PHOENIX – Three small case series reported at the annual meeting of the American Society for Laser Medicine and Surgery reported good results using a picosecond laser for tattoo removal and explored different regimens for treatment.

One study at a single center used a 532-nm Nd-YAG laser with a pulse duration of 450-500 picoseconds (ps) in all 17 patients. Up to 10 treatments spaced every 4-8 weeks used a spot size of 2.5-5 mm, an energy density of 0.3-2.2 J/cm², and a frequency of 5 Hz in a single pass. Some patients also were treated with a 1,064-nm Nd:YAG laser with a pulse duration of 500-600 ns or a 755-nm alexandrite laser with a pulse duration of 550-750 ns.

A tattoo on the lower back before treatment.

A single treatment cleared 75% of red pigment in tattoos on nine patients treated with the 532-nm picosecond laser. Red ink cleared completely in two patients after a second or third session, Dr. Hamad Al-Abdulrazzaq and his associates reported at the meeting.

Difficult-to-remove yellow pigment lightened by 75% in three patients after two to four treatments with the 532-ns picosecond laser.

Black ink cleared by 50%-75% after one or two treatments in four patients using the 1,064-ps laser, reported Dr. Al-Abdulrazzaq, a fellow at the Laser and Skin Surgery Center of New York.

The lower back tattoo after five treatments with the 532-nm picosecond laser.

Although there were no signs of scarring or textural skin changes after treatment, one patient developed paradoxical darkening that was removed using the 1,064-nm picosecond laser. Other adverse events were as expected with laser treatment, including erythema, edema, hypopigmentation, pain, mild blistering, and crust formation that healed within a week, Dr. Al-Abdulrazzaq said.

Nearly 90% of patients reported satisfaction with treatment, and nearly 70% said they were extremely satisfied.

A separate study compared single-pass to dual-pass treatments for 26 tattoos on 20 patients using a 755-nm, 750-ps alexandrite laser. Half of each tattoo received a single pass and the other half underwent two passes separated by a 20-minute interval at multiple treatment sessions.

After the first session, the two-pass method produced a 3.4-fold improvement in pigment, significantly better than a 2.1-fold improvement seen after a single-pass treatment, Dr. Trenton Custis and his associates reported. After three treatment sessions, pigment had improved 4.5-fold using the dual-pass method and 3.3-fold using the single-pass method, a statistically significant difference.

Lasers whose pulse durations are in the picosecond range produce a very high peak power that yields more rapid heating and photoacoustic shattering of the ink, which may allow for fewer treatments compared with conventional laser methods, said Dr. Custis, a procedural dermatology fellow at the University of California, Davis.

A separate dose-ranging study applied test spots of 1.3-4.1 J/cm² over tattoos and adjacent normal skin on 18 patients using a 755-nm alexandrite laser. The best-tolerated fluence based on the test spots was used for half of each tattoo over the course of four treatments, and the other half of each tattoo received escalating doses not to exceed 4.1 J/cm².

Initial laser treatment using lower fluences (1.3-2.0 J/cm²) were best tolerated, Dr. Emil A. Tanghetti and his associates reported. Higher initial doses were associated with discomfort, blistering, transient hypopigmentation, and postinflammatory hyperpigmentation, said Dr. Tanghetti of the Center for Dermatology and Laser Surgery, Sacramento, Calif.

The 1.3- to 2.0-J/cm² fluences produced significant clearing of the tattoo, but dose escalation up to 4.1 J/cm² appeared to better clear the tattoos with minimal side effects. "Dose escalation rather than high-dose treatment is tolerated best by patients with less downtime and blistering," he said. Fluences of 2 J/cm² seemed to be necessary for consistent clearing of tattoos over four treatments. Blue, green, and light-black ink often disappeared after one treatment.

"Based upon this data and our experience, the picosecond alexandrite is our laser of choice for most of our tattoo patients," Dr. Tanghetti said. It’s important to consider skin type, tanning history, and other variables when choosing a fluence, he added.

An estimated 20% of U.S. residents have a tattoo. Requests for laser tattoo removal increased by 52% from 2012 to 2013, Dr. Al-Abdulrazzaq said.

Dr. Tanghetti reported financial associations with Cynosure. Dr. Al-Abdulrazzaq reported having no disclosures; one of his coinvestigators reported financial associations with Cynosure and four other companies. Dr. Custis reported financial associations with Cynosure and 12 other companies.

sboschert@frontlinemedcom.com

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Picosecond laser makes its mark for tattoo removal