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White Paper
Elite MPXTM for the Treatment of Solar
Lentigines and Pigmentation
Raminder Saluja, MD
Saluja Cosmetic and Laser Center (SCLC)
SUMMARY
As laser technology continues to advance, physicians have choices regarding wavelengths, spot
sizes and pulse durations that can effectively target a specific chromophore while respecting the
surrounding epithelium in darker skin types. These advances allow for more efficient eradication of
chromophores, such as melanin, with less downtime.
The safety and efficacy of the long-pulsed The Elite MPX laser (Cynosure, Westford, MA) Alexandrite laser for treating solar lentigines has been a gold standard platform for laser hair has been reported.1 Thus, for patients with removal. With the dual-wavelength delivery of more diffuse dyschromia, or with greater areas the 1064nm Nd:YAG wavelength and the 755nm of solar lentigines, the long-pulsed Alexandrite Alexandrite wavelength, clinicians can titrate the laser may present a useful and effective percentage of each, and modify pulse durations alternative to the Q-Switched laser for to provide the most effective and safe destruction pigment reduction. of the hair follicle. However, the applications of Elite MPX are greater than hair removal alone. By utilizing the additional intense pulsed light (IPL) component, and isolating the Alexandrite wavelength in different spot sizes, the clinician is armed with a powerful solution to address both diffuse pigmentation and discreet melanin.
MELANIN
Melanin production occurs in the basal layer
of the skin in response to UV stimulation. The
absorption curve of melanin has a gradual slope;
therefore, there is no single "best" wavelength
for targeting this chromophore. However,
shorter wavelengths within the blue spectrum
or the green/yellow spectrum will be absorbed
better than longer wavelengths. Balancing
the wavelength, spot-size, and pulse duration
parameters will allow the clinician to target the
cosmetically concerning pigmentation.
THE ELITE MPX LASER
Elite MPX is a dual-wavelength, sequentially
heard, and the lentigo took on a rough, textural, emitting laser consisting of both the Alexandrite darkened appearance. The patient described his and the Nd:YAG wavelengths. These wavelengths discomfort as 2 out of 10 for both the IPL and the can be fired sequentially or singularly in a wide Alexandrite laser on the visual analog scale. The array of spot sizes ranging from 3mm to18mm. patient followed up six weeks post the first laser Versatility is further increased by the IPL component.
treatment and was happy with the results post one treatment. The IPL can be used to treat generalized dyschromia, while the Alexandrite wavelength A 36-year-old white female with Fitzpatrick skin type can target discreet solar lentigines, which will III presented to our office because of solar lentigines audibly "pop" when treated at a 5 Hz repetition on her legs. She was bothered by their appearance rate. The melanin will immediately darken, and felt self-conscious of the pigmentation when and appear elevated and textural as a result. wearing skirts or dresses.
Perilesional erythema and slight edema may persist for up to 24 hours. Patients are instructed Upon examination, her lesions appeared discreet to use sun protection and to wash normally and with no surrounding pigmentation, so the Alexandrite not exfoliate the treated areas. The darkened laser was selected to target the lesions. As before, no lentigines will typically flake off within 10-14 topical numbing was applied, and the integrated days. If a second treatment is needed, it is SmartCool air cooling system was set at 2. Fluence typically scheduled 4-6 weeks post initial treatment. was increased until the popping sound and change in texture and color was noted. Mild perilesional erythema and edema developed, then resolved A 38-year-old male with Fitzpatrick skin type III after six hours. The patient did very well post one presented to our clinic with solar lentigines on treatment with nearly 100% clearance of her lesions. the left side of his face. He reported currently using sunscreen with SPF of 30 or higher, but did not use as a child. He had not previously been A 42-year-old female with Fitzpatrick skin type III treated with tretinoin or hydroquinone. He was and solar lentigines of the décolletage presented interested in exploring laser and light-based to our clinic. She had used a combination of tretinoin options to treat his area of concern.
and hydroquinone 4% in the past, but felt that During consultation, the patient was informed the pigmentation was only minimally lightened that 2-3 treatments may be needed every by this combination. She wanted to explore other 4-6 weeks. No topical numbing was applied treatment options.
to the skin. The 560nm filter IPL was used first to The discrete nature of her solar lentigines correlated address diffuse pigmentation. The fluence was well to the efficacy of the Alexandrite wavelength increased until the pigmentation darkened and alone. She was treated using the Alexandrite laser mild erythema developed. Once the integrated with a fluence of 16 J/cm2. The patient did very well SmartCool air cooling system was set at a low post one laser treatment. level of 3, treatment with the Alexandrite laser began at a fluence of 16 J/cm2 and a 5mm spot size. The pulse duration was shortened to 0.5ms and the repetition rate was increased to 5 Hz. An audible "popping" noise could be

Subject 1
6 weeks post 1 Tx
IPL 560nm
13 J/cm2
755nm
5mm spot size
16 J/cm2
0.5ms
5 Hz
Subject 2
6 weeks post 1 Tx
755nm
5mm spot size
16 J/cm2
0.5ms
5 Hz
Subject 3
3 months post 1 Tx
755nm
5mm spot size
18 J/cm2
5 Hz
Solar lentigines and generalized dyschromia 1. Rosenbach A, Lee SJ, Johr RH. Treatment can be treated with a variety of different of medium brown solar lentigines using an laser and light sources.2,3 The primary class Alexandrite laser designed for hair reduction. of lasers for treating melanin has been the Arch Dermatol 2002. 138:547-8. Q-Switched laser, which can induce instant melanocyte destruction, but may damage 2. Rosenback A, William CW, Alster TS. normally pigmented epidermis in some patients. Comparison of the Q-Switched Alexandrite Conversely, a long-pulsed Alexandrite laser (755nm) and Q-Switched Nd:YAG (1064nm) gently heats the melanin and is less spatially lasers in the treatment of benign melanocytic selective, so broader areas of pigmentation nevi. Dermatol Surg 1997; 23: 239-44. can be treated quickly and safely.3 3. Traeli J, Kwan JM, Meehan KJ, Domankivitz Y, The combination of IPL and long-pulsed Gilbert S, Malomo K, Ross EV. Use of a long- Alexandrite together can aid in pigment pulsed Alexandrite laser in the treatment of lightening with better yields still. The IPL is superficial pigmented lesions. Dermatol Surg used first for dyschromia, followed by discrete treatment of the solar lentigines with the Alexandrite wavelength. Both the IPL and the Alexandrite laser are found in Elite MPX, thus providing safe and effective treatment for pigmentation. 2013 Cynosure, Inc. Cynosure is a registered trademark of Cynosure, Inc. Elite MPX is a trademark of Cynosure, Inc. 921-0443-000 Rev.1 05/13

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