Background: Q-switched (QS) pigmented lasers and intense pulsed light (IPL) successfully treat pigment disorders. Objective: We sought to compare efficacy and side effects of QS alexandrite laser (QSAL) and IPL for freckle and lentigo treatment in Asians. Methods: In all, 15 patients with freckles and 17 patients with lentigines were treated randomly with one session QSAL in one cheek and two sessions IPL in the other cheek at 4-week intervals. Efficacy was determined using a new pigmentation area and severity index score. Results: All patients experienced improvement (P <.0001). Postinflammatory hyperpigmentation developed in one patient with freckles and 8 patients with lentigines after QSAL. No postinflammatory hyperpigmentation occurred after IPL. Freckles achieved greater improvement after QSAL than IPL (P = .04). In lentigines, the results after IPL were better than QSAL among those with postinflammatory hyperpigmentation after QSAL. Limitations: Limitations include a small case number and short follow-up period. Conclusion: QSAL was superior to IPL for freckle treatment. IPL should be used for lentigines in Asian persons.
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