(5):447-451. doi:10.1080/09546634.2016.1254330
3. Lee SY, Kim KR, Kim S, et al. Refractory solar lentigines successfully treated with 532-nm nanosecond Nd:YAG Vasculature Salvage Laser Surgery (VSLS) system: case series. Skin Res Technol. 2024;30(9):e70055. doi:10.1111/srt.70055
4. Kim YH, Cheon YS, Jeong GH, et al. The efficacy and stability of 532 nm nanosecond Nd: YAG Vasculature Salvage Laser Surgery (VSLS) system in ex vivo pigmented micropig skin. Lasers Med Sci. 2023;38(1):180. doi:10.1007/s10103-023-03844-9
5. Anvery N, Christensen RE, Dirr MA. Management of post-inflammatory hyperpigmentation in skin of color: a short review. J Cosmet Dermatol. 2022;21(5):1837-1840. doi:10.1111/jocd.14916