Optimum fluence of Q-switched 1064nm laser in lip melanosis

Pink lips have always been considered an attribute of a beautiful face. The content of lip cosmetics is cause for concern as they are easily ingested. Hence, the need for lip-lightening by other means, like lasers. We aimed to find the efficacy and optimum fluence of the Qs-Nd :YAG 1064 nm laser in reducing lip melanosis of unknown cause. A prospective Case series study was carried out. Fifteen consecutive patients with lip melanosis of unknown etiology, were selected. Patients were advised to undergo Lip toning with Spectra laser (Qs Nd:YAG 1064 nm) every 2 weeks, for atleast 8-10 sessions. Before each session, photographs and Digital dermoscopy (polarized,20x) pictures were taken to assess outcome. Lip pigmentation and erythema were assessed quantitatively using skin colorimetric device called ‘Dermacatch’ Ten patients completed atleast 5 sessions. Of this, four patients completed 7-8 sessions and showed significant clinical improvement. Dermoscopic changes in patients after treatment are ‘hazy whitening’ of areas which were ‘velvety’ in color. The four patients who showed clinical improvement also showed dermoscopic changes. Lip pigmentation improvement is slow and fluence-dependent and may need more than five sessions. The effective fluence for lip lesions is 3 to 4 times that for facial melanosis. Patients maybe started on higher fluences depending on tolerance. Dermoscopic changes precede clinical improvement. Lip pigmentation was found to respond to high fluences only. Dermoscopic changes can give an early indication of possible clinical improvement that can be expected. Skin colorimetry device did not correlate well with clinical features with respect to melanosis of lip.