Picosecond Lasers: A New and Emerging Therapy for Skin of Color, Minocycline-induced Pigmentation, and Tattoo Removal

Jeannette Jakus, MD, MBA Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York

Ajay Kailas, BS University of Central Florida College of Medicine, Orlando, Florida

Author correspondence: Ajay Kailas; E-mail: ajay.kailas@Knights.ucf.edu

Disclosure: The authors report no relevant conflicts of interest.

J Clin Aesthet Dermatol. 2017;10(3):14–15 


In 2012, the United States Food and Drug Administration (FDA) approved the very first picosecond laser, a 755-nm alexandrite laser (PicoSure®, Cynosure, Westford, Massachusetts), for the treatment of unwanted tattoos and pigmented lesions. The picosecond laser is a revolutionary laser technology due to its much shortened pulse duration of just 10^-12 seconds.[1]

Laser treatments in skin of color may result in unwanted side effects, such as postinflammatory hypo- or hyperpigmentation or even scarring. Due to these potential complications, laser treatments are typically ineffective or altogether avoided, leaving patients without adequate treatment options. A retrospective analysis of 13 Asian patients with Fitzpatrick scores of III (n=1) and IV (n=12) with Nevus of Ota, café au lait patches, solar lentigines, and other pigmentary issues treated with a 755-nm picosecond laser reported fair to complete resolution of their lesions, with only two patients (4.8%) developing transient hypopigmentation and no reports of postinflammatory hyperpigmentation.[2] However, success with the picosecond laser is not limited to pigmentary lesions in skin of color patients. Another retrospective chart review of 56 patients with Fitzpatrick skin types VI to VI showed effectiveness in the treatment of striae and acne scarring using this same laser, but with a diffractive lens array (DLA) attachment. In this review, a spot size of 6mm, fluence of 0.71J/cm2, and pulse width of 750 to 850 picoseconds were used with the only observed side effect being transient erythema which resolved in all cases.[1]

A recent case series reported the use of a picosecond laser in treating minocycline-induced pigmentation (MIP). MIP is a rare side effect that occurs after the long-term use of minocycline at doses above 100mg daily and often takes months or years to resolve. While the Q-switched alexandrite laser is considered to be the most effective laser to date, it typically requires several treatments many months apart to achieve the desired clearance. In this report, two patients were treated in a split-face comparison of a 755-nm picosecond alexandrite laser (PicoSure®) versus a Q-switched Nd:YAG. A third patient was treated with PicoSure® alone. Results demonstrated superior clearance of the 755-nm picosecond laser after one treatment when compared to the QS Nd:YAG, and all three patients had significant to complete resolution of their MIP after just 1 to 2 treatments with the picosecond laser. A spot size of 3mm and fluence of 2.8 to 3J/cm2 were used in all cases. Aside from mild self-resolving erythema, the procedure was well-tolerated with no reported side effects.[3] The safe, rapid, and effective treatment of MIP with picosecond laser therefore deserves further consideration and investigation.

Finally, picosecond laser technology continues to evolve with the addition of newer wavelengths allowing for more targeted tattoo removal. A recent study demonstrated the use of a 1,064-nm wavelength Nd:YAG picosecond laser for the successful removal of blue, black, and purple ink while 532-nm was used for red and yellow ink. These variable wavelengths allow for the more effective treatment of difficult-to-remove colors.[4] Furthermore, while most lasers take around 7 to 10 treatments, which can be both costly and time-consuming, a recent review article reported several studies in which the picosecond laser achieved 75-percent clearance in just 1 or 2 treatments. This article also cites unpublished data in which the multi-pass R20 method showed a 3.4-fold improvement in treatment compared to the 2.1-fold improvement seen with a single pass method.

Ultimately, this letter to the editor outlines exciting and new prospects for the picosecond laser. As the use of these lasers becomes more regular and widespread, larger scale clinical studies will be useful in further establishing their potential.

Jeannette Jakus, MD, MBA Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York

Ajay Kailas, BS University of Central Florida College of Medicine, Orlando, Florida


1. Haimovic A, Brauer JA, Cindy Bae YS, Geronemus RG. Safety of a picosecond laser with diffractive lens array (DLA) in the treatment of Fitzpatrick skin types IV to VI: a retrospective review. J Am Acad Dermatol. 2016;74(5):931–936.

2. Chan JC, Shek SY, Kono T. A retrospective analysis on the management of pigmented lesions using a picosecond 755-nm alexandrite laser in Asians. Lasers Surg Med. 2016;48(1):23–19.

3. Rodrigues M, Bekhor P. Treatment of minocycline-induced cutaneous pigmentation with the picosecond alexandrite (755-nm) laser. Dermatol Surg. 2015;41(10):1179–1182.

4. Ho S, Goh CL. Laser tattoo removal: a clinical update. J Cutan Aesthet Surg. 2015;8(1):9–15.