A Prospective Randomized Controlled Study of Oral Tranexamic Acid for the Prevention of Postinflammatory Hyperpigmentation After Q‐Switched 532‐nm Nd:YAG Laser for Solar Lentigines

Rutnin, Suthinee; Pruettivorawongse, Duangrat; Thadanipon, Kunlawat; Vachiramon, Vasanop

doi:10.1002/lsm.23135

Cited by 23 publications

(26 citation statements)

References 34 publications

(71 reference statements)

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“…There have been several reports of attempts to prevent laser treatment-associated PIH [41][42][43]. For example, 10% glycolic acid cream, 4% hydroquinone cream, and 0.025% tretinoin cream have been used with CO2 lasers, but such treatments did not prevent PIH [41]. Oral tranexamic acid also did not prevent QS 532 nm Nd:YAG laser-induced PIH [39].…”

Section: Discussionmentioning

confidence: 98%

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A Randomized Controlled Trial on the Effectiveness of Epidermal Growth Factor-Containing Ointment on the Treatment of Solar Lentigines as Adjuvant Therapy

Kim

Kang

et al. 2021

Medicina

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Background and Objective: Little is known about the anti-pigmentation effects of whitening agents on solar lentigines. Epidermal growth factor (EGF) has been used as a booster for wound healing in the skin, and it has been suggested to have anti-pigmentation effects. This study aimed to evaluate the effect and safety of EGF-containing ointment for treating solar lentigines with a Q-switched (QS) 532 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser (Bluecore company, Seoul, Republic of Korea). Materials and Methods: Subjects who underwent QS 532 nm Nd:YAG laser treatment of solar lentigines were randomly assigned to treatment with an EGF ointment or petrolatum. After the laser procedure, the subjects were administered the test ointment twice a day for 4 weeks. The physician’s assessment of the degree of pigment clearance and patient’s satisfaction were assessed after 4 and 8 weeks. Additionally, the melanin index (MI), erythema index (EI), transepidermal water loss (TEWL), and post-inflammatory hyperpigmentation (PIH) were evaluated. This trial was registered with ClinicalTrials.gov (NCT04704245). Results: The blinded physician’s assessment using 5-grade percentage improvement scale and patient’s satisfaction were significantly higher in the study group than in the control group at the 4th and 8th weeks. The MI was significantly higher in the control group than in the study group at the 4th and 8th weeks. The EI and TEWL did not differ significantly between the two groups at either time point. The incidence of PIH was higher in the control group (37.5%) than in the EGF group (7.14%) at the 8th week. Conclusions: The application of EGF-containing ointment on facial solar lentigines with a QS 532 nm Nd:YAG laser showed efficient and safe therapeutic effects, with less PIH. Thus, EGF-containing ointment could be suggested as the promising adjuvant treatment strategy with a QS laser for solar lentigines.

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Section: Discussionmentioning

confidence: 98%

“…Post-laser PIH has been reported at the rates of 10-47% [9,[38][39][40]. There have been several reports of attempts to prevent laser treatment-associated PIH [41][42][43]. For example, 10% glycolic acid cream, 4% hydroquinone cream, and 0.025% tretinoin cream have been used with CO2 lasers, but such treatments did not prevent PIH [41].…”

Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial on the Effectiveness of Epidermal Growth Factor-Containing Ointment on the Treatment of Solar Lentigines as Adjuvant Therapy

Kim

Kang

et al. 2021

Medicina

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“…However, oral TXA did speed resolution of PIH when continued up to six weeks post-treatment. 4 The third study found a single dose of intradermal TXA injection (50 mg/mL) was mildly successful in reducing PIH after SL removal with a Q-switched 532-nm Nd:YAG laser when compared with placebo (0.9% normal saline) injection. 5 We use oral TXA at a dose of 650 mg daily until the injury is fully healed and no PIH is present.…”

Section: Discussionmentioning

confidence: 99%

“…TXA is contraindicated in patients with hypercoagulable conditions, renal impairment, vision impairment disorders, pregnancy, breast-feeding, or on hormone therapies. 3,4,5 From 2015-2020, we have used TXA off-label to successfully treat and/or prevent PIH in approximately 82 high-risk patients after injuries or prior to procedures that disrupt the epidermis. We also have used TXA to prevent PIH after acute injuries such as irritant dermatitis, thermal burns, and abrasions.…”

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confidence: 99%

The Use of Tranexamic Acid to Prevent and Treat Post-Inflammatory Hyperpigmentation

Lindgren¹,

Austin²,

Welsh³

2021

JDD

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The patient had no contraindications for oral TXA. Given the high concern for PIH, she was prescribed TXA 650 mg daily and clobetasol 0.05% cream twice daily. The clobetasol cream was discontinued after one week and TXA was discontinued after eight weeks. Sixteen weeks later, she presented with normalappearing skin. Her previous similar episode of PIH had been treated with clobetasol 0.05% cream for 2 weeks followed by hydroquinone 4% and monthly light chemical peels, leading to resolution only after six months. We believe the addition of TXA was responsible for her quick recovery without PIH, and without multiple chemical peels or prolonged use of hydroquinone (Figure 2). CASE 2 A 20-year-old woman with Fitzpatrick skin type 4, presented with acne, acne excorie, and PIH (Figure 3, left side). She was treated with topicals (sunscreen and tretinoin 0.05%) and daily spironolactone 100 mg. A series of light chemical peels was planned. She was prophylactically prescribed oral TXA 650 mg daily for her ongoing excoriation and concern that the peels would exacerbate her current PIH. Over a period of 2.5 years, she completed nine exfoliative chemical peels (Vitalize peels, Allergan, Irvine, CA) without any complications (Figure 3, right side). She did not develop any new PIH during this time despite continued excoriation.

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“…Hence, the skin texture and rhytides correct well with both non‐ablative fractional laser (NAFL) and ablative fractional laser (AFL) resurfacing . Mottled pigmentation, on the contrary, responds to intense pulsed light (IPL), q‐switched, and pico‐second lasers . Telangiectasia are reduced by lasers targeting hemoglobin, typically solid state KTP, pulsed dye lasers (PDL), and IPL .…”

Section: Introductionmentioning

confidence: 99%

Fractional 1,927 nm Thulium Laser Plus Photodynamic Therapy Compared and Combined for Photodamaged Décolleté Skin: A Side‐by‐Side Randomized Controlled Trial

et al. 2019

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Background and Objectives: Décolleté photodamage is a common condition typically treated with light and energy-based devices. This study investigated the efficacy and safety of a fractional 1,927 nm thulium laser (TL) alone and combined with photodynamic therapy (PDT). Study Design/Materials and Methods: In a 12-week follow-up study, participant décolletés were divided into four treatment areas and randomized to receive a single treatment with field-directed TL, PDT, combination TL-PDT, or lesion-directed curettage control. All actinic keratoses (AKs) underwent lesion-directed curettage before randomization. TL was delivered at 20 mJ/mb, 500 mJ/cm 2 fluence, 5 W, and 8 (n = 6 pts.) or 16 (n = 6 pts.) passes. PDT was performed with 16% methyl aminolevulinate (MAL) creme incubated for 3 h, followed by red light-emitting diode light at 37 J/cm 2 . Outcome measures included clinical assessment of overall photodamage and specific subcomponents, assisted by optical coherence tomography (OCT) imaging. Results: Twelve women with moderate to severe photodamage on the décolleté and a cumulative total of 184 thin grade I AKs were included. Field-directed treatments TL and combination TL-PDT equally improved the overall photodamage, mottled pigmentation, and rhytides compared with lesion-directed control (P < 0.05). The skin texture improved by TL alone and was further improved by combining TL and PDT (P < 0.05). Median AK complete responses were similar for field-directed interventions TL-PDT (100%), TL (90%), PDT (82%), and lesion-directed curettage control (52%) (P = 0.464). Patients presented with mild local skin responses, slightly more pronounced when combining TL with PDT versus individual treatments (P < 0.05). No scarring or adverse events were observed. Conclusions: The 1,927 nm fractional thulium laser is an effective, tolerable, and safe field-directed treatment for décolleté photodamage. Provided alone, TL proved to be as effective as combined TL-PDT for overall photodamage, while a greater improvement in skin texture was achieved using TL and PDT in combination. Lasers Surg. Med.

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A Prospective Randomized Controlled Study of Oral Tranexamic Acid for the Prevention of Postinflammatory Hyperpigmentation After Q‐Switched 532‐nm Nd:YAG Laser for Solar Lentigines

Cited by 23 publications

References 34 publications

A Randomized Controlled Trial on the Effectiveness of Epidermal Growth Factor-Containing Ointment on the Treatment of Solar Lentigines as Adjuvant Therapy

A Randomized Controlled Trial on the Effectiveness of Epidermal Growth Factor-Containing Ointment on the Treatment of Solar Lentigines as Adjuvant Therapy

The Use of Tranexamic Acid to Prevent and Treat Post-Inflammatory Hyperpigmentation

Fractional 1,927 nm Thulium Laser Plus Photodynamic Therapy Compared and Combined for Photodamaged Décolleté Skin: A Side‐by‐Side Randomized Controlled Trial

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