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case_images: Patient showing grayish maculae on the malar prominences and brownish maculae on the frontal, malar and nasal regions.
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case_images: Department of Dermatology at Hospital das Clinicas, Medical School, Sao Paulo complaining that, despite the treatment, the lesions had worsened. Dermatological examination showed confluent grayish macules on the malar prominence on both sides and brownish macules on the frontal, malar and nasal regions (Fig. 1).
case_images: Histopathology of the skin of the left malar region revealing brownish-ocher pigmented clumps in the superficial reticular dermis and a mild interstitial and perivascular lymphohistiocytic infiltrate (Hematoxilin & eosin, 100X).
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case_images: An incisional biopsy was then performed, and histopathology detected a brownish-ochre pigment in the superficial dermis (Fig. 2), corroborating the suggestion of EO.
case_images: Slight improvement of lesions after the use of QS Nd:YAG 1064 nm laser (Etherea; Vydence Medical) for eight sessions in toning mode (fluence between 1.0-1.3 J/cm2, 8-mm spot size and frequency of 10 Hz), followed by four sessions with a fluence of 4-5 J and a spot size of 5 mm.
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case_images: As therapy, the 1064 nm QS Nd:YAG laser (Etherea, Vydence Medical) was used, first during eight sessions per month (toning mode, fluence between 1.0-1.3 J/cm2, spot size of 8 mm, frequency of 10 Hz), followed by four sessions a month with fluence between 4-5 J and spot size of 5 mm, with slight improvement (Fig. 3).
case_images: Partial response after seven sessions of Intense Pulsed Light (IPL; Etherea, Vydence Medical) using a 580 nm filter, with a fluence of 15 J/cm2 and a single pulse of 15 ms.
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case_images: Subsequently, he underwent seven sessions, one per month, of intense pulsed light (IPL; Etherea, Vydence Medical; 580 nm filter, 15 J/cm2 fluence, 15 ms pulse), with partial response (Fig. 4).
case_images: Significant lesion improvement after five sessions of fractional 10,600 nm CO2 laser (Sculptor, Vydence Medical) with 120 nm tip, energy between 80-100 mJ and density of 50 MTZ/cm2.
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case_images: Finally, fractional 10,600 nm CO2 laser (Sculptor, Vydence Medical) was used with a 120 nm tip, energy between 80-100 mJ and density of 50 MTZ/cm2 (total of five bimonthly sessions), with significant lesion improvement (Fig. 5).