Treatment of pigmented lesions has evolved over the past five to 10 years, according to Eliot Battle Jr., M.D., cosmetic dermatologist and chief executive officer, Cultura Dermatology & Laser Center, Washington, and clinical instructor, department of dermatology, Howard University Hospital.
"We still have our old gold standards - the KTP (potassium-titanyl-phosphate) laser, the alexandrite laser, IPLs (intense pulsed light), Q-switched lasers - but with the advent of fractional technology we now are able to use additional options to treat some of the stubborn lesions, some of the dermal pigmentation lesions that we couldn't treat before. Fractional technology also opens up the treatment options to people of color, which has been a very exciting change in what we can offer," he says.
Diagnosing the lesion
Next, clinicians need to treat appropriately. Lentigos respond well to most laser treatments, Dr. Kilmer says.
"Because they are mostly in the epidermis, it's easy to target those lesions," she says.
Café au lait macules or more unusual pigmented lesions, however, can sometimes be more difficult to treat, Dr. Kilmer says.
"I would say a third of the time they clear and never come back, a third of the time they clear but then they come back with sun exposure within a year or two, and then a third of the time even after several treatments you really can't get them to ever go away," she says.
Dr. Kilmer says patients need to understand the number of treatments that will be needed and the potential outcomes of these therapies.
Weighing laser options
It's important to know what each treatment offers. When using lasers with longer wavelengths, less melanin is absorbed, whereas there is more absorption and less penetration with shorter wavelengths, Dr. Kilmer says.
Pulse width is another consideration. Dr. Kilmer says nanosecond domain lasers, such as Q-switched lasers, can be used for tiny clumps of melanin, whereas millisecond domain lasers would be used in cases with larger clumps of melanin.