1
|
Yepuri V, Patil AD, Fritz K, Salavastru C, Kroumpouzos G, Nisticò SP, Piccolo D, Sadek A, Badawi A, Kassir M, Gold MH, Große-Büning S, Grabbe S, Goldust M. Light-Based Devices for the Treatment of Facial Erythema and Telangiectasia. Dermatol Ther (Heidelb) 2021; 11:1879-1887. [PMID: 34562267 PMCID: PMC8611125 DOI: 10.1007/s13555-021-00607-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Indexed: 10/26/2022] Open
Abstract
Facial erythema is one of the most common outpatient complaints in dermatology. There are various causes of facial erythema and several devices are available for its treatment. Pulsed dye laser (PDL) and intense pulsed light (IPL) are the two common light devices used for these conditions. In this review, we evaluated the literature to assess efficacy of IPL versus PDL in facial erythema and telangiectasia. We searched published articles including clinical trials or reviews articles, case series, and case reports. Electronic databases (MEDLINE and PubMed) were searched to retrieve the articles. Reference lists of selected articles were also considered for the review. Articles published in English language until June 2021 were considered for this review.
Collapse
Affiliation(s)
- Vani Yepuri
- Venkat Charmalaya, Centre for Advanced Dermatology and Post Graduate Training, Bangalore, Karnataka, India
| | - Anant D Patil
- Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
| | - Klaus Fritz
- Dermatology and Laser Center, Reduitstr. 13, 76829, Landau, Germany.,"Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Str, 020021, Bucharest, Romania
| | - Carmen Salavastru
- "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Str, 020021, Bucharest, Romania.,"Colentina" Clinical Hospital, Pediatric Dermatology Discipline, Dermato-Oncology Research Facility, 19-21 Stefan cel Mare Str, Bucharest, Romania
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode, Island.,Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil.,GK Dermatology, PC, South Weymouth, Massachusetts, USA
| | - Steven Paul Nisticò
- Dermatology Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, 88100, Catanzaro, Italy
| | | | - Ahmed Sadek
- Cairo Hospital for Dermatology and Venereology (Al-Haud Al-Marsoud) Manager, Cairo, Egypt
| | - Ashraf Badawi
- Medical Laser Applications, National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt.,Dermatology and Allergology Department, Faculty of Medicine, Szeged University, Szeged, Hungary.,, Oakville, Canada
| | | | - Michael H Gold
- Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA
| | | | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany.
| |
Collapse
|
2
|
Combination Therapy of Pulsed Dye Laser With Intense Pulsed Light in Port-Wine Stain Treatment: A Prospective Side-by-Side Comparison. Dermatol Surg 2021; 47:1229-1232. [PMID: 34448759 DOI: 10.1097/dss.0000000000003114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pulsed dye laser (PDL) treatment currently represents the mainstream choice for port-wine stain (PWS) treatment in accordance with selective photothermolysis. However, most PWS lesions cannot be removed despite several treatments. Intense pulsed light (IPL) is reportedly an effective alternative to PDL for PWS treatment. No studies have thus far been reported on the combination therapy of PDL with IPL in PWS treatment. OBJECTIVE This study evaluated the efficacy and safety of PDL with IPL for PWS treatment. METHODS A total of 33 PWS lesions underwent 3 treatment sessions. Each PWS was divided into IPL + PDL, PDL, and untreated sites. Therapeutic outcomes were evaluated by visual assessment and chromametric assessment 3 months after the final treatment. RESULTS The overall average blanching rates were 36.2% and 32.6% at the sites treated with IPL + PDL and PDL, respectively (p > .05). No permanent side effects were reported. CONCLUSION In this laser setting, although IPL + PDL is a safe and effective PWS treatment, no significant improvement in the efficacy was observed using IPL + PDL in contrast to PDL alone.
Collapse
|
3
|
Tran JM, Kelly KM, Drolet BA, Krakowski AC, Arkin LM. Light-based treatment of pediatric port-wine birthmarks. Pediatr Dermatol 2021; 38:351-358. [PMID: 33368674 DOI: 10.1111/pde.14503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Port-wine birthmarks (PWBs) are progressive vascular malformations with significant disfigurement and psychosocial morbidity; early light-based treatment has shown improved outcomes in the pediatric population. Somatic mosaic mutations underly the progressive nature of PWBs and explain the significant differences in response and heterogeneity of vessel architecture in the pediatric population when compared to the adult cohort. Here, we summarize a review of pediatric specific literature on the various light-based treatment modalities, including pulsed dye laser, near-infrared lasers, and intense pulsed light, providing the various indications, tips, advantages, and disadvantages for the pediatric dermatologist.
Collapse
Affiliation(s)
- Jennifer M Tran
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kristen M Kelly
- Department of Dermatology, University of California Irvine, Irvine, CA, USA
| | - Beth A Drolet
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Andrew C Krakowski
- Department of Dermatology, St. Luke's University Health Network, Easton, PA, USA
| | - Lisa M Arkin
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| |
Collapse
|
4
|
Comparison of two intense pulsed light patterns for treating patients with meibomian gland dysfunction. Int Ophthalmol 2020; 40:1695-1705. [DOI: 10.1007/s10792-020-01337-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
|
5
|
In S, Park H, Song H, Park J, Kim H, Cho SB. Broadband light treatment using static operation and constant motion techniques for skin tightening in Asian patients. J COSMET LASER THER 2018; 21:132-137. [PMID: 29883238 DOI: 10.1080/14764172.2018.1481511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Broadband light (BBL) devices irradiate photons of different wavelength to induce photothermal reactions on various aging-related chromophores. OBJECTIVES To evaluate three BBL treatment settings for skin tightening in Asian patients. METHODS A total of 27 patients underwent three sessions of BBL treatment via (1) an 800-nm cutoff filter using a static operation technique and a 695-nm cutoff filter using a constant motion technique (group 1, N = 9), (2) an 800-nm cutoff filter using a constant motion technique (group 2, N = 9), and (3) a 590-nm cutoff filter using a constant motion technique (group 3, N = 9). RESULTS The patients in group 1 presented marked clinical improvements in zygomatic wrinkles, nasolabial folds, and marionette lines, with a median overall global aesthetic improvement scale (GAIS) score of 3. Meanwhile, patients in group 2 exhibited noticeable improvements in zygomatic wrinkles, nasolabial folds, perioral expression wrinkles at the cheek, and marionette lines, with a median GAIS score of 3. Patients in group 3 experienced improvement in skin tone and texture, zygomatic wrinkles, nasolabial folds, and marionette lines, with a median GAIS score of 2. CONCLUSIONS Our data demonstrated that BBL treatment for nonablative, noninvasive skin tightening elicits satisfactory clinical outcomes.
Collapse
Affiliation(s)
| | - Henry Park
- b Institute for Healthcare and Life Science, International St. Mary's Hospital , Catholic Kwandong University College of Medicine , Incheon , Korea
| | - Heejin Song
- a Human Dermatology Clinic , Incheon , Korea
| | - Jiho Park
- c Department of Dermatology and Cutaneous Biology Research Center, International St. Mary's Hospital , Catholic Kwandong University College of Medicine , Incheon , Korea
| | - Heesu Kim
- c Department of Dermatology and Cutaneous Biology Research Center, International St. Mary's Hospital , Catholic Kwandong University College of Medicine , Incheon , Korea
| | - Sung Bin Cho
- c Department of Dermatology and Cutaneous Biology Research Center, International St. Mary's Hospital , Catholic Kwandong University College of Medicine , Incheon , Korea.,d Kangskin Dermatology Clinic , Seoul , Korea
| |
Collapse
|
6
|
Alcántara-González J, Boixeda P, Truchuelo-Díez M, Jiménez-Gómez N, Pérez-García B, Pérez-Carmona L, Jaén Olasolo P. Capillary Malformations Treated With Sequential Pulsed Dye and Nd:YAG Laser Therapy: A Retrospective Study. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2017.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
7
|
Lee JW, Chung HY. Capillary Malformations (Portwine Stains) of the Head and Neck. Otolaryngol Clin North Am 2018; 51:197-211. [DOI: 10.1016/j.otc.2017.09.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
8
|
Capillary Malformations Treated With Sequential Pulsed Dye and Nd:YAG Laser Therapy: A Retrospective Study. ACTAS DERMO-SIFILIOGRAFICAS 2017; 109:155-161. [PMID: 29183621 DOI: 10.1016/j.ad.2017.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 10/14/2017] [Accepted: 10/16/2017] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Capillary malformations are the most common vascular malformations in childhood. The current treatment of choice is pulsed dye laser (PDL) therapy, but this frequently does not result in complete resolution. The search for alternative treatment strategies thus continues. In this study we describe our experience with the use of sequential dual-wavelength PDL and Nd:YAG laser therapy in patients with capillary malformations. MATERIAL AND METHODS We conducted a retrospective, descriptive study of patients with capillary malformations treated with dual-wavelength PDL and Nd:YAG laser therapy between 2006 and 2011. Four dermatologists rated the effectiveness of treatment on a scale of 10 to 0. We also investigated the potential value of the following factors as predictors of better treatment response: sex, malformation size and color, and presence of associated hypertrophy. Adverse effects were also analyzed. RESULTS We studied 71 patients and most of them experienced a statistically significant improvement after treatment. More favorable responses were observed for violaceous malformations, lesions with associated hypertrophy, and smaller lesions. Adverse effects were reported for 26.76% of patients, and the most common effect was the appearance of isolated areas of skin atrophy. CONCLUSIONS We consider that sequential dual-wavelength PDL and ND:YAG laser therapy is an effective alternative for treating capillary malformations in selected patients.
Collapse
|
9
|
Li D, Lin SB, Cheng B. Intense Pulsed Light: From the Past to the Future. Photomed Laser Surg 2016; 34:435-447. [DOI: 10.1089/pho.2016.4139] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Dan Li
- Joint Shantou International Eye Center of Shantou University and Chinese University of Hong Kong, Shantou, China
- Southern Medical University, Guangzhou, China
| | - Shi-Bin Lin
- Joint Shantou International Eye Center of Shantou University and Chinese University of Hong Kong, Shantou, China
| | - Biao Cheng
- Southern Medical University, Guangzhou, China
- Department of Plastic Surgery, General Hospital of Guangzhou Military Command of PLA, Guangzhou, China
| |
Collapse
|
10
|
Balzani A, Orfaniotis G, Lazzeri D, Ciudad P, Perdanasari AT, Nicoli M, Chilgar RM, Gesakis K, Sacak B, Nicoli F. Efficacy of a Novel Optimized Pulsed Light Source (MaxG) for the Treatment of Facial Vascular Lesions. Photomed Laser Surg 2016; 35:12-17. [PMID: 27623081 DOI: 10.1089/pho.2015.3973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Facial vascular malformations can cause a number of functional problems, including difficulties in breathing, eating, speech, and mobility. Psychological problems can also arise due to the possible unpleasant appearance of such lesions. Further, these lesions can lead to a number of complications, including pain, ulceration, infection, and significant bleeding. Many treatments have been proposed in the literature. Laser therapy (and its related treatments by non-coherent light sources) is now considered the gold standard in the treatment of the majority of vascular lesions. METHODS Here, we present our experience with a novel optimized pulsed light source for the treatment of vascular anomalies. In this prospective study, we evaluate the clinical outcomes of 30 patients treated with this method. RESULTS Our results confirm the efficacy and safety of this treatment for facial vascular lesions. CONCLUSIONS Based on our experience and results, we believe this device could be considered as both an alternative monotherapy and a useful adjunctive to the already existing laser instruments.
Collapse
Affiliation(s)
- Alberto Balzani
- 1 Department of Plastic and Reconstructive Surgery, University of Rome "Tor Vergata," Rome, Italy
| | - Georgios Orfaniotis
- 2 Department of Plastic and Reconstructive Surgery, St. Thomas' Hospital , London, United Kingdom .,3 Department of Plastic and Reconstructive Surgery, China Medical University Hospital , Taichung, Taiwan
| | - Davide Lazzeri
- 4 Plastic Reconstructive and Aesthetic Surgery, Villa Salaria Clinic , Rome, Italy
| | - Pedro Ciudad
- 3 Department of Plastic and Reconstructive Surgery, China Medical University Hospital , Taichung, Taiwan .,5 Institute of Biomedical Engineering, National Chung Hsing University , Taichung, Taiwan
| | - Aurelia Trisliana Perdanasari
- 6 Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine , Shanghai, China
| | - Marzia Nicoli
- 1 Department of Plastic and Reconstructive Surgery, University of Rome "Tor Vergata," Rome, Italy .,4 Plastic Reconstructive and Aesthetic Surgery, Villa Salaria Clinic , Rome, Italy
| | - Ram M Chilgar
- 3 Department of Plastic and Reconstructive Surgery, China Medical University Hospital , Taichung, Taiwan
| | - Kanellos Gesakis
- 2 Department of Plastic and Reconstructive Surgery, St. Thomas' Hospital , London, United Kingdom .,3 Department of Plastic and Reconstructive Surgery, China Medical University Hospital , Taichung, Taiwan
| | - Bulent Sacak
- 3 Department of Plastic and Reconstructive Surgery, China Medical University Hospital , Taichung, Taiwan .,7 Department of Plastic and Reconstructive Surgery, Marmara University School of Medicine , Istanbul, Turkey
| | - Fabio Nicoli
- 1 Department of Plastic and Reconstructive Surgery, University of Rome "Tor Vergata," Rome, Italy .,3 Department of Plastic and Reconstructive Surgery, China Medical University Hospital , Taichung, Taiwan .,4 Plastic Reconstructive and Aesthetic Surgery, Villa Salaria Clinic , Rome, Italy
| |
Collapse
|
11
|
Grillo E, Rita Travassos A, Boixeda P, Cuevas A, Pérez B, Paoli J, Jaén P. Histochemical Evaluation of the Vessel Wall Destruction and Selectivity After Treatment with Intense Pulsed Light in Capillary Malformations. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2015.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
12
|
Husain Z, Alster TS. The role of lasers and intense pulsed light technology in dermatology. Clin Cosmet Investig Dermatol 2016; 9:29-40. [PMID: 26893574 PMCID: PMC4745852 DOI: 10.2147/ccid.s69106] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The role of light-based technologies in dermatology has expanded dramatically in recent years. Lasers and intense pulsed light have been used to safely and effectively treat a diverse array of cutaneous conditions, including vascular and pigmented lesions, tattoos, scars, and undesired hair, while also providing extensive therapeutic options for cosmetic rejuvenation and other dermatologic conditions. Dermatologic laser procedures are becoming increasingly popular worldwide, and demand for them has fueled new innovations and clinical applications. These systems continue to evolve and provide enhanced therapeutic outcomes with improved safety profiles. This review highlights the important roles and varied clinical applications that lasers and intense pulsed light play in the dermatologic practice.
Collapse
Affiliation(s)
- Zain Husain
- Department of Dermatology, Georgetown University Hospital, Washington, DC, USA
| | - Tina S Alster
- Department of Dermatology, Georgetown University Hospital, Washington, DC, USA; Washington Institute of Dermatologic Laser Surgery, Washington, DC, USA
| |
Collapse
|
13
|
Grillo E, Rita Travassos A, Boixeda P, Cuevas A, Pérez B, Paoli J, Jaén P. Histochemical Evaluation of the Vessel Wall Destruction and Selectivity After Treatment with Intense Pulsed Light in Capillary Malformations. ACTAS DERMO-SIFILIOGRAFICAS 2015; 107:215-23. [PMID: 26744242 DOI: 10.1016/j.ad.2015.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 10/09/2015] [Accepted: 10/18/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Among the different approaches for improving the effectiveness in the treatment of Capillary Malformations type Port Wine Stain (CM type PWS) are the intense pulsed light sources. There are few clinical studies prove useful in the treatment of CM. Furthermore, no studies have been published yet demonstrating the histological effects of IPL in CM. OBJECTIVES To assess the histological effects of pulsed light in capillary malformations type port wine stain. We wanted to compare epidermal, dermal and vessel wall damage after treatment with different combinations of IPL parameters. MATERIAL AND METHODS Fifty-five post-treatment biopsies were performed in 15 consenting patients with CM and stained with nitroblue-tetrazolium chloride (NBTC). Patients had not been treated previously. RESULTS Fifteen patients with CM, with a median age of 39 years-old were enrolled in this study. In this series, the patients with the most severe epidermal damage were those with a darker phototype. Pink CM were especially resistant to treatment, even using high fluences, short pulse durations and stacking pulses. Longer intra- and interpulse delays were effective in purple CM, achieving adequate vessel destruction. CONCLUSIONS IPL devices provide a vast amount of treatment possibilities and further studies are necessary to optimize therapeutic approaches to CM. In this study we have observed the histological effects of different pulses on the MC type PWS.
Collapse
Affiliation(s)
- E Grillo
- Department of Dermatology, Hospital Ramón y Cajal, Madrid, Spain.
| | - A Rita Travassos
- Clínica Universitária de Dermatologia, Hospital de Santa Maria-Centro Hospital Norte, Lisboa, Portugal
| | - P Boixeda
- Department of Dermatology, Hospital Ramón y Cajal, Madrid, Spain
| | - A Cuevas
- Department of Pathology, Hospital Ramón y Cajal, Madrid, Spain
| | - B Pérez
- Department of Dermatology, Hospital Ramón y Cajal, Madrid, Spain
| | - J Paoli
- Department of Dermatology, Hospital Ramón y Cajal, Madrid, Spain
| | - P Jaén
- Department of Dermatology, Hospital Ramón y Cajal, Madrid, Spain
| |
Collapse
|
14
|
Ramot Y. Cutaneous Vascular Changes in Pregnancy. CURRENT DERMATOLOGY REPORTS 2014. [DOI: 10.1007/s13671-014-0080-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
15
|
Mulligan PR, Prajapati HJS, Martin LG, Patel TH. Vascular anomalies: classification, imaging characteristics and implications for interventional radiology treatment approaches. Br J Radiol 2014; 87:20130392. [PMID: 24588666 DOI: 10.1259/bjr.20130392] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The term vascular anomaly represents a broad spectrum of vascular pathology, including proliferating vascular tumours and vascular malformations. While the treatment of most vascular anomalies is multifactorial, interventional radiology procedures, including embolic therapy, sclerotherapy and laser coagulation among others, are playing an increasingly important role in vascular anomaly management. This review discusses the diagnosis and treatment of common vascular malformations, with emphasis on the technique, efficacy and complications of different interventional radiology procedures.
Collapse
Affiliation(s)
- P R Mulligan
- Division of Interventional Radiology & Image Guided Medicine, Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | |
Collapse
|
16
|
Wat H, Wu DC, Rao J, Goldman MP. Application of Intense Pulsed Light in the Treatment of Dermatologic Disease: A Systematic Review. Dermatol Surg 2014; 40:359-77. [DOI: 10.1111/dsu.12424] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
17
|
Savas JA, Ledon JA, Franca K, Chacon A, Nouri K. Pulsed dye laser-resistant port-wine stains: mechanisms of resistance and implications for treatment. Br J Dermatol 2013; 168:941-53. [PMID: 23290045 DOI: 10.1111/bjd.12204] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Port-wine stains (PWS) are among the most common congenital vascular malformations. Unlike capillary haemangiomas, these lesions do not involute spontaneously but rather become progressively more disfiguring as the patient ages. While benign in nature, the cosmetic deformity and attendant psychological and emotional distress prompt the majority of those afflicted to seek treatment. The pulsed dye laser (PDL) has long been considered the treatment of choice for these vascular lesions; however, very few patients achieve total clearance with PDL therapy and a significant number of lesions fail to respond at all. In order to address these recalcitrant cases, the mechanisms that contribute to treatment resistance must be understood and novel laser and light therapies must be employed. This review will address what is currently known about lesion-specific characteristics of PDL-resistant PWS as well as discuss current and future treatment options.
Collapse
Affiliation(s)
- J A Savas
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL 33136, USA.
| | | | | | | | | |
Collapse
|
18
|
Wang B, Wu Y, Zhu X, Xu XG, Xu TH, Chen HD, Li YH. Treatment of neck port-wine stain with intense pulsed light in Chinese population. J COSMET LASER THER 2013; 15:85-90. [DOI: 10.3109/14764172.2012.748204] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
19
|
Chen JK, Ghasri P, Aguilar G, van Drooge AM, Wolkerstorfer A, Kelly KM, Heger M. An overview of clinical and experimental treatment modalities for port wine stains. J Am Acad Dermatol 2012; 67:289-304. [PMID: 22305042 DOI: 10.1016/j.jaad.2011.11.938] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 10/15/2011] [Accepted: 11/10/2011] [Indexed: 01/03/2023]
Abstract
Port wine stains (PWS) are the most common vascular malformation of the skin, occurring in 0.3% to 0.5% of the population. Noninvasive laser irradiation with flashlamp-pumped pulsed dye lasers (selective photothermolysis) currently comprises the gold standard treatment of PWS; however, the majority of PWS fail to clear completely after selective photothermolysis. In this review, the clinically used PWS treatment modalities (pulsed dye lasers, alexandrite lasers, neodymium:yttrium-aluminum-garnet lasers, and intense pulsed light) and techniques (combination approaches, multiple passes, and epidermal cooling) are discussed. Retrospective analysis of clinical studies published between 1990 and 2011 was performed to determine therapeutic efficacies for each clinically used modality/technique. In addition, factors that have resulted in the high degree of therapeutic recalcitrance are identified, and emerging experimental treatment strategies are addressed, including the use of photodynamic therapy, immunomodulators, angiogenesis inhibitors, hypobaric pressure, and site-specific pharmaco-laser therapy.
Collapse
Affiliation(s)
- Jennifer K Chen
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, California, USA
| | | | | | | | | | | | | |
Collapse
|
20
|
KIM SEONGEON, LEE JOONHO, KWON HYOKBU, AHN BYUNGJIN, LEE AIYOUNG. Greater Collagen Deposition with the Microneedle Therapy System Than with Intense Pulsed Light. Dermatol Surg 2011; 37:336-41. [DOI: 10.1111/j.1524-4725.2011.01882.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
21
|
Wang XT, Duan XG, Huang Q, Bian GB, Zhao HH, Huang NY, Gu Y, Tang XY. Development and clinical evaluation of medical robot assisted photodynamic therapy of port wine stains. Int J Med Robot 2011; 7:107-17. [PMID: 21341369 DOI: 10.1002/rcs.377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2010] [Indexed: 11/06/2022]
Abstract
BACKGROUND Port wine stains (PWS) are a kind of skin disease for which photodynamic therapy (PDT) has already achieved good results. With manual operation of clinical PDT, the laser density is uneven and laser irradiation of the lesion is arbitrary and non-uniform. In addition, lengthy manual operation tires doctors; thus a robot system has been developed to assist them. METHODS First, a novel medical manipulator consisting of five passive joints (robot arm) and two active joints (robot wrist) was developed to automatically improve the uniformity of laser irradiation. Second, image processing of the lesion was introduced. Third, kinematics and path planning of the robot were analysed, and safety precautions were introduced. Then, accuracy tests of the robot wrist and robot system were conducted separately before clinical application. Finally, a total of 50 PWS cases were treated using the robot system. The clinical outcomes and comparison of non-parametric values were employed to evaluate the robot system. RESULTS The accuracies of the robot wrist and robot system were shown to meet the requirements of clinical PDT treatment. The robot system performed successfully in 50 PWS cases. Doctors can devote more energy to clinical judgments during treatment with the assistance of the robot system. All the PWS have shown different degrees of improvement. The results show that the robot system is useful in assisting doctors for the PDT treatment of PWS. CONCLUSIONS The experiments show the feasibility and usefulness of the robot system in assisting doctors giving PDT treatment for PWS. The robot system can lighten the load on doctors and improve the therapeutic effect.
Collapse
Affiliation(s)
- Xing-tao Wang
- Intelligent Robotics Institute, Beijing Institute of Technology, 5 Nandajie, Zhongguancun, Haidian, Beijing, China
| | | | | | | | | | | | | | | |
Collapse
|
22
|
|
23
|
Campolmi P, Bonan P, Cannarozzo G, Bruscino N, Troiano M, Prignano F, Lotti T. Intense pulsed light in the treatment of non-aesthetic facial and neck vascular lesions: report of 85 cases. J Eur Acad Dermatol Venereol 2010; 25:68-73. [PMID: 20477927 DOI: 10.1111/j.1468-3083.2010.03700.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- P Campolmi
- Department of Dermatology II, University of Florence, Florence, Italy
| | | | | | | | | | | | | |
Collapse
|
24
|
Babilas P, Schreml S, Eames T, Hohenleutner U, Szeimies RM, Landthaler M. Split-face comparison of intense pulsed light with short- and long-pulsed dye lasers for the treatment of port-wine stains. Lasers Surg Med 2010; 42:720-7. [DOI: 10.1002/lsm.20964] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
25
|
Dong X, Yu Q, Ding J, Lin J. Treatment of facial port-wine stains with a new intense pulsed light source in Chinese patients. J COSMET LASER THER 2010; 12:183-7. [DOI: 10.3109/14764172.2010.502458] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
26
|
Abstract
BACKGROUND Laser applications have revolutionized the treatment of many cutaneous vascular anomalies. Because most of these lesions are congenital, the pediatric population has benefited primarily. In this article, the authors focus primarily on laser treatment options, realizing that this modality is but one part of an overall comprehensive plan of management options for these affected children. METHODS The literature was reviewed and interjected into the authors' 20 years of experience in the use of lasers in the pediatric population. RESULTS The use of different therapy modalities, such as the neodymium:yttrium-aluminum-garnet laser, pulsed dye laser, erbium:yttrium-aluminum-garnet laser, and intense pulsed light systems, is discussed. Outcomes, risks, benefits, and treatment protocols vary for each entity and for each laser. The authors' results and those of others are presented. CONCLUSIONS Lasers play a vital role as an adjunctive therapy or definitive therapy in many of the authors' pediatric patients. Anyone treating such patients should be well aware of lasers as a valuable tool.
Collapse
|
27
|
Babilas P, Schreml S, Szeimies RM, Landthaler M. Intense pulsed light (IPL): a review. Lasers Surg Med 2010; 42:93-104. [PMID: 20166155 DOI: 10.1002/lsm.20877] [Citation(s) in RCA: 159] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Intense pulsed light (IPL) devices use flashlamps and bandpass filters to emit polychromatic incoherent high-intensity pulsed light of determined wavelength spectrum, fluence, and pulse duration. Similar to lasers, the basic principle of IPL devices is a more or less selective thermal damage of the target. The combination of prescribed wavelengths, fluences, pulse durations, and pulse intervals facilitates the treatment of a wide spectrum of skin conditions. OBJECTIVE To summarize the physics of IPL, to provide guidance for the practical use of IPL devices, and to discuss the current literature on IPL in the treatment of unwanted hair growth, vascular lesions, pigmented lesions, acne vulgaris, and photodamaged skin and as a light source for PDT and skin rejuvenation. METHODS A systematic search of several electronic databases, including Medline and PubMed and the authors experience on intense pulsed light. RESULTS Numerous trials show the effectiveness and compatibility of IPL devices. CONCLUSION Most comparative trials attest IPLs similar effectiveness to lasers (level of evidence: 2b to 4, depending on the indication). However, large controlled and blinded comparative trials with an extended follow-up period are necessary.
Collapse
Affiliation(s)
- Philipp Babilas
- Department of Dermatology, University Hospital Regensburg, 93042 Regensburg, Germany.
| | | | | | | |
Collapse
|
28
|
Babilas P. Light-assisted therapy in dermatology: The use of intense pulsed light (IPL). ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.mla.2010.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
29
|
|
30
|
Bjerring P, Christiansen K, Troilius A. Intense pulsed light source for the treatment of dye laser resistant port‐wine stains. J COSMET LASER THER 2009. [DOI: 10.1080/14764170310000790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
31
|
Levy JL. Intense pulsed light treatment for chronic facial erythema of systemic lupus erythematosus: a case report. ACTA ACUST UNITED AC 2009; 2:195-8. [PMID: 11350676 DOI: 10.1080/146288300750163772] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND A 33-year-old woman, who had been diagnosed previously with systemic lupus erythematosus, presented with chronic erythema and rosacea of the face. The patient suffered from flushing and burning of the facial skin and sought prior treatment with anti-malarial drugs. METHOD After various treatment options were discussed with the patient, she agreed to undergo intense pulsed light therapy. RESULTS Improvement was noted after the first session and 75% clearance was observed at 1 month after a second session. There were no adverse effects associated with the treatment. One year later it was observed that the results of the two treatments had been maintained. CONCLUSION This case report suggests that there is another safe and efficacious alternative for treatment of chronic erythema and rosacea.
Collapse
Affiliation(s)
- J L Levy
- Centre Laser Dermatologique, 3, bd Lord Duveen, 13008 Marseille, France.
| |
Collapse
|
32
|
Town G, Ash C, Eadie E, Moseley H. Measuring key parameters of intense pulsed light (IPL) devices. J COSMET LASER THER 2009; 9:148-60. [PMID: 17763023 DOI: 10.1080/14764170701435297] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Unlike medical lasers, intense pulsed light (IPL) devices are largely unregulated and unclassified as to degree of safety hazard. With the exception of most of the USA, the United Kingdom and parts of Europe, the Far East and Australia, the sale of IPLs is generally unrestricted, with the majority being sold into the beauty therapy and spa markets. Standards are only imposed on manufacturers for technical performance data and operating tolerances determined by CE-compliance under electrical safety standards or the EU Medical Device Directive. Currently, there is no requirement for measurement of key IPL performance characteristics. OBJECTIVE To identify the key IPL parameters, emphasize their importance in terms of safe and effective treatment and provide examples of preliminary measurement methods. These measurements can highlight changes in an IPL device's performance, improving patient safety and treatment efficacy. METHODS Five key parameters were identified as having an important role to play in the way light interacts with the skin, and therefore an important role in patient safety and effective treatment. Simple methods were devised to measure the parameters, which include fluence, pulse duration, pulse profile, spectral output and time-resolved spectral output. RESULTS The measurement methods permitted consistent and comparable measurements to be made by two of the authors at working clinic locations on 18 popular IPL devices and allowed assessment of output variations. Results showed discrepancies between the measured IPL device outputs and those values displayed on the system or claimed by the manufacturers. The importance of these discrepancies and their impact is discussed. CONCLUSIONS This study, of 18 popular devices in regular daily use in England and Wales, provides example methods for measuring key IPL device parameters and highlights the need for regular measurement of at least those five key parameters measured in this study. These methods can help service technicians to check performance and eliminate device malfunction.
Collapse
Affiliation(s)
- Godfrey Town
- Independent Laser Protection Adviser, Haywards Heath, West Sussex, UK.
| | | | | | | |
Collapse
|
33
|
Faurschou A, Togsverd-Bo K, Zachariae C, Haedersdal M. Pulsed dye laser vs. intense pulsed light for port-wine stains: a randomized side-by-side trial with blinded response evaluation. Br J Dermatol 2009; 160:359-64. [DOI: 10.1111/j.1365-2133.2008.08993.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
34
|
Drosner M, Ellwanger J, Schöttle K, Stockmeier M, Gatty F, Hellbrügge G, Christiansen K. Comparison of intense pulsed light (IPL) and pulsed dye laser (PDL) in port-wine stain treatment. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.mla.2008.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
35
|
McGill DJ, MacLaren W, Mackay IR. A direct comparison of pulsed dye, alexandrite, KTP and Nd:YAG lasers and IPL in patients with previously treated capillary malformations. Lasers Surg Med 2008; 40:390-8. [DOI: 10.1002/lsm.20638] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
36
|
Özdemir M, Engin B, Mevlitoǧlu İ. Treatment of facial port-wine stains with intense pulsed light: a prospective study. J Cosmet Dermatol 2008; 7:127-31. [DOI: 10.1111/j.1473-2165.2008.00375.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
37
|
Adamic M, Troilius A, Adatto M, Drosner M, Dahmane R. Vascular lasers and IPLS: guidelines for care from the European Society for Laser Dermatology (ESLD). J COSMET LASER THER 2007; 9:113-24. [PMID: 17558762 DOI: 10.1080/14764170701280693] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Dermatology and dermatologic surgery have rapidly evolved during the last two decades thanks to the numerous technological and scientific acquisitions focused on improved precision in the diagnosis and treatment of skin alterations. Given the proliferation of new devices for the treatment of vascular lesions, we have considerably changed our treatment approach. Lasers and non-coherent intense pulse light sources (IPLS) are based on the principle of selective photothermolysis and can be used for the treatment of many vascular skin lesions. A variety of lasers has recently been developed for the treatment of congenital and acquired vascular lesions which incorporate these concepts into their design. The list is a long one and includes pulsed dye (FPDL, APDL) lasers (577 nm, 585 nm and 595 nm), KTP lasers (532 nm), long pulsed alexandrite lasers (755 nm), pulsed diode lasers (in the range of 800 to 900 nm), long pulsed 1064 Nd:YAG lasers and intense pulsed light sources (IPLS, also called flash-lights or pulsed light sources). Several vascular lasers (such as argon, tunable dye, copper vapour, krypton lasers) which were used in the past are no longer useful as they pose a higher risk of complications such as dyschromia (hypopigmentation or hyperpigmentation) and scarring. By properly selecting the wavelength which is maximally absorbed by the target--also called the chromophore (haemoglobin in the red blood cells within the vessels)--and a corresponding pulse duration which is shorter than the thermal relaxation time of that target, the target can be preferentially injured without transferring significant amounts of energy to surrounding tissues (epidermis and surrounding dermal tissue). Larger structures require more time for sufficient heat absorption. Therefore, a longer laser-pulse duration has to be used. In addition, more deeply situated vessels require the use of longer laser wavelengths (in the infrared range) which can penetrate deeper into the skin. Although laser and light sources are very popular due to their non-invading nature, caution should be considered by practitioners and patients to avoid permanent side effects. These guidelines focus on patient selection and treatment protocol in order to provide safe and effective treatment. Physicians should always make the indication for the treatment and are responsible for setting the machine for each individual patient and each individual treatment. The type of laser or IPLS and their specific parameters must be adapted to the indication (such as the vessel's characteristics, e.g. diameter, colour and depth, the Fitzpatrick skin type). Treatments should start on a test patch and a treatment grid can improve accuracy. Cooling as well as a reduction of the fluence will prevent adverse effects such as pigment alteration and scar formation. A different number of repeated treatments should be done to achieve complete results of different vascular conditions. Sunscreen use before and after treatment will produce and maintain untanned skin. Individuals with dark skin, and especially tanned patients, are at higher risk for pigmentary changes and scars after the laser or IPLS treatment.
Collapse
Affiliation(s)
- Metka Adamic
- Dermatology Centre Parmova, Ljubljana, Slovenia.
| | | | | | | | | |
Collapse
|
38
|
Redondo P. Malformaciones vasculares (II). Diagnóstico, histopatología y tratamiento. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s0001-7310(07)70055-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
|
39
|
Redondo P. Vascular malformations (II). Diagnosis, Pathology, and Treatment. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s1578-2190(07)70435-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
|
40
|
Landthaler M, Hohenleutner U. Laser therapy of vascular lesions. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2006; 22:324-32. [PMID: 17100741 DOI: 10.1111/j.1600-0781.2006.00254.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Since the first construction of a laser by Maiman in 1960 and the first clinical application of a laser in the therapy of skin lesions by Leon Goldman, laser therapy has become an important therapeutic modality in dermatology. Various lasers can be used for the treatment of different vascular and non-vascular lesions. According to our results, vascular lesions constitute the most important indication for laser therapy in dermatology.
Collapse
Affiliation(s)
- M Landthaler
- Department of Dermatology, University Clinic Regensburg, Regensburg, Germany.
| | | |
Collapse
|
41
|
Tévar E, Calvo M, Moratinos M, Boixeda P. Láser y otras fuentes de luz en el tratamiento de manchas en vino de Oporto. ACTAS DERMO-SIFILIOGRAFICAS 2006; 97:419-27. [PMID: 16978541 DOI: 10.1016/s0001-7310(06)73434-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Laser treatment of vascular skin lesions is rapidly improving. Port wine stain (PWS) is one of the first lesions successfully treated with laser. The pulsed dye laser (PDL) has been developed on the concept of selective photothermolysis and has revolutionized PWS treatment. Even though the response is variable, substantial blanching can be obtained after several sessions. Greater selectivity and better response have been achieved by modifying PDL parameters such as longer pulse width, longer wavelength, or higher energy fluencies with cooling skin devices. It is known that thick, deep or raised lesions present poor response to conventional treatments. The aim of this study is to review the different lasers and other light sources which are developing for the treatment of PWS and other vascular lesions.
Collapse
Affiliation(s)
- E Tévar
- Hospital Ramón y Cajal, Madrid, España
| | | | | | | |
Collapse
|
42
|
Abstract
Capillary malformations (CM) are defects of the dermal capillary bed. These slow-flow malformations can affect any part of the body and are always lateralized, despite Unna's naevus. Present at birth, they grow proportionally with the child. In rare instance, they can be part of a more complex syndrome such as Sturge-Weber syndrome. Ectatic CMs of telangiectatic types can be cutaneous, isolated, multiples, diffuse or generalized. In rare instance, they can be associated with epidermal modifications. They can also be part of a syndrome such as Fabry disease, Osler-Weber-Rendu disorder or Cutis marmorata telangiectatica congenita (CMTC). This chapter details the various clinical aspects of CMs.
Collapse
Affiliation(s)
- A-C Bataille
- Service de dermatologie, centre des anomalies vasculaires, cliniques universitaires Saint-Luc, avenue Hippocrate, 1200 Bruxelles, Belgique.
| | | |
Collapse
|
43
|
Abstract
Lasers have been competing with non-laser intense pulsed light (IPL) sources in the cosmetic arena over the past 10 years. Initially IPLs were somewhat cumbersome and accepted by a minority of "serious" practitioners. Recently, however, the popularity of full-face visible light skin rejuvenation, enhanced engineering of IPLs, and favorable cost versus many lasers, have lead to a proliferation of IPL devices. No longer a stepchild in the rejuvenation market, IPLs may overtake lasers as the devices of choice among most physicians. We review the pros and cons of lasers and IPLs within the context of design, cost, and other practical concerns for a typical office-based practice.
Collapse
Affiliation(s)
- E Victor Ross
- Dermatology Department, 34520 Bob Wilson Dr., Suite 300, Naval Medical Center San Diego, San Diego, California 92134, USA.
| |
Collapse
|
44
|
Abstract
Laser treatment of vascular birthmarks remains one of the more common applications of dermatologic lasers and is the treatment of choice for port-wine stains (PWS) and superficial capillary hemangiomas. Before the development of laser technology, these lesions were treated with radiation, surgical excision and grafting, cryosurgery, and camouflage with cosmetics or tattoos. All of these techniques produced unsatisfactory results or poor aesthetic outcomes. The development of the pulsed dye laser in the 1980s permitted selective photocoagulation and destruction of lesional blood vessels without damage to the surrounding normal skin, thereby producing dramatic clearing of PWS and hemangiomas with minimal risk of scarring.
Collapse
Affiliation(s)
- Tina S Alster
- Washington Institute of Dermatologic Laser Surgery, Washington, DC 20037, USA.
| | | |
Collapse
|
45
|
Goldman MP, Weiss RA, Weiss MA. Intense Pulsed Light as a Nonablative Approach to Photoaging. Dermatol Surg 2006; 31:1179-87; discussion 1187. [PMID: 16176769 DOI: 10.1111/j.1524-4725.2005.31924] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE To describe the introduction and use of intense pulsed light (IPL) to treat vascular and pigmented lesions comprising photorejuvenation and its use in photodynamic therapy. METHODS Review of the medical literature and the authors' experience with IPL. RESULTS AND CONCLUSIONS IPL is an excellent treatment modality for vascular and pigmented manifestations of photoaging and can be combined with photodynamic therapy for the treatment of early forms of skin cancer.
Collapse
|
46
|
Abstract
Laser treatment of vascular lesions remains one of the more common applications of lasers in dermatology. In fact, lasers have largely become the treatment of choice for vascular birthmarks such as hemangiomas and port-wine stains and the definitive treatment of the telangiectatic form of rosacea. The range of congenital and acquired vascular lesions effectively treated with lasers continues to expand.
Collapse
Affiliation(s)
- Divya Railan
- Laser and Skin Surgery Center, Sacramento, CA 94203, USA
| | | | | | | |
Collapse
|
47
|
Henry F, Quatresooz P, Valverde-Lopez JC, Piérard GE. Blood vessel changes during pregnancy: a review. Am J Clin Dermatol 2006; 7:65-9. [PMID: 16489843 DOI: 10.2165/00128071-200607010-00006] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The profound endocrine upheaval of pregnancy is frequently associated with changes in the function and structure of the blood and lymph microvasculature of the skin and mucosae. Palmar erythema is frequent but rarely severe and is associated with burning sensations. Spider telangiectasias develop in the majority of pregnant White women but are less often identified in women with darker skin. Hemangiomas and glomus tumors occur in one-third of women. A firm edema may develop on the face and extremities in the final months of pregnancy. Venous hypertension and varicosities of the lower limbs are common. Gingivitis, gum hypertrophy, and pyogenic granuloma are common in the oral cavity. The vaginal mucosa is also affected, showing a violaceous aspect, at times accompanied by varicosities of the vulva. Many gestational vascular changes regress spontaneously in the postpartum phase. Some vascular tumors may need to be treated with a vascular laser or intense pulsed light.
Collapse
Affiliation(s)
- Frédérique Henry
- Department of Dermatopathology, University Hospital Sart-Tilman, Liège, Belgium
| | | | | | | |
Collapse
|
48
|
Schroeter CA, Haaf-von Below S, Neumann HAM. Effective treatment of rosacea using intense pulsed light systems. Dermatol Surg 2005; 31:1285-9. [PMID: 16188180 DOI: 10.1111/j.1524-4725.2005.31204] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND To date, a variety of lasers have been used for treating vascular skin lesions. Intense pulsed light (IPL) is a proven technology for vascular lesion management, such as rosacea. OBJECTIVES The aim of this study was to test the effectiveness of IPL in treating vascular facial lesions in rosacea patients. METHODS Sixty patients presenting with telangiectasia owing to facial rosacea were selected randomly from the patient population in the Department of Laser Therapy at the Medical Centre Maastricht, the Netherlands. Patients of various skin types (Fitzpatrick I-IV) were selected with an average age of 44.2 years. Five hundred eight sites were treated, with a mean of 4.1 treatments per site and an IPL spectrum ranging from 515 to 1,200 nm with different pulse durations between 4.3 and 6.5 milliseconds. The energy density varied from 25 to 35 J/cm2. RESULTS Patients were assessed clinically and photographically. A mean clearance of 77.8% was achieved and was maintained for a follow-up period averaging 51.6 months (range 12-99 months). No correlation was found between the clearance of rosacea and patient-related or technical data. For approximately 3 years post-treatment, lesion recurrence was noted in 4 of the 508 treated facial sites. DISCUSSION This study demonstrated that IPL treatment of facial rosacea is effective in obtaining clearance of 77.8%, with minimal side effects, and that treatment effects are maintained. CONCLUSION The IPL system, with its broad range of technical variables, is an effective tool in achieving meaningful and lasting rosacea clearance.
Collapse
Affiliation(s)
- Careen A Schroeter
- Department of Lasertherapy, Medical Centre Maastricht, Becanusstraat 17 A05, 6216 BX Maastricht, the Netherlands.
| | | | | |
Collapse
|
49
|
Reynolds N, Exley J, Hills S, Falder S, Duff C, Kenealy J. The role of the Lumina intense pulsed light system in the treatment of port wine stains—a case controlled study. ACTA ACUST UNITED AC 2005; 58:968-80. [PMID: 16043156 DOI: 10.1016/j.bjps.2005.04.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2004] [Revised: 02/25/2005] [Accepted: 04/12/2005] [Indexed: 11/28/2022]
Abstract
The pulsed dye laser has been the treatment of choice for port wine stains over the past 20 years. In the past 5 years there has been increasing discussion of the role of other light treatments, such as the intense pulsed light system in the treatment of port wine stains. These systems use high-energy lamps, which emit noncoherent broad-spectrum light. Cut off filters are applied depending on the treatment modality to limit the wavelengths emitted. We present the results of a 3-year prospective within patient controlled clinical trial using an intense pulsed light system called the Lumina, developed by Lynton Lasers of Cheshire, England. Our aims and objectives were to assess the effectiveness of the system in the treatment of port wine stains in a human model and to record the optimum treatment parameters and the incidence of side effects. Following ethical approval 12 subjects were enrolled into the trial. In order to meet the requirements of the local ethics committee these were all adults with port wine stains located in less visible areas of the body. The results showed that eight of the 12 subjects had some degree of fading of their port wine stain as measured on a percentage scoring system. Of the four who failed to show any response, all had pink port wine stains. It did seem the case that the darker the port wine stain, the better the fading seen. Furthermore, the more distal lesions tended to be less responsive than those situated closer to the head area. However, it is difficult to draw any definitive statistical conclusions due to the small number of patients in the trial.
Collapse
Affiliation(s)
- N Reynolds
- Department of Plastic Surgery, Laser Centre of the South West, Frenchay Hospital, Frenchay, Bristol BS16 1LE, UK.
| | | | | | | | | | | |
Collapse
|
50
|
Pençe B, Aybey B, Ergenekon G. Outcomes of 532 nm frequency-doubled Nd:YAG laser use in the treatment of port-wine stains. Dermatol Surg 2005; 31:509-17. [PMID: 15962732 DOI: 10.1111/j.1524-4725.2005.31152] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Port-wine stains (PWSs) are congenital dermal malformations involving venules, capillaries, and, probably, perivascular nerves. The primary morbidities of PWS are psychological disturbances that adversely affect the development of personality. Lasers have been the treatment of choice for PWS. However, only one type of laser is not a panacea for all PWS malformations. For the treatment of PWSs, carbon dioxide, argon, krypton, copper bromide, frequency-doubled neodymium:yttrium-aluminum-garnet (Nd:YAG), flashlamp pumped pulsed dye laser, and also intense pulsed light sources can be used. OBJECTIVE To determine the efficacy and the frequency of side effects of the frequency-doubled Nd:YAG laser for the treatment of PWSs. PATIENTS AND METHODS In this study, 532 nm frequency-doubled Nd:YAG laser with a 2 to 6 mm spot size, 15- to 50-millisecond pulse width, and a 9.5 to 20 J/cm2 fluence was applied for 89 patients (62 female, 27 male; age range 3-49 years) with PWSs on the face and/or neck for 1 to 12 sessions, with 2-month treatment-free intervals. Improvement rates were considered a failure (< 25%), mild (25-49%), moderate (50-74%), good (75-94%), and excellent (> 95%). RESULTS Excellent (n = 12; 13%), good (n = 34; 38%), moderate (n = 39; 44%), and mild (n = 4; 5%) improvement of lesions was obtained after an average of 5.6, 5.5, 4.4, and 3.8 therapy sessions, respectively. No treatment failure was observed for any patient. As adverse effects, transient hyperpigmentation (n = 2; 2.25%), hypopigmentation (n = 1; 1.12%), and hypotrophic scarring (n = 1; 1.12%) were noted. CONCLUSIONS The results obtained asserted that the frequency-doubled Nd:YAG laser is a quick, safe, and effective treatment modality for PWS malformations and can be appreciated as a useful alternative therapy that can raise the rates of success in cases with PWSs refractory to other laser therapies.
Collapse
Affiliation(s)
- Buket Pençe
- Dermatology Clinic, International Hospital, Istanbul, Turkey
| | | | | |
Collapse
|