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DL-PDT in comparison with c-PDT was as effective, better tolerated and nearly painless with high patient satisfaction, and may be considered a treatment of choice to meet needs of patients with mild or moderate facial/scalp AKs.

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The novel picosecond lasers, initially developed for faster tattoo removal, have also shown great efficacy in endogenous pigmentary disorders. To describe the efficacy and safety profile of an alexandrite (755-nm) picosecond laser in a wide range of pigmented flat and elevated cutaneous lesions. A retrospective study was performed in which we collected all the clinical images of patients treated with the 755-nm alexandrite picosecond laser for 12 months (November 2016-November 2017). Clinical features were obtained from their medical charts. Patients treated for tattoo removal were excluded. All the images were analyzed by three blind physicians attending to a visual analogue scale (VAS) from 0 to 5 (0, no change; 1, 1-24% clearance; 2, 25-49% clearance; 3, 50-74% clearance; 4, 75-99% clearance; 5, complete clearance). Patient satisfaction was obtained from a subjective survey including four items: very satisfied, satisfied, non-satisfied, and totally dissatisfied. Thirty-seven patients were included (12 males; 25 females). The mean age of the study was 42.35 years. Twenty-five patients (68%) were treated for different pigmented flat disorders such as solar and mucosal lentigines (5), stasis dermatitis (4), or nevus of Ota (4), among other diagnoses. Twelve patients (32%) were treated for epidermal elevated lesions such as warts (5), epidermal nevi (2), and seborrheic keratosis (3), among other elevated lesions. Mean number of laser treatment was 3.02 sessions while mean follow-up after last laser treatment was 4.02 months. Mean VAS score of the three observers was 3.44 (61% of clearance) for pigmentary flat disorders and 3.60 (67%) for elevated lesions. Adverse effects reported were mild blistering in the first 2-5 days following laser treatment in some of the patients. Overall satisfaction among the patients included was high. The novel 755-nm picosecond alexandrite laser is effective not only for the resolution of pigmented flat lesions of different nature but also for the treatment of the more difficult elevated pigmented lesions.

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We treated six patients with static alopecia areata (AA) with photodynamic therapy (PDT). All patients had received other treatment before starting PDT, but with no benefit. All previous treatments were stopped at least 3 months before beginning PDT, and no other treatment was given during the study period. PDT was used on only one of the affected areas, or if there was only one affected area, to only part of that area; untreated areas served as controls. For all patients methylaminolaevulinic acid was applied under occulsion 3 h after irradiation with red light at 630 nm (37 J/cm(2), 7.5 min). One session was carried out each month. Clinical and fluorescence photographs were taken with a digital camera connected to ultraviolet flashes, both before and after each treatment. None of the patients with AA of the scalp achieved complete hair regrowth, either in the treated or the untreated areas. Two of the patients showed growth of some thin hair over < 10 of the treated area. The remaining patients had no change. However, the patient with AA of the beard experienced complete regrowth after four sessions. To our knowledge, this is the first case of AA treated with PDT in this location. It may be that AA of beard hair responds better to PDT, but further studies are necessary.