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Khode S, Tan SHT, Tan EPA, Uppal S. Xanthelasma Palpebrarum: More than Meets the Eye. Indian J Otolaryngol Head Neck Surg 2019; 71:439-446. [PMID: 31742000 DOI: 10.1007/s12070-018-1345-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 04/05/2018] [Indexed: 10/17/2022] Open
Abstract
Xanthelasma palpebrarum (XP) is the most common form of cutaneous xanthomata, and is important aesthetically, because of its close relation to the eyes, as well as medically for its association with cardiovascular disease (CVD). To provide avant-garde review discussing the various aspects of XP, including its aetio-pathogenesis and various treatment modalities. A structured Pubmed and Medline were searched for relevant articles. The finding of recent research has strongly espoused the link between XP and CVD, and mechanisms have been suggested for its formation. The new technologies have led to a multitude of treatment options for XP. XP is a multi-faceted entity; other than simple treatment of the cosmetic aspect of the disease, one must be cognizant of its cardiovascular implications.
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Affiliation(s)
- Shailesh Khode
- Department of Otolaryngology - Head and Neck Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Yishun, 768828 Singapore
| | - Soon Heng Terry Tan
- Department of Otolaryngology - Head and Neck Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Yishun, 768828 Singapore
| | - En-Pei Amanda Tan
- Department of Otolaryngology - Head and Neck Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Yishun, 768828 Singapore
| | - Sandeep Uppal
- Department of Otolaryngology - Head and Neck Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Yishun, 768828 Singapore
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Patel L, McGrouther D, Chakrabarty K. Evaluating evidence for atrophic scarring treatment modalities. JRSM Open 2014; 5:2054270414540139. [PMID: 25352991 PMCID: PMC4207294 DOI: 10.1177/2054270414540139] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Atrophic scars cause significant patient morbidity. Whilst there is evidence to guide treatment, there does not appear to be a systematic review to analyse the efficacy of treatment options. Objectives To retrieve all evidence relating to atrophic scar treatment and evaluate using the Clinical Evidence GRADE score in order to allow clinicians to make evidence-based treatment choices. Method Searches were performed in Medline, EMBASE, CINHL and Cochrane to identify all English studies published evaluating treatment of atrophic scars on adults excluding journal letters. Each study was allocated a GRADE score based on type of study, quality, dose response, consistency of results and significance of results. The end score allowed categorisation of evidence into high, moderate, low or very low quality. Results A total of 41 studies were retrieved from searches including randomised controlled trials, observational studies, retrospective analyses and case reports of which 7% were allocated a high-quality score, 10% a moderate score, 7% a low score and 75% a very low score. Treatment modalities included ablative laser therapy, non-ablative laser therapy, autologous fat transfer, dermabrasion, chemical peels, injectables, subcision, tretinoin iontophoresis and combination therapy. Conclusion There is a paucity of good-quality clinical evidence evaluating treatment modalities for atrophic scarring. Evidence supports efficacy of laser, surgery and peel therapy. Further biomolecular research is required to identify targeted treatment options and more randomised controlled trials would make the evidence base for atrophic scar treatment more robust.
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Affiliation(s)
- Lopa Patel
- Department of Plastic Surgery and Burns Care, University Hospitals of South Manchester, Wythenshawe, Manchester M23 9LT, UK
| | - Duncan McGrouther
- Department of Plastic Surgery and Burns Care, University Hospitals of South Manchester, Wythenshawe, Manchester M23 9LT, UK
| | - Kaushik Chakrabarty
- Department of Plastic Surgery and Burns Care, University Hospitals of South Manchester, Wythenshawe, Manchester M23 9LT, UK
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Abstract
Acne vulgaris is a prevalent and non-discriminatory condition affecting individuals of all races and ethnicities. As people with skin of color make up a rapidly expanding segment of the US population, dermatologic care must evolve accordingly to address their distinct concerns. Patients with skin of color with acne can be particularly challenging, given their potential for cosmetically disturbing complications, including post-inflammatory hyperpigmentation and keloid development. A variety of treatments have been shown to be effective in preventing or treating these complications. Topical retinoids are considered first-line therapy for acne in patients of color; topical alternatives include azelaic acid, dapsone, and antimicrobials. Hydroquinone may be used in combating post-inflammatory hyperpigmentation, specifically. For more severe acne, oral agents, including oral antibiotics or isotretinoin, may be used. Most recently, various lasers and phototherapies have been suggested for their safety and efficacy in patients with skin of color with acne. Ultimately, recognizing the clinical and histologic differences, as well as the variations in treatment regimens for darker skin types will allow for better care and patient satisfaction.
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Affiliation(s)
- Natalie C Yin
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, USA,
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Clinical and histopathological evaluation of percutaneous collagen induction (dermaroller) in the treatment of postacne scars. JOURNAL OF THE EGYPTIAN WOMEN’S DERMATOLOGIC SOCIETY 2013. [DOI: 10.1097/01.ewx.0000432504.85255.ec] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Preissig J, Hamilton K, Markus R. Current Laser Resurfacing Technologies: A Review that Delves Beneath the Surface. Semin Plast Surg 2013; 26:109-16. [PMID: 23904818 DOI: 10.1055/s-0032-1329413] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Numerous laser platforms exist that rejuvenate the skin by resurfacing its upper layers. In varying degrees, these lasers improve the appearance of lentigines and rhytides, eliminate photoaging, soften scarring due to acne and other causes, and treat dyspigmentation. Five major classes of dermatologic lasers are currently in common use: ablative and nonablative lasers in both fractionated and unfractionated forms as well as radiofrequency technologies. The gentler nonablative lasers allow for quicker healing, whereas harsher ablative lasers tend to be more effective. Fractionating either laser distributes the effect, increasing the number of treatments but minimizing downtime and complications. In this review article, the authors seek to inform surgeons about the current laser platforms available, clarify the differences between them, and thereby facilitate the identification of the most appropriate laser for their practice.
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Affiliation(s)
- Jason Preissig
- Department of Dermatology, Baylor College of Medicine, Houston, Texas
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Sobanko JF, Alster TS. Management of acne scarring, part I: a comparative review of laser surgical approaches. Am J Clin Dermatol 2012; 13:319-30. [PMID: 22612738 DOI: 10.2165/11598910-000000000-00000] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Acne scarring is the result of a deviation in the orderly pattern of healing and can have profound psychosocial implications for patients. While the most effective means of addressing acne scarring is to prevent its formation through good acne control, there are a number of therapeutic interventions that improve the appearance of acne scars. Many of these procedural modalities have flaws and are limited by operator skill and experience. Laser scar revision, on the other hand, is a precise, well tolerated procedure with clinically demonstrable efficacy and minimal adverse effects that may be used alone or in combination with other scar treatments. The last 20 years has seen a dramatic evolution in laser treatment of acne scars, spanning ablative and nonablative technologies, to the current popularity of fractional laser scar revision. Determining which laser system to use depends upon the type and severity of acne scarring, the amount of recovery a patient can tolerate, and the ultimate goals and expectations of each patient. The importance of proper acne scar classification, laser scar revision techniques, and the evidence that addresses each laser system is reviewed in this article.
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Affiliation(s)
- Joseph F Sobanko
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
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Yeung CK, Chan NPY, Shek SYN, Chan HHL. Evaluation of combined fractional radiofrequency and fractional laser treatment for acne scars in Asians. Lasers Surg Med 2012; 44:622-30. [PMID: 22899398 DOI: 10.1002/lsm.22063] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Fractionated radiofrequency (RF) induces deep dermal heating and leaves the epidermis less affected. We studied the efficacy and safety of bipolar RF and fractional diode laser followed by fractional RF in Asians with acne scars. MATERIALS AND METHODS Twenty-four patients (skin types III and IV) with acne scars received up to five treatments of combined fractional 915-nm laser and bipolar RF using a Matrix IR applicator (Syneron Medical Ltd, Yokneam, Israel) with fluence ranging from 50 to 70 J/cm(2) , RF at 70-100 J/cm(3) , double passes followed by full-face bipolar fractional RF treatment using Matrix RF at energy ranging from 50 to 62 mJ/pin, at 4-week intervals. Changes in acne scars, skin texture, pore size, pigmentation irregularity, and complications were assessed up to 3 months post-treatment by standardized photographs obtained with Canfield Visia-CR system®. Subjective improvement and patient satisfaction were assessed by questionnaire. RESULTS Twenty patients (age 27.7 ± 8.4 years) completed the study. Modest but statistically significant improvement was noted in acne scars, with the mean grade decreased by 29% (P < 0.001), and 52% were rated with at least moderate objective global improvement at 3 months. Mean pain score was 2.6 on a scale of 0-4. There were also objective improvements in all secondary endpoints. Post-inflammatory hyperpigmentation (PIH) occurred mainly over bony areas in 6.5% of all treatments. Subjective improvement was moderate to significant for 36.8% of patients, and 63% reported being satisfied with the treatment results at 3 months despite considerable pain level. CONCLUSION Use of fractional laser with RF followed by fractional RF was shown to be safe and effective for acne scars with modest improvement and low PIH rate comparable to other resurfacing techniques in this Asian case series. Adequate pain control and recduced energy level when treating areas in close proximity to bone are advised. Lasers Surg. Med. 44: 622-630, 2012. © 2012 Wiley Periodicals, Inc.
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Affiliation(s)
- Chi K Yeung
- Division of Dermatology, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong.
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Wada T, Kawada A, Hirao A, Sasaya H, Oiso N. Efficacy and safety of a low-energy double-pass 1450-nm diode laser for the treatment of acne scars. Photomed Laser Surg 2011; 30:107-11. [PMID: 22133153 DOI: 10.1089/pho.2011.3063] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficacy and safety of a 1450-nm diode laser on acne scars in Asian patients. BACKGROUND DATA Acne and acne scars affect individuals during puberty and adolescence, and decrease their quality of life. METHODS An open study was performed on 24 Japanese patients (17 female and 7 male, aged 15-44 years) with acne scars on the face treated with five sessions of low-energy double-pass 1450-nm diode laser at 4-week intervals. The mean duration of the acne scars prior to receiving laser therapy was 4.8 years (range 1-9). Clinical evaluation by physicians and with photographs was conducted at baseline, 1 month after the final treatment, and at a 3-month follow-up visit. Topical therapies for acne vulgaris were permitted during the follow-up period. RESULTS All patients completed the five treatment sessions. Seventy-five percent of the subjects showed at least 30% improvement of acne scars. At the 3-month follow-up evaluation, 92.9% of the subjects with >30% improvement maintained the effectiveness. Vesicle formation and transient hyperpigmentation also occurred in one case. CONCLUSIONS The 1450-nm diode laser therapy was effective and well-tolerated in patients with acne scars, suggesting that this may be an appropriate modality for treating facial acne scars.
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Affiliation(s)
- Tamae Wada
- Department of Dermatology, Kinki University Faculty of Medicine, Ohno-Higashi, Osaka-Sayama City, Osaka, Japan
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ABAD-CASINTAHAN F, CHOW SKW, GOH CL, KUBBA R, MIYACHI Y, NOPPAKUN N, SEE J, SUH DH, YANG LC, KANG S. Toward evidence-based practice in acne: Consensus of an Asian Working Group. J Dermatol 2011; 38:1041-1048. [DOI: 10.1111/j.1346-8138.2011.01266.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Katz TM, Glaich AS, Goldberg LH, Friedman PM. 595-nm long pulsed dye laser and 1450-nm diode laser in combination with intralesional triamcinolone/5-fluorouracil for hypertrophic scarring following a phenol peel. J Am Acad Dermatol 2010; 62:1045-9. [PMID: 20363524 DOI: 10.1016/j.jaad.2009.06.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 05/19/2009] [Accepted: 06/11/2009] [Indexed: 11/19/2022]
Abstract
Hypertrophic scars and keloids are a therapeutic challenge because of the low response to treatment and recurrences after treatment. A variety of treatment regimens have been used with different degrees of success, with no universally accepted treatment protocol resulting in their complete and permanent resolution. We offer this case to demonstrate a combination approach for the treatment of hypertrophic scarring. A 75-year-old woman (with Fitzpatrick skin type II) presented with a 4-month history of scarring, which had developed following a phenol peel for perioral rhytides. The patient underwent 10 treatment sessions with the 595-nm long-pulsed dye laser followed immediately by the 1450-nm diode laser in combination with intralesional triamcinolone and 5-fluorouracil. After the fifth treatment session, about 90% improvement was noted; at the last treatment session, greater than 95% overall improvement was noted. Two and a half years after the last treatment session, the patient and treating physician noted no regression. A limitation of this therapy is that the combination approach makes it difficult to determine what individual contributions each treatment modality had on the final result. We have illustrated a successful multifaceted treatment regimen for hypertrophic scars and keloids using a combination approach.
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Lee DH, Choi YS, Min SU, Yoon MY, Suh DH. Comparison of a 585-nm pulsed dye laser and a 1064-nm Nd:YAG laser for the treatment of acne scars: A randomized split-face clinical study. J Am Acad Dermatol 2009; 60:801-7. [DOI: 10.1016/j.jaad.2008.11.883] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Revised: 11/03/2008] [Accepted: 11/19/2008] [Indexed: 12/22/2022]
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Ethnic groups and sensitive skin: two examples of special populations in dermatology. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.ddmec.2008.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Goerge T, Peukert N, Bayer H, Rütter A. Ablative fractional photothermolysis – A novel step in skin resurfacing. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.mla.2008.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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TAY YONGKWANG, KWOK COLIN. Minimally Ablative Erbium:YAG Laser Resurfacing of Facial Atrophic Acne Scars in Asian Skin: A Pilot Study. Dermatol Surg 2008; 34:681-5. [DOI: 10.1111/j.1524-4725.2008.34127.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Keller R, Belda Júnior W, Valente NYS, Rodrigues CJ. Nonablative 1,064-nm Nd:YAG laser for treating atrophic facial acne scars: histologic and clinical analysis. Dermatol Surg 2007; 33:1470-6. [PMID: 18076613 DOI: 10.1111/j.1524-4725.2007.33318.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Non-ablative methods have been attempted in treating atrophic facial scars, but the histologic findings do not always coincide with the clinical results and patient satisfaction. OBJECTIVE To study the effects and safety of the Nd:YAG laser for treating atrophic facial scars. MATERIAL AND METHODS Twelve subjects (skin phototypes II-V) with mild to moderate atrophic facial acne scars received five monthly treatments with 1,064 nm Nd:YAG laser and were photographed before, in the middle of, and 6 months after the last treatment. Histologic evaluations were performed on skin biopsies obtained before treatment and 1 month after the last session. Collagen quantification per area, before and after the treatment, was performed by morphometry, with computerized image analysis. Patient satisfaction and clinical condition were assessed using standard grading scales. RESULTS Mild to moderate clinical improvement was observed in most patients. Photographic assessment of scars found visible cosmetic improvement in eleven patients. All patients were satisfied. There were statistically significant collagen increases in the dermis following the treatment. Side effects were limited to mild transient erythema and increased skin sensitivity after the procedure. CONCLUSIONS The 1,064 nm Nd:YAG laser is a safe and effective nonablative method for improving atrophic scars, even in darker skin.
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Affiliation(s)
- Raquel Keller
- Department of Dermatology, University of São Paulo, São Paulo, Brazil.
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Abstract
BACKGROUND Therapeutic intervention for postacne scarring has historically been limited by the considerable morbidity of most treatments for only marginal disease improvement. Within the past decade, however, a greater understanding of the pathogenesis of acne scarring has led to the development of techniques that offer more favorable risk-benefit profiles. OBJECTIVE The aims of this article are to highlight a number of newer techniques and to assign their appropriateness to particular grades of acne scarring. MATERIALS AND METHODS Current modalities are discussed as they relate to disease process and specific acne scar types. Techniques are presented in order of most effectual therapeutic interventions for defined grades of acne scarring. Acne scarring grades have been described previously in terms of disease load, severity, and lesion morphologies. RESULTS A comprehensive discussion of updated therapeutic techniques and their biologic rationales in the treatment of acne scarring is presented. These include targeted interventions of inflammatory and postinflammatory processes, angiogenesis, immunologic processes, dermal and subcutaneous fibrosis, hypertrophy, and keloid scarring. DISCUSSION A requirement for developing successful treatments for postacne scarring is a greater understanding of its pathogenesis, variability among afflicted individuals, and the inflammatory mediators and immunology of the scarring process. Many innovative techniques introduced in the past decade attempt to counteract these pathologic processes while keeping the procedural and postoperative risks to a minimum.
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Affiliation(s)
- Greg J Goodman
- Skin and Cancer Foundation of Victoria and Monash University Department of Community Medicine, Victoria, Australia.
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Abstract
The ubiquity of increased sun exposure, oral contraceptives, and phototoxic drugs has led to an increased prevalence of conditions such as dyschromia, melasma, rhytides, and other signs of photoaging over the past few decades. Through the application of selective photothermolysis, laser surgery has attempted to create therapeutic options for these medically recalcitrant conditions. To date, however, this technology has been met with limited success, due to a high incidence of posttreatment side effects, inability to treat off the face, and a safety profile tailored to Fitzpatrick skin types I to III. More recently, a novel approach coined "fractional photothermolysis" was developed in an attempt to overcome these limitations. This new laser treatment modality has allowed for effective treatment of a diverse array of dermatologic conditions on and off the face with a wider therapeutic index and improved safety profile independent of Fitzpatrick skin type. This review sheds light on the technical aspects, biologic mechanisms, and clinical effects of fractional photothermolysis that help set it apart from previous modes of laser surgery.
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Affiliation(s)
- Basil M Hantash
- Division of Plastic Surgery, and Department of Dermatology, Stanford University Medical Center, 257 Campus Drive, Stanford, CA 94305, USA.
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Handley JM. Adverse events associated with nonablative cutaneous visible and infrared laser treatment. J Am Acad Dermatol 2006; 55:482-9. [PMID: 16908355 DOI: 10.1016/j.jaad.2006.03.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Revised: 03/08/2006] [Accepted: 03/14/2006] [Indexed: 11/26/2022]
Abstract
Since the theory of selective thermolysis was developed in the early 1980s, there have been numerous advances in both laser technology and the understanding of laser-tissue interaction. Nonablative dermatologic treatments involving laser light continue to be increasingly used for a number of diverse applications such as skin remodeling, the treatment of cutaneous melanocytic and vascular lesions, and the removal of undesired hair and tattoo pigment. Although these techniques are regarded as safe, both temporary and permanent adverse reactions do occur, many of which are thermally mediated. Little has been published on the frequency of adverse events in nonablative cutaneous laser treatments, or on the comparative efficacy of the various strategies commonly used to minimize them. Through reviewing relevant publications from the last 5 years, this article will address both these issues.
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Affiliation(s)
- Julian M Handley
- Bloomfield Laser and Cosmetic Surgery Centre, Bangor, Northern Ireland, United Kingdom.
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