Lasers and laser-like devices: Part one

Photobiomodulation transiently increases the spontaneous firing in the superficial layer of the rat spinal dorsal horn

The therapeutic benefits of photobiomodulation (PBM) in pain management, although well documented, are accompanied by concerns about potential risks, including pain, particularly at higher laser intensities. This study investigated the effects of laser intensity on pain perception using behavioral and electrophysiological evaluations in rats. Our results show that direct laser irradiation of 1000 mW/cm2 to the sciatic nerve transiently increases the frequency of spontaneous firing in the superficial layer without affecting the deep layer of the spinal dorsal horn, and this effect reverses to pre-irradiation levels after irradiation. Interestingly, laser irradiation at 1000 mW/cm2, which led to an increase in spontaneous firing, did not prompt escape behavior. Furthermore, a significant reduction in the time to initiate escape behavior was observed only at 9500 mW/cm2 compared to 15, 510, 1000, and 4300 mW/cm2. This suggests that 1000 mW/cm2, the laser intensity at which an increase in spontaneous firing was observed, corresponds to a stimulus that did not cause pain. It is expected that a detailed understanding of the risks and mechanisms of PBM from a neurophysiological perspective will lead to safer and more effective use of PBM.

A Systematic Review of Laser Treatment for Angiofibromas in Tuberous Sclerosis

BACKGROUND

While mammalian target of rapamycin inhibitors have revolutionized the management of angiofibroma in tuberous sclerosis complex (TS), physical modalities such as laser are still indicated for recalcitrant lesions.

OBJECTIVE

The authors performed a systematic review of the efficacy and safety of laser treatment for TS-related facial angiofibroma.

METHODS

The electronic databases such as MEDLINE, Embase, PubMed, Cochrane Central Register of Controlled Trials, and Web of Science were searched from inception to October 10, 2023, for eligible records.

RESULTS

Forty-seven articles met the inclusion criteria, representing a total of 217 patients with TS-related facial angiofibroma who received laser treatment. Several lasers have been trialed in patients including carbon dioxide ( n = 95, 43.7%), pulsed dye ( n = 21, 9.7%), argon ( n = 16, 7.4%), neodymium-doped: yttrium aluminum garnet ( n = 12, 5.5%), copper vapor ( n = 9, 4.1%), potassium titanyl phosphate ( n = 7, 3.2%), erbium: yttrium aluminum garnet ( n = 2, 0.9%), lasers and various combination therapies ( n = 55, 25.3%).

CONCLUSION

Potassium titanyl phosphate, pulsed dye, and neodymium-dopsed:yttrium aluminum garnet lasers are better suited to manage the vascular components of angiofibroma while ablative lasers such as erbium: yttrium aluminum garnet and carbon dioxide lasers may present better options for lesions with a prominent fibrous component. While several lasers have been trialed with broadly favorable results, the low level of evidence precludes definitive conclusions, and no single laser appears superior.

Tissue Ablation: Applications and Perspectives

Tissue ablation techniques have emerged as a critical component of modern medical practice and biomedical research, offering versatile solutions for treating various diseases and disorders. Percutaneous ablation is minimally invasive and offers numerous advantages over traditional surgery, such as shorter recovery times, reduced hospital stays, and decreased healthcare costs. Intra-procedural imaging during ablation also allows precise visualization of the treated tissue while minimizing injury to the surrounding normal tissues, reducing the risk of complications. Here, the mechanisms of tissue ablation and innovative energy delivery systems are explored, highlighting recent advancements that have reshaped the landscape of clinical practice. Current clinical challenges related to tissue ablation are also discussed, underlining unmet clinical needs for more advanced material-based approaches to improve the delivery of energy and pharmacology-based therapeutics.

Split-face study to evaluate efficacy of global cryomodulation for reduction of pain and inflammation after nonablative fractional resurfacing

OBJECTIVES

Cryomodulation, or the delivery of controlled cooling to downregulate inflammatory processes in the skin, has been proposed to mitigate acute side effects following various dermatologic treatments. A new controlled cooling device has been developed to deliver cryomodulation for a range of different indications. In this clinical study, we evaluate the device for the reduction of pain, erythema, and edema following nonablative fractional resurfacing (NAFR).

METHODS

A single-blind, prospective, randomized, split-face study was conducted to assess the efficacy of the controlled dermal cooling device for the reduction of pain, edema, and erythema following nonablative fractional resurfacing with the dual 1550 nm erbium-doped fiber and 1927 nm thulium fiber laser. Subjects were randomized to receive a 10-min controlled cooling treatment to either the left or right side of the face immediately following full face NAFR. Pain ratings were recorded immediately postlaser treatment and immediately postcryomodulation treatment. At follow-up, subjects were surveyed for reduction of side effects and treatment satisfaction. Blinded review of photographs by two physicians was conducted to assess efficacy.

RESULTS

The average pain score for subjects immediately post-NAFR was 5.15. Following cryomodulation, the average pain score on the treatment side was reduced by 69%, to an average of 1.6. The untreated side of the face was reduced by 19%, to an average of 4.2. Overall, 90% of subjects endorsed reduced discomfort. At follow-up, 70% of subjects reported a noticeable improvement in edema and 50% reported a noticeable improvement in erythema between the treatment and control sides. The average subject satisfaction score for the cryomodulation treatment was 4.2. All subjects (100%) indicated that they would elect to undergo the cryomodulation treatment again. Both blinded physician reviewers were successful in identifying the cryomodulation-treated side of the face in 70% of subjects' posttreatment photographs.

CONCLUSIONS

The results of this split-face study support the efficacy of a global cryomodulation device for the reduction of pain, edema, and erythema following NAFR treatment. Cryomodulation was delivered in a simple 10 min procedure and yielded high patient satisfaction.

1927nm fractional thulium fiber laser combined with 30% salicylic acid for the treatment of acne and acne scars: A prospective, randomized, and split-face study

OBJECTIVES

Patients with acne usually develops acne scars subsequently, early intervention of scars is crucial in acne management. 1927nm fractional thulium fiber laser (TFL) is effective in scars improvement and chemical peels with 30% supramolecular salicylic acid (SSA) can be applied for the treatment of acne. The purpose of this study is to evaluate and compare the efficacy and safety of TFL monotherapy versus the concomitant application of TFL and 30% SSA on acne and acne scars.

MATERIALS AND METHODS

Thirty-three patients with acne and acne scars were enrolled, and two sides of the face were randomly divided to receive either TFL and SSA chemical peeling or TFL. Four sessions of TFL treatments were applied with 4-week intervals for both sides, SSA combined treatment side received eight SSA chemical peels with 2-week intervals additionally. GAGS, ECCA score, the number of acne lesions, melanin index (MI) and erythema index (EI), transepidermal water loss (TEWL), and side effects were recorded at Weeks 0, 4, 8, 12, and 18. Satisfaction of patients was recorded on both sides at the end of the study.

RESULTS

Thirty patients completed the study. Both control group (TFL monotherapy) and SSA group (TFL combined with SSA chemical peeling) significantly improved GAGS and ECCA score. SSA group showed higher efficacy in terms of GAGS and ECCA score, acne lesion count, TEWL, MI, EI, and satisfaction than control group. All the side effects were temporary and tolerable, no adverse effects were observed.

CONCLUSIONS

Both TFL and the TFL combined with 30% SSA chemical peeling are safe and effective for the treatment and prevention of acne and acne scars, though the combined group has higher efficacy.

Effect of high-intensity laser therapy in patients with non-specific chronic neck pain: study protocol for a randomized controlled trial

BACKGROUND

Chronic non-specific neck pain (CNNP) is a prevalent musculoskeletal disorder known for its significant disability and economic burden, ranking second only to low back pain in musculoskeletal conditions. Physical therapy offers effective interventions for CNNP, including low-level laser therapy (LLLT). High-intensity laser therapy (HILT) is a recent treatment for musculoskeletal pain, but studies that support its use in CNNP are limited. The objective of this study is to assess the effect of high-intensity laser therapy on pain intensity in patients with CNNP, given the existing evidence on LLLT for this condition.

METHODS

This is a 2-arm, randomized, placebo-controlled trial with blinded evaluators. The research will be carried out in the laboratory of physical agents at the Andrés Bello University, Campus Casona de las Condes. Eligible participants include the entire internal and external community associated with Andrés Bello University suffering from chronic non-specific NP. Participants will be stratified by sex (4 subgroups) and randomized into 2 study groups: group 1 (HILT and stretching exercises) and group 2 (sham HILT and stretching exercises). Treatments will be performed twice a week for 4 weeks with 3 assessments: before treatment (T0), at the end of treatment (T1), and 12 weeks after treatment (follow-up) (T2). The main outcomes will be pain intensity at rest, pain intensity at movement (active cervical movements: flexion, extension, right and left side bending, and right and left rotation), and pain pressure threshold (average obtained for six evaluation points). Secondary outcome measures will include neck range of motion in the sagittal, coronal, and transverse planes and neck disability.

DISCUSSION

In this study, HILT's effects on patients with non-specific NP will be compared to those of a sham laser intervention. This RCT will offer new evidence regarding the potential benefits of HILT in terms of pain intensity, range of movement, and disability in people suffering with non-specific NP.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05689788. January 19, 2023.

Microneedle fractional radiofrequency in the treatment of periorbital dark circles

BACKGROUND

Periorbital hyperpigmentation (POH) is a common disorder in the patients. Women are more upset with POH in compare to males. Several methods have been used to the POH, with different efficacy and adverse reactions.

AIM

The aim of the present study is to evaluate the efficacy of microneedle fractional radiofrequency (MRF) in treating POH.

METHODS

So, nine patients with POH and the age range of 25-57 years, were treated by microneedle fractional radiofrequency (MRF). The outcome was evaluated via biometric assessment. The colorimeter was used to assess the skin lightness. Mexameter was used for evaluated the amount of Melanin in the periorbital skin. Cutometer was used for skin elasticity assessment. The skin ultrasound imaging system was utilized to estimate the epidermis and dermis diameter and density. Furthermore, Visioface was applied to assessed the skin color and wrinkles. Also patient's satisfaction and physician's assessment were evaluated.

RESULTS

The results displayed that the periorbital skin lightness 32.38% ± 5.67 and elasticity of the R2: 40.29% ± 8.18, R5: 39.03 ± 5.38 and R7: 42.03% ± 14.16 were significantly improved after treatment (p < 0.05). Also the melanin content of the skin was decreased (49.41% ± 9.12). The skin layers were denser in the dermis and also in the epidermis (skin density: 30.21% ± 10.16 and skin thickness: 41.12% ± 13.21) (p < 0.05). The results revealed the decrease in the percent change of the skin color (30.34% ± 9.30) and wrinkle (area: 25.84% ± 6.43 and volume: 30.66% ± 8.12) (p < 0.05). Similarly, the physician and patient's assessment were confirmed the obtained outcomes.

CONCLUSION

In conclusion, the microneedle RF technique is practicable, effective and safe method for periorbital dark circles treatment.

Diffractive micro-lens array (DLA) for uniform and selective picosecond laser treatment

Picosecond Nd:YAG lasers using diffractive optical elements (DOE) and micro-lens arrays (MLA) have widely been used in dermatology for the treatment of pigmented lesions and skin rejuvenation. This study designed and developed a new optical element of diffractive micro-lens array (DLA) by combing the features of DOE and MLA in order to achieve uniform and selective laser treatment. Both optical simulation and beam profile measurement demonstrated that DLA created a square macro-beam consisting of multiple micro-beams in a uniform distribution. Histological analysis confirmed that the DLA-assisted laser treatment generated micro-injuries at various skin depths from the epidermal layer to the deep dermal layer (up to 1200 µm) by adjusting the focal depths while DOE showed shallow penetration depths and MLA created non-uniform micro-injury zones. The DLA-assisted picosecond Nd:YAG laser irradiation can provide a potential benefit for pigment removal and skin rejuvenation via uniform and selective laser treatment.

MACULAR HOLE FORMATION ASSOCIATED WITH INTENSE PULSED LIGHT THERAPY

PURPOSE

To describe the first case of macular hole formation following intense pulsed light therapy.

METHODS

This is a retrospective case report. A 68-year-old woman presented with blurry vision that occurred 1 day following intense pulsed light therapy for hair removal.

RESULTS

A full thickness macular hole, which had not been previously documented was noted on fundus exam. Ocular coherence tomography confirmed a full-thickness macular hole.

DISCUSSION

Laser treatment for hair removal has been reported to cause ocular injuries including iris atrophy, pupillary distortion, cataracts, and uveitis. Intense pulsed light therapy, a specific type of laser therapy, has been reported to cause iris transillumination defects, anterior uveitis, and pupil abnormalities. Our case is the first to describe a macular hole secondary to intense pulsed light therapy. The etiology of the macular hole is postulated to be secondary to possible thermal injury with absorption of energy at the level of the retinal pigment epithelium. This emphasizes the role and importance of preventative measures, such as protective glasses in reducing the risk of ocular injuries.

Clinical Effect of Photobiomodulation on Wound Healing of Diabetic Foot Ulcers: Does Skin Color Needs to Be Considered?

Diabetic foot ulcers (DFUs) are one of the most common complications of diabetes. DFUs impede patients' quality of life and are known to be unresponsive to conventional therapy. Photobiomodulation (PBM) is a pain-free, noninvasive treatment method that has been shown to promote chronic wound healing and has been successfully used for the treatment of DFUs. Since skin tone and color can affect the way light interacts with tissue, studies should take this into consideration when determining protocols for the use of PBM. This review is aimed at critically evaluating data of existing studies conducted to evaluate the clinical effect of PBM on DFUs, taking skin color into consideration. A literature search was conducted and resulted in articles on cell studies, animal studies, and clinical trials. Only 13 clinical trials and 2 clinical case studies were adopted and used in this review. All the clinical trials adopted for this review show evidence that PBM together with conventional treatment results in an increased healing rate of DFUs; however, only one study adjusted their protocol according to skin color. There are not enough studies conducted on people of color to determine the safety and efficacy of PBM therapy in such ethnic groups. Future randomized, placebo-controlled clinical trials are necessary on PBM and DFUs and should take skin color into consideration.

Efficacy of fractional laser, radiofrequency and IPL rejuvenation of periorbital region

The purpose of this study was to assess skin elasticity, the reduction in the number and the depth of wrinkles and changes in the other skin defects (bags under the eyes, dark circles under the eyes, skin hyperpigmentation in the ageing eye area following the use of non-ablative fractional laser, bipolar radiofrequency and intense pulsed light). Moreover, the study was also comparison which device brought better results than the others. This study included 71 patients (66 women, 5 men), aged 33–63 years (the average age was 45.81 years) with skin phototypes II and III. Twenty-four patients received five treatment sessions with a 1410-nm non-ablative fractional laser in 2-week intervals, 23 patients received five treatment sessions with a bipolar radiofrequency in 1-week intervals and 24 patients received five treatment sessions with an intense pulsed light in 2-week intervals. The treatment was applied on the skin in the eye area. The Cutometer (Courage + Khazaka electronic) reference test was used as an objective method for the assessment of skin elasticity. A questionnaire was used to compare baseline state with changes that occurred after the series of treatment sessions. The results of cutometric measurements of R2, R6 and R7 parameters and the results of questionnaires indicated that non-ablative fractional laser therapy, bipolar radiofrequency and intense pulsed light improved skin elasticity. Of the three treatments, the most significant percentage improvement in the R6 parameter was demonstrated by non-ablative fractional laser therapy which gave better final results than the other methods (p < 0.0001). No other statistically significant relationships were found between RF and IPL. In the (subjective) opinion of study participants (questionnaire), all used methods resulted in the reduction of the amount and the depth of wrinkles. However, they did not observe significant impact of individual treatment method on the signs of skin ageing, including discolorations within eye area, bags (fatty hernia), dark circles (vascular/pigmentary) and oedema (predisposition to water retention). Non-ablative fractional laser therapy, bipolar radiofrequency and intense pulsed light improved skin elasticity and the reduction of wrinkles. The most significant improvement of elasticity was demonstrated by laser therapy. It seems necessary to expand the group with the effect of individual treatments against bags and dark circles under the eyes.

Laser treatment of specific scar characteristics in hypertrophic scars and keloid: A systematic review

BACKGROUND

Hypertrophic scarring and keloid can cause significant emotional and physical discomfort. Cosmetic appearance, functional limitations, pain and pruritus form a degree of impairment. While the etiology is not fully known, there is a wide array of treatment options, which include excision, radiation, cryotherapy, silicone gel sheeting, and intralesional injections. A relatively new modality is laser therapy. While results are promising, the number of different laser systems is substantial. This review evaluates the available evidence regarding outcomes on specific objective characteristics (i.e., erythema, pigmentation, height, and pliability) of the different laser systems.

METHODS

A systematic literature review was performed using MEDLINE, Cochrane Library, and EMBASE. Data on scar characteristics were extracted from scar scales Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS), and from objective measurement tools.

RESULTS

Heterogeneity was seen in a lot of aspects: maturity of scar, origin of scar, follow-up, and number of treatments. The fractional ablative lasers CO₂ 10,600 nm and Er:YAG 2940 nm were found to produce the best results regarding erythema, height, and pliability, while the flash lamp-pumped pulsed dye laser (PDL) 585 nm scored slightly below that.

CONCLUSIONS

Laser systems, and specifically the fractional ablative lasers CO₂ and Er:YAG, improved various characteristics of excessive scarring. An overview of preferred laser modality per scar characteristic is presented. Accounting for the methodological quality and the level of evidence of the data, future research in the form of randomized trials with comparable standardized scar scales is needed to confirm these results.

Laser Treatment of Accidental Tattoos: Experience at a Tertiary Referral Center

BACKGROUND

To date, information on laser treatment of accidental tattoos is limited.

OBJECTIVES

This study analyzes the efficacy and safety of quality-switched ruby, quality-switched Nd:YAG and picosecond lasers in the treatment of accidental hyperpigmentation in a larger patient cohort. To date, there is limited information on laser therapy of accidental hyperpigmentation.

METHODS

We conducted a retrospective systematic single-center analysis on 70 patients, which presented with accidental hyperpigmentation at the Dermatology Department of the University Hospital of Zurich between 2008 and 2017. Patients with accidental tattoos due to road injuries, explosives or other traumas and iatrogenic measures were included. We analyzed the data including laser parameters such as wavelength, energy density, spot size and intervals between the sessions. Also, the number of sessions performed and the overall success were registered.

RESULTS

We treated 38 patients by quality-switched nano- and/or picosecond laser therapy and completed the treatment in 28 cases within a mean number of 3-5 laser sessions. No complications occurred.

CONCLUSION

We demonstrate the validity and safety of quality-switched and picosecond lasers in the treatment of accidental hyperpigmentation. Using a combination of different wavelengths and pulse lengths on the same lesion and gradually increasing the fluence in the course of the laser treatment is recommendable to increase efficacy. We observed a tendency towards faster elimination of facial accidental tattoos and/or originating from road injuries compared to tattoos located on the extremities and those caused by explosions, piercings or iatrogenic measures or consisting of metal pigment particles.

A cross-sectional, multi-center study on treatment of facial acne scars with low-energy double-pass 1450-nm diode laser

Acne scars are the ultimate outcome of acne vulgaris, a prevalent skin disorder affecting the pilo-sebaceous unit. Laser resurfacing has been demonstrated to be an efficient therapy option for acne scars. Hence, we adopted this concept and conducted a study to evaluate the safety and efficacy of low-energy double-pass 1450-nm diode laser on acne scars. This study was conducted on 48 patients with acne scars, treated at 4-week interval with low-energy double-pass 1450-nm diode laser. Patients were evaluated clinically and with photographs, at day 0, first month and third month post the final treatment and during follow-up visit. Five treatment sessions were completed by all patients. Approximately, 79.2% of patients showed around 30% improvement. At the end of third month follow-up, 92.9% of the patients demonstrated >30% improvement. Vesicle formation was observed in two cases, with no post-inflammatory hyperpigmentation and transient hyperpigmentation was observed in one case, which vanished within 2 months. Our study showed that 1450-nm diode laser treatment was efficient and well endured in facial acne scars when used with double-pass at low-energy.

Assessment of Laser Effects on Skin Rejuvenation

Laser skin resurfacing has changed the approach of facial skin rejuvenation over the past decade. This article evaluates the laser effects on skin rejuvenation by the assessment of laser characteristics and histological and molecular changes, accompanied by the expression of proteins during and after laser-assisted rejuvenation of skin. It is important to note that different layers of skin with different cells are normally exposed to the sun's UV radiation which is the most likely factor in aging and damaging healthy skin. To identify the expression of proteins, using validated databases and reviewing existing data could reveal altered proteins which could be analyzed and mapped to investigate their expression and their different effects on cell biological responses. In this regard, proteomics data can be used for better investigation of the changes in the proteomic profile of the treated skin. Different assessments have revealed the survival and activation of fibroblasts and new keratinocytes with an increase of collagen and elastin fibers in the dermis and the reduction of matrix metalloproteinases (MMPs) and heat shock proteins (HSPs) as a result of different low-power laser therapies of skin. There are a wide range of biological effects associated with laser application in skin rejuvenation; therefore, more safety considerations should be regarded in the application of lasers in skin rejuvenation.

The use of lasers and light sources in skin rejuvenation

Smooth, wrinkle-free skin is associated with supposed attractiveness, youthfulness, and health, while rhytids have a negative impact on one's perceived appearance, image, and self-esteem. Noninvasive esthetic procedures such as laser or light therapy have been used to achieve and attain a more youthful appearance. Currently, there is a wide range of lasers and devices available for the regeneration and healing of skin. Lasers and light sources for skin rejuvenation involve the removal of aged skin tissue via thermal heat from high-powered lasers, stimulating the surrounding tissues to recover through natural wound-healing processes. In contrast, photobiomodulation, which makes use of low energy lasers or light emitting diodes, uses no heat and has shown positive effects in the reduction of wrinkles and improving skin laxity.

Enhanced laser surface ablation with an integrated photoacoustic imaging and high intensity focused ultrasound system

BACKGROUND AND OBJECTIVE

Combined laser and ultrasound treatments have been found to have synergistic effects, which may be of particular note in dermatology. We aim to investigate the potential of this technology for dermatology through in vitro and ex vivo experiments.

METHODS

In vitro tissue phantoms made of agar and tattoo ink and tattooed ex vivo chicken breast tissue were used. An integrated photoacoustic imaging and high intensity focused ultrasound (HIFU) system, using a 5-ns tunable OPO laser system and a 5 MHz HIFU transducer, was used to perform photoacoustic analysis to identify the optical contrast, and perform combined laser and ultrasound ablation. On the tissue phantoms, lines of ablation were created under various operating conditions. The samples were then quantified to determine the level of ablation. Same procedures were performed on the tattooed chicken breast tissue and the tattoo was removed by using combined laser and ultrasound.

RESULTS

Ablation in the in vitro tissue phantoms was observed with properly synchronized laser and ultrasound while no ablation was found with either laser or ultrasound alone. Increases to the intensity or pulse duration of ultrasound caused an increase in ablation to the samples. The tattoo was removed from the ex vivo chicken breast using combined laser and ultrasound with a radiant exposure of 1.2 J/cm² while laser and ultrasound alone were unable to remove the tattoo.

CONCLUSIONS

We determined that by supplementing nanosecond laser pulses with ultrasound, ablation, and tattoo removal can be achieved at laser radiant exposures levels would otherwise be ineffective. The area of ablation can be adjusted through changes in the intensity and duration of the ultrasound burst with a constant laser intensity. Additionally, the system can be used to perform photoacoustic analysis of the tissue to estimate the relative optical absorbance at various available wavelengths, allowing for pretreatment analysis. Lasers Surg. Med. 9999:1-9, 2019. © 2019 Wiley Periodicals, Inc.

Treatment of burn scars in Fitzpatrick phototype III patients with a combination of pulsed dye laser and non-ablative fractional resurfacing 1550 nm erbium:glass/1927 nm thulium laser devices

Introduction:

Burn scars cause cosmetic disfigurement and psychosocial distress. We present two Fitzpatrick phototype (FP) III patients with burn scars successfully treated with combination pulsed dye laser (PDL) and non-ablative fractional lasers (NAFL).

Case 1:

A 30-year-old, FP III woman with a history of a second-degree burn injury to the bilateral arms and legs affecting 30% body surface area (BSA) presented for cosmetic treatment. The patient received three treatments with 595 nm PDL (7 mm, 8 J, 6 ms), six with the 1550 nm erbium:glass laser (30 mJ, 14% density, 4–8 passes) and five with the 1927 nm thulium laser (10 mJ, 30% density, 4–8 passes). Treated burn scars improved significantly in thickness, texture and colour.

Case 2:

A 33-year-old, FP III man with a history of a second-degree burn injury of the left neck and arm affecting 7% BSA presented for cosmetic treatment. The patient received two treatments with 595 nm PDL (5 mm, 7.5 J, 6 ms), four with the 1550 nm erbium:glass laser (30 mJ, 14% density, 4–8 passes) and two with the 1927 nm thulium laser (10 mJ, 30% density, 4–8 passes). The burn scars became thinner, smoother and more normal in pigmentation and appearance.

Discussion:

Our patients’ burn scars were treated with a combination of PDL and NAFL (two wavelengths). The PDL targets scar hypervascularity, the 1550 nm erbium:glass stimulates collagen remodelling and the 1927 nm thulium targets epidermal processes, particularly hyperpigmentation. This combination addresses scar thickness, texture and colour with a low side effect profile and is particularly advantageous in patients at higher risk of post-procedure hyperpigmentation.

Conclusion:

Our cases suggest the combination of 595nm PDL plus NAFL 1550 nm erbium:glass/1927 nm thulium device is effective and well-tolerated for burn scar treatment in skin of colour.

While all scars can be bothersome, burn scars can be particularly troubling. They can be large, itchy, painful and limit range of motion. Patients with medium and darker skin tones may be more likely to develop dark and discoloured scars due to burns and other scarring injuries. In our case series, we used two types of lasers to treat thick, darkly pigmented burn scars in two patients with medium and darker skin tones. While the pulsed dye laser targets the redness and thickened aspects of scars to restore a more normal appearance, the non-ablative fractional resurfacing laser creates microscopic zones of controlled injury to resurface scars, stimulate new collagen growth, improve texture and lighten excess pigmentation. Treatments were performed once a month for 6–12 months. Using these lasers in combination, our treatment method made our patients’ scars thinner, smoother and more evenly coloured over time, resulting in a more natural appearance. This multi-modal approach was a safe and effective no-downtime method for the improvement of scars in skin of colour patients.

[Therapy of scars with lasers]

Scar formation is the consequence of trauma to the skin that affects the deep parts of the dermis. Different scar types like immature, mature, atrophic, hypertrophic, or keloid scars can develop depending on factors like age, anatomic localization, cause of trauma, the course of the healing process, and individual predispositions. Keloids and hypertrophic scars are often associated with itching, pain, tautness of the skin, and functional impairments, thus, leading to significantly reduced quality of life in some patients. However, even seemingly physiologically healed scars can cause tremendous psychological strain as is the case with self-harm scars. Despite increased research efforts, the exact pathomechanisms of excessive scarring are still scarcely understood, and dependably effective treatment options are often lacking. However, through continually improving scientific progress, scar treatment paradigms for a variety of scar types, thus far often dominated by conventional treatment methods, are increasingly complemented by new laser technologies and wavelengths.

Laser and light-based therapy for cutaneous and soft-tissue metastases of malignant melanoma: a systematic review

Invasive cutaneous melanoma is a growing health concern. Although surgical excision can effectively treat in situ tumors, use for metastatic melanoma is limited. Laser and light-based therapies may be a valuable palliative treatment option for patients with stage III and stage IV cutaneous metastatic melanoma. Our goal is to review the published literature and provide evidence-based recommendations on laser and light-based palliative therapies for metastatic melanoma. A search of the databases Pubmed, EMBASE, Web of Science, and CINAHL was performed on March 10, 2016. Key search terms were related to melanoma, laser, and light-based modalities. Our search initially identified 13,923 articles and 27 original articles met inclusion criteria for our review. Grade of recommendation: C for non-fractionated carbon dioxide laser, Grade of recommendation: D for fractionated carbon dioxide laser, ruby laser, neodymium laser, near-infrared diode laser, and photodynamic therapy. Non-fractionated carbon dioxide laser had the best palliative efficacy of the reviewed laser and light-based therapies, while other treatment modalities may have potential as adjunctive therapy to standard of care.

Combination Therapy in Midfacial Rejuvenation

BACKGROUND

Facial aging in the midface reflects cumulative results of multiple intrinsic and extrinsic factors over time. Midfacial rejuvenation procedures can make a positive impact on facial attractiveness and patient satisfaction.

OBJECTIVE

To review evidence and clinical experience using combination treatments for midfacial rejuvenation to achieve optimal outcomes.

MATERIALS AND METHODS

This article provides a review of published scientific evidence supporting the use of combination therapy in midfacial rejuvenation. In addition, the authors share their cumulative clinical experience and best practices for combination treatments in the midface.

RESULTS

Clinical experience and evidence shows that combining multiple aesthetic therapies targeting multiple aspects of the aging process provides optimal results, with greater overall efficacy and a higher level of patient satisfaction.

Traditional Cautery for Medical Treatment Among the Bedouins of Southern Israel

Traditional cautery for the cure of disease is an ancient and widespread mode of treatment in various cultures and is a central modality among Israeli Bedouins. To date the use of this treatment has not been assessed systematically. A personal interview was conducted among Muslim Bedouin patients who came to clinics in the Negev region in southern Israel. There were 250 participants including 128 women (51.2 %). The mean age was 45.16 ± 16.2 (range 18-86). Eighty nine (35.7 %) of the participants declared that they had personally undergone curative cautery therapy in the past. Two hundred and five (82 %) were familiar with this mode of therapy. Two thirds of those who underwent the treatment in the past said that it helped them a great deal and another 19 % said that it helped them somewhat. More men underwent the therapy than women (P = 0.034), believed in its effectiveness (P = 0.013), and declared that they were prepared to use it again in the future (P < 0.0001). Elderly patients, over the age of 61, used this therapy more than younger ones (P = 0.001). The majority of the Bedouin population in the Negev is familiar with cautery and a significant part of the population has personally undergone this therapy and believes that it is effective.

Intense pulsed light (IPL) treatment for the skin in the eye area - clinical and cutometric analysis

OBJECTIVE

The aim of the research was to establish the influence of IPL treatment on skin ageing in the eye area.

MATERIAL AND METHODS

This study included 24 women, aged 38-63 years (mean age was 48.04) with Fitzpatrick skin type II and III who underwent five successive treatment sessions with an IPL in two-week intervals. The Cutometer (Courage + Khazaka electronic) reference test was an objective method for the assessment of the biomechanical properties of the skin. The measurements were made in three places around the eye. The photo documentation was used to compare state of skin before and after three months of treatments. Additionally, patients filled in a questionnaire, which contained questions concerning self-assessment of the procedure effects.

RESULTS

Cutometric analysis showed significant improvement of skin elasticity (statistical significance level is mostly < 0.0001). The comparison of clinical changes in the therapy, based on photo documentation, showed a 25% improvement.

CONCLUSIONS

This treatment was used in order to improve skin elasticity and decrease the amount and depth of wrinkles. It is a non-invasive treatment, with low risk of complications.

Noninvasive Facial Rejuvenation. Part 3: Physician-Directed-Lasers, Chemical Peels, and Other Noninvasive Modalities

A proper knowledge of noninvasive facial rejuvenation is integral to the practice of a cosmetic surgeon. Noninvasive facial rejuvenation can be divided into patient- versus physician-directed modalities. Patient-directed facial rejuvenation combines the use of facial products such as sunscreen, moisturizers, retinoids, α-hydroxy acids, and various antioxidants to both maintain youthful skin and rejuvenate damaged skin. Physicians may recommend and often prescribe certain products, but patients are in control with this type of facial rejuvenation. On the other hand, physician-directed facial rejuvenation entails modalities that require direct physician involvement, such as neuromodulators, filler injections, laser resurfacing, microdermabrasion, and chemical peels. With the successful integration of each of these modalities, a complete facial regimen can be established and patient satisfaction can be maximized. This article is the last in a three-part series describing noninvasive facial rejuvenation. Here the authors review the mechanism, indications, and possible complications of lasers, chemical peels, and other commonly used noninvasive modalities.

Melanoma diagnosed in lesions previously treated by laser therapy

Laser therapy has become a routine procedure in dermatological practice and is frequently also used for pigmented lesions. Few reports exist of melanomas diagnosed in lesions previously treated by laser therapy. Between 2007 and 2014, we identified 11 patients who presented to our department with a melanoma diagnosed in a region previously treated by laser therapy. The course of events until the diagnosis of melanoma was assessed as well as patient outcome including treatment for disease progression. No histological assessment had been performed prior to laser therapy in nine of 11 (82%) cases. Benign melanocytic lesions had been diagnosed by biopsy prior to laser therapy in the other two cases. Time from laser therapy to diagnosis of melanoma ranged from less than 1 to 10 years. Stage of disease at diagnosis varied from stage IA to IIIC. Four patients progressed to stage IV disease, of whom at least one died of melanoma. We conclude that laser treatment of pigmented lesions can complicate the diagnosis of melanoma and lead to diagnosis delay with potentially fatal consequences. Considering this risk, we believe laser therapy for pigmented lesions should either be avoided entirely or at a minimum performed only after prior histological assessment.

Cooling Devices in Laser therapy

Cooling devices and methods are now integrated into most laser systems, with a view to protecting the epidermis, reducing pain and erythema and improving the efficacy of laser. On the basis of method employed, it can be divided into contact cooling and non-contact cooling. With respect to timing of irradiation of laser, the nomenclatures include pre-cooling, parallel cooling and post-cooling. The choice of the cooling device is dictated by the laser device, the physician's personal choice with respect to user-friendliness, comfort of the patient, the price and maintenance costs of the device. We hereby briefly review the various techniques of cooling, employed in laser practice.