Pulsed Dye Laser Treatment of Warts: An Update

BACKGROUND: Warts are a therapeutic challenge. New studies indicate that pulsed dye laser therapy may be effective, with clearance rates of 72 to 93%. OBJECTIVE: To determine clearance rate in pulsed dye laser treatment of warts and compare our rate to those of other published studies. METHODS: Thirty-three patients with 96 warts received pulsed dye laser treatment for recalcitrant plantar, digital, peri- and subungual, and body warts. RESULTS: Forty-eight percent of patients had complete wart clearance; 45% partially cleared. Sixty-nine percent of those who cleared remained wart-free for an average of 11 months. Mean fluence was 9.4 J/cm2, with an average of 3.4 treatments. Body and palmar warts responded best, digital and peri- and subungual next, and plantar lesions worst. No significant side effects were observed. CONCLUSION: Pulsed dye laser is an effective treatment option for recalcitrant warts with an excellent side effect profile. However, our response rates were not as high as those previously reported, and we feel that further studies would be useful.     

Pulsed dye laser treatment of recalcitrant verrucae: A preliminary report

Patients with recalcitrant warts on the fingers and hands, periungual, and other parts of the body including verrucae plana and plantar surfaces were treated using the pulsed dye laser at 585 nm, 450 usec, and a spotsize of 5 mm diameter. Of the 39 patients treated, 28 (72%) were cleared of their warts after an average of 1.68 treatments at fluences of 6.25–7.5 J/cm². Seven (18%) patients had a reduction of between 80–95% of their warts after 1.3 treatments, and verrucae reduced by 50% in four of the 39 patients after one treatment. The average follow-up period of the 28 cases cleared of their warts has been 5 months. Of this group, those with periungual warts have been followed for up to 6.4 months, compared to 4.8 months for those with warts on other parts of their body, 4.0 months for those with finger and hand warts, and 2.0 months for plantar warts. Only one of the 28 patients has had a recurrence after 3 months of clearance. © 1993 Wiley-Liss, Inc.     

Pulsed dye laser therapy for viral warts.

Twenty-eight patients with 103 recalcitrant and 20 simple viral warts were treated with the Cynosure PhotoGenica V pulsed dye laser at 585 nm, and fluencies of 6.0-9.0 J/cm(2). An eradication rate of 92% for recalcitrant warts after an average of 2.1 (range 1-7) treatments and 75% for simple warts after an average of 1.6 (range 1-2) treatments was achieved with a mean follow-up period of 7.2 (range 3-15) months. Mild hypopigmentation was noted in one patient and superficial infection in another. Unlike ablative treatment modalities, with pulsed dye laser therapy, no wound was created thus avoiding prolonged postoperative pain, disability and scarring. Treatment was well tolerated by patients, most of whom returned to work or normal activities immediately postoperatively. Pulsed dye laser is an effective treatment for both recalcitrant and simple warts. It is the treatment of choice for these lesions in cosmetically sensitive areas.     

Pulsed dye laser treatment of genital warts

BACKGROUND AND OBJECTIVES: Genital warts represent benign epithelial proliferations induced by human papillomavirus. The goal of treatment is the clearance of visible warts. Different regimens are available. Flashlamp-pumped pulsed dye laser (FPDL) represents one of many treatment options for the management of viral warts (verrucae vulgares), its effectiveness being comparable with that of conventional therapies. We evaluated the effectivity of FPDL light for the treatment of genital warts. STUDY DESIGN/MATERIALS AND METHODS: A prospective study was performed to examine the efficacy of FPDL in untreated genital warts in which 22 patients were included. RESULTS: All patients showed complete remission after 1.59 (1-5) laser sessions and no scarring was observed. CONCLUSIONS: This study demonstrate that FPDL is a simple and safe, cost and time saving alternative treatment option for genital warts and should be listed in genital warts treatment guidelines.     

Cutaneous Compression for the Laser Treatment of Epidermal Pigmented Lesions with the 595-nm Pulsed Dye Laser

BACKGROUND The 595-nm pulsed dye laser has been the standard of care for many vascular lesions and has rarely been used in the treatment of epidermal pigmented lesions.
OBJECTIVE The objective was to investigate the effectiveness and safety of a compression technique for the treatment of epidermal pigmented lesion using a modified 595-nm pulsed dye laser with no epidermal cooling.
METHODS Twelve subjects (mean age 58 years) underwent treatments using a modified 595-nm dye laser with a compression handpiece and no epidermal cooling. Treatments were performed with radiant exposures of 7 to 12 J/cm², 7-mm spot size, and 1.5-ms pulse duration. Each subject received one to four treatments, 4 to 6 weeks apart. Follow-up evaluations were held before each treatment and 4 months after last treatment.
RESULTS Clearance of 75% to 100% was obtained in 43, 59, 76, and 79% of the lesions treated after one, two, three, and four treatments respectively. The fourth treatment was evaluated 4 months posttreatment. Side effects included immediate erythema and edema and rare cases of transient hyperpigmentation and atrophy. No purpura and long-lasting side effects were observed.
CONCLUSION The compression technique with a modified 595-nm pulsed dye laser system is effective and safe for the treatment of epidermal pigmented lesions.     

Treatment of Common Warts with an Intralesional Mixture of 5-Fluorouracil, Lidocaine, and Epinephrine: A Prospective Placebo-Controlled, Double-Blind Randomized Trial

BACKGROUND 5-Fluorouracil is an antimetabolite that has been known to be effective for the treatment of common warts.
OBJECTIVE The objective was to evaluate the efficacy of a combination of 5-fluorouracil, lidocaine, and epinephrine (5-FU+LE) for the treatment of common warts.
MATERIALS AND METHODS Of the 40 patients initially enrolled, 34 patients with at least 68 verruca vulgaris (one pair for each subject) completed the study. The selected warts were randomized into two treatment groups, with one wart on each patient receiving intralesional 5-FU+LE (4 mL of 50 mg/mL 5-fluorouracil and 1 mL of a mixture of 20 mg/mL [2%] lidocaine and 0.0125 mg/mL epinephrine) and the other receiving intralesional normal saline placebo using a Mantoux needle. Patients received up to four injections at weekly intervals and were followed at 1 and 6 months after the initial injection.
RESULTS Complete response was observed in 64.7% of the warts treated with 5-FU+LE compared to 35.3% in the warts treated with placebo ( p <.05). Systemic reaction or treatment-related adverse medical events and recurrence rate did not differ significantly between two groups.
CONCLUSION The results show that intralesional 5-FU+LE is a safe and effective approach for common warts with high success rate.     

Nonablative Dermal Remodeling With a 585-nm, 350-μsec, Flashlamp Pulsed Dye Laser: Clinical and Ultrastructural Analysis

BACKGROUND.   A nonablative 350-μsec, 585-nm, flashlamp pulsed dye laser is currently being used for the treatment of rhytides.
OBJECTIVE.   To analyze both clinical rhytid improvement and electron microscopic evidence of ultrastructural changes after treatment with a nonablative 350-μsec, 585-nm, flashlamp pulsed dye laser.
RESULTS.   At 6 months after two treatments, 40% of the treated subjects noted mild improvement in rhytid appearance. Nontreating physician evaluation revealed some degree of improvement in 50% of the treated subjects. Mild improvement in quality and texture of the skin was also reported by 50% of the subjects. Electron microscopic evaluation showed ultrastructural changes that are consistent with new collagen formation.
CONCLUSION.   Treatment with a nonablative 350-μsec, 585-nm, flashlamp pulsed dye laser can lead to both clinical and electron microscopic evidence of improvement in photo-damaged skin.     

Evaluating the Efficacy of Treatment of Resistant Port-Wine Stains With Variable-Pulse 595-nm Pulsed Dye and 532-nm Nd:YAG Lasers

Background. Some port wine stains (PWSs), despite multiple treatments with the 585-nm 0.45-ms pulsed dye laser (PDL), fail to improve substantially.
Objective. To determine the efficacy and tolerability of variable pulse width 595-nm PDL and 532-nm Nd:YAG laser in the treatment of resistant PWS.
Methods. Twenty-two patients whose PWS failed to achieve more than 75% lightening after more than 15 treatments with the 585-nm 0.45-ms PDL were recruited. A homogenous patch of PWS was divided into five areas. Area 1 (control area) was treated with 585-nm, 0.45-ms PDL (fluence 7.5 J/cm²). Areas 2 and 3 were treated with 595-nm PDL at fluence 15 J/cm² (with cryogen spray cooling) and pulse durations of 1.5 and 10 ms, respectively. Areas 4 and 5 were treated with a 532-nm Nd:YAG laser at 2 ms, 7 J/cm² and 10 ms, 16 J/cm², respectively (with a contact cooling tip). The response was assessed by photographic evaluation.
Results. Three patients had further lightening in area 2, and two patients had further lightening in area 3. Each of three patients had further lightening in areas 4 and 5, respectively. One patient had further lightening in the control area.
Conclusion. In individual patients, it may be effective to treat resistant PWS with the variable-pulse width 595-nm PDL and the 532-nm Nd:YAG laser.     

Pulsed dye laser and intralesional bleomycin for treatment of resistant viol hand warts

BACKGROUND AND OBJECTIVE: Viral warts affect 7-10% of the population and are a major burden on time and resources of dermatology departments everywhere. Some warts prove resistant to multiple therapies, and this is particularly common in the immunosuppressed patient. Numerous treatments are available, but no one treatment has emerged as the treatment of choice. Bleomycin has been shown to be effective in treating warts, but administration can be difficult with risk of local complications. To demonstrate a new technique for easily and safely administrating bleomycin into warts, we undertook an open study to assess the practicality, efficacy, and tolerability of pulsed dye laser immediately followed by intralesional bleomycin in resistant viral hand warts. STUDY DESIGN/MATERIALS AND METHODS: Ten subjects, all with resistant viral hand warts of at least 3 years duration were recruited. Four subjects were on long-term immunosuppressant drugs. Eighteen warts treated in total. Area of the wart was anaesthetized with 1% lignocaine, then treated with a pulsed dye laser (7 mm spot, fluence 10 J/cm2). Immediately following this bleomycin (0.5 IU/ml) was injected into the base of the wart. Monthly follow-up and treatment until satisfactory clearance. RESULTS: Sixteen out of eighteen warts cleared (89%). Eight out of ten warts in the immunosuppressed subjects cleared. The remaining two warts responded partially to two treatments, but the patient was happy with the result and did not wish further treatment. All warts in the immunocompetent subjects cleared. No serious side effects were seen. CONCLUSIONS: The initial treatment of the wart with pulsed dye laser serves to "prepare" the wart for the bleomycin injection, which can then be given very easily. This ensures the drug is deposited into the base of the wart where it is most needed and minimises the risk of infiltration of normal skin or the operative environment. This method of combining pulsed dye laser and intralesional bleomycin appears to be a safe, rapid, well tolerated, and successful treatment for resistant hand warts. It has proven to be effective in warts in immunosuppressed patients and at difficult sites (e.g., subungual warts). These findings need confirmation from a larger controlled study.     

Use of a Novel Pulse Dye Laser for Rapid Single-Pass Purpura-Free Treatment of Telangiectases

BACKGROUND Purpura-free elimination of telangiectases with a single pass of a pulsed dye laser with a large spot has proved difficult.
OBJECTIVE The purpose of this report was to define parameters that achieve single-pass purpura-free telangiectasia reduction.
MATERIALS Thirty patients between the ages of 23 and 78 years were treated with a pulsed dye laser with a 10-mm spot and fluences ranging from 9 to 10 J/cm². The macropulse width was 20 ms. Each macropulse was composed of eight pulselets. Treatments were carried out over facial areas with discrete telangiectases.
RESULTS Smaller telangiectases (<600 μm) showed transient bluing followed by stenosis. Larger vessels (600–10,000 μm) showed bluing but inconsistent closure. A second pass typically resulted in closure.
CONCLUSION A modified pulsed dye laser was capable of single-pass purpura-free reduction with a 10-mm spot size.     

Treatment of Angiokeratoma of Fordyce with Pulsed Dye Laser

BACKGROUND: Angiokeratomas of Fordyce are typically asymptomatic vascular lesions characterized by blue-to-red papules with a scale surface, most often located on the scrotum. Although considered benign, the lesions may bleed, either spontaneously or secondary to rupture, leading to patient anxiety and social embarrassment. OBJECTIVE: The objective was to determine the safety and effectiveness of 585-nm pulsed dye laser for the treatment of angiokeratomas of Fordyce. METHODS: Twelve patients with Fitzpatrick skin type II to IV were treated for angiokeratomas of Fordyce with pulsed dye laser (5.5-8.0 J/cm(2)) in two to six sessions. Lesion clearance was evaluated by two specialists on the basis of digital photographs taken before the first treatment and 2 months after the last treatment. RESULTS: Seven patients had an excellent response (clearance rating 75%-100%) and five patients had a good response (clearance rating 50%-75%). Transient purpura and pain were present in all patients. Bleeding during treatment occurred in five patients. There were no permanent side effects. CONCLUSION: Pulsed dye laser is effective and safe for the treatment of angiokeratoma of Fordyce, with minimum side effects, providing an additional nonablative therapeutic option.     

脉冲染料激光治疗溃疡性血管瘤的临床研究

目的探讨脉冲染料激光(Pulsed dye laser,PDL)治疗溃疡性血管瘤的临床疗效和安全性。方法创面清洁的溃疡性血管瘤患儿,采用脉冲染料激光治疗(波长585 nm,脉宽0.45 ms,光斑5 mm,能量密度6.0～6.5 J/cm2),治疗间隔时间2～3周。治疗后随访观察溃疡完全再上皮化时间、疼痛缓解时间,以及溃疡创面的出血、感染等情况。结果本组共15例溃疡性血管瘤患儿,治疗前及治疗过程中均未接受其他治疗。14例(93.3%)仅接受1次PDL治疗,1～2周内溃疡创面完全再上皮化;1例(6.7%)接受2次PDL治疗后,溃疡创面再上皮化。溃疡的平均完全再上皮化时间为(1.68±0.23)周。所有患儿均在治疗后1～2 d内疼痛得到缓解。治疗后无一例出现溃疡创面扩大,未发生出血、感染等并发症。结论PDL能加快溃疡性血管瘤的创面愈合,缓解疼痛,治疗后无出血、感染及溃疡加重等并发症,可作为溃疡性血管瘤早期治疗的安全有效的方法。     

Light Therapy in the Treatment of Acne Vulgaris

Background. Over the past decade, lasers and light-based systems have become a common modality to treat a wide variety of skin-related conditions, including acne vulgaris. In spite of the various oral and topical treatments available for the treatment of acne, many patients fail to respond adequately or may develop side effects. Therefore, there is a growing demand by patients for a fast, safe, and side-effect–free novel therapy.
Objectives. To address the role of light therapy in the armamentarium of treatments for acne vulgaris, to discuss photobiology aspects and biomedical optics, to review current technologies of laser/light-based devices, to review the clinical experience and results, and to outline clinical guidelines and treatment considerations.
Results. Clinical trials show that 85% of the patients demonstrate a significant quantitative reduction in at least 50% of the lesions after four biweekly treatments. In approximately 20% of the cases, acne eradication may reach 90%. At 3 months after the last treatment, clearance is approximately 70% to 80%. The nonrespondent rate is 15% to 20%.
Conclusions. Laser and light-based therapy is a safe and effective modality for the treatment of mild to moderate inflammatory acne vulgaris. Amelioration of acne by light therapy, although comparable to the effects of oral antibiotics, offers faster resolution and fewer side effects and leads to patient satisfaction.     

Use of a Long-Pulse Alexandrite Laser in the Treatment of Superficial Pigmented Lesions

BACKGROUND/OBJECTIVE Although the alexandrite 755-nm-wavelength laser is effective in the treatment of unwanted hair, there are no published studies gauging the efficacy of the variable long-pulse alexandrite laser in the treatment of superficial pigmented lesions.
STUDY DESIGN/METHODS Eighteen patients underwent a single treatment session using a variable pulse-width alexandrite laser. Test sites were performed using a 10-mm spot size and up to four pulse widths (3, 20, 40, 60 ms) with and without epidermal cooling. Full treatments were performed 3 weeks later using optimum test parameters. The patients were evaluated at 3 and 6 weeks.
RESULTS Patients with darker lentigines had greater lesion clearance than those patients with lighter colored lentigines. Shorter pulse widths and treatment without cryogen cooling both, independently, lowered the fluence threshold for lentigo clearance.
CONCLUSION A long-pulse alexandrite laser is effective in clearing solar lentigines in a single pass with minimal adverse effects.     

Variables affecting clinical response to treatment of facial port-wine stains by flash lamp-pumped pulsed dye laser: the importance of looking beyond the skin

The response of port-wine stains (PWS) to conventional laser treatment in adults is difficult to predict. To assess the influence of local or systemic hemodynamic variables on the clearance of PWS by using flash lamp-pumped pulsed (FLPP) dye laser. All consecutive patients ages 18 years or older undergoing laser treatment for a facial PWS were eligible. Laser sessions were scheduled every 8 weeks. All patients were evaluated based on a standard scale with four evaluation categories, from no or minimal improvement to total or almost total clearance. Clearance was achieved by 50.1 % (95 % confidence interval 35.6–64.7) of patients after a maximum of 15 treatment sessions. In multivariate analysis, increased age, a newly described Type III capillaroscopic pattern, and presence of lesions in dermatome V2 were all associated with a reduced clinical response to treatment. In a model restricted to demographic pattern and patient characteristics, arterial hypertension was also associated with a lower clinical response. A strong association was found between arterial hypertension and the Type III capillaroscopic pattern. Age, arterial hypertension, capillaroscopic pattern, and body location should be considered when planning laser treatment of PWS.     

Clinical Evaluation of a 1,450-nm Diode Laser as Adjunctive Treatment for Refractory Facial Acne Vulgaris

BACKGROUND Despite aggressive multitreatment medical acne regimens, many patients demonstrate modest benefit. The 1,450-nm diode laser has been shown to improve acne in a study setting.
OBJECTIVE Herein we evaluate the use of this laser as an adjunctive tool in the management of refractory facial acne vulgaris.
MATERIALS AND METHODS Thirteen patients were treated. Lesion counts, clinical evaluation, and digital photography were performed at baseline and at all follow-up visits. Patients received an average of three treatments. Acne severity index and patient satisfaction were assessed. Patients continued their medical acne regimen where applicable.
RESULTS Mean total lesion and inflammatory lesion counts decreased from 66 ± 14 and 23 ± 5 at baseline to 34 ± 12.9 and 14 ± 7 after three treatments ( p <.05). Side effects were mild, including erythema lasting up to 24 hours.
CONCLUSION The 1,450-nm diode laser provides moderate improvement of refractory acne vulgaris. Our findings support the use of this device as an adjunctive treatment for acne management.     

Treatment of Anogenital Warts by Pulsed Dye Laser

BACKGROUND: Treatment of anogenital warts is difficult in that the disease spectrum is wide. Moreover, varying degrees of improvement are obtained. OBJECTIVE: To study the treatment of persistent anogenital warts by pulsed dye laser. METHODS: Pulsed dye laser was used with the following settings: spot size 7 mm, pulse duration 1500 microsec, and fluence 7.5 J/cm2. Two different wavelengths were used: 585 and 595 nm. RESULTS: Lesions healed completely using both wavelengths after one treatment. CONCLUSION: Pulsed dye laser has been found to be safe, effective, satisfactory, and less traumatic compared to other options for treatment of perianal warts in children.     

Off-label photodynamic therapy for recalcitrant facial flat warts using topical 5-aminolevulinic acid

The facial flat wart (verruca plana) is one of the most common reasons for dermatology and primary care visits. Although there are many therapeutic modalities, no single therapy has been proven to be completely curative. Case reports and uncontrolled studies suggested that photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) can effectively treat recalcitrant facial flat warts. A total of 12 patients with recalcitrant facial flat warts were enrolled in the study. ALA gel (10 %) was applied topically to lesions and incubated for 3 h. The lesions were irradiated by an LED light of 630?±?10 nm at dose levels of 60–100 mW/cm. Clinical assessment was conducted before and after every treatment for up to 24 weeks. Among the ten patients completing three sessions of ALA-PDT, five had complete lesions clearance, and the other five patients were significantly improved. At the 24-week follow-up, the average effective rate was 88.8 %, with no recurrences. No significant side effects were reported. A low-dose topical ALA-PDT regimen using 10 % ALA, 3 h incubation, and a red light source for three treatment sessions are suggested as the optimal scheme for the treatment of recalcitrant flat warts on the face in Chinese patients. Superior efficacy is found in elevated or active period lesions with mild side effects.     

Evaluation of the 1,540-nm Erbium:Glass Laser in the Treatment of Inflammatory Facial Acne

BACKGROUND The erbium:glass laser is approved to treat inflammatory acne on the back.
OBJECTIVE This aim of this study was to evaluate the use of the 1,540-nm erbium:glass laser in the treatment of moderate to severe inflammatory acne on the face.
METHODS AND MATERIALS An erbium:glass laser (Aramis, Quantel Medical, Clermont-Ferrand, France) was used to treat 15 patients with moderate to severe acne four times at 2-week intervals. Active lesions were first treated with six pulses at 10 J/cm². The entire face was then treated with a single pass using bursts of four pulses at 10 J/cm². Sebum measurements were performed. Six patients continued in a double-arm study to determine whether an additional treatment at 6 months would prolong the lesion-free period. Final evaluation was at 9 months.
RESULTS At 6-month follow-up, patients rated improvement as 68%, and the mean investigator improvement assessment was 78%. Sebum measurements did not change. No patients required anesthesia, and no side effects were observed. A single retreatment session 6 months after the initial course held clearance at 80% at 9-month follow-up, whereas patients without retreatment had 72% clearance.
CONCLUSION Treatment of inflammatory facial acne with the 1,540-nm erbium:glass laser is effective and relatively painless. Papules, pustules, and nodules all respond well to therapy. Additional treatment sessions may prolong the lesion-free period, and maintenance therapy should be included as a part of the treatment course.     

Recalcitrant Adverse Reaction to Vitamin K: Response to Pulsed Dye Laser

BACKGROUND: Adverse cutaneous reaction to vitamin K manifests in sclerodermatous or erythematous plaque-like reactions. Most of the cases with erythematous plaque-like dermatitis arising at the site of intramuscular vitamin K injection were recalcitrant and did not respond to various attempts with topical and intralesional corticosteroid. OBJECTIVE: The objective was to describe a 25-year-old woman with recalcitrant adverse reaction owing to vitamin K who was successfully treated with pulsed dye laser. METHODS: Two consecutive pulsed dye laser treatments were performed 3 weeks apart with 450-microec pulse duration, 585-nm pulse width, and fluence of 5 and 7 J/cm(2), respectively, using a 7-mm handpiece. RESULTS: One week after the second treatment, her skin lesion was cleared and she was followed without recurrence for 7 months. CONCLUSION: Although the precise mechanism remains yet to be proven, we have demonstrated successful treatment of localized adverse cutaneous reaction to vitamin K in one patient with the pulsed dye laser.