Long pulsed dye laser with a back‐to‐back double‐pulse technique and compression for the treatment of epidermal pigmented lesions

Background In the recent past, long pulsed dye lasers (LPDL) have been investigated for the treatment of epidermal pigmented lesions (EPLs). Using a pigmented lesion compression headpiece, blood is pushed laterally out of the laser field focusing laser energy on melanin. Recent studies have demonstrated excellent responses using a single‐pulse at the following settings: 9–12 J/cm2, 1.5 milliseconds, 7‐10 mm spot size with compression. However, the majority of these studies report patients requiring up to four treatments for lesion resolution. Herein, we describe our experiences utilizing a back‐to‐back double‐pulse technique to decrease the total number of treatments needed for EPL clearance. Methods Thirty‐six patients (27 females, 9 males; skin types I–IV) with benign facial EPLs were included. Each lesion received two back‐to‐back pulses (fluence of 9–12 J/cm2, 1.5 milliseconds duration, and 7 mm spot size). If needed, a second treatment was delivered 4–8 weeks later. Pre‐ and post‐photos after the first treatment were evaluated by two independent board‐certified dermatologists. Results Lesion clearance after the first treatment was graded on a Likert scale as: 1 = poor (75%). Of the 36 participants, 23 had excellent clearing, 10 with good, 2 with fair and 1 with poor clearance. There was only one case of post‐inflammatory hyperpigmentation that subsequently resolved, and no cases or scarring or hypopigmentation. Conclusion LPDL with compression continues to be a safe and effective modality for treatment of EPLs. Double‐pulsing decreases the total number of treatments needed for lesion resolution, while maintaining safety and potentially decreasing cost. Lasers Surg. Med. 51:136–140, 2019. © 2018 Wiley Periodicals, Inc.