title: Combined therapy using Q-switched ruby laser and bleaching treatment with tretinoin and hydroquinone for acquired dermal melanocytosis.
abstract: OBJECTIVE
  Acquired dermal melanocytosis (ADM; acquired bilateral nevus of Ota-like macules) is known for its recalcitrance compared with Nevus of Ota, and we assume that one of the reasons is a higher rate and degree of postinflammatory hyperpigmentation (PIH) seen after laser treatments.
  
  
  METHODS
  Topical bleaching treatment with 0.1% tretinoin aqueous gel and 5% hydroquinone ointment containing 7% lactic acid was initially performed (4 to 6 weeks) to discharge epidermal melanin. Subsequently, Q-switched ruby (QSR) laser was irradiated to eliminate dermal pigmentation. Both steps were repeated two to three times until patient satisfaction was obtained (usually at a 2-month interval for laser sessions). This treatment was performed in 19 patients with ADM. Skin biopsy was performed in six cases at baseline, after the bleaching pretreatment, and at the end of treatment.
  
  
  RESULTS
  All patients showed good to excellent clearing after two to three sessions of QSR laser treatments. The total treatment period ranged from 3 to 13 (mean of 8.3) months. PIH was observed in 10.5% of the cases. Histologically, epidermal hyperpigmentation was observed in all specimens and was dramatically improved by the topical bleaching pretreatment.
  
  
  CONCLUSIONS
  QSR laser combined with the topical bleaching pretreatment appeared to treat ADM consistently with a low occurrence rate of PIH and lessen the number of laser sessions and total treatment period and may also be applied to any other lesions with both epidermal and dermal pigmentation.
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Momosawa
authors.forename: Kotaro
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Gentaro
authors.initials: G
authors.lastname: Uchida
authors.forename: Katsujiro
authors.initials: K
authors.lastname: Sato
authors.forename: Emiko
authors.initials: E
authors.lastname: Aiba
authors.forename: Daisuke
authors.initials: D
authors.lastname: Matsumoto
authors.forename: Hisayo
authors.initials: H
authors.lastname: Yamaoka
authors.forename: Saori
authors.initials: S
authors.lastname: Mihara
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Tsukamoto
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Harii
authors.forename: Takao
authors.initials: T
authors.lastname: Aoyama
authors.forename: Tatsuji
authors.initials: T
authors.lastname: Iga
mesh_terms: D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006873:Hydroquinones / Q000009:adverse effects / Q000627:therapeutic use*; D017495:Hyperpigmentation / Q000209:etiology / Q000276:immunology / Q000628:therapy*; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009508:Nevus, Pigmented / Q000628:therapy*; D016896:Treatment Outcome; D014212:Tretinoin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D003879:Dermatologic Agents; D006873:Hydroquinones; D014212:Tretinoin; C031927:hydroquinone