Laser removal of pigmented and vascular lesions

Intense Pulsed Light (IPL) for the treatment of vascular and pigmented lesions

BACKGROUND

IPL devices emit a wide range of wavelengths that can be absorbed by different chromophores in the skin. Selective destruction of a specific chromophore with minimal side effects is controlled by wavelength, pulse duration, and fluence.

AIM

This study aims to evaluate the treatment of vascular and pigmented lesions using narrow-band Intense Pulsed Light (IPL) with Advanced Fluorescence Technology (AFT), which offers more efficient energy usage per pulse to increase safety, and improve clinical outcomes.

METHODS

A retrospective analysis of data from 100 patients treated with narrow-band IPL for vascular and pigmented lesions. Efficacy was measured by the Global Aesthetic Improvement Scale (GAIS) and Patient Satisfaction Scale (0-10). Safety was assessed by evaluating pain levels and adverse events.

RESULTS

Mean GAIS scores were 8.02 ± 0.84 for vascular and 8.14 ± 0.9 for pigmented lesions with no significant difference between groups (p=0.49, α=0.05). Patient satisfaction correlated with GAIS scores (correlation coefficient 0.8). No pain was reported and two patients experienced temporary and transient side effects.

CONCLUSION

Overall, the advanced IPL treatments provided favorable outcomes for vascular and pigmented lesions.

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.

Laser treatment of infantile hemangioma

BACK GROUNDS AND OBJECTIVE

Infantile hemangiomas (IH) are common benign tumors of infancy. Most IH either involute spontaneously or respond to treatment with systemic Beta- blockers, but unfortunately not in all cases. In poor responses or in cases of contra indications for pharmacological treatment, laser treatment poses a very good solution.

METHODS

As a search strategy and study selection we searched the MEDLINE database via PubMed starting 1982 to June 2022 using a key terms related to interventions for IH (e.g., infantile hemangioma, laser, Beta blockers).

RESULTS

In this article, we reviewed the published data regarding the use of energy-based devices in treatment of children with IH, and noted our experience over the course of treating dozens of cases over the years.

CONCLUSION

There are many laser systems used for the treatment of hemangioma and vascular tumors. These laser systems are of different wavelengths and penetration depths, however, they operate by similar mechanisms and in some cases two or more lasers can be applied during the course of treating these lesions.

Combination of Specific Vascular Lasers and Vascular Intense Pulsed Light Improves Facial Telangiectasias and Redness

Background and objectives: Facial telangiectasias are dilated blood vessels that can represent a cosmetic issue for patients. They may be associated with other conditions, such as rosacea. Laser and light treatments are nowadays becoming a cornerstone in the management of these lesions. Materials and Methods: In total, 68 patients seeking medical treatment for facial telangiectasias were enrolled from 1 March 2019 to 1 March 2020 at the Dermatological Unit of Magna Graecia University (Catanzaro, Italy). A protocol consisting of a 1064 Nd:YAG laser for darker blue telangiectasias and 532 nm Nd:YAG for red lesions followed by intense pulsed light with an optimized spectrum for vascular lesion 3 weeks after the first procedure was proposed. A three-month follow-up visit assessed patient’s satisfaction using a visual analog scale (VAS). Two dermatologists measured clinical results using a 4-point scale, comparing pictures before treatment and at follow-up. Results: A total of 68 patients (32 males and 36 females) completed the study, performing all requested treatments. No severe side effects were reported. Patient satisfaction was very high (8.15 ± 1.05 out of a 10-point VAS scale), as well as dermatologists’ clinical evaluations (2.19 ± 0.74 out of 3). Conclusions: The combination of vascular lasers and Vascular Intense Pulsed Light acting specifically on small blood vessels may help to improve the aesthetic outcome, reducing side effects. A prospective study with a larger number of participants will be necessary to confirm this study’s findings.

High-power quasi-CW diode-pumped 750-nm AlGaAs VECSEL emitting a peak power of 29.6 W and an average power of 8.5 W

A peak output power of 29.6 W and an average output power of 8.5 W at a wavelength of 750 nm were demonstrated in quasi-CW multi-mode operation using an AlGaAs-based vertical external-cavity surface-emitting laser (VECSEL) diode-pumped at a wavelength of 675 nm. The comparatively low bandgap of the barrier material that was tuned to the pump-photon energy allowed a good compromise between low heat generation due to the quantum defect and strong absorptance of the pump radiation. The limitations for the average output power came mainly from insufficient heat flow from the intra-cavity heat spreader to the heat sink. These results show the potential for power scaling of diode-pumped VECSELs and the importance of effective heat removal.

Skin vascular lesions: A new therapeutic option with sequential laser-assisted technique

Treatment of skin unaesthetic vascular lesions is still suboptimal. In this article, we present a multicenter study evaluating the efficacy and safety of the sequential 755 nm Alexandrite and 1064 nm ND:YAG lasers for the treatment of acquired and congenital vascular lesions of the skin. A total of 171 patients were included in the study (141 female and 30 male), median age 38, skin type from I to IV. Numbers of patients categorized for treated disease: 22 spider angiomas, 67 facial telangiectasia/spider veins, 58 leg telangiectasia/reticular leg veins, 24 port wine stains (PWS). Of those lesions 30.7% was on legs, 63.7% on face (6.7% on forehead, 10.1% on temples, 21.7% on cheeks, 25.2% on nose, 1.7% on chin) and 5.6% on chest. Spider angiomas required from 1 to 3 treatments. Facial telangiectasias had been treated from 1 to 4 times. Leg telangiectasias needed from 2 to 6 treatment sessions. Regarding PWS, it takes from 6 to 9 laser treatment to reach the clearance of the lesion. All the vascular disorders treated showed marked improvement while side effects were limited to low pain sensation and transitory fenomena. This sequential treatment is an effective, safe, and new approach for unaesthetic skin vascular lesions.

Laser Treatment of Oral and Maxillofacial Hemangioma

Hemangioma is a congenital vascular soft tissue tumor, defined as a vascular lesion present in the newborn, with a progressive developmental pattern related to age. It has a progressive and regressive periodic growth mode, in comparison with arteriovenous malformation (AVM). Although there are many treatment approaches for curing this lesion such as; surgery, cryotherapy, sclerosant agents, laser therapy has more advantages in comparison to the other methods. Such as, hemostasis and clean operating field, decreased amount of pain and edema. There are many types of lasers manufactured that could be used for therapeutic purposes. This article focuses on different types of laser applications in the treatment of these lesions.

Effects of KTP Laser Bleaching on Traumatized Tooth Enamel

BACKGROUND

Bleaching of traumatized discolored teeth is considered an important issue in esthetic dentistry. Various methods have been introduced for bleaching, some of which may have adverse effects on soft or hard tissues of the tooth.

OBJECTIVES

The objective of the study was to evaluate the effects of KTP laser bleaching on enamel of traumatized teeth.

MATERIALS AND METHODS

A square of 36 mm(2) was chosen on the labial surface of 32 extracted teeth. The corners were drilled in order to indicate the location precisely. The shade of each sample was recorded and the teeth were divided into four groups, each with eight teeth: group A (Smartbleach with KTP laser for 30 seconds), group B (Smartbleach with G-Light for 5 minutes), group C (only Smartbleach for 10 minutes) and group D (control group with no bleaching). After one session of bleaching, shade assessment was performed again. In another experiment on nine teeth, Smartbleach with KTP laser was used for 150 seconds to 1500 seconds. The samples were critically processed and observed by using scanning electron microscope (SEM) to assess enamel damage. Data was statistically analyzed using Kruskal-Wallis test (confidence interval level were set at 95%).

RESULTS

Smartbleach was highly effective when used with KTP laser (P = 0.0419). Enamel damage was observed after frequent KTP bleaching and 750 seconds of KTP bleaching was recognized as the limit by morphological evaluation via SEM, indicating a major difference between under and over 750 seconds of bleaching.

CONCLUSIONS

Application of KTP laser may increase the bleaching effect of Smartbleach, nevertheless it may cause some enamel damage.

Pigmentation: selective photothermolysis or non-specific skin necrosis using different intense pulsed light systems?

BACKGROUND AND OBJECTIVE

This study considers end point tissue responses and side effects to determine whether 'square pulse' IPL is more or less effective than the traditional IPL. Supporting histological data and computational modelling results are provided. It provides guidance for IPL users unfamiliar with constant spectrum IPL devices and redirects attention to treatment end points.

MATERIALS AND METHODS

Twenty subjects of Fitzpatrick Skin Types I-III, presenting with various epidermal pigmented lesions, were treated 1-3 times with two different IPLs. Coupling gel was used and firm pressure was applied to exclude blood from the treatment area. Immediate and post-treatment side effects, degree of discomfort and end results at fourteen and thirty days were evaluated by professional observation, digital photography and a patient questionnaire.

RESULTS

Both IPLs showed a mean clearance of over 80% after 1-3 treatments but the free discharge IPL demonstrated a greater side effect profile with a higher incidence of ulceration, crusting and erythema.

CONCLUSIONS

Clinical observation and mathematical modelling suggests that the square pulse, partial discharge IPL system may provide the IPL operator with greater control over the coagulation of pigment and is therefore the more efficient device for effective pigment lightening with fewer side effects.

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.