전신성 은피증에서 초저출력 Q-switched Nd:YAG와 피코세컨드 레이저 병합 치료: 단일 증례 보고

Abstract

Objectives: Argyria is a rare disorder characterized by bluish-gray discoloration of the skin and mucosa due to chronic deposition of silver or silver compounds. This case report presents a patient with generalized argyria who achieved significant clinical improvement through combined low-fluence Q-switched 1064 ㎚ Nd:YAG and 785 ㎚ picosecond laser therapy. Methods: A 70-year-old female patient presented with diffuse bluish-gray facial pigmentation following 2-years ingestion of colloidal silver since 2010. She underwent nine treatment sessions over a four-month period. Interventions included ultra-low fluence (100–200 mJ) Q-switched Nd:YAG laser and 785 ㎚ picosecond laser, applied in sequential and combined modes. Clinical outcomes were assessed using standardized photographs under identical imaging conditions and a Numeric Rating Scale (NRS) for patient-reported satisfaction and treatment-associated pain Results: Baseline pigmentation severity was rated NRS 10. After the second session, the patient reported improvement with NRS reduced to 9. Following application of the 785 ㎚ picosecond laser, infraorbital and nasal lesions showed marked clearance, and overall pigmentation steadily improved. By the eighth session, significant resolution of periorbital and nasal lesions was observed, with NRS further reduced to 4. The patient expressed high cosmetic satisfaction, and no serious adverse effects were reported. Conclusions: Combined low-fluence Q-switched Nd:YAG and picosecond laser therapy was effective for improving discoloration in generalized argyria. The complementary mechanisms of both wavelengths suggest a safe and practical therapeutic strategy for this otherwise intractable condition, underscoring the clinical potential of multimodal laser approaches in pigmentary disorders.