The pulsed dye laser for cutaneous vascular and nonvascular lesions

Assessment of the efficacy of 595 nm pulsed dye laser in the management of facial flat angiomas. Results of a case series

BACKGROUND

Studies on pulsed dye laser (PDL) have shown the best efficacy and safety data for treating vascular anomalies among the various lasers used and the 595-nm PDL has been used to treat cutaneous vascular anomalies for about 30 years. The purpose of this study was to assess the efficacy of 595 nm Pulsed Dye Laser in the management of facial flat angiomas present in the form of Port-Wine Stain.

MATERIALS AND METHODS

Seven cases of PWS in Fitzpatrick skin type ranged from I to III and colour ranging from pink to purple, were treated with 595 nm pulse Dye Laser. Patients underwent to 6-8 laser sessions at 20-30 days intervals. Results obtained were judged by dermatologist, by comparing pre-treatment and post-treatment photographs, 6 months after the last session and a quartile scale of lesion clearance (4-point Investigator Global Assessment scale): 1 = no or low results (0%-25% of the lesion area improved), 2 = slight improvement (25%-50% of the lesion area cleared), 3 = moderate-good improvement (50%-75%), and 4 = excellent improvement (75%-100%) was used. Possible side effects such as blisters, hyper/hypopigmentation, and scarring were monitored.

RESULTS

All patients observed global improvements. 71% of patients achieved excellent clearance and 29% patients achieved good-moderate clearance of their angioma. Patients were asked for a subjective evaluation of the results: 57% of patients were very satisfied, 29% were satisfied, and 14% patients were not very satisfied with the results. No patients were dissatisfied. No significant side effects were noted.

CONCLUSION

This research confirms the efficacy of the 595 nm PDL for flat angioma management, without considerable side effects.

Safety and Efficacy of a Novel, Variable-Sequenced, Long-Pulsed, 532-nm and 1,064-nm Laser With Cryogen Spray Cooling for Pigmented and Vascular Lesions

BACKGROUND

Patients frequently seek treatment for vascular and pigmented lesions. More recently, a novel, variable-sequenced, long-pulsed, 532-nm and 1,064-nm laser with cryogen spray cooling was developed to offer greater flexibility in treatments.

OBJECTIVE

A prospective clinical trial evaluated the safety and efficacy of a novel, variable-sequenced, long-pulsed, 532-nm and 1,064-nm laser with cryogen spray cooling (DermaV, Lutronic, South Korea).

MATERIALS AND METHODS

Subjects with vascular and/or pigmented lesions were enrolled and underwent laser treatments.

RESULTS

Twenty-three subjects were enrolled with vascular lesions (39.1%), pigmented lesions (17.4%), and both (43.5%). Mean age was 53.1 years, and 91.3% were women. Fitzpatrick skin types II-IV were included. All subjects were treated with 532 nm, and 4 were also treated with 1,064 nm. According to 4 blinded physician reviewers, correct before and after photographs were selected in 94.7%, 92.1%, 84.2%, and 76.3% of cases. Overall, 86.8% were responders, meaning that at least 3 of 4 reviewers agreed. For Global Aesthetic Improvement Scale, improvement occurred in 81.6%, 81.6%, 81.6%, and 76.3% of cases. No serious adverse events occurred. Overall, 87.0% of subjects reported being very satisfied or satisfied.

CONCLUSION

A novel, variable-sequenced, long-pulsed, 532-nm and 1,064-nm laser with cryogen spray cooling can safely and effectively improve vascular and pigmented lesions.

Dermatologic and cosmetic procedures in pregnancy

Background:

Materials and Methods:

Results:

Safety and efficacy of dual-wavelength laser (1064 + 595 nm) for treatment of non-treated port-wine stains

BACKGROUND

Patients with port-wine stain (PWS) suffer physically and psychologically because of the high incidence (0.3%-0.5%) of the disease. Pulsed-dye laser (PDL) at 595 nm is the gold standard of the treatment for PWS. Nevertheless, clinicians intend to determine whether the dual-wavelength laser (DWL; 595-nm PDL + 1064-nm Nd:YAG) is an adequate choice in the treatment of non-treated PWS. This study is the first prospective within-patient controlled research seeking to investigate the safety and efficacy of DWL for the treatment of non-treated PWS.

METHODS

A total of 61 patients with non-treated flat facial PWS, who were treated using the Cynergy laser system in our clinic, were included in this study. Each PWS lesion was divided into two adjacent test treatment sites of similar size and colour. The two sites were randomly assigned to PDL or DWL treatment in a blinded manner of participants. In each case, two sets of treatment parameters were used: (i) 595-nm PDL and (ii) 595-nm PDL + 1064-nm Nd:YAG. Both had a 10 mm spot size, an epidermal cooling system and 1-s interpulse interval between two pulses. Clinical efficacy and safety outcomes were evaluated by visual assessment 2 months after treatment.

RESULTS

Comparison by visual evaluation suggests that the responses of non-treated PWS to treatment by PDL and DWL were not significantly different. Moreover, three patients developed scarring after DWL treatment.

CONCLUSION

Compared with PDL, DWL exhibits a higher risk of potential scarring and has no advantage in efficacy of treating non-treated PWS.

Prospective Comparison of Dual Wavelength Long-Pulsed 755-nm Alexandrite/1,064-nm Neodymium:Yttrium-Aluminum-Garnet Laser versus 585-nm Pulsed Dye Laser Treatment for Rosacea

BACKGROUND

Rosacea treatments including oral/topical medications and laser therapy are numerous but unsatisfactory.

OBJECTIVE

To compare the effectiveness of the dual wavelength long-pulsed 755-nm alexandrite/1,064-nm neodymium: yttrium-aluminum-garnet laser (LPAN) with that of 585-nm pulsed dye laser (PDL) for rosacea.

METHODS

This was a randomized, single-blinded, comparative study. Full face received four consecutive monthly treatments with LPAN or PDL, followed-up for 6 months after the last treatment. Erythema index was measured by spectrophotometer, and digital photographs were evaluated by consultant dermatologists for physician's global assessment. Subjective satisfaction surveys and adverse effects were recorded.

RESULTS

Forty-nine subjects with rosacea enrolled and 12 dropped out. There were no significant differences between LPAN and PDL in the mean reduction of the erythema index (p=0.812; 3.6% vs. 2.8%), improvement of physician's global assessment (p=1.000; 88.9% vs. 89.5%), and subject-rated treatment satisfaction (p=0.842; 77.8% vs. 84.2%). PDL showed more adverse effects including vesicles than LPAN (p=0.046; 26.3% vs. 0.0%). No other serious or permanent adverse events were observed in both treatments.

CONCLUSION

Both LPAN and PDL may be effective and safe treatments for rosacea.

Treatment of superficial cutaneous vascular lesions: experience with the long-pulsed 1064 nm Nd:YAG laser

Recent published studies evaluating the long-pulsed 1064 nm Nd:YAG laser for superficial cutaneous vascular lesions have limited subjects and optimal treatment parameters have not been established. To determine the efficacy and safety of the long-pulsed 1064 nm Nd:YAG laser on superficial cutaneus vascular lesions and analyse retrospectively our experience of a 3-year period are the aims of this study. Over the 3-year period, 255 patients were treated [189 female and 66 male; median age 35 (range 7-65) years; Fitzpatrick skin types II-V]. Twenty-six patients with spider angioma, 130 with facial telangiectasia, and 99 with leg telangiectasia were treated. A long-pulsed 1064 nm Nd:YAG laser was used. A test dose was performed at the initial consultation and thereafter patients were reviewed and treated at 4-week intervals for 5 months. Of those patients who completed treatment and followup, 26/26 (100%) of spider angiomas, 125/130 (97%) of facial telangiectasia, and 80/99 (80,8%) of leg telangiectasia markedly improved or cleared. We suggest that the long pulsed Nd:YAG laser is a safe and effective treatment for common superficial cutaneous vascular lesions. However, it is not the first choise to use to treat superficial vessels on the face where depth is not the concern.

Laser treatment of superficial leg veins: a review

BACKGROUND

Superficial leg veins affect millions of people worldwide, and treatment of these vessels is a common dermatologic request. The advance of lasers in recent years has led to numerous laser and light devices intended to treat these superficial vessels.

OBJECTIVE AND METHOD

A review of the literature on the laser and light devices available for the treatment of superficial leg vessels with historical and recent trends is presented.

RESULTS AND CONCLUSIONS

The appropriate choice of light system to treat telangiectases, venulectases, and reticular veins varies depending on anatomical, physiological, and biological differences in the vessels. Safe and efficacious treatment of superficial leg vessels can be achieved with multiple lasers by taking advantage of the oxyhemoglobin absorption peaks. The authors have indicated no significant interest with commercial supporters.

Síndrome de Klippel-Trenaunay: relato de caso

A síndrome de Klippel-Trenaunay é caracterizada por uma tríade composta de mancha vinho do porto, veias varicosas com ou sem malformações venosas e hipertrofia óssea e dos tecidos moles, envolvendo, geralmente, apenas uma extremidade (hipercrescimento da extremidade afetada). Sua causa continua a ser pesquisada, embora existam diversas teorias. É uma síndrome sem predileção por sexo e etnia, apresentando-se mais ao nascimento, infância ou adolescência. Apresentamos o relato de um caso de um menino de oito anos com essa síndrome.

Malformações vasculares

Com o conhecimento cada vez maior da angiogênese, as anomalias vasculares foram divididas em tumores e malformações vasculares. As malformações vasculares, objeto deste trabalho, são categorizadas ou pela natureza dos canais vasculares (capilares, arteriais, venosos ou linfáticos), ou pelo tipo de fluxo (alto ou baixo), ou ainda pela distribuição (localizadas ou difusas). Além disso, há as malformações complexas combinadas, nas quais se encaixa a maioria das síndromes vasculares. Os autores apresentam uma revisão do asssunto, discorrendo sobre características clínicas, diagnóstico e tratamento dessas anomalias.

Clinically significant facial edema after extensive treatment with purpura-free pulsed-dye laser

BACKGROUND

Long-pulsed pulsed-dye lasers permit treatment of facial erythema and telangiectasia with purpura-free technique, which may be more comfortable for the patient than purpura-inducing treatment. However, there are anecdotal reports of treatment-associated discomfort even when purpura is not elicited.

OBJECTIVE

To determine whether patients experience clinically significant erythema, edema, and pain after purpura-free treatment with pulsed-dye laser.

METHODS

In this prospective, controlled study, subjects included 15 patients who were undergoing purpura-free treatment of diffuse erythema and fine telangiectasia of at least half the facial surface area with purpura-free pulsed-dye, and it included 15 age, gender, and skin-type matched control subjects who were undergoing similar treatments but with the induction of trace to mild purpura. Patients were seen in person and were surveyed by phone regarding symptoms and signs during their postoperative courses.

RESULTS

Postoperative erythema of a mean 3.3-days duration and 3.4/5.0 intensity was reported by 73% (11 of 15) of the purpura-free patients. Among purpura patients, the duration was 5.6 days. The intensity was 4.0, and again, 73% of patients reported this finding. Postoperative edema occurred among 87% of purpura-free patients, but such edema occurred in all of the purpura patients, in whom it lasted longer and was more intense. Symptomatic eye swelling and uncomfortable/painful edema were seen in 27% and 20%, respectively, of purpura-free patients, but in 40% and 53% of purpura patients. Among purpura-free patients receiving fewer than 250 laser pulses per treatment, erythema and edema lasted less than 1 day and 2.5 days, whereas the mean durations were 3.4 and 5.0 days for purpura-free patients receiving greater than 250 pulses.

CONCLUSION

Extensive purpura-free treatment for erythema and telangiectasia of the face with the long-pulsed pulsed-dye laser can lead to clinically significant erythema, edema, and discomfort in patients. The duration, magnitude, and frequency of these undesired effects are markedly less with purpura-free treatment compared with purpura-inducing treatment and are also less for less extensive purpura-free treatments.

Laser surgery: new applications for pediatric skin and airway lesions

Recent research pertaining to laser applications for the treatment of capillary malformations (port wine stains) and cutaneous and subglottic hemangiomas is reviewed within the context of advances in laser technology and current therapeutic practices and controversies. Although laser advances have resulted in the concomitant growth of new clinical applications, research over the past year has focused on refining and improving existing applications, with the ultimate goal of being able to individualize treatment. Research initiatives aimed at improving the outcomes of pulse dye laser treatment for capillary malformations have illustrated the complexity of the interaction between laser characteristics, methods of laser application, variations in human skin and tissue, and morphologic parameters of involved blood vessels. Investigations of cutaneous hemangioma have addressed the issue of early pulse dye laser intervention, and results of a significant prospective study clearly demonstrate that this offers no benefit. Studies of subglottic hemangioma have compared the outcomes of treatment with carbon dioxide (CO(2)) and the potassium-titanyl-phosphate lasers, concluding that the latter results in superior outcomes, with less risk of posttreatment subglottic stenosis.

Dermatologic surgery and the pregnant patient

BACKGROUND

Because of concerns about potential harm to the mother or fetus, dermatologic surgeons are frequently hesitant to perform cutaneous surgery on pregnant patients.

OBJECTIVE

To review the relevant physiologic changes during pregnancy, appropriate preparation for and timing of procedures, and drug safety.

METHODS

A literature review was performed of dermatologic and nondermatologic journals discussing physiology, surgery, and drug safety in the pregnant patient.

RESULTS

Special positioning is required for the pregnant patient during surgery. Low doses of most local anesthetics with epinephrine as well as nitrous oxide less than 50% are safe to use during pregnancy. Sedatives and opioids are potential teratogens and should be avoided. Safe antibiotics to use during skin surgery in pregnancy include penicillins, cephalosporins, and nonestolate erythromycin. If necessary, lymph node dissections under general anesthesia in the pregnant melanoma patient should occur during the second trimester.

CONCLUSION

With appropriate preparation, safe and successful cutaneous surgery can be performed on the pregnant patient.