Standardized Application of Advanced Optimal Pulse Technology for Erythromelanosis Follicularis of Faciei and Colli: A Split-face Method

Summary

This protocol demonstrates a randomized split-face method for evaluating the efficacy and safety of Advanced Optimal Pulse Technology compared with standard Optimal Pulse Technology for treating erythromelanosis follicularis of faciei and colli.

Abstract

Erythromelanosis follicularis of faciei and colli (EFFC) is a chronic dermatological disorder characterized by hyperpigmentation, erythema, and follicular papules. Management remains challenging, as conventional treatments such as pulsed dye lasers can induce purpura and pose a risk of post-inflammatory hyperpigmentation, particularly in individuals with darker skin types. This article presents a standardized and reproducible clinical protocol using Advanced Optimal Pulse Technology (AOPT), a tunable intense pulsed light system, to target the vascular and pigmentary components of EFFC. A randomized, split-face clinical study involving 14 patients is described. Specific parameter settings, including dual-band vascular filters and adjustable pulse structures, were applied to the intervention side and compared with standard Optimal Pulse Technology (OPT) on the contralateral side. Quantitative assessments were performed using a skin colorimetric probe and a digital skin analysis imaging system to objectively evaluate lesion clearance. All 14 patients completed follow-up without attrition. The AOPT-treated side showed statistically significant reductions in erythema and melanin indices compared with the OPT control, with substantial inter-rater reproducibility for clinical evaluations. Additionally, the procedure was generally well tolerated, with few adverse events and limited downtime. Methodological limitations of this study include the small sample size, the absence of long-term follow-up (>6 months) to assess recurrence rates, and the lack of prospective clinical trial registration. This protocol provides clinicians with a standardized approach for applying AOPT to EFFC and may help address some limitations of traditional laser modalities in selected patients.

Introduction

Erythromelanosis follicularis of faciei and colli (EFFC) is a distinct and persistent dermatological condition, particularly prevalent among young Asian males^1,2,3. It is defined by well-demarcated erythema (telangiectasia), hyperpigmentation, and follicular papules, typically presenting symmetrically on the preauricular areas, cheeks, and lateral neck^1,4. Although the etiopathogenesis is multifactorial, encompassing genetic predisposition and follicular keratinization abnormalities, the clinical impact can be substan....

Protocol

All methods described in this protocol were approved by the Medical Ethics Committee of Huashan Hospital (Approval No.: KY2017-004). Written informed consent was obtained from all participants before enrollment (Figure 1).

1. Patient selection and preparation

1. Screen patients for inclusion based on a clinical diagnosis of Erythromelanosis Follicularis of Faciei and Colli (EFFC), characterized by reddish-brown pigmentation, telangiectasia, and follicular papules on the preauricular area, maxilla, or neck.
2. Exclude patients with a history of deep vein thrombosis, connective ti....

Results

Baseline characteristics

A total of 14 patients with clinically diagnosed erythromelanosis follicularis of faciei and colli (EFFC) were enrolled in this split-face study. The enrollment, allocation, and follow-up processes are detailed in the study flowchart (Figure 1). The cohort consisted of 12 males and 2 females, with ages ranging from 16 to 31 years (mean disease duration: 12.2 ± 3.83 years). Before treatment, there were no statistically sign.......

Discussion

EFFC remains a therapeutic challenge due to its multifactorial pathogenesis involving follicular hyperkeratosis, vascular dilation, and epidermal hyperpigmentation. While existing therapies such as topical keratolytics and pulsed dye laser (PDL) have demonstrated variable success, they are often constrained by limited efficacy or adverse effects, including purpura and PIH, particularly in Fitzpatrick skin types III–IV. In this randomized split-face study, AOPT showed greater clearance of both erythema and pigmentat.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Anthelios Melt-in Milk Sunscreen (SPF 60)	La Roche-Posay	https://www.laroche-posay.com	Generic name used in text: broad-spectrum sunscreen
Aquasonic 100 Ultrasound Transmission Gel	Parker Laboratories, Inc.	01-50	Generic name used in text: ultrasound transmission gel
CeraVe Moisturizing Cream	L'Oréal (CeraVe)	https://www.cerave.com	Generic name used in text: gentle moisturizer
Cetaphil Gentle Skin Cleanser	Galderma Laboratories, L.P.	https://www.cetaphil.com	Generic name used in text: mild cleanser
GraphPad Prism (Version 9.0)	GraphPad Software, LLC	https://www.graphpad.com	Statistical analysis and graphing software
IBM SPSS Statistics (Version 26.0)	IBM Corp.	https://www.ibm.com/products/spss-statistics	Statistical analysis software
M22 Universal IPL System (AOPT and OPT Modules)	Lumenis Be Ltd.	https://lumenis.com/aesthetics/products/m22/	Generic name used in text: intense pulsed light (IPL) system
Mexameter MX 18	Courage + Khazaka Electronic GmbH	MX 18	Generic name used in text: skin colorimetric probe
R (Version 4.1.2)	The R Foundation for Statistical Computing	https://www.r-project.org/	Statistical computing environment
VISIA Complexion Analysis System (Generation 7)	Canfield Scientific, Inc.	VISIA-7	Generic name used in text: skin analysis imaging system