title: Spotted leucoderma after treatment of facial hyperpigmentation on hemodialysis patients employing 1064-nm Q-switched Nd:YAG laser.
abstract: The development of skin hyperpigmentation in patients with end-stage renal disease (ESRD) on hemodialysis (HD) have been well documented. However, the cosmetic concern was neither valued seriously nor treated effectively in the past. We report a female case who suffered from facial hyperpigmentation (FH). She was treated by large-spot sized, 1064-nm Q-switched Nd:YAG laser (QSNYL). A significant improvement was found after three treatment sessions at a fluence of 3.9 J/cm(2) with 8-day intervals, but spotted leucoderma developed at the fourth visit. Neither residual FH nor spotted leucoderma subsequently improved following two additional sessions of 1064-nm QSNYL at a lower fluence with topical hydroquinone and HeNe laser, and it persisted at the 1-year follow-up. This clinically specific round-shaped leucoderma suggested laser-induced damage to melanocytes due to unsuitable application. The 1064-nm QSNYL with a large spot size and an appropriate parameter may become an effective therapeutic modality if properly utilized.
authors.affiliation: Department of Dermatology, Taipei General Veterans Hospital, Taipei, Taiwan, Republic of China.
authors.forename: Chian-Yaw
authors.initials: CY
authors.lastname: Hwang
authors.forename: Chrang-Shi
authors.initials: CS
authors.lastname: Lin
authors.forename: Ming-Li
authors.initials: ML
authors.lastname: Tseng
authors.forename: Han-Nan
authors.initials: HN
authors.lastname: Liu
mesh_terms: D000368:Aged; D005145:Face; D005260:Female; D006801:Humans; D017495:Hyperpigmentation / Q000209:etiology / Q000532:radiotherapy*; D017496:Hypopigmentation / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D053844:Lasers, Solid-State / Q000009:adverse effects / Q000627:therapeutic use; D028022:Low-Level Light Therapy / Q000009:adverse effects* / Q000379:methods; D006435:Renal Dialysis