Pigment Lasers and Light Treatments

  • Daniel A. Belkin
  • Roy G. GeronemusEmail author


Altered or uneven pigmentation is a common reason to present to a dermatologist or laser surgeon. Modalities available for treating pigmentary alterations include medication, destruction, excision, resurfacing lasers, and lasers specifically targeted to pigment. The last modality will be the focus of this chapter.


Hyperpigmentation Q-switched lasers Picosecond lasers Tattoo lasers Light treatments 


  1. 1.
    Vejjabhinanta V, Elsaie ML, Patel SS, Patel A, Caperton C, Nouri K. Comparison of short-pulsed and long-pulsed 532 nm lasers in the removal of freckles. Lasers Med Sci. 2010;25(6):901–6.PubMedGoogle Scholar
  2. 2.
    Wattanakrai P, Mornchan R, Eimpunth S. Low-fluence Q-switched neodymium-doped yttrium aluminum garnet (1,064 nm) laser for the treatment of facial melasma in Asians. Dermatol Surg. 2010;36(1):76–87.PubMedGoogle Scholar
  3. 3.
    Park JM, Tsao H, Tsao S. Combined use of intense pulsed light and Q-switched ruby laser for complex dyspigmentation among Asian patients. Lasers Surg Med. 2008;40(2):128–33.PubMedGoogle Scholar
  4. 4.
    Schoenewolf NL, Hafner J, Dummer R, Bogdan Allemann I. Laser treatment of solar lentigines on dorsum of hands: QS Ruby laser versus ablative CO2 fractional laser – a randomized controlled trial. Eur J Dermatol. 2015;25(2):122–6.PubMedGoogle Scholar
  5. 5.
    Shah S, Alster TS. Laser treatment of dark skin: an updated review. Am J Clin Dermatol. 2010;11(6):389–97.PubMedGoogle Scholar
  6. 6.
    Alexis AF. Lasers and light-based therapies in ethnic skin: treatment options and recommendations for Fitzpatrick skin types V and VI. Br J Dermatol. 2013;169 Suppl 3:91–7.PubMedGoogle Scholar
  7. 7.
    Sadighha A, Saatee S, Muhaghegh-Zahed G. Efficacy and adverse effects of Q-switched ruby laser on solar lentigines: a prospective study of 91 patients with Fitzpatrick skin type II, III, and IV. Dermatol Surg. 2008;34(11):1465–8.PubMedGoogle Scholar
  8. 8.
    Michel S, Hohenleutner U, Baumler W, Landthaler M. Q-switched ruby laser in dermatologic therapy. Use and indications. Hautarzt. 1997;48(7):462–70.PubMedGoogle Scholar
  9. 9.
    Kang W, Lee E, Choi GS. Treatment of Ota’s nevus by Q-switched alexandrite laser: therapeutic outcome in relation to clinical and histopathological findings. Eur J Dermatol. 1999;9(8):639–43.PubMedGoogle Scholar
  10. 10.
    Suh DH, Hwang JH, Lee HS, Youn JI, Kim PM. Clinical features of Ota’s naevus in Koreans and its treatment with Q-switched alexandrite laser. Clin Exp Dermatol. 2000;25(4):269–73.PubMedGoogle Scholar
  11. 11.
    Yang HY, Lee CW, Ro YS, Yu HJ, Kim YT, Kim JH. Q-switched ruby laser in the treatment of nevus of Ota. J Korean Med Sci. 1996;11(2):165–70.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Kono T, Nozaki M, Chan HH, Mikashima Y. A retrospective study looking at the long-term complications of Q-switched ruby laser in the treatment of nevus of Ota. Lasers Surg Med. 2001;29(2):156–9.PubMedGoogle Scholar
  13. 13.
    Wang HW, Liu YH, Zhang GK, et al. Analysis of 602 Chinese cases of nevus of Ota and the treatment results treated by Q-switched alexandrite laser. Dermatol Surg. 2007;33(4):455–60.PubMedGoogle Scholar
  14. 14.
    Watanabe S, Takahashi H. Treatment of nevus of Ota with the Q-switched ruby laser. N Engl J Med. 1994;331(26):1745–50.PubMedGoogle Scholar
  15. 15.
    Geronemus RG. Q-switched ruby laser therapy of nevus of Ota. Arch Dermatol. 1992;128(12):1618–22.PubMedGoogle Scholar
  16. 16.
    Alster TS, Williams CM. Treatment of nevus of Ota by the Q-switched alexandrite laser. Dermatol Surg. 1995;21(7):592–6.PubMedGoogle Scholar
  17. 17.
    Gach JE, James MP. Laser treatment of lentiginosis in an Afro-Caribbean. J R Soc Med. 2001;94(5):240–1.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Kono T, Chan HH, Ercocen AR, et al. Use of Q-switched ruby laser in the treatment of nevus of ota in different age groups. Lasers Surg Med. 2003;32(5):391–5.PubMedGoogle Scholar
  19. 19.
    Chan HH, Leung RS, Ying SY, Lai CF, Chua J, Kono T. Recurrence of nevus of Ota after successful treatment with Q-switched lasers. Arch Dermatol. 2000;136(9):1175–6.PubMedGoogle Scholar
  20. 20.
    Chang CJ, Kou CS. Comparing the effectiveness of Q-switched Ruby laser treatment with that of Q-switched Nd:YAG laser for oculodermal melanosis (Nevus of Ota). J Plast Reconstr Aesthet Surg. 2011;64(3):339–45.PubMedGoogle Scholar
  21. 21.
    Chan HH, Ying SY, Ho WS, Kono T, King WW. An in vivo trial comparing the clinical efficacy and complications of Q-switched 755 nm alexandrite and Q-switched 1064 nm Nd:YAG lasers in the treatment of nevus of Ota. Dermatol Surg. 2000;26(10):919–22.PubMedGoogle Scholar
  22. 22.
    Belkin DA, Jeon H, Weiss E, Brauer JA, Geronemus RG. Successful and safe use of Q-switched lasers in the treatment of nevus of Ota in children with phototypes IV-VI. Lasers Surg Med. 2018;50(1):56–60.PubMedGoogle Scholar
  23. 23.
    Wang CC, Sue YM, Yang CH, Chen CK. A comparison of Q-switched alexandrite laser and intense pulsed light for the treatment of freckles and lentigines in Asian persons: a randomized, physician-blinded, split-face comparative trial. J Am Acad Dermatol. 2006;54(5):804–10.PubMedGoogle Scholar
  24. 24.
    Levin MK, Ng E, Bae YS, Brauer JA, Geronemus RG. Treatment of pigmentary disorders in patients with skin of color with a novel 755 nm picosecond, Q-switched ruby, and Q-switched Nd:YAG nanosecond lasers: a retrospective photographic review. Lasers Surg Med. 2016;48(2):181–7.PubMedGoogle Scholar
  25. 25.
    Jang WS, Lee CK, Kim BJ, Kim MN. Efficacy of 694-nm Q-switched ruby fractional laser treatment of melasma in female Korean patients. Dermatol Surg. 2011;37(8):1133–40.PubMedGoogle Scholar
  26. 26.
    Brauer JA, Alabdulrazzaq H, Bae YS, Geronemus RG. Evaluation of a low energy, low density, non-ablative fractional 1927 nm wavelength laser for facial skin resurfacing. J Drugs Dermatol. 2015;14(11):1262–7.PubMedGoogle Scholar
  27. 27.
    Lee B, Kim YC, Kang WH, Lee ES. Comparison of characteristics of acquired bilateral nevus of Ota-like macules and nevus of Ota according to therapeutic outcome. J Korean Med Sci. 2004;19(4):554–9.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Lam AY, Wong DS, Lam LK, Ho WS, Chan HH. A retrospective study on the efficacy and complications of Q-switched alexandrite laser in the treatment of acquired bilateral nevus of Ota-like macules. Dermatol Surg. 2001;27(11):937–41. discussion 941–932PubMedGoogle Scholar
  29. 29.
    Yoshimura K, Sato K, Aiba-Kojima E, et al. Repeated treatment protocols for melasma and acquired dermal melanocytosis. Dermatol Surg. 2006;32(3):365–71.PubMedGoogle Scholar
  30. 30.
    Momosawa A, Yoshimura K, Uchida G, et al. Combined therapy using Q-switched ruby laser and bleaching treatment with tretinoin and hydroquinone for acquired dermal melanocytosis. Dermatol Surg. 2003;29(10):1001–7.PubMedGoogle Scholar
  31. 31.
    Manuskiatti W, Sivayathorn A, Leelaudomlipi P, Fitzpatrick RE. Treatment of acquired bilateral nevus of Ota-like macules (Hori’s nevus) using a combination of scanned carbon dioxide laser followed by Q-switched ruby laser. J Am Acad Dermatol. 2003;48(4):584–91.PubMedGoogle Scholar
  32. 32.
    Cho SB, Kim JS, Kim MJ. Melasma treatment in Korean women using a 1064-nm Q-switched Nd:YAG laser with low pulse energy. Clin Exp Dermatol. 2009;34(8):e847–50.PubMedGoogle Scholar
  33. 33.
    Vachiramon V, Sahawatwong S, Sirithanabadeekul P. Treatment of melasma in men with low-fluence Q-switched neodymium-doped yttrium-aluminum-garnet laser versus combined laser and glycolic acid peeling. Dermatol Surg. 2015;41(4):457–65.PubMedGoogle Scholar
  34. 34.
    Vachiramon V, Sirithanabadeekul P, Sahawatwong S. Low-fluence Q-switched Nd: YAG 1064-nm laser and intense pulsed light for the treatment of melasma. J Eur Acad Dermatol Venereol. 2015;29(7):1339–46.PubMedGoogle Scholar
  35. 35.
    Choi M, Choi JW, Lee SY, et al. Low-dose 1064-nm Q-switched Nd:YAG laser for the treatment of melasma. J Dermatolog Treat. 2010;21(4):224–8.PubMedGoogle Scholar
  36. 36.
    Jeong SY, Shin JB, Yeo UC, Kim WS, Kim IH. Low-fluence Q-switched neodymium-doped yttrium aluminum garnet laser for melasma with pre- or post-treatment triple combination cream. Dermatol Surg. 2010;36(6):909–18.PubMedGoogle Scholar
  37. 37.
    Choi CP, Yim SM, Seo SH, Ahn HH, Kye YC, Choi JE. Retreatment using a dual mode of low-fluence Q-switched and long-pulse Nd:YAG laser in patients with melasma aggravation after previous therapy. J Cosmet Laser Ther. 2015;17(3):129–34.PubMedGoogle Scholar
  38. 38.
    Chan HH, Leung RS, Ying SY, et al. A retrospective analysis of complications in the treatment of nevus of Ota with the Q-switched alexandrite and Q-switched Nd:YAG lasers. Dermatol Surg. 2000;26(11):1000–6.PubMedGoogle Scholar
  39. 39.
    Polnikorn N, Tanrattanakorn S, Goldberg DJ. Treatment of Hori’s nevus with the Q-switched Nd:YAG laser. Dermatol Surg. 2000;26(5):477–80.PubMedGoogle Scholar
  40. 40.
    Ee HL, Goh CL, Khoo LS, Chan ES, Ang P. Treatment of acquired bilateral nevus of ota-like macules (Hori’s nevus) with a combination of the 532 nm Q-Switched Nd:YAG laser followed by the 1,064 nm Q-switched Nd:YAG is more effective: prospective study. Dermatol Surg. 2006;32(1):34–40.PubMedGoogle Scholar
  41. 41.
    Kim S, Cho KH. Treatment of facial postinflammatory hyperpigmentation with facial acne in Asian patients using a Q-switched neodymium-doped yttrium aluminum garnet laser. Dermatol Surg. 2010;36(9):1374–80.PubMedGoogle Scholar
  42. 42.
    Noh TK, Chung BY, Yeo UC, Chang S, Lee MW, Chang SE. Q-switched 660-nm versus 532-nm Nd: YAG laser for the treatment for facial lentigines in Asian patients: a prospective, randomized, double-blinded, split-face comparison pilot study. Dermatol Surg. 2015;41(12):1389–95.PubMedGoogle Scholar
  43. 43.
    Tse Y, Levine VJ, McClain SA, Ashinoff R. The removal of cutaneous pigmented lesions with the Q-switched ruby laser and the Q-switched neodymium: yttrium-aluminum-garnet laser. A comparative study. J Dermatol Surg Oncol. 1994;20(12):795–800.PubMedGoogle Scholar
  44. 44.
    Ge Y, Jia G, Lin T. Q-switched Nd:YAG laser treatment for labial lentigines associated with Peutz-Jeghers syndrome. J Dtsch Dermatol Ges. 2015;13(6):551–5.PubMedGoogle Scholar
  45. 45.
    Park GH, Rhee do Y, Moon HR, et al. Effect of an epidermal growth factor-containing cream on postinflammatory hyperpigmentation after Q-switched 532-nm neodymium-doped yttrium aluminum garnet laser treatment. Dermatol Surg. 2015;41(1):131–5.PubMedGoogle Scholar
  46. 46.
    Jun HJ, Cho SH, Lee JD, Kim HS. A split-face, evaluator-blind randomized study on the early effects of Q-switched Nd:YAG laser plus Er:YAG micropeel (combined therapy) versus Q-switched Nd:YAG alone in light solar lentigines in Asians. Lasers Med Sci. 2014;29(3):1153–8.PubMedGoogle Scholar
  47. 47.
    Chan JC, Shek SY, Kono T, Yeung CK, Chan HH. A retrospective analysis on the management of pigmented lesions using a picosecond 755-nm alexandrite laser in Asians. Lasers Surg Med. 2016;48(1):23–9.PubMedGoogle Scholar
  48. 48.
    Haimovic A, Brauer JA, Cindy Bae YS, Geronemus RG. Safety of a picosecond laser with diffractive lens array (DLA) in the treatment of Fitzpatrick skin types IV to VI: a retrospective review. J Am Acad Dermatol. 2016;74(5):931–6.PubMedGoogle Scholar
  49. 49.
    Kuperman-Beade M, Levine VJ, Ashinoff R. Laser removal of tattoos. Am J Clin Dermatol. 2001;2(1):21–5.PubMedGoogle Scholar
  50. 50.
    Ho DD, London R, Zimmerman GB, Young DA. Laser-tattoo removal – a study of the mechanism and the optimal treatment strategy via computer simulations. Lasers Surg Med. 2002;30(5):389–97.PubMedGoogle Scholar
  51. 51.
    Ross V, Naseef G, Lin G, et al. Comparison of responses of tattoos to picosecond and nanosecond Q-switched neodymium: YAG lasers. Arch Dermatol. 1998;134(2):167–71.PubMedGoogle Scholar
  52. 52.
    Herd RM, Alora MB, Smoller B, Arndt KA, Dover JS. A clinical and histologic prospective controlled comparative study of the picosecond titanium:sapphire (795 nm) laser versus the Q-switched alexandrite (752 nm) laser for removing tattoo pigment. J Am Acad Dermatol. 1999;40(4):603–6.PubMedGoogle Scholar
  53. 53.
    Saedi N, Metelitsa A, Petrell K, Arndt KA, Dover JS. Treatment of tattoos with a picosecond alexandrite laser: a prospective trial. Arch Dermatol. 2012;148(12):1360–3.PubMedGoogle Scholar
  54. 54.
    Brauer JA, Reddy KK, Anolik R, et al. Successful and rapid treatment of blue and green tattoo pigment with a novel picosecond laser. Arch Dermatol. 2012;148(7):820–3.PubMedGoogle Scholar
  55. 55.
    Alabdulrazzaq H, Brauer JA, Bae YS, Geronemus RG. Clearance of yellow tattoo ink with a novel 532-nm picosecond laser. Lasers Surg Med. 2015;47(4):285–8.PubMedGoogle Scholar
  56. 56.
    Konishi N, Kawada A, Kawara S, et al. Clinical effectiveness of a novel intense pulsed light source on facial pigmentary lesions. Arch Dermatol Res. 2008;300(Suppl 1):S65–7.PubMedGoogle Scholar
  57. 57.
    Kawada A, Shiraishi H, Asai M, et al. Clinical improvement of solar lentigines and ephelides with an intense pulsed light source. Dermatol Surg. 2002;28(6):504–8.PubMedGoogle Scholar
  58. 58.
    Kono T, Manstein D, Chan HH, Nozaki M, Anderson RR. Q-switched ruby versus long-pulsed dye laser delivered with compression for treatment of facial lentigines in Asians. Lasers Surg Med. 2006;38(2):94–7.PubMedGoogle Scholar
  59. 59.
    Kono T, Chan HH, Groff WF, et al. Long-pulse pulsed dye laser delivered with compression for treatment of facial lentigines. Dermatol Surg. 2007;33(8):945–50.PubMedGoogle Scholar
  60. 60.
    Ho SG, Chan NP, Yeung CK, Shek SY, Kono T, Chan HH. A retrospective analysis of the management of freckles and lentigines using four different pigment lasers on Asian skin. J Cosmet Laser Ther. 2012;14(2):74–80.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Laser and Skin Surgery Center of New YorkNew YorkUSA
  2. 2.The Ronald O. Perelman Department of DermatologyNYU School of MedicineNew YorkUSA

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