INTRODUCTION
Treatment of solar lentigines can be accomplished
through several modalities, including the use of cryogen,
hyfrecation, and light-based options. Based on
the theory of selective photothermolysis,1 quality-switched
(QS) lasers have been employed to treat pigmented lesions
with great success. The high energy output and short pulse durations
offer precise, spatially confined heating of epidermal
pigmented lesions while avoiding significant heat diffusion
from the target.2 However, for patients who have dyschromia
involving a large portion of the face or with chronic bronzing,
treatment of large areas becomes labor-intensive and timeconsuming.
Intense pulsed light devices have the benefit of
larger spot sizes with efficacy that approaches that of QS lasers
in the treatment of pigmented lesions.3,4 Therefore, they have
utility in treating larger areas. As an additional alternative, the
efficacy and safety of treatment of these lesions with a longpulse
alexandrite laser with fixed pulse duration has been reported.
2,5 The following study further demonstrates the safety
and efficacy of a new long-pulse alexandrite laser (ClearScan
ALX, 755 nm, Sciton, Palo Alto, CA) that employs contact cooling
in the treatment of superficial pigmented lesions.
METHODS
Patients
A total of 5 patients were enrolled and treated in this prospective
study after approval from the Scripps Institutional Review Board. Each patient was advised of the risks and benefits regarding
the procedure, and consent was obtained before
treatment. The study conformed to the guidelines of the 1975
Declaration of Helsinki. Patients in this study had a mean age
of 59 years and were all female. All patients had Fitzpatrick skin
types II and III, with 4 patients having type II skin. All had clinically
diagnosed lentigines on the arms, hands, chest, or legs.
Exclusion criteria included Fitzpatrick skin types V and VI, immunocompromised
patients, history of connective tissue disease,
age younger than 18 years or older than 75 years, the inability
to read and comprehend English, known photosensitivity,
pregnancy, recent tan, history of poor wound healing, scarring
in the treatment area and history of keloid formation, active local
or systemic infection, or history of isotretinoin use within 6
months before the initiation of treatment.
Procedure
Each patient enrolled in the study underwent an initial evaluation
and test spot treatment to determine the most efficacious
and safe fluence for each individual. Follow-up full treatments
of designated areas were performed at subsequent visits.
Sites were photographed using a digital camera (D70, Nikon,
Melville, NY), with and without a cross-polarizing filter (Canfield
Imaging Systems, Fairfield, NJ). Topical anesthetic of 5% lido-
