LAUSR

A 23‐year‐old woman with a 1‐year history of a grayish silvery mac‐ ule on the right nasal ala, following a silver jewelry nose piercing, pre‐ sented to the laser clinic for consideration of, at her request, ablative laser treatment for removal of what she described as a discoloration that is having a profound effect on her psychological well‐being. The macule was asymptomatic and had been unsuccessfully treated prior to her presentation with a 1064 nm Q‐switched laser though the exact parameters were not available as this was performed in a dif‐ ferent city. Treatment was performed with the 1064 nm wavelength of a picoseconds laser (Picoway; Candela) using the nonfractional zoom handpiece with a 4 mm spot, with 1.8 J/cm2 in 2 passes. There was erythema as an endpoint. The macule gradually disappeared in <2 weeks with no scarring (Figure 1). Localized argyria is a gray‐silvery colored macule or a patch that results from cutaneous contact to objects containing silver metal.1 It is usually asymptomatic and in dermatology is seen mostly following piercings. It has also been seen following sil‐ ver nitrate applications and acupuncture.2 Previous reports have shown efficacy of Q‐switched 1064 nm Nd:YAG laser in localized argyria; however, this was unsuccessful in our patient.3 Treatment with a picoseconds laser was successful in one setting with no recurrence after 12 months. The picoseconds lasers generate ultrashort pulses in a trillionth of a second leading to a predominance of a photoacoustic effect rather than a photothermal one. While the efficacy of picoseconds lasers in tattoos is beyond doubt, superiority in the treatment of benign pigmented conditions compared to Q‐switched nanosecond lasers was reported in split‐face studies.4,5 Reports of conditions unresponsive to the Q‐switched nanosecond lasers, which subse‐ quently cleared with the picoseconds laser—as is the case in our patient—further proves the superior efficacy of the picoseconds lasers.6