Laser shows promise in treatment for pigmented lesions

A laser that made news in tattoo removal and shows promise in the treatment of acne is now cleared for a new indication: the treatment of pigmented lesions.

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A picosecond is a one trillionth of a second pulse duration, and the PicoWay offers the shortest picosecond pulse and highest peak power on the market, according to Syneron Medical’s CEO Amit Meridor. PicoWay is a dual wavelength device, with 532nm and 1064nm wavelengths. The FDA has approved the PicoWay for the treatment of pigmented lesions.

New indication

Vic Narurkar, M.D.Dermatologist Vic Narurkar, M.D., principal investigator for the pivotal FDA clinical trial for PicoWay for benign pigmented lesions, said he uses the PicoWay for the treatment of multicolored tattoos, the indication for the first FDA clearance in 2014, as well as benign epidermal and dermal pigmented lesions, such as lentigos, nevus of Ota, nevus of Ito, ephelides and dyschromia on the face, neck, chest and hands.

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“Epidermal pigmented lesions such as lentigos typically clear in one to two treatments [with the PicoWay],” Dr. Narurkar says. “There is no need for topical anesthesia. The clinical appearance immediately after treatment is a flaky white color; followed by some crusting, which can last several days; followed by clearance of the lesion.”

Suzan Kilmer, M.D.In the clinical trial, the results of which were presented as a poster abstract at the American Society for Laser Medicine and Surgery (ASLMS)  2015 annual meeting, patient satisfaction was high and pain scales  were less than one in the majority of patients. Treatment side effects were few and minor, including post-treatment crusting and purpura, which, if it occurs, can last several days, according to Dr. Narurkar.

In general, use of picosecond devices on pigmented lesions has had mixed results, according to Sacramento, Calif.-based dermatologist Suzanne Kilmer, M.D.

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“In many cases, the alexandrite picosecond laser has more rapidly cleared a pigmented lesion than a Q-switched alexandrite laser. We have seen this in several nevus of Ota, melasma, traumatic and drug-induced (minocycline, silver, hydroquininone) hyperpigmentation and congenital nevi. However, café-au-lait macules, lentigos and freckling are more unpredictable in their responses [to picosecond lasers],” Dr. Kilmer says.

NEXT: PicoWay best practices

PicoWay best practices

The PicoWay device works best for benign epidermal pigmented lesions and multicolored tattoos, according to Dr. Narurkar. “In both instances, fewer treatments are required than previous laser and light-based technologies.”

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Dr. Narurkar says that while the PicoWay is excellent as a standalone treatment for benign pigmented lesions, dermatologists can enhance treatment results with the use of topical lightening agents, pre- and post-treatment. That’s especially true in darker skin tones, he says.

“The main advantage of the PicoWay over other picosecond lasers is it delivers the shortest picosecond pulse, allowing for more photo-acoustic than photothermal effects, thereby, making treatments considerably less painful and also with less risk of postinflammatory hypo- or hyperpigmentation,” Dr. Narurkar says. “Unlike the 755nnm wavelength, the 1064nm laser is much safer for darker skin tones, when treating dermal pigmented lesions such as tattoos and nevus of Ota and Ito. It also penetrates deeper than 755nm; thereby, there is more effective clearance.”

NEXT: Claim up for debate

Claim up for debate

That claim, however, is up for debate. Roy G. Geronemus, M.D., director of Laser & Skin Surgery of New York and clinical professor of dermatology at New York University Medical Center, New York City, says he disagrees that the 1064nm wavelength picosecond laser is much safer than the 755nm picosecond laser for the treatment of benign pigmented lesions.

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“We have successfully treated pigmented lesions, as well as tattoos, at the 755nm wavelength with minimal risk of side effects,” Dr. Geronemus says. “The focus lens attachment to that particular laser [the 755nm wavelength] allows for the treatment of various pigmented lesions, acne scars and facial rejuvenation without noticeable downtime.”

The PicoWay’s other wavelength of 532nm, is safe in darker skin tones, according to Dr. Narurkar. That’s because the photo-acoustic effect predominates the photothermal effect. The fluences, however, should be reduced by about 20%, he says.

When it comes to treating pigmented lesions with picosecond devices, wavelength still seems to determine absorption, according to Dr. Kilmer.

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“Our hope was that the picosecond technology would be colorblind with respect to treating tattoos. Unfortunately, this did not turn out to be the case. Red light still better treats green ink and vice versa. So, it’s important to have more wavelengths, which all the companies are working on,” Dr. Kilmer said.

NEXT: Picosecond devices at a glance

Disclosures:

Dr. Narurkar is a clinical investigator for Syneron Candela. Dr. Geronemus is an investigator for Cynosure and performed the clinical trials on the PicoSure. Dr. Kilmer is a researcher for Cynosure and consultant for Syneron Candela and Cutera.