case_images: PMC10788405_01
case_images: Front view of the patient's face showing (A) nonpolarized and (B) cross-polarized photography before laser treatment demonstrates classic slate-gray hyperpigmentation of characteristic minocycline pigmentation. On the lower pictures, front view of the patient showing (C) nonpolarized and (D) cross-polarized photography of the patient's face after completion of 3 treatments with 730 nm picosecond laser.
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case_images: fig1
case_images: On examination, light brown and slate-gray hyperpigmented patches were predominantly observed on the temples, nose, chin, cutaneous lips, and lateral cheeks, without involvement of the mucosa or nails (Fig 1). Three treatments were administered at 6 to 8 week intervals resulting in pigment clearance (Fig 1).
case_images: The upper picture showing different test spots with (A) 6.4 J/cm2 fluence, 755 nm/2 mm spot size, (B) 1.8 J/cm2 fluence, 730 nm and 3 mm spot size, (C) 1.4 J/ cm2 fluence, 785 nm and 3 mm spot size, and (D) 3.2 J/cm2 fluence, 1064 nm and 4 mm spot size. The lower picture showing tested areas with most response to 730 nm (B) followed by 755 nm (A) picosecond laser after 4 weeks.
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case_images: fig2
case_images: Ti:sapphire picosecond-domain laser emitting 730-nm (PicoWay, Candela Medical Corporation) using 1.8 J/cm2 and a 3 mm spot, a 755-nm alexandrite picosecond-domain laser (PicoSure, Cynosure, LLC) using 6.4 J/cm2 fluence and a 2 mm spot, and a 785-nm Ti:sapphire picosecond-domain laser (PicoWay, Candela Medical Corporation) using 1.4 J/cm2 and a 3 mm spot (Fig 2). The efficacy of the test spots was evaluated 1 month after treatment, and the test site treated the 730 nm, Ti:sapphire laser-pumped-laser handpiece with a fluence of 1.8 J/cm2, and a 3 mm spot exhibited the most favorable response (Fig 2).
case_images: PMC10788405_02
case_images: Front view of the patient's face:nonpolarized (left) and cross-polarized (right) photography before laser treatment demonstrates slate-gray hyperpigmentation on the nose and upper cutaneous lip.
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case_images: fig3
case_images: On presentation, the patient was examined using a cross-polarized, magnifying headlamp (v600, Syris Scientific), revealing slate-gray pigmentation involving the nose and upper cutaneous lip, consistent with minocycline pigmentation (Fig 3).
case_images: Front view of the patient's face:nonpolarized (left) and cross-polarized (right) photography, 2 months later after 1 treatment with Nd:YAG Q-switched laser demonstrates minimal response. Nd:YAG, neodymium:yttrium-aluminum-garnet.
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case_images: fig4
case_images: Ferndale Laboratories Inc Company) the patient was treated with a nanosecond-domain, Q-switched 1064 nm laser with a fluence of 6.6 J/cm2, and a 5 mm spot size, with minimal improvement noted 2 months after treatment (Fig 4). For his second treatment, a picosecond-domain, Ti:sapphire, 785 nm laser (PicoWay, Candela Corporation), was selected using a fluence of 0.8 J/cm2, and a spot size of 4 mm on the nose, and 1.4 J/cm2 with a of 3 mm spot on the upper lip.
case_images: Front view of the patient's face:nonpolarized (left) and cross-polarized (right) photography, 2 months later after 1 treatment with a 785 nm picosecond laser demonstrates a good response.
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case_images: fig5
case_images: Significant improvement was seen 2 months after this treatment (Fig 5).
case_images: Front view of the patient's face:nonpolarized (left) and cross-polarized (right) photography, 2 months later after 1 treatment with a 730 nm picosecond laser demonstrates maximum response.
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case_images: fig6
case_images: Two months later a second treatment was administered using the Ti:sapphire, 730 nm, picosecond laser (PicoWay, Candela Corporation) with a fluence of 1.8 J/cm2 and a 3 mm spot, resulting in dramatic clearing of the pigment 5 months after his final treatment (Fig 6).
case_images: PMC10788405_03
case_images: Front view of the patient's face:cross-polarized photography before (left) and after 3 treatments (right) with a 1064 nm Q-switched laser.
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case_images: fig7
case_images: Five-years after the final treatment the patient presented for treatment of an unrelated condition and demonstrated long-term improvement (Fig 7).