Lasers in dermatology: a review

The revolution in laser technology has had a significant impact on medicine in general and dermatology in particular and has piqued the interest of physicians, the lay public, and the media. Advances in laser therapy have dramatically improved the clinicians' ability to treat cosmetic and noncosmetic skin lesions safely and effectively. The number and variety of skin problems amenable to laser treatment continues to grow. We will provide a review of the major cosmetic and therapeutic applications of laser therapy.

Successful treatment of spider leg veins with a high-energy, long-pulse, frequency-doubled neodymium:YAG laser (HELP-G)

BACKGROUND

While sclerotherapy has been the standard treatment for spider leg veins for many years, recent advances have allowed lasers to be considered as a treatment option.

OBJECTIVE

To study the efficacy of a frequency-doubled Nd:YAG laser at 532 nm with a 50 ms pulse width and chill tip device in the treatment of spider leg veins.

METHODS

Forty-six patients with spider leg veins with a diameter of less than 1 mm or 1-2 mm were treated with a frequency-doubled Nd:YAG laser at 532 nm with a pulse width of 50 ms (VersaPulse HELP-G laser) while using a water-cooled chill tip device.

RESULTS

Of patients with veins less than 1 mm in diameter, 60% had greater than 50% clearing after one treatment and 80% had greater than 50% clearing after two treatments. Of patients with veins 1-2 mm in diameter, 39% achieved greater than 50% clearing after one treatment and 67% had greater than 50% clearing after two sessions.

CONCLUSION

Our results suggest that the frequency-doubled Nd:YAG laser with a pulse width of 50 ms and chill tip device offers an excellent alternative to sclerotherapy in the treatment of small spider leg veins.

A case report of laser resurfacing as a skin cancer prophylaxis

BACKGROUND

Many patients suffer from multiple nonmelanoma skin cancers. We recently encountered two such patients who requested some form of prophylaxis against future skin cancers.

OBJECTIVE

To highlight the potential utility of laser resurfacing as a skin cancer prophylaxis.

METHODS

Two patients with histories of multiple facial skin cancers were treated with CO2 laser resurfacing for the purpose of skin cancer prophylaxis.

RESULTS

During a follow-up period of 33 and 52 months, both patients have remained free of skin cancers in the main treatment field while developing new tumors outside of this area.

CONCLUSION

Laser resurfacing should be considered as a potential method of achieving skin cancer prophylaxis in selected patients.

A novel application of the infrared coagulator in hair transplantation. Significant reduction of width of the donor site wound

BACKGROUND

The infrared coagulator, a by-product of laser technology, has been used in dermatology in a variety of settings. During hair transplantation sessions, we observed a significant reduction of the donor ellipse width while performing hemostasis with the infrared coagulator.

OBJECTIVE

Quantitative assessment of the donor wound width after infrared coagulator use, and correlation to the number of previous transplant sessions and patients' age.

METHODS

Twenty-four patients (22 men, two women) underwent hair transplantation. The infrared coagulator was utilized for hemostasis with a pulse duration of 2.5 seconds.

RESULTS

The infrared coagulator produced an average donor area decrease of 42%, while achieving rapid hemostasis. No correlation was demonstrated to number of previous transplant sessions or patients' age.

CONCLUSIONS

The infrared coagulator significantly decreases the donor wound width while providing hemostasis. Advantages include the potential of larger donor strip harvest, minimal tissue manipulation, and less traumatic closure.

A comparison of frozen and paraffin sections in dermatofibrosarcoma protuberans

BACKGROUND

Dermatofibrosarcoma protuberans (DFSP) is a tumor with a high local reoccurrence rate. Mohs micrographic surgery offers the highest cure rate. However, differentiating minimal residual tumor from normal skin can be difficult during Mohs surgery.

OBJECTIVE

To clarify the problem of determining when a tumor-free plane had been achieved during Mohs surgery for a DFSP.

METHODS

In two patients with DFSPs, we compared frozen and paraffin-embedded sections extending from tumor to normal skin, using both H&E and CD34 stains.

RESULTS

On frozen, but not paraffin-embedded, sections scattered dermal spindle cells were seen in normal skin.

CONCLUSIONS

Scattered dermal spindle cells in the dermis of normal skin make it difficult to differentiate minimal residual tumor from normal dermis during Mohs surgery. A biopsy of normal skin can be useful as a control in this setting.