Treatment of Granuloma Annulare with the 585 nm Pulsed Dye Laser

BACKGROUND: Granuloma annulare is a chronic asymptomatic dermatosis that is typically manifested by annular papules arising on the dorsa of the hands, feet, elbows, and knees. Multiple treatment modalities have been used with variable efficacy, but no known cure exists. Obtaining long-term resolution of involved areas is often a therapeutic challenge. OBJECTIVE: We report the results of treatment of a patient with localized erythematous granuloma annulare with a 585 nm flashlamp-pumped pulsed dye laser. METHODS: A single granuloma annulare plaque present on the left wrist for 3 years was treated on three occasions with a 585 nm flashlamp-pumped pulsed dye laser initially and repeated at months 5 and 13. RESULTS: After initial pulsed dye laser treatment, significant flattening and reduction of erythema were evident within the treated area. After a second treatment at month 5 and a third treatment at month 13, further improvement was evident, and long-term remission was achieved. CONCLUSION: Localized granuloma annulare may be difficult to manage, presenting a therapeutic challenge. Thorough understanding of available treatment options, their relative efficacies, and risks of complication can facilitate successful management of this chronic disease. Pulsed dye laser therapy may be an effective and relatively safe treatment option for erythematous granuloma annulare, although prospective studies in additional patients would be desirable. Improvement of the condition in a single patient does not imply that others might improve, and variability in response is more likely.     

Use of a 585 nm Pulsed Dye Laser for the Treatment of Morphea

INTRODUCTION: The clinical presentation of morphea varies from localized plaques to generalized eruptions. Its cause remains unknown and medical treatments have often proved unsatisfactory. Studies have previously shown that improvement of hypertrophic scars and fibrotic skin can be achieved with the use of a 585 nm pulsed dye laser (PDL). METHODS: A case of plaque-type morphea was treated with 585 nm pulsed dye laser irradiation at an average fluence of 5.0 J/cm2 at bimonthly time intervals. RESULTS: Marked clinical improvement as evidenced by improved pliability and skin coloration was seen after 4 successive PDL treatments. No side effects or complications were encountered. CONCLUSION: Pulsed dye laser therapy is a viable treatment option for morphea. The mechanism of its effect in this condition remains unknown.     

Effect of the 585 nm Flashlamp-Pumped Pulsed Dye Laser for the Treatment of Keloids

BACKGROUND: Due to its potential effects on skin microcirculation and collagen metabolism, the 585 nm flashlamp-pumped pulsed dye laser has been proposed for treating abnormal scars. Indeed, one of the main problems with keloidal scars is their disfiguring erythematous color. OBJECTIVE: To assess the efficacy of the 585 nm pulsed dye laser on the appearance of keloids. METHODS: Eleven patients with skin phototypes II-IV and keloids were treated with the 585 nm pulsed dye laser. After one to three treatment sessions, clinical assessments of the scars were performed in combination with remittance spectroscopy measurements of the redness and melanin pigmentation. A group of nine keloids covered by silicone gel sheeting served as controls. Data were compared statistically. RESULTS: During laser treatments, a discrete decrease in redness of the scars was clinically reported. However, this improvement was not confirmed by the objective spectrophotometric data. No side effects, especially hyperpigmentation, were disclosed. The keloids redness was not improved in the control group. CONCLUSION: The 585 nm pulsed dye laser yields only minimal effects, if any, on the erythema of keloids. Similarly silicone gel sheeting does not modify the keloids redness.     

Selective Nonablative Treatment of Acne Scarring With 585 nm Flashlamp Pulsed Dye Laser

BACKGROUND: Selective nonablative wrinkle reduction with low-fluence pulsed dye laser has been shown to provide cosmetic benefits by stimulating the production of dermal collagen. The clinical efficacy for improving the appearance of acne scarring using selective nonablative laser treatments has yet to be established. OBJECTIVE: To evaluate the improvement in the appearance and topography of acne scarring following application of a 585 nm pulsed dye laser with a temporal profile and pulse duration designed specifically to target healthy microvasculature in the dermis. METHODS: Ten patients (mean age 34.8 years) with Fitzpatrick skin types I-IV and shallow to moderately deep, saucerized facial acne scars were enrolled in a prospective trial to receive a single laser treatment of both cheeks. Patients were evaluated at 30, 60, 90, and 120 days to assess the degree of clinical improvement. The evaluation process included assessment of pre- and posttreatment photography by two independent observers, patient assessment surveys, and surface profilometry using silicone imprints in order to quantify the degree of clinical improvement. RESULTS: All 10 patients reported visible cosmetic improvement in the treated areas while surface profilometry showed that, on average, the depth of the acne scars was reduced by 47.8%. No adverse effects of this treatment were reported. CONCLUSION: The treatment of acne scars utilizing a 585 nm pulsed dye laser with a temporal profile and pulse duration designed specifically to target healthy microvasculature in the dermis may be a safe and effective noninvasive alternative for a natural result.     

The Effect of Cold Air Cooling on 585 nm Pulsed Dye Laser Treatment of Port-Wine Stains

BACKGROUND: The use of cryogen spray cooling in the course of dye laser treatment of port-wine stains has established itself in recent years because of its good analgesic and epidermally protective effects. The disadvantages of this kind of evaporative cooling are the cost and, in the case of dichlorodifluoromethane, the effects on the ozone layer. Cold air is an innovative cooling method that costs nearly nothing to use, is environmentally friendly, and can be easily adapted to existing laser systems. OBJECTIVE: To examine and evaluate cold air cooling as an alternative method of cooling in laser treatment. METHODS: In a prospective study, 13 patients (9 female, 4 male) with port-wine stains were treated with a pulsed dye laser (lambda = 585 nm, tau(p) = 450 microsec). In every case, either the entire area or a sample area of the port-wine stain was treated with cold air cooling on 50% of the surface and without on the other 50%. Clearance, analgesia, and adverse and concomitant effects were assessed. RESULTS: In nine patients (69%) there were similar results in terms of clearance. In four cases, better lightening results (in two patients) and worse lightening results (in two other patients) were achieved in the area treated with cold air. Nine of the patients (69%) felt that the laser impulses accompanied by cold air were significantly less painful. Adverse effects (purpura, erythema, edema) and concomitant effects (hypopigmentation, hyperpigmentation, scars) were much less marked in the cooled areas. CONCLUSION: Cold air is a safe and effective alternative to cryogen spray cooling. It is easy to use, economical, and environmentally friendly. Continuing studies are necessary to determine if there are interactions which affect the tissue.     

Treatment of Pigmented Hypertrophic Scars with the 585 nm Pulsed Dye Laser and the 532 nm Frequency-Doubled Nd:YAG Laser in the Q-Switched and Variable Pulse Modes: A Comparative Study

BACKGROUND: Pigmented hypertrophic scars are a difficult condition to treat. They may result from traumatic injuries or from surgical and cosmetic procedures. The 585 nm flashlamp-pumped pulsed dye laser (FLPDL) has been used to treat this condition, with significant improvement of varying degrees. It remains to be determined whether other laser modalities may have a similar or even greater success in the treatment of pigmented hypertrophic scars. OBJECTIVE: To determine the efficacy of the 532 nm frequency-doubled Nd:YAG laser in the treatment of pigmented hypertrophic scars as compared to the 585 nm FLPDL. METHODS: Six patients with pigmented hypertrophic scars and skin phototypes II-IV were chosen. A scar was selected for treatment in each patient and divided into four equal 2 cm segments. Three segments were each treated with a different laser modality and one was left untreated to serve as the control. A 585 nm FLPDL was used with an energy of 3.5 J, a pulse duration of 450 microsec, and a 10 mm spot size. A 532 nm Q-switched frequency-doubled Nd:YAG laser was set to an energy of 2.8 J, a 10-nsec pulse, and a 3 mm spot size. The same 532 nm laser was set to the variable pulse mode to treat a 2 cm scar segment, with an energy of 9.5 J, a 10-msec pulse, and a 4 mm spot size. An average of 3.3 treatments were performed on each scar segment, at intervals of 4-6 weeks and long-term follow-up at 22 weeks. Treatment outcome was graded by a blind observer using the Vancouver General Hospital (VGH) Burn Scar Assessment Scale. A SigmaStat t-test was used to determine the statistical significance of the values obtained. RESULTS: Treatment of pigmented hypertrophic scars with the 532 nm Q-switched Nd:YAG laser led to a significant improvement of 38% in the VGH scores when compared to baseline (P =.005). The 585 nm FLPDL also had a favorable effect on the scars, with an average improvement of 36.1% in the VGH scores. There was no significant difference noted between the outcome of treatment with either of these two lasers. Treatment with the 532 nm variable pulse Nd:YAG laser led to a 19% improvement in the VGH scores of scars, which did not differ significantly from the 16.1% improvement observed in control scars on the last follow-up visit. No side effects or complications from treatment were noted or reported during the course of the study. At the conclusion of the study, five of six patients chose the segment treated with the 532 nm Q-switched Nd:YAG laser as the best segment overall. CONCLUSION: The 532 nm Q-switched Nd:YAG laser and the 585 nm FLPDL offer comparable favorable results in the treatment of pigmented hypertrophic scars. The 532 nm Q-switched Nd:YAG laser may be preferred by patients particularly distressed by the dark color of their scars.     

Treatment of Dermatofibroma with a 600 nm Pulsed Dye Laser

BACKGROUND: Dermatofibroma (DF) is one of the most basic and common dermatologic diseases treated by practicing dermatologists on a daily basis. Although benign, it can be pruritic or tender. Furthermore, it is difficult to treat effectively with optimal cosmetic outcomes. OBJECTIVE: We report a safe, effective, and cosmetically superior method of treating DF with the 600 nm pulsed dye laser (PDL). METHODS: We used a 600 nm PDL to treat 20 lesions from 18 Caucasian patients. The laser parameter was set at a fluence of 7 J/cm2, a spot size of 7 mm and a pulse duration of 1.5 ms. Each lesion was treated three times at a 6- to 8-week interval. For each treatment, the lesion was double pulsed with a 20 to 30% overlap. Clinical improvement was graded by a single examiner in evaluating three clinical parameters: color, size/volume, and symptoms. For each parameter, improvement was ranked as no improvement, partial improvement, and complete response. RESULTS: All 18 patients (17 women) completed the study. For the volume/size parameter, 15 of 20 lesions (75%) showed complete response. For improvement in color, 12 of 20 patients (60%) showed complete response. Only six lesions were symptomatic (i.e., tender and irritating), and all six lesions showed complete resolution of symptoms after the PDL treatments. After each treatment, all patients experienced blistering, crusting, and purpura that usually resolved after 10 days. CONCLUSIONS: We have demonstrated for the first time that PDL (600 nm and 1.5 ms pulse duration) is an effective and safe treatment of DF. It may provide superior cosmetic outcomes compared with other modalities such as surgical excision.     

Collagen Remodeling After 585-nm Pulsed Dye Laser Irradiation: An Ultrasonographic Analysis

BACKGROUND AND OBJECTIVES: Nonablative dermal remodeling is an evolving technology that has generated great interest among both laser surgeons and patients. Evidence indicates that dermal collagen formation is the key mechanism of action for the nonablative techniques. We studied, with ultrasound, new collagen formation after nonablative laser irradiation. METHODS: Ten patients with facial rhytids underwent a single treatment with a 585-nm pulsed dye laser. The patients were all female, ranging in age from 47 to 67, and were Fitzpatrick skin types I-III. Laser parameters were as follows: an energy fluence of 2.4 to 3.0 J/cm2, a pulse duration of 350 microsec, and a spot size of 5 mm with no overlap. Ultrasonographic assessments of dermal collagen were taken at baseline and at 30 and 90 days after treatment. RESULTS: Ultrasonography demonstrated an increase in dermal collagen after a single treatment with the 585-nm pulsed dye laser. The greatest degree of neocollagenesis occurred periocularly. CONCLUSION: A single treatment with a 585-nm pulsed dye laser appears to increase dermal collagen. This increase in dermal collagen can be assessed with noninvasive cutaneous ultrasound.     

585-nm Pulsed Dye Laser in the Treatment of Surgical Scars Starting on the Suture Removal Day

BACKGROUND: The optimal time frame to improve the quality and cosmetic appearance of scars by laser therapy has not been clearly elucidated by prior controlled clinical trials. OBJECTIVE: To determine the efficacy of the 585-nm pulsed dye laser (PDL) in the treatment of surgical scars starting on the day of suture removal. METHODS: Eleven patients (skin types I-IV) with 12 postoperative linear scars that were greater than 2 cm were treated three times on monthly intervals with the 585-nm PDL (450 micro s, 10-mm spot size, 3.5 J/cm2 with 10% overlap) on one scar half, whereas the other half received no treatment. Scars were later evaluated by a blinded examiner using the Vancouver Scar Scale (VSS) for pigmentation, vascularity, pliability, and height. Scars were then blindly examined for cosmetic appearance using a visual analog scale. RESULTS: One month after the last treatment, final scar analysis by the blinded examiner revealed a significant difference between treated and untreated sites, with the treated halves scoring better in all scar parameters in the VSS and in cosmetic appearance. The treated halves demonstrated an overall average improvement in the VSS between the first treatment score and the final score of 54% versus 10% in the controls (P=0.0002). The cosmetic appearance score (0=worst; 10=best) at final assessment was significantly better for the treated scars, scoring 7.3 versus the averaged control score of 5.2 (P=0.016). CONCLUSION: The 585-nm PDL is effective and safe in improving the quality and cosmetic appearance of surgical scars in skin types I-IV starting on the day of suture removal.     

Treatment of Vascular Skin Lesions with the Variable Pulse 595 nm Pulsed Dye Laser

BACKGROUND: In the dermatology field, variable-pulse 595 nm pulsed dye lasers (PDLs) are now being widely used to treat vascular skin lesions. However, there is little information available on variable-pulse 595 nm PDL treatment of dark-skinned patients. OBJECTIVE: The objective of this study was to evaluate the outcome of variable-pulse 595 nm PDL treatment on Korean patients. METHOD: Two hundred thirty-nine patients (Fitzpatrick skin phototypes III to V) with vascular skin lesions, such as nevus flammeus, telangiectasia, or hemangioma, were included in this study. All patients were treated with a variable-pulse 595 nm PDL, and the outcomes were assessed by comparing preoperative and postoperative photographs. RESULTS: The average number of treatments per patient was 4.29, and 51.9% of patients showed a good (51-75% clearance) to excellent (76-100% clearance) response. For nevus flammeus, 48.0% of the patients achieved good to excellent results. The gender and age of the patients did not influence the clinical response; however, lesions of the head and neck were found to respond more favorably to treatment. For telangiectasia, 78.0% of patients showed good to excellent results, and, again, the gender and age of the patients did not alter the treatment outcome. For hemangioma, the male to female ratio of patients was 1.0:3.1 and 54.1% of the patients achieved a good to excellent response. Superficial hemangioma showed a better clinical response than deep hemangioma, and the lesions of younger patients responded more favorably than those of older patients. CONCLUSION: The variable-pulse 595 nm PDL was found to be effective for treating several vascular skin lesions in dark-skinned patients. However, there were differences in treatment outcome owing to disease, age, and the location of the lesions.     

Radiofrequency and 585-nm Pulsed Dye Laser Treatment of Striae Distensae: A Report of 37 Asian Patients

BACKGROUND: Various lasers have recently been reported as effective treatment modalities for striae distensae, but pigmentary alterations are a major concern to the darker skin type. The Thermage (Therma Cool TC; Thermage Inc, Hayward, CA) is a radiofrequency device for the lifting of face and neck, and there is no report of using it for striae distensae. OBJECTIVE: The purpose was to evaluate the effectiveness of the Thermage in combination with pulsed dye laser. MATERIALS AND METHODS: Thirty-seven patients with abdominal striae distensae were treated with the Thermage and 585-nm pulsed dye laser in the first session at baseline. An additional two sessions of pulsed dye laser were performed at Weeks 4 and 8. Thermage was used at fluences of 53 to 97 J/cm2 and pulsed dye laser at fluences of 3.0 J/cm2 with 10-mm spot. Skin biopsies were taken of nine patients. RESULTS: In the subjective assessment, 89.2% of the patients showed "good and very good" to overall improvement, and 59.4% were graded as "good and very good" in elasticity. All of the nine specimens showed an increase in the amount of collagen fibers, and increased elastic fibers were found in six specimens. CONCLUSION: The Thermage and pulsed dye laser appear to be an effective treatment for striae distansae.     

Laser Scar Revision: Comparison Study of 585-nm Pulsed Dye Laser With and Without Intralesional Corticosteroids

BACKGROUND: Hypertrophic scars affect 1.5% to 4.5% of the general population and remain notoriously difficult to eradicate because of the high recurrence rates and the incidence of side effects associated with treatment. Pulsed dye laser (PDL) treatment and intralesional corticosteroids have individually been reported to be effective in reducing hypertrophic scar bulk and symptoms. OBJECTIVE: To determine whether combination PDL and intralesional corticosteroid treatment produces better hypertrophic scar improvement than PDL treatment alone. METHODS: Bilateral hypertrophic inframammary scars in 22 females were randomly assigned to receive treatment with 585-nm PDL alone or in combination with intralesional corticosteroid. Clinical evaluations and scar pliability scores were determined before each of the two treatment sessions and 6 weeks after the final treatment. Histologic evaluation of skin biopsies obtained before and after treatment was performed in four patients. RESULTS: All scars showed clinical improvement with increased pliability and decreased symptoms (pruritus) after each of the two treatments. Clinical improvement scores were not significantly better with the concomitant use of corticosteroids. Side effects were limited to mild purpura and transient hyperpigmentation. Decreased sclerosis was seen in scars after PDL treatment (with or without concomitant corticosteroids). CONCLUSIONS: Treatment of hypertrophic inframammary scars with 585-nm PDL irradiation alone effected substantial clinical and histologic improvement. The adjunctive use of intralesional corticosteroids did not significantly enhance clinical outcome except in those scars that were most symptomatic.     

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.     

婴幼儿血管瘤的脉冲染料激光治疗

婴幼儿血管瘤(Infantile hemangioma,IH)是最常见的婴幼儿良性肿瘤,虽为自限性疾病,但其外观及并发症影响患儿的身心发育,成为家长的心理负担。脉冲染料激光(Pulse dye laser,PDL)是用于血管性病灶的规范化激光,用于治疗浅表婴幼儿血管瘤已有20余年,但仍存在争议。本文综合阐述PDL治疗IH的研究进展,为IH的治疗提供方向。     

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.     

IPL联合595nm脉冲染料激光治疗玫瑰痤疮的疗效及安全性分析

目的:探究强脉冲光(Intense pulsed light,IPL)联合595 nm脉冲染料激光(PDL)治疗玫瑰痤疮的疗效和安全性。方法:选取2019年1月-2020年1月笔者科室就诊的80例玫瑰痤疮患者进行回顾性分析,其中仅采用595 nm PDL治疗的38例患者为对照组,采用IPL联合595 nm PDL治疗的42例患者为观察组。比较两组治疗效果并分析其安全性。结果:观察组治疗总有效率显著高于对照组,差异有统计学意义(P<0.05);治疗后,观察组红斑毛细血管扩张、脓疱丘疹、瘙痒、红斑评分及DLQI生活质量评分均显著低于对照组,差异有统计学意义(P<0.05);治疗后,观察组C反应蛋白(CRP)、肿瘤坏死因子(TNF-α)、白介素-6(IL-6)水平均显著低于对照组,差异有统计学意义(P<0.05);观察组在治疗方式、治疗效果、术后护理方面满意度均显著高于对照组,差异有统计学意义(P<0.05);治疗后两组均未出现瘢痕、色素沉着、结痂及水疱等不良反应,且肝肾功能及眼底检查未见异常。结论:IPL联合595 nm PDL治疗玫瑰痤疮疗效明显,可有效改善红斑、...     

Treatment of Elastosis Perforans Serpiginosa with the Flashlamp Pulsed Dye Laser

BACKGROUND: Elastosis perforans serpiginosa (EPS) is an uncommon and chronic dermatosis characterized by the transepidermal elimination of altered elastic fibers originating in the dermis. Frequently arranged in an arcuate or serpiginous pattern, the end stage of the disease is atrophic or stellate-shaped scars. OBJECTIVE: Prior therapy has primarily involved cryotherapy with liquid nitrogen which may cause scar or keloid formation. We present our experience using the flashlamp pulsed dye laser to treat EPS. METHODS: A young man with Down syndrome was referred by his primary care physician for treatment of a chronic dermatosis unresponsive to topical therapy. The clinical findings were consistent with EPS, and a biopsy specimen and elastic tissue stain confirmed the diagnosis histologically. After a successful test spot, treatment was begun on the erythematous papules using a flashlamp pulsed dye laser (585 nm) with a 5 mm spot size and fluences of 6.0-7.0 J/cm2. RESULTS: Treated areas showed moderate to marked improvement overall. There was less erythema, thickness, and scarring in treated areas compared with active or end-stage lesions. CONCLUSION: The flashlamp pulsed dye laser may be an effective treatment method for EPS.     

Treatment of "Cyrano" Angioma with Pulsed Dye Laser

BACKGROUND: Hemangiomas of the nasal tip, the so-called Cyrano nose, are often deep, disfiguring, and persistent. OBJECTIVE: To evaluate the effect of treatment with pulsed dye laser on Cyrano nose. METHODS: A 3-month-old boy with hemangioma of the nasal tip of 1-months duration underwent six sessions of pulsed dye laser treatment with a 7 mm collimated beam at fluences of 5.75-6.5 J/cm2, 6 weeks apart. RESULTS: Initial improvement was noted after two treatments, and the lesion showed a marked reduction in size and improvement in color over a total treatment period of 9 months. CONCLUSION: Treatment with the 585 nm pulsed dye laser should be considered in the management of infants with mild to moderate degrees of nasal tip hemangiomas since it effectively reduces the lesions with minimal adverse effects.     

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.