Journal of Asia Pacific Aesthetic Sciences

ABSTRACT: Chronic solar lentigines of the lower limbs are challenging to manage due to delayed healing and variable responses to conventional therapies, and evidence guiding optimal treatment strategies for this anatomical region remains limited. We report a case of a 69-year-old Malaysian Chinese woman with a 20-year history of progressive solar lentigines affecting both lower limbs, predominantly over the knees and calves, with minimal response to conservative skincare measures. A sequential treatment protocol was employed, consisting of six sessions of Q-switched Nd:YAG laser (QSNYL) at two-month intervals (Phase 1), followed by alternating monthly sessions of QSNYL and polynucleotide (PN) therapy (Phase 2). Progressive lightening of pigmentation was observed during Phase 1, with further improvement after the introduction of combination therapy in Phase 2. The treatment was well tolerated, with no significant adverse events. Patient-reported outcomes, assessed using the Global Aesthetic Improvement Scale (GAIS), scored 1 (very much improved). At the two-year follow-up, sustained clinical improvement was observed. This sequential combination therapy may represent a safe, effective, and well-tolerated strategy for managing chronic lower limb solar lentigines.