Treatment of congenital nevi with the Q-switched Alexandrite laser

Q-switched mode lasers have been utilized for treatment of many pigmentary lesions. Because of their short pulse durations (1-100 ns), these lasers selectively destroy pigment laden cells while sparing the surrounding normal tissues. To determine if the Q-switched alexanderite laser (QSAL) is effective in the treatment of congenital melanocytic nevi, 53 patients with these lesions were treated with QSAL; of these, 16 also received CO, laser treatment between QSAL treatments. We observed an average improvement score in the 53 treated patients of 2.623 + 1.13, corresponding to a 721% improvement. Treatment with the combination of QSAL and a CO2 laser resulted in a significant enhancement of improvement score (3.06 +/- 1.18) compared to patients treated with the QSAL alone (2.43 +/- 1.07; p = 0.0393). Complications were mild, with 35 nevi (67.3%) showing textural change of skin after treatment, 2 (3.8%) showing depressed scar formation, and 4 (7.5%) showing hypertrophic changes, while 12 nevi (23%) showed no changes. Hypopigmentation was observed in 16 patients (30%), and hyperpigmentation was observed in 15 patients (28%) 48 weeks after the final QSAL treatment. Repigmentation to a brown to black spot was observed in 44/53 (83%) patients within an average of 5.45 +/- 3.93 months. These results indicate that the QSAL was as effective as other Q switch mode lasers in the treatment of congenital melanocytic nevi, but repigmentation is a problem.