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Nunez JH, Strong AL, Comish P, Hespe GE, Harvey J, Sorkin M, Levi B. A Review of Laser Therapies for the Treatment of Scarring and Vascular Anomalies. Adv Wound Care (New Rochelle) 2023; 12:68-84. [PMID: 35951024 DOI: 10.1089/wound.2021.0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Significance: Laser use has become part of the gold standard of treatment as an effective adjuvant in multimodal therapy for pathologic scarring caused by burns, trauma, acne, and surgery, as well as vascular anomalies. Understanding indications and applications for laser therapy is essential for physicians to improve patient outcomes. Recent Advances: Since the 1980s, the medical use of lasers has continuously evolved with improvements in technology. Novel lasers and fractionated technologies are currently being studied in the hopes to improve treatment efficacy, while reducing complications. Recent advancements include acne treatment with novel picosecond lasers, new hypertrophic scar therapies with simultaneous laser and intense pulsed light use, and novel systems such as lasers with intralesional optical fiber delivery devices. In addition, optimizing the timing of laser therapy and its use in multimodal treatments continue to advance the field of photothermolysis. Critical Issues: Selecting the correct laser for a given indication is the fundamental decision when choosing a laser balancing effective treatment with minimal complications. This article covers the principles of laser therapy, the preferred lasers used for the treatment of scarring and vascular anomalies, and discusses the current evidence behind these laser choices. Future Directions: To optimize laser therapy, larger randomized control trials and split scar studies are needed. Continued advancement through better randomized controlled studies will help to improve patient outcomes on a broader scale.
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Affiliation(s)
- Johanna H Nunez
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Amy L Strong
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul Comish
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Geoffrey E Hespe
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jalen Harvey
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael Sorkin
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Benjamin Levi
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Cutaneous vascular lesions in the pediatric population: a review of laser surgery applications and lesion-specific device parameters. Lasers Med Sci 2020; 35:1681-1687. [PMID: 32514864 DOI: 10.1007/s10103-020-03058-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022]
Abstract
Laser surgery is becoming an increasingly efficacious and customizable treatment modality for the management of pediatric vascular lesions. Proper use requires a thorough understanding of the scientific principles of laser surgery and knowledge of the various lasers available. Moreover, each laser has a multitude of settings that can be employed to properly target the lesion at hand. Each patient will present with unique challenges and variations in the presentation of their vascular lesion. This requires understanding of the most effective laser to use for each lesion and the factors that may alter the desired device settings. Using key search terms, a literature search was conducted on laser surgery for pediatric vascular lesions using PubMed/MEDLINE and Embase for articles published in English or French. Ultimately, 52 articles met our search criteria. The laser indications, limitations, and settings utilized for each type of vascular lesion were compiled for the purposes of this summative review. Laser surgery is an effective and appropriate option for the treatment of certain pediatric vascular lesions. Knowledge of optimal device parameters in every setting is essential to good clinical practice.
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Stevic M, Vlajkovic A, Trifunovic B, Rakic I, Ristic N, Budic I, Marjanovic V, Jovanovski-Srceva M, Simic D. Topical anesthetics for pediatric laser treatment. J COSMET LASER THER 2019; 21:417-421. [PMID: 31698962 DOI: 10.1080/14764172.2019.1689273] [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: 10/25/2022]
Abstract
Topical anesthetic agent causes transient insensibility to pain in a limited area of skin, and provides effective anesthesia in a short onset time, short duration, with seldom local or systemic side effects on intact skin and is simple to use. Topical formulations may offer significant benefits for prevention of procedural pain. Currently, they are considered to be the most effective anesthesia for laser treatments. Unfortunately, there is no standard anesthetic technique for this procedure. Lasers are being widely used in numerous dermatological and esthetics treatments in childhood. The advancement of new knowledge in laser technology have contributed to the development of new lasers that are commonly used in a pediatric population, such as Pulsed Dye, Carbon-dioxide and Nd:YAG laser. The most commonly used topical anesthetics in young patients for minimally or moderately painful laser cutaneous procedures are Lidocaine, Prilocaine, Tetracaine gel and combinations thereof.
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Affiliation(s)
- Marija Stevic
- Department of Anesthesia, Medical Faculty University of Belgrade, Serbia.,Department of Anesthesia, University Children's Hospital, Belgrade, Serbia
| | - Ana Vlajkovic
- Department of Anesthesia, University Children's Hospital, Belgrade, Serbia
| | | | - Ivan Rakic
- Department of Plastic Surgery, University Children's Hospital, Belgrade, Serbia
| | - Nina Ristic
- Department of Gastroenterology, University Children's Hospital, Belgrade, Serbia
| | - Ivana Budic
- Department of Anesthesia, Medical Faculty University of Nis, Serbia
| | - Vesna Marjanovic
- Department of Anesthesia, Medical Faculty University of Nis, Serbia
| | | | - Dusica Simic
- Department of Anesthesia, Medical Faculty University of Belgrade, Serbia.,Department of Anesthesia, University Children's Hospital, Belgrade, Serbia
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Patel PD, Mohan GC, Bhattacharya T, Patel RA, Tsoukas M. Pediatric Laser Therapy in Pigmented Conditions. Am J Clin Dermatol 2019; 20:647-655. [PMID: 31134589 DOI: 10.1007/s40257-019-00449-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Advances in laser therapy have led to novel therapeutic approaches to common pediatric skin conditions. As a non-invasive alternative to surgical options, laser therapy is efficacious in treating a broad range of conditions, from vascular and pigmented lesions to tattoo and hair removal. This paper reviews the basic mechanics of laser therapy, its role in common pigmented pediatric dermatoses, and special considerations for this unique age group.
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Fabiano A, Moro R, Zane C, Caravello S, Fusano M, Calzavara-Pinton P, Gualdi G. Pediatric dermatologic surgery: our experience. GIORN ITAL DERMAT V 2018; 155:775-779. [PMID: 30251807 DOI: 10.23736/s0392-0488.18.06140-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Surgical treatment for pediatric skin disorders is used for diagnostic and therapeutic reasons. We underline these procedures are usually easy and uncomplicated without the need for general anesthesia. Objective of this study was to share our experience in the field of pediatric dermatologic surgery. METHODS We retrospectively analysed records of all pediatric patients receiving surgical therapy at the Dermatology Department of Spedali Civili of Brescia. Demographic data and treatments characteristics were recorded and analyzed. RESULTS During the study period of one year, 670 surgical treatments concerning pediatric patients were collected. Number of procedures progressively grows with increasing age. All treatments were performed under local anesthesia except for a dermatofibrosarcoma protuberans for which general anesthesia was needed. CONCLUSIONS Our data show that cryosurgery, electrodessication and excisional surgery constitute with equal proportion almost the whole of surgical procedures in dermatologic pediatric patients. Dermatologist's habit to perform surgery in local anesthesia avoids the risk of overtreatments, limits discomfort, anxiety, and pain perception linked to procedures performed.
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Affiliation(s)
- Antonella Fabiano
- Department of Dermatology, ASST degli Spedali Civili, Spedali Civili of Brescia, Brescia, Italy
| | - Ruggero Moro
- Department of Dermatology, ASST degli Spedali Civili, Spedali Civili of Brescia, Brescia, Italy -
| | - Cristina Zane
- Department of Dermatology, ASST degli Spedali Civili, Spedali Civili of Brescia, Brescia, Italy
| | - Simone Caravello
- Department of Dermatology, ASST degli Spedali Civili, Spedali Civili of Brescia, Brescia, Italy
| | - Marta Fusano
- Department of Dermatology, ASST degli Spedali Civili, Spedali Civili of Brescia, Brescia, Italy
| | | | - Giulio Gualdi
- Department of Dermatology, ASST degli Spedali Civili, Spedali Civili of Brescia, Brescia, Italy
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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]
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Shahriari M, Makkar H, Finch J. Laser therapy in dermatology: Kids are not just little people. Clin Dermatol 2015; 33:681-6. [DOI: 10.1016/j.clindermatol.2015.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Reconstruction of the cheek after large port-wine stain lesion resection. Aesthetic Plast Surg 2011; 35:795-801. [PMID: 21424172 DOI: 10.1007/s00266-011-9689-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 02/24/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND A laser is commonly used in treatment of port-wine stain (PWS). Although observable lightening of the stains can be achieved, complete removal is rare. A significant proportion of lesions are resistant to laser treatment, including hypertrophic lesions and scars developed after improper (unsuccessful) treatments. Alternatively, resection is used to eliminate such lesions, but the reconstruction of the aesthetic appearance of the cheek after large lesion resection remains a huge challenge. METHODS Ten patients with a PWS larger than two-thirds of the cheek were selected for this study. In those patients, prefabricated induced expanded flaps carried by the superficial temporal vessels were prepared to cover the defect areas after resection of the PWS lesion. RESULTS In eight patients, all the donor sites and defect areas were covered primarily with the expanded flaps, which then survived completely. All patients were satisfied with the cheek appearance after reconstruction with prefabricated induced expanded flaps, which provided a good match for color and texture, restored facial contour, placed scars in a concealed location, and achieved minimal donor-site morbidity. Two of the ten patients did not finish the original surgical plan due to infection or damage to the vascular pedicle. CONCLUSION We show that the technique of using prefabricated expanded flaps based on the superficial temporal vessels can be an effective option for repairing large cheek defects after PWS resection.
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Abstract
PURPOSE OF REVIEW Cosmetic procedures are being performed with increased frequency in the United States and worldwide. Many of these procedures are being performed on children for aesthetic reasons and for the management of dermatological conditions such as psoriasis and vitiligo. This review serves as an overview of selected cosmetic procedures with pediatric applications. RECENT FINDINGS Recent developments in laser technology have improved our ability to treat a large number of pediatric cutaneous disorders. The vast majority of these technologies were first developed for aesthetic dermatology in adults. Collagen-stimulatory agents such as poly-L-lactic acid were first approved for lipoatrophy associated with human immunodeficiency virus. Poly-L-lactic acid and dermal fillers have potential therapeutic applications in children with atrophic disorders such as lipoatrophy and morphea. Injection of botulinum toxin is very successful in the treatment of hyperhidrosis in adults and can be utilized to improve quality of life in children with hyperhidrosis. SUMMARY The field of cosmetic dermatology is evolving quickly, with limited safety and efficacy studies in the pediatric age group. Children may benefit from thoughtful application of these technologies.
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Abstract
Infantile haemangioma therapy has long been a wait-and-see policy. Since recent development of laser and light therapy, pulsed dye laser has been successfully used for treating superficial haemangiomas. Few studies have been published about treatment with intense pulsed light (IPL) to assess the risk/benefit of IPL in the treatment of infantile haemangiomas during their early proliferative phase. In the present retrospective cohort study, we retrieved data about a series of 14 Caucasian children (median age: 4.8 months) with infantile haemangiomas treated with Photoderm Vasculight flash lamp. All patients experienced a rapid regression of the haemangiomas after 3 treatments on average. Few adverse events were noted, including ulceration and crusts. No residual scarring and cosmetic damages were noticed. Fast growing haemangiomas should be treated with light therapy as soon as possible. This technology is safe, efficient, inducing regression, and preventing any further functional and aesthetic complications. The benefit-risk ratio favours the treatment of most types of haemangiomas which are out of the scope of betablocker administration.
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McHoney M. Early human development: neonatal tumours: vascular tumours. Early Hum Dev 2010; 86:613-8. [PMID: 20850940 DOI: 10.1016/j.earlhumdev.2010.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 08/26/2010] [Indexed: 11/30/2022]
Abstract
Vascular tumours (haemangiomas and malformations) are common tumours of infancy and childhood. They represent a group of mostly benign conditions, which present early, can grow rapidly and be symptomatic or disfiguring. There are various management options, with different cosmetic and functional outcomes. Haemangiomas and vascular malformations have different clinical courses which dictate respective management; differentiating them is key. Haemangiomas are generally self-limiting after initial proliferation; generally management is conservative. Symptoms can call for treatment. Options include laser, steroids, chemotherapy and surgery. Propanolol, the newest modality of treatment, may have a dramatic effect in problematic lesions. Vascular malformations are a less common group of heterogenous lesions, with some overlap between entities. They do not involute. Treatment options include laser therapy, sclerotherapy, embolisation, and surgery. Emerging therapies include photodynamic therapy and angiogenesis inhibitors. This review will outline the evidence for the various modalities in managing these conditions.
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Affiliation(s)
- Merrill McHoney
- Royal Hospital for Sick Children Edinburgh, Sciennes Road, Edinburgh, EH1 1LF, UK.
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Gelmetti C, Frasin A, Restano L. Innovative Therapeutics in Pediatric Dermatology. Dermatol Clin 2010; 28:619-29. [DOI: 10.1016/j.det.2010.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Seoighe DM, Conroy FJ, Beausang E. The use of lasers in the treatment of cutaneous lesions. Ir J Med Sci 2010; 179:321-6. [PMID: 20512665 DOI: 10.1007/s11845-010-0487-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 04/19/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Laser has progressed significantly over the last three decades. Light amplification by stimulated emission of radiation (lasers) are currently employed by a number of medical and surgical specialties and used to treat a wide range of conditions. AIM This article aims to provide an insight into laser science and describe its current usage in the treatment of cutaneous lesions and its potential for future developments. CONCLUSION There are many types of lasers, each having unique properties that enable them to fulfil their task and achieve the desired result. Their applications will no doubt continue to expand with the parallel advancement in laser technology.
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Affiliation(s)
- D M Seoighe
- Mater Misericordiae University Hospital, Eccles St, Dublin 7,
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Blei F. Literature Watch. Lymphat Res Biol 2009. [DOI: 10.1089/lrb.2009.7403] [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
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