Gingival melanin depigmentation by Er:YAG laser: A literature review

Laser ablation is recently suggested as a most effective and reliable technique for depigmentation of melanin hyperpigmented gingiva. To date, different lasers have been used for gingival depigmentation (CO₂, diode, Nd:YAG, Er:YAG and Er,Cr:YSGG lasers). The use of Er:YAG laser for depigmentation of melanin hyperpigmented gingiva has gained increasing importance in recent years. The purpose of this study was to report removal of gingival melanin pigmentation using an Er:YAG laser in a literature review. The main outcomes, such as improvement of signs (clinical parameters of bleeding, erythema, swelling and wound healing), symptoms (pain) and melanin recurrence/repigmentation were measured. The literature demonstrated that depigmentation of gingival melanin pigmentation can be performed safely and effectively by Er:YAG laser resulting in healing and an esthetically significant improvement of gingival discoloration. Thus, Er:YAG laser seems to be safe and useful in melanin depigmentation procedure. However, the main issue in giving the final conclusion of the optimal Er:YAG laser use in melanin depigmentation is that, to date, studies are offering completely discrepant Er:YAG laser procedure protocols (complex settings of laser parameters), and different criteria for the assessment of depigmentation and repigmentation (recurrence), thus hampering the comparison of the results. Therefore, further studies are necessary to give an optimal recommendation on the use of Er:YAG laser in gingival melanin hyperpigmentation.     

All done procedure by laser in free gingival graft treatment: A case series study

Aim: This case series study evaluated the application of Er;Cr:YSGG laser for a free gingival graft procedure and the effect of low level laser therapy on post surgical pain and wound healing. Cases: 6 cases with mucogingival problems needing free gingival grafts were selected. First, the recipient site was anesthetized and de-epithelialization was done with a Er;Cr:YSGG laser. After tracing the palatal donor site with the laser, the graft was harvested. For root modification of the recipient tooth, conditioning of the dentin was done by the same laser. The inner side of graft was trimmed by the laser before suturing at the recipient site. After final adaptation of the grafts and suturing process, the recipient and donor sites were irradiated by therapeutic laser for reduction of post surgical complications. Results: All patients reported the reduction in pain level after day 2 on donor and recipient site. Also, the wound healing was achieved after 14 days in all cases in donor site. Conclusion: According to high surface absorbance, better incision, coagulation and application on both soft and hard tissues, Er;Cr:YSGG laser can be safe, minimally invasive manner and useful for all steps of the free gingival graft procedure.     

Correction of nasolabial folds wrinkle using intraoral non-ablative Er:YAG laser

Background: The accentuated nasolabial folds (NLFs) is the most pronounced sign of aging. Non-ablative erbium:yttrium aluminum garnet laser (ER:YAG), Smooth mode was used for the treatment of mucosal tissue. It was reported that it is effective in facial rejuvenation.

Aim: To assess the safety and the effectiveness of intraoral ER:YAG Smooth mode laser in the treatment of NLFs wrinkle. Materials and methods: A total of 20 patients with different grades of NLFs wrinkle treated with 2940 nm Er:YAG laser intraorally. Six sessions were done every 2 weeks. The efficacy was assessed by two blinded dermatologists. Photographs were taken at the baseline, end of treatment and 6 months after the final session to document visible changes in NLFs wrinkle. The assessment was based on Modified Fitzpatrick Wrinkle Scale (MFWS) and by comparing the photographs. Patient’s self-assessment and patient’s satisfaction were used for assessment of final results and any side effects associated to treatment were observed. Results: There was significant reduction of the NLFs wrinkle. The MFWS was significantly improved 6 months after treatment compared to before treatment (p < 0.001). At the end of the follow-up period, there was improvement in overall appearance of the wrinkles. Patient’s self -assessment and satisfaction demonstrated better cosmetic outcomes. Conclusion: Intraoral Er:YAG laser is safe, painless, and effective treatment option for NLFs wrinkle.     

Silicone gel enhances the efficacy of Er:YAG laser treatment for atrophic acne scars: A randomized,split-face,evaluator-blinded,placebo-controlled,comparative trial

Background: The effect of topical silicone gel has been studied to prevent scars from burn, postoperative wound and to treat hypertrophic scars. No previous studies have been done to evaluate the efficacy of topical silicone gel on atrophic acne scars. Material and methods: Nineteen patients were treated with three sessions of ablative Er:YAG laser with 1-month intervals. Following each laser treatment, the randomlyassigned silicone gel or placebo was applied in split-face manner. Objective assessments, which included roughness, smoothness, hydration, transepidermal water loss were measured at baseline and prior to each treatment. Subjective assessments by dermatologists and subjects were done at baseline and 1 month after last laser treatment. Results: The laser treatments were well tolerated and resulted in clinical improvements. Topical silicone gel treatment resulted in significantly less roughness at weeks 4 and 12 compared with placebo (p < 0.05). Conclusion: Adding topical silicone gel to ablative Er:YAG laser treatment may provide additional benefits in improving acne scars.     

Comparative study of ablative fractional photothermolysis versus topical retinoid cream in the treatment of idiopathic guttate hypomelanosis

Background: Despite various treatments attempts, no prospective studies have compared the different therapeutic modalities for treatment of idiopathic guttate hypomelanosis (IGH). This study aimed to compare the efficacy of CO₂ fractional laser (CO?FL), Er:YAG fractional laser (EYFL), and 0.025% topical tretinoin for treating IGH. Materials and Methods: A total of 122 lesions were analyzed from 18 patients (mean age, 70.00 ± 20.00 years). Treatment outcome evaluations included the visual analog scale (VAS) to assess lesion severity, investigator’s global assessment (IGA) to assess the extent of improvement, and patient’s satisfaction score (PSS). Results: Among the 122 lesions, 42, 40, and 40 were assigned to the CO?FL, EYFL, and topical tretinoin treatment groups, respectively. The VAS score was significantly improved after the second treatment. CO?FL and EYFL therapy had superior treatment efficacy compared to topical tretinoin (p < 0.01 in VAS, IGA, and PSS). There was no significant difference between the two types of fractional lasers. Conclusions: Ablative fractional laser (AFL) was an effective treatment with a relatively short treatment time without serious adverse events. We recommended AFL to treat IGH as an active treatment strategy.     

Clinical effect of ablative fractional laser-assisted topical anesthesia on human skin: A randomized pilot study

Background and objectives: Most topical medications need a long time to penetrate into the skin owing to the stratum corneum (SC) barrier. The fractional erbium-doped yttrium aluminum garnet (Er:YAG) laser has the ability to disrupt the SC and assist in the delivery of topical drugs to penetrate into the skin. This study was intended to determine whether pretreatment with a painless fractional Er:YAG laser could assist transdermal delivery of topical anesthesia. Materials and methods: In 22 healthy female subjects, three 4 × 3 cm regions on the right forearm were randomized to: fractional laser plus topical lidocaine cream (Group LaserAnes), sham irradiation plus topical anesthesia (Group Anes), and sham irradiation plus sham anesthesia (Group Con). After 5 minutes, each site was treated with yttrium scandium gallium garnet laser to evaluate the pain sensation using the visual analog scale. Results: The average pain scores of Group LaserAnes, Group Anes, and Group Con are 3.74 ± 1.93, 4.90 ± 2.09, and 5.19 ± 2.15, respectively. The pain score of Group LaserAnes has a 25.57% reduction compared to Group Anes (p < 0.001) and a 28.70% reduction compared to Group Con (p < 0.001). There is no significant pain reduction for Group Anes compared with Group Con (p = 0.094). Conclusions: Pretreatment using fractional Er:YAG laser before topicals might be an effective method for drug delivery.     

Successful treatment of acne keloidalis nuchae with erbium:YAG laser: a comparative study

Background: Acne keloidalis nuchae (AKN) is a chronic inflammatory disease involving hair follicles of the neck. It is a form of keloidal scarring alopecia that is often refractory to medical or surgical management.

Objective: To evaluate the efficacy of Er:YAG laser in the treatment of AKN as compared to long pulsed Nd:YAG laser. Patients and

Methods: This study was conducted on 30 male patients with AKN. Their ages ranged from 19 to 47 years with a mean age of 36.87 ± 7.8 years. Patients were divided randomly into two groups of 15 patients, each receiving six sessions of either Er:YAG or long-pulsed Nd:YAG laser therapy.

Results: A statistically significant decrease in the number of papules was detected at the end of therapy in both groups, with a mean of 91.8% improvement in the Er:YAG group versus 88% in the Nd:YAG group. A significant decrease in plaques count was detected only in the Er: YAG group while a significant decrease in plaques size and consistency was recorded in both groups.

Conclusion: The Er: YAG laser proved to be a potentially effective and safe modality both in the early and late AKN lesions.     

Intradermal tranexamic acid injections to prevent post-inflammatory hyperpigmentation after solar lentigo removal with a Q-switched 532-nm Nd:YAG laser

Introduction: Post-inflammatory hyperpigmentation (PIH) after solar lentigo removal using a Q-switched (QS) 532-nm Nd:YAG laser is a cause for concern. This study aimed to evaluate the efficacy and safety of intradermal injections of tranexamic acid (TA) at reducing the risk of PIH after QS 532-nm Nd:YAG laser treatment of solar lentigines. Methods: Twenty-five patients with 50 solar lentigines on forearms underwent QS 532-nm Nd:YAG laser treatment. Then, TA (50 mg/mL) was injected randomly into one lesion and 0.9% normal saline was injected intradermally into another lesion. Two blinded dermatologists and a Mexameter® evaluated photographs at baseline, and at weeks 2, 4, 8, and 12. Results: At the end of the study, the mean melanin index (MI) had decreased significantly in both groups. The TA group showed a significant reduction in the mean MI compared with that in the control group at week 4 (p = 0.025). The overall PIH rates were 16% and 28% in the TA and control groups, respectively. The side effects of TA were minimal and they were resolved within 1 h. Conclusion: Single dose of intradermal TA (50 mg/mL) injected can reduce the risk of developing PIH 4 weeks after 532-nm QS Nd:YAG laser treatment of solar lentigines.     

Erbium:yttrium aluminum garnet laser versus Q-switched neodymium:yttrium aluminum garnet laser for the treatment of xanthelasma palpebrarum

Background: Several lasers have been used for the treatment of xanthelasma palpebrarum (XP), such as Q-switched neodymium:yttrium aluminum garnet (QSNd:YAG) and erbium:yttrium aluminum garnet (Er:YAG) laser. Up to now, a comparative study among these laser options in the treatment of XP has not been reported. Objective: The aim of this study was to compare the clinical efficacy and response rates of QSNd:YAG and Er:YAG in the treatment of XP. Methods: Sixty patients with a total of 102 XP lesions were randomly and equally divided into two groups. The first group was treated with QSNd:YAG at a fluence of 10 joule/cm², 10 Hz and 2 mm spot size, and the second group was treated with Er:YAG at 200-300 millijoule, 4 Hz and 2 mm spot size. Results: In the Er:YAG group, the percentage of patients who required 3 or 4 sessions and wound healing time were higher compared to those of the QSNd:YAG group. Furthermore, the percentage of patients who had an improvement score of 4 was higher in the Er:YAG than that in the QSNd:YAG group. Conclusion: Er:YAG is an efficient, successful and minimally invasive method without long-lasting adverse effects.     

Treatment of gingival melanin hyperpigmentation with Er,Cr:YSGG laser: Short-term follow-up of patient

The increasing melanin hyperpigmentation of dark skinned individuals is related to the high activity of melanocytes. A healthy 36-year-old female patient complained about unaesthetic gingiva and she had been smoking for over 17 years and also smoking reactive the melanocytes. Gingival depigmentation is a periodontal plastic procedure which has been carried out by various techniques. Hyperpigmentation of gingiva was observed on the labial surface of both maxilla and mandibula. Erbium, chromium-doped yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser was used for depigmentation with wavelength of 2780 nm, frequency of 20 Hz, and pulse energy between 0 and 300 mJ. Topical anesthetic spray was applied and there was mild bleeding and pain in the operation area. The ablated regions were healed almost in 1 week. After 3-month and 6-month follow-up there were no repigmented areas. It may be concluded that the application of Er,Cr:YSGG laser appears to be a safe and an effective alternative procedure for the treatment of gingival melanin hyperpigmentation.     

Treatment of Dowling-Degos disease with fractional Er:YAG laser

Abstract

Dowling-Degos disease (DDD) is a rare, benign, autosomal dominant disorder characterized by reticulated pigmentation on flexural areas. Recently, a report of successful Er:YAG ablative laser treatment without any adverse effects was issued.

A 49-year-old Korean woman presented with numerous small, hyperpigmented macules in a reticular pattern on her face, axillae, and inguinal folds of several years duration. Histologic examination revealed acanthosis with thin elongated rete ridges, basal branching, and widening. She was diagnosed as having DDD and was treated successfully without any adverse effects using a fractional 2,940-nm Er:YAG ablative laser (LOTUSII, Laseroptek, Sungnam, Korea).

Er:YAG ablative laser treatment could be an effective treatment modality for DDD, but in Asians, who have darker skins than Caucasians, or in patients with skin lesions on the face, post-inflammatory hyperpigmentation could be problematic after treatment. Fractional Er:YAG ablative laser treatment should be viewed as an alternative therapeutic option for DDD.     

The effects of a high glycerin content hydrogel premolded mask dressing on post-laser resurfacing wounds

Abstract

Background: Laser resurfacing for the rejuvenation of facial skin remains a popular cosmetic procedure. Postoperative care for laser resurfacing is important to optimize healing, reduce pain and minimize complications. Objective: To compare the efficacy of the new dressing against placebo (Vaseline^® cream) after Er:YAG laser resurfacing. Methods: Fifteen patients between 45 and 72 years of age with facial wrinkles were enrolled in the study. Patients underwent full-face Er:YAG procedures. The wounds were then dressed: one side of the face was treated with Vaseline and the other with a hydrogel dressing. Erythema, edema, pigmentation, average time of re-epithelization, pain score, itching, clinical evaluation of infection, crust formation and acidity were documented. Results: The hydrogel dressing decreased postoperative morbidity. The site treated by hydrogel showed a shorter epithelial healing time than the Vaseline site. The dressing relieved the immediate pain of facial resurfacing as well as preventing crust formation and itching. Conclusion: A hydrogel dressing is a better and suitable alternative to the open technique to manage post-laser wound healing.     

The clinical effectiveness and cost-effectiveness of fractional CO2 laser in acne scars and skin rejuvenation: A meta-analysis and economic evaluation

Introduction: Fractional CO₂ has many indications in medicine including in treatment of acne scars and rejuvenation. The aim of this study was to evaluate the safety, efficacy, and cost-effectiveness of Fractional CO₂ Laser in comparison with other methods of rejuvenation and acne scar treatment. Materials and Methods: Several databases including Medline, OVID, EMBASE, CINHAL, SCOPUS, Web of science, CRD, and Cochrane were searched. After conducting the search and evaluation of selected publications, critical appraisal was done and eligible studies were accepted for inclusion in the systematic review. Results and Discussion: From 2667 identified publications two of the trials were eligible. The effectiveness and complications of Fractional CO₂ laser were comparable with Er:YAG but Fractional CO₂ laser was 14.7% (p = 0.01) more effective than Q-Switched ND:YAG laser. Cost affectivity of this method was the same as other alternative lasers. In conclusion Fractional CO₂ laser is an effective and safe method for curing of several kinds of skin diseases. Nevertheless there was not sufficient evidence to support its advantage. This device has equal or lower price in comparison to competent technologies except for the non- fractional ablative CO₂ laser that has the same or lower price and comparable effects.     

A fractional 2940 nm short-pulsed,erbium-doped yttrium aluminium garnet laser is effective and minimally invasive for the treatment of photodamaged skin in Asians

Abstract

Background: Although ablative fractional laser for the facial photodamaged skin was effective and safe, there have been only limited reports regarding the efficacy and safety of fractional Er:YAG laser treatments for photodamaged facial skin in Asians. Objective: Our objective was to assess the efficacy and safety of the Er:YAG laser (2940 nm) using the ‘‘ablative’’ fractional resurfacing mode to treat photodamaged facial skin. Methods: A total of 29 Korean patients were treated for photodamaged facial skin using a fractional Er:YAG laser. The number of treatments was mean 2.3 sessions at two-week intervals. Independent investigators assessed the efficacy using standardized photographs. The patients’ satisfaction rate was also evaluated. Results: For dyspigmentation, 62.5% of the treated patients showed improvement greater than 26%. Regarding wrinkles, 50% of the treated patients showed improvement greater than 26%. All patients showed various degrees of improvement in skin laxity. Assessing the overall features, 62.5% of the study subjects showed improvement greater than 26%, and most of them (91.7%) reported that their subjective satisfaction rate was above ‘slight satisfaction’. Downtime accounted for approximately one week in most patients. Conclusions: A fractional Er:YAG laser can deliver an effective and minimally invasive treatment for photodamaged facial skin in Asians.     

Efficacy and safety of 1550-nm fractional laser in the treatment of acne scars in Chinese patients: A split-face comparative study

Objective: To evaluate the efficacy and side effects of 1550-nm fractional Er:Glass laser in treating atrophic acne scar. Materials and methods: Thirty Chinese patients aged 18–65 with atrophic acne scars on both cheeks received a split-face treatment, one side with four sessions of treatment with fractional 1550-nm Er:Glass laser at 20-day interval and the other with topical asiaticoside cream application three times daily as control. Clinical response and side effects were evaluated by a dermatologist three weeks after each treatment and again 12 weeks after the last laser treatment. In addition, self-evaluation of satisfaction by the patients was done at the end of treatment. Results: The study found that mean scores decrease after treatment was 5.65 ± 4.34 for the treated side and 1.23 ± 3.41 for the control side. The improvement in acne scars after the fractional Er:Glass laser 1550-nm treatment was more significant than the control side (p = 0.0001). The side effects were mainly local skin irritation and erythema, which disappeared within one week. Conclusion: The research results show that the fractional 1550-nm Er:Glass laser is an effective and safe treatment device for atrophic acne scars.     

A split-face,evaluator-blind randomized study on the early effects of Q-switched Nd:YAG laser versus Er:YAG micropeel in light solar lentigines in Asians

Abstract

Background: Asians are prone to develop epidermal pigmentary lesions as a result of photoaging. Solar lentigines, especially those which are light in color, show somewhat limited response to pigment lasers and intense pulsed light sources. Objectives: We sought to compare the early effects as well as side effects of Q-switched Nd:YAG and Er:YAG micropeel in treating light solar lentigines in Asians. Patient and methods: This was a split-face, evaluator-blind, randomized controlled study. A single session of treatment was performed on Asian patients with light facial lentigines. Q-switched Nd:YAG laser was allocated to one half of the face, and Er:YAG micropeel to the other half. The response to therapy was evaluated by two independent dermatologists with standardized photographs taken 2 weeks and 1 month after the laser treatment. Patients’ satisfaction and preference in treatment were also assessed. Results: Fifteen patients completed the study and were analyzed. A reduction in pigment was observed with both lasers during the study period. The degree of pigment reduction in the Q-switched Nd:YAG treated side of the face was significantly higher than that of the Er:YAG micropeel treated side at 2-week follow-up (p < 0.001). The degree of pigment reduction between the Q-switched Nd:YAG-treated side and the Er:YAG micropeel-treated side was similar at 1-month follow-up (p = 0.110). Conclusion: While there is no perfect therapy for light solar lentigines, a single session of Q-switched Nd:YAG laser and Er:YAG micropeel was shown to reduce pigmentation. The immediate effects (2-week follow-up) were better with the Q-switched Nd:YAG laser but there was no great difference between the two laser types at 1-month follow-up due to the greater degree of post-inflammatory hyperpigmentation following Q-switched Nd:YAG. Both laser types could be applied either singly in turns, or in combination for maximal efficacy in future.     

A study of multiple full-face treatments with low-energy settings of a 2940-nm Er:YAG fractionated laser

Abstract

Background and objective: Fractional Er:YAG 2940-nm laser resurfacing is a relatively new approach to the treatment of photodamaged skin. Typically, this approach uses fairly high delivered energies in order to create ‘microscopic wounds’ of tissue coagulation at various dermal depths. The purpose of this study was to evaluate the efficacy, safety and tolerability of low-energy, multiple-treatment, fractional Er:YAG laser resurfacing for the treatment of photoaged skin. Methods: Sixteen subjects with photoaged skin received six, lower-fluence laser treatments with a 2940-nm wavelength Er:YAG laser, using a fractionated handpiece and a maximum energy of 30 mJ per micro-spot. Subject satisfaction, treatment tolerability, and subject outcome assessment were performed. Results: Of the 12 subjects who completed the trial, all recorded improvement in their treated skin; half reported over 50% improvement. Most patients reported none or only mild stinging and burning during and after treatment. There was no downtime associated with the procedure. No adverse events were reported. Patient satisfaction rates were high. Conclusion: Low-energy, multiple treatment, 2940-nm Er:YAG laser resurfacing with this novel device is a safe and well-tolerated method for the treatment of superficial to moderate photoaged skin.     

Long-pulsed Nd:YAG laser vs. intense pulsed light for hair removal in dark skin: a randomized controlled trial

Background Although several lasers meet the wavelength criteria for selective follicular destruction, the treatment of darker skin phototypes is particularly challenging because absorption of laser energy by the targeted hairs is compromised by an increased concentration of epidermal melanin. Objectives To compare satisfaction level, safety and effectiveness of a long‐pulsed Nd:YAG laser and intense pulsed light (IPL) in axillary hair reduction in subjects with dark skin. Methods The study design was a within‐patient, right‐left, assessor‐blinded, comparison of long‐pulsed Nd:YAG laser and IPL. Fifty women (skin phototypes IV–VI) volunteered for removal of axillary hair. Five sessions at 4‐ to 6‐week intervals were performed. Hair counts at both sides were compared at baseline and 6 months after the last session. Final overall evaluations were performed by subjects and clinician at the end of the study. Satisfaction was scored for both devices. Results Thirty‐nine women completed the study. At 6 months, the decrease in hair counts on the laser side (79·4%, P < 0·001 vs. pretreatment) was significantly (P < 0·01) greater than that on the IPL side (54·4%, P < 0·01 vs. pretreatment). Only temporary adverse effects were reported at both sides. Higher pain scores and more inflammation were reported with Nd:YAG laser; however, it was preferred by 29 volunteers (74%). Volunteers reported higher satisfaction score with Nd:YAG laser (P < 0·01). Conclusions Dark skin can be treated by both systems safely and effectively; however, long‐pulsed (1064 nm) Nd:YAG laser is more effective as reported by both subjects and clinician.     

Lasers in non-surgical periodontal treatment – a review

Aim: Aim of this review was to present a comprehensive outline of the use of hard tissue lasers in Periodontics with respect to non-surgical periodontal treatment.

Materials and method: Electronic databases of PubMed and Cochrane Library were searched from 1992 to 2018. 18 clinical studies were evaluated after the inclusion, exclusion criteria.

Results: It was deduced that Er:YAG laser is a feasible option for non-surgical periodontal therapy if proper parameters are followed i.e. the energy in the range of 140–160 mJ and frequency of 10 Hz. None of the studies favoured the use of Nd:YAG and CO₂ laser because of their prospective adverse effects.

Conclusion: It can be concluded that Er:YAG laser application in non-surgical periodontal therapy is valuable. In combination with mechanical debridement, the results are similar or better with significant gains in clinical attachment level as compared to other various lasers. It is an excellent alternative to control the proliferation of micro-organisms. Nd:YAP, diode and other low power lasers can be used but with caution since they offer no additional advantage over conventional treatment modalities.     

Treatment of atrophic facial acne scars with fractional Er:YAG laser in skin phototype III–IV: A pilot study

Background: Fractional ablative lasers have recently been used for the treatment of skin scars. The objective of this study was to assess the efficacy and safety of the fractional erbium-doped yttrium aluminum garnet (Er:YAG) laser (2940 nm) in the treatment of skin scars. Materials and methods: A total of 9 patients (8 female, 1 male) with Fitzpatrick skin types III and IV suffering from atrophic facial acne scars were treated with a fractional Er:YAG laser for 2–5 (mean 3.3) sessions 4–6 weeks apart. One independent investigator assessed the efficacy, using standardized photographs, before and 1 month after the last treatment. The patients’ satisfaction rate was also evaluated. Results: The treatment was well tolerated by all patients without any anesthesia. The downtime was 2–3 days. All patients showed improvement in scars: excellent in 1, good in 1, and fair in 7 patients. Six patients were highly satisfied and 3 were satisfied with treatment. No adverse effect was noted. Conclusion: A fractional Er:YAG laser can deliver an effective and minimally invasive treatment for acne scars.