Lentigines

Jessner s peels have been used to treat acne, melasma, post-inflammatory hyperpigmentation, lentigines, freckles, and photodamage (Figs. 3.2a,b, 3.3a, b and 3.4a, b). 

Patients with photoaging showed a smoother texture, less evident fine wrinkles and an important lightening of hyperpigmentations (freckles and lentigines) [7,8]... 

Given these findings, indications for salicylic acid peels include acne vulgaris (inflammatory and non-inflammatory lesions), acne rosacea, melasma, post-inflammatory hyperpigmentation, freckles, lentigines, mild to moderate photodamage, and texturally rough skin. 

Fig. 7.ia-c. Medium depth chemical peel for widespread lentigines in type 11 skin, (a) Pre-operative, (b) 10 days status post medium depth chemical peel, (c) One month status post medium depth chemical peel... 

Epidermal growths such as actinic keratosis, lentigines or thin seborrheic keratoses can all be treated effectively with 25-35% TCA peels. Thicker epidermal growths or growths involving the dermis will be more resistant to treatment such as hypertrophic actinic keratoses and thicker seborrheic keratoses and may even be resistant to a medium-depth peel. Resistant lesions many times are best treated with a combination of a medium-depth chemical peel and other modalities such as manual dermasanding or CO, laser. 

Excellent to Good Response Actinic keratoses Superficial melasma Superficial hyperpigmentation Ephelides Lentigines... 

Fig. 8.11. a Fifty-two-year-old patient with wrinkles and solar lentigines before the peel, b First day after the peel. The face is covered by bismuth subgalate powder... 

Late 30S-40S Early senile lentigines Dyschromia Early actinic keratoses Parallel smile lines Early wrinkling Some foundation worn Mild acne scarring... 

Azelaic acid is a naturally occurring dicarboxyl-ic acid (1,7-heptanedicarboxylic acid) that has demonstrated beneficial therapeutic effects in the treatment of acne and several disorders of hyperpigmentation [48]. There are minimal effects on normally pigmented human skin, freckles, senile lentigines, and nevi. The cytotoxic and antiproliferative effects of azelaic acid may be mediated via inhibition of mitochondrial ox-idoreductase activity and DNA synthesis. Disturbance of tyrosinase synthesis by azelaic acid may also influence its therapeutic effects. Azelaic acid can be used as a hypopigmenting agent in patients sensitive to hydroquinone. 

There is a bath PUVA and an oral PUVA. Bath PUVA therapies involve soaking in a bath of psoralens liquid for 15 minutes prior to UVA treatment. Oral PUVA involves taking an oral psoralens capsule the day prior to a UVA treatment. Oral psoralens such as methoxsalen cause nausea in many patients. Other adverse effects of PUVA include photosensitivity, which necessitates the use of eye protection and UVA-blocking sunscreen for 24 hours after a PUVA treatment macular melanosis at exposed sites (PUVA lentigines) and increased risk of skin cancers, especially squamous cell carcinoma.21... 

Superficial Spreading Nodular Lentigo Maligna Melanoma Acral Lentiginous Basal Cell Carcinoma Squamous Cell Carcinoma... 

Lentigines Plural of lentigo, which is a small, flat, tan to dark brown or black, macular melanosis on the skin that looks like a freckle but is histologically distinct. Lentigines do not darken on exposure to sunlight, freckles do. 

Molyneux, R. J. and James, L. F. 1982. Loco intoxification Indolizidine alkaloids of spotted locoweed (Astragalus lentiginous). Science, 216 190-191. 

Hyperpigmentation and development of discreet dark macules called PUVA lentigines. 

Interstitial pneumonitis with acute respiratory failure was attributed to flecainide in a 59-year-old man with congenital heart disease related to the LEOPARD sjmdrome, in which there are multiple freckles (Lentigines), Electrocardiographic abnormalities. 

Pigment alterations, notably PUVA lentigines (SEDA-9,130) absence of PUVA lentigines may be an indicator of a lower risk of PUVA malignancy (25)... 

Chronic PUVA exposure in humans results in premature skin aging, PUVA keratoses, PUVA lentigines, and nonmelanoma skin cancer (NMSC) typically in a dose-dependent fashion. The incidence of cataracts may also be higher among PUVA treated patients. Cardiovascular disease, noncutaneous neoplasms and teratogenic effects have not been shown to be associated with PUVA therapy. 

DMAE is also assumed to inhibit formation and enhance elimination of lipofuchsin, a waste product of the aging cell metabolism of fatty acids. Experiments have shown that lipofuchsin is eliminated from the liver by DMAE. This build-up, which occurs in all organs, has not been associated with any disorder apart from lentigines. Some authors have reported a gradual reduction in lentigines on the hands with oral DMAE treatment. To date, there have been no studies published on the topical use of DMAE in the treatment of lentigines. 

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