Split treatment of photodamaged skin with KTP 532 nm laser with 10 mm handpiece versus IPL: a cheek-to-cheek comparison

BACKGROUND AND OBJECTIVES: The treatment of photodamaged skin with potassium-titanyl-phosphate (KTP) laser and intense pulsed light (IPL) has been reported in several studies. Each device has strengths and weaknesses; however, patient and device variability have made it difficult to ascertain the optimal device for photorejuvenation. The objective of this study was to obtain a head-to-head comparison of IPL and KTP laser for photorejuvenation. Each patient received one KTP laser treatment on one side of the face and one IPL treatment on the other side. STUDY DESIGN/MATERIALS AND METHODS: Seventeen patients with skin types I-IV were accepted into the study based on existence of dyschromias (pigmented and vascular) and/or discrete telangiectases. After performance of test spots on each patient to determine optimal settings for both devices, patients were treated with both devices in a split face manner. Evaluations and photographs were performed 1 week and 1 month after treatment. Patient and observer evaluations of results were recorded, as well as time to perform each treatment, and patient feedback with regard to pain and edema. No anesthesia was used in these treatments. Photographs were reviewed by a panel of blinded observers to assess changes in red and brown dyschromias. RESULTS: One month average improvement (evaluator) for IPL side was (mean) 38.16%/35.08% for vascular/pigment lesions versus 41.99%/30.21% for KTP side. Patient self-evaluated global improvement at 1 month was (mean) 65.59% for IPL side versus 60.88% for KTP side. A majority of patients found the KTP to be slightly more painful with a mean pain rating of 5.27 of 10 versus 4.4 of 10 for IPL. A majority of patients experienced subjectively greater post-procedure swelling on the KTP side. Time to conduct treatment was an average of 10.0 minutes for IPL, 8.7 minutes for KTP. CONCLUSIONS: Both large spot KTP and IPL achieved marked improvement in vascular and pigmented lesions in one session. The KTP laser caused slightly more discomfort and edema than the IPL. On the other hand, the KTP laser was faster, and more ergonomically flexible.     

Full-face photorejuvenation of photodamaged skin by intense pulsed light with integrated contact cooling: initial experiences in Asian patients

BACKGROUND AND OBJECTIVES: For Asian skin, recent "non-ablative" skin rejuvenation techniques have become the focus of attention for darker complected patients. In our earlier research, we have shown that intense pulsed light (IPL) technology can be applied to Asian skin with a high degree of safety and efficacy. In this study, we performed full-face photorejuvenation using a new IPL device incorporating a 560 nm filter and integrated contact cooling system for the improvement of various symptoms associated with photoaging in Asian patients. STUDY DESIGN/MATERIALS AND METHODS: A total of 73 patients were treated with a series of five or more full-face treatments at 3-4 week intervals using IPL with integrated contact cooling. One month after the third and fifth treatments, the patient and the treating physicians subjectively evaluated improvement in five areas-in pigmentation, telangiectasia, fine wrinkles, skin texture, and over-all improvement. In addition, histological changes were evaluated. RESULTS: Pigmentation improvement, telangiectasia reduction, fine wrinkle reduction, smoother skin texture, and over-all improvement were evaluated according to five grades of percentage improvement. In addition, the subjective rating by the patients and the physicians was averaged, and the combined results were evaluated. After the fifth treatment, a combined rating of greater than 60% improvement was given to more than 80% of patients for pigmentation improvement, telangiectasia reduction or removal, smoother skin texture, and overall improvement. Histological evaluations showed strong staining of Type I and Type III collagen. Complications were minor and transitory, with burning sensations and erythema in only two patients. CONCLUSION: Full-face photorejuvenation for Asian patients using this device is not only effective but is also associated with fewer post-treatment complications than other more invasive modalities. We conclude that IPL photorejuvenation can be the basis for safe and effective skin rejuvenation in Asian patients.     

A Pulsed Dye Laser with a 10-mm Beam Diameter and a Pigmented Lesion Window for Purpura-Free Photorejuvenation

BACKGROUND AND OBJECTIVES In traditional pulsed dye lasers (PDLs), power limitations and pulse characteristics have compromised purpura-free procedures. This study evaluated a new PDL with a modified pulse structure and a 10-mm beam diameter for purpura-free photorejuvenation. A compression handpiece was used for targeting lentigines.
MATERIALS AND METHODS Twenty patients with skin types I to III were treated three times at 3- to 4-week intervals. The first pass was delivered through a 10-mm compression handpiece to target pigment dyschromias using fluences between 6.5 and 8.0 J/cm² with a 1.5-ms pulse duration. A second pass was then performed with a 10-mm spot with fluences between 9.5 and 10 J/cm², a 20-ms pulse duration, and cryogen spray enabled. Improvement was evaluated by comparing pre- and posttreatment photographs and live subjects 1 month after the third treatment.
RESULTS In the majority of patients, >90% reduction of fine telangiectasias (<0.6 mm) and dark lentigines was achieved. Pigmented dyschromias improved proportional to the degree of pigment at presentation. Avoidance of purpura with the compression handpiece was dependent on obtaining proper compression before laser emission. Mean textural improvement was 34%.
CONCLUSIONS The new 595-nm PDL is highly effective for two-pass purpura-free improvement of telangiectases, pigment dyschromias, and texture.     

Intense Pulsed Light Treatment of Photoaged Facial Skin

BACKGROUND: It has been reported that intense pulsed light is efficacious for rejuvenation of photoaged skin, specifically the improvement of appearance of telangiectases and solar lentigines. OBJECTIVE: The objective was to define the treatment variables for photodamaged facial skin using a newer intense pulsed light system. METHODS: Twenty-three female subjects received three treatments using double-stacked pulses with fluences of 24 and 30 J/cm2. Response to treatment was evaluated using digital photography. Three signs of photoaging were evaluated: surface texture/roughness, mottled hyperpigmentation, and erythema/telangiectases. RESULTS: There was a shift in clinical grading from more to less severe on all three measures of photoaging. CONCLUSION: Intense pulsed light therapy was efficacious in ameliorating the clinical signs of photoaging. The device was well tolerated with minimal side effects.     

强脉冲光美容效果的评价

目的观察强脉冲光对皮肤表浅色素性和血管性疾病、寻常痤疮的疗效;评价其嫩肤美容及脱毛的疗效。方法采用GP666型强脉冲比（IPL）治疗仪对皮肤老化、面部色沉性皮损、皮肤毛细血管扩张、寻常痤疮及多毛症各20例共100例进行治疗,光子嫩肤每3周治疗1次,5次为1个疗程;脱毛每月治疗1次。结果经5次治疗,色素痫和血管痫有效率为90％,痤疮疗效为75%,美容效果为100％,脱毛效果为90％。无小可逆不良反膻发牛。结论IPL能有效治疗皮肤浅表色素沉着性皮损和毛细血管扩张;有较好的关容效果;脱毛效果肯定。     

Photorejuvenation by Intense Pulsed Light with Objective Measurement of Skin Color in Japanese Patients

BACKGROUND AND OBJECTIVES: This study had two objectives: subjective evaluation of overall skin rejuvenation effects of relatively short-wavelength intense pulsed light (IPL) and objective changes in basic skin tone as measured by a spectrophotometer. STUDY DESIGN/MATERIALS AND METHODS: Twenty-five women selected at random received a series of three IPL treatments. Efficacy was evaluated over a 3-month follow-up period. Concurrently, a spectrophotometer was used to measure "lightness" (L(*)) to quantify the lightening effect changes to pretreatment and posttreatment basic skin tone. RESULTS: Subjective improvement of 50% or more was seen in 18 of 25 patients for pigmentation. One patient showed exacerbation of latent epidermal melasma as a complication. In the spectrophotometric analysis, the mean value of L(*) increased from a baseline value of 60.86 to 63.22, at 3-month follow-up period, with statistical significance. CONCLUSION: IPL skin rejuvenation using relatively shorter wavelengths and pulse widths brought about significant macroscopic and quantitative improvements, especially in the treatment of epidermal pigmentation and improvement of basic skin tone.     

Split-Face Treatment of Facial Dyschromia: Pulsed Dye Laser with a Compression Handpiece versus Intense Pulsed Light

BACKGROUND Many visible light lasers and intense pulsed light (IPL) devices are available to treat photodamaged skin.
OBJECTIVES The objective was to perform a multiple-treatment split-face comparison evaluating a pulsed dye laser (PDL) with a compression handpiece versus IPL for photorejuvenation.
METHODS Ten subjects were treated three times at 3- to 4-week intervals. One side of the face was treated with the PDL with compression handpiece, and the other with IPL. One month after final treatment, blinded evaluation assessed for improvements in dyschromias and texture. Patients provided self-assessment of improvement in dyschromias and texture. Time to complete final treatments and pain during all treatments were recorded for each device.
RESULTS Improvement of the PDL was (mean) 86.5, 65, 85, 38, and 40% for dark lentigines, light lentigines, vessels <0.6 mm, vessels >0.6 mm, and texture, respectively, versus 82, 62.5, 78.5, 32.5, and 32%, respectively, for the IPL side. Patient-evaluated difference in improvement for vascular lesions significantly favored the PDL ( p =.011). Mean third treatment times were 7.7 minutes for PDL versus 4.6 minutes for the IPL ( p =.005). Mean pain ratings were 5.8 for the PDL and 3.1 for the IPL ( p =.007). Purpura-free procedures depended on proper technical use of the compression handpiece when treating lentigines with the PDL.
CONCLUSIONS The PDL with compression handpiece and IPL are highly effective for photorejuvenation.     

Hair removal with a non-coherent filtered flashlamp intense pulsed light source

BACKGROUND AND OBJECTIVE: To evaluate the effects on disruption of hair growth of the non-coherent filtered flashlamp intense pulsed light (IPL) source. MATERIALS AND METHODS: Twenty-eight sites on 23 patients with Fitzpatrick type I-III were enrolled using a single treatment IPL followed for three months post-treatment. Another 56 on 48 patients with Fitzpatrick skin types I-V randomly enrolled for two treatments one month apart and followed for six months. STUDY DESIGN: Prior to beginning treatment and at each follow-up visit hair counts were obtained by averaging three 1-cm2 areas on a clear acetate template placed over the skin. Repeat hair counts and photographs were obtained at 2, 4, 8, and 12 weeks for the single treatment protocol and at additional 4, 5, and 6 months for the double treatment protocol. Parameters utilized were a 2.8-3.2 millisecond pulse duration typically for three pulses with thermal relaxation intervals of 20-30 milliseconds with a total fluence of 40-42 J/cm2. RESULTS: For the double treatment protocol hair clearance of 64% was achieved immediately following the second treatment. By week 8 reduction of hair counts was 42%. At 6 months, hair counts were reduced by 33%. CONCLUSIONS: Non-coherent IPL is an effective modality for long-term hair removal. IPL is safe with minimal side effects of epidermal injury or pigmentation change.     

A prospective study of the safety and efficacy of a combined bipolar radiofrequency,intense pulsed light,and infrared diode laser treatment for global facial photoaging

The clinical features of photoaging include: skin texture changes, laxity, rhytides, pigmentary changes, and vascular changes such as erythema and telangiectasias. In order to meet patients’ increasing demands for improving all aspects of photoaging at one office visit, employing a multi-modality treatment for all aspects of photoaging has become increasingly desirable for the physician and patient alike. We examine a novel device that employs bipolar radiofrequency (RF), intense pulsed light (IPL), and infrared diode laser. These laser and light source treatments are performed sequentially. This study aims to evaluate the clinical efficacy and safety of this device (i.e., ELOS Triniti?). Twenty-six subjects received four ELOS Triniti? treatments at 1-month intervals. They were followed up 1, 3, and 6 months after completing the treatments. Two blinded dermatologists used a comprehensive grading scale to evaluate the degree of the photoaging in terms of rhytides, laxity, dyschromia, erythema, telangiectasias, and texture. Subjects used a 0–10 grading scale for self-assessment of photoaging. Additionally, we measured the Erythema Index (EI), Melanin Index (MI), transepidermal water loss scores (TEWL), stratum corneum moisture scores (SC), and dermis moisture scores (D) before treatment and 1, 3, and 6 months after treatment. There was a statistically significant improvement in all five aspects of the comprehensive grading scale. Overall, it had excellent efficacy for improving erythema, telangiectasias, and skin texture. It also had a relatively long effect on improving skin laxity; however, it had only a limited ability to improve rhytides and dyschromia. It can mildly to moderately improve the global photoaging. This global effect can be noted 1 month after treatment and becomes most clinically apparent 3 months after treatment. This is maintained at least 6 months after treatment. MI index and SC and D values increased while EI index and TEWL values decreased after the treatment. The subjects’ self-assessment improved by 2.7 ± 1.2 points. The overall satisfaction rate was 88%. The degree of pain measured 2.5 ± 1.9 points on average. There was no downtime and no severe side effects reported. The sequential implementation of bipolar radiofrequency based optical combination devices (IPL, IR, diode laser) is effective and safe for global facial photoaging.     

Prospective study on the treatment of postburn hyperpigmentation by intense pulsed light

BACKGROUND AND OBJECTIVES: Postburn hyperpigmentation is a common phenomenon among Asian especially over grafted areas and sometimes over donor sites and healed wounds without skin graft. This condition is difficult to treat and can cause severe psychological distress. Intense pulsed light (IPL) has been used to treat melanocytic lesions with promising result. The role of IPL in treating postburn hyperpigmentation has not been explored. The purpose of this study was to assess the efficacy and complication of IPL in the treatment of postburn hyperpigmentation prospectively. STUDY DESIGN/MATERIALS AND METHODS: Nineteen Chinese patients with postburn hyperpigmentation were treated by IPL. There were 14 females and 5 males. Their age ranged from 8 to 51 years with a mean age of 29.4 +/- 11.6 years. The cutoff filters of 550, 570, and 590 nm were used for 3-7 treatments at intervals of 3-4 weeks. Patients were treated with an energy fluence of 28-46 J/cm(2), pulse width of 1.7-4 milliseconds, double pulse mode, and a delay of 15-40 milliseconds. RESULTS: Treatment results and complications were evaluated and scored after each treatment. Over 78% of the patients showed more than 50% clinical clearance and nearly 32% of the patients were able to achieve more than 75% clearing. Although two patients had no clinical response, one patient had 100% clearing. Three patients developed blisters and one patient had erythema that all resolved within 1 week without leaving permanent marks. They have been followed-up from 11-32 months and there was no recurrence of the hyperpigmentation. CONCLUSIONS: IPL is effective and safe in treating postburn hyperpigmentation in Asian patients.     

Rejuvenation of Photoaged Skin: 5 Years Results with Intense Pulsed Light of the Face, Neck, and Chest

BACKGROUND: Photorejuvenation involves the use of lasers or light sources to reverse signs of photoaging. Multiple devices have been shown to be effective over the short-term. OBJECTIVE: To investigate the long-term clinical results on the face, neck and chest at 4 years using filtered flashlamp intense pulsed light (IPL) for treatment of photoaging changes of telangiectasias, dyspigmentation, and rough skin texture. METHODS: A chart review of 80 randomly selected patients with skin types I-IV who were treated by IPL during 1996 and 1997 was performed. Photos and patient self-assessment were graded for features of textural smoothness, telangiectasia severity, and blotchy pigmentation into four categories of worse, no change, slightly better (less than 50% improvement) and much better (greater than 50% improvement). RESULTS: At 4 years following initial treatment, skin textural improvement was noted in 83% of the subjects. Telangiectasias were improved in 82% of subjects, while pigmentation remained improved in 79%. The median number of treatments was 3. The face responded slightly better than the chest or neck. Most common side-effects included temporary mild crusting (19%), erythema (15%) and purpura (6%). CONCLUSION: Signs of photoaging including telangiectasias and mottled pigmentation of the face, neck, and chest, can be improved by IPL with a long-lasting result. Minimal or no downtime with minimal adverse effects can be achieved with the settings reported. Skin textural smoothing, although not easily quantified, is an additional benefit observed long-term.     

Photorejuvenation for Asian Skin by Intense Pulsed Light

BACKGROUND: Dermabrasion and deep chemical peeling are used in the treatment of photoaged skin. These ablative procedures are effective enough to produce a certain improvement but have often caused postinflammatory hyperpigmentation among Asian patients. To avoid such adverse effects, a new, nonablative procedure has been sought. OBJECTIVE: To determine the effectiveness of photorejuvenation for Asian skin using intense pulsed light (IPL). The specific parameters used, improvement ratios, side-effects, and downtime required are also discussed. METHODS: Ninety-seven patients were treated for photoaging using IPL. The cutoff filters of 550 nm and 570 nm were utilized for three to six treatments at intervals of 2 to 3 weeks. RESULTS: Treatment results were evaluated and rated by both patients and physicians at the end of the third treatment based on improvement in pigmentation, telangiectasia, and skin texture. A combined rating of "good" or "excellent" was given to more than 90% of the patients for pigmentation, more than 83% for telangiectasia, and more than 65% for skin texture. There were some minor complications in four cases: one had erythema that continued to the next day and three had minor blisters leaving no marks. CONCLUSION: Photorejuvenation using IPL is a completely safe and effective procedure even for Asian skin. It will be increasingly used for skin rejuvenation in the future.     

Effects of Intense Pulsed Light and the 1,064 nm Nd:YAG Laser on Sun-Damaged Human Skin: Histologic and Immunohistochemical Analysis

BACKGROUND: Nonablative methods may produce collagen synthesis in sun-damaged skin. OBJECTIVE: To study the effects of intense pulsed light (IPL) and 1,064 nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser: a histologic and immunohistochemical analysis of sun-damaged skin. MATERIALS AND METHODS: Nine subjects participated. Five subjects received five-monthly treatments with IPL (560 nm cutoff filter, 8 x 35 mm spot size, pulse duration 2.4/4.2 milliseconds, pulse delay 15 milliseconds, fluence 28-35 J/cm2). Four subjects received treatment with a 1,064 nm Nd:YAG laser (130 J/cm2, triple pulse, 7.0/7.0/7.0-millisecond pulse duration, 75-millisecond delay). Routine histology and immunohistochemistry on 2 mm punch biopsies were taken before treatment and then at 3 and 6 months. We quantified collagen in the upper dermis and expression of heat shock protein 70 and procollagen 1. RESULTS: Pretreatment specimens contained solar damage. After treatment with the 1,064 nm Nd:YAG laser, the amount of collagen in the papillary dermis was slightly thicker than in those subjects treated with the IPL device (nonsignificant differences). Scattered dendritic cells in the papillary and upper reticular dermis expressed heat shock protein 70 and procollagen 1 after treatment with either light device. CONCLUSION: Both the IPL and 1,064 nm Nd:YAG laser-induced heat activation of superficial dermal dendritic cells resulted in deposition of collagen in the papillary dermis without evident morphologic damage to the epidermis or dermis.     

Epidermal Cooling Crystal Collar Device for Improved Results and Reduced Side Effects on Leg Telangiectasias Using Intense Pulsed Light

BACKGROUND: Intense pulsed light (IPL), utilizing noncoherent yellow, red, and near-infrared wavelengths can be used to treat telangiectasias. In order to circumvent epidermal heating and allow greater fluence to be delivered safely, a new device that circulates water around the IPL crystal in contact with the skin to provide continuous cooling at 1 degrees C-4 degrees C range was developed. OBJECTIVE: To observe the effects of contact cooling on IPL treatment of leg telangiectasias. METHODS: A total of 25 patients were treated using two similar sites of matted telangiectasias on the leg, one site was treated without epidermal cooling and the other with the epidermal cooling crystal collar device. Results were evaluated by comparison with pretreatment photographs at 1 month. At one treatment center, a crossover was performed at the 1-month visit in which the non-E3C site was treated by cooling. Parameters consisted of a 570 nm filter, coupled pulses of 2-2.5 msec/6-7 msec with a 10-msec delay with fluences of 38-40 J. On the site receiving contact cooling the fluence was increased by 10% (4 J/mm2). Sites were graded worse, unchanged, or improved (RAW) or on a numerical scale of 1-4 (NSS). RESULTS: Compared to the contact cooling sites, uncooled sites showed 7 were improved, 5 were unchanged, and 3 were worsened, but cooled sites showed 10 were improved, 5 were unchanged, and none were worsened (P<.05). The grading scale on 10 patients revealed a mean improvement of 1.7 for noncooled sites and 2.7 for cooled sites (P<.001). For crossover treatment, eight noncooled sites (unchanged or worsened) were subsequently treated with cooling, demonstrating six improved (P<.001) and two with no change. Less erythema and edema was noted at all cooled sites. Furthermore, pain was significantly reduced with cooling (P<.003). Epidermal injury involving hyper- or hypopigmentation, crusting, or vesiculation was not observed in any of the cooled sites, but was recorded in three of the noncooled sites. CONCLUSIONS: These data indicate that continuous epidermal cooling with IPL allows delivery of higher fluences with less pain and fewer side effects. Efficacy is significantly improved using the coupled short pulse/long pulse protocol. An additional benefit is that IPL treatment becomes less operator dependent because the chilled crystal may be placed directly in contact with the skin.     

Photoepilation Results of Axillary Hair in Dark-Skinned Patients by IPL: A Comparison Between Different Wavelength and Pulse Width

BACKGROUND: Recently, intense pulsed light (IPL) sources have been shown to provide long-term hair removal. OBJECTIVE: This study examined the photo-epilatory effects of different wavelengths and pulse width application in the same IPL device and compared their efficiencies in Asian skin. METHODS: Twenty-eight Korean women were treated using hair removal (HR) (600-950 nm filter) and 27 using HR-D (645-950 nm filter) in the axillary area. Four treatments were carried out at intervals of 4 to 6 weeks; follow-ups were conducted 8 months after the last treatment. Mean energy settings were 14.9 6 2.0 J/cm2 for HR and 17.1 6 0.6 J/cm2 for HR-D. Longer pulse widths were applied in case of HR-D treatment. Hair counts and photographic evaluation of skin sites were made at baseline and at the last follow-up. Final overall evaluations were performed by patients and clinicians. RESULTS: Average clearances of 52.8% and 83.4% were achieved by HR and HR-D, respectively. No significant adverse effects were reported after HR-D treatment. One case each of hypopigmentation and hyperpigmentation was reported for HR. CONCLUSION: An IPL source removing 45 nm of the emitted spectra and applying a longer pulse width was found to provide a safer and more effective means of photo-epilation in Asian patients.     

Treatment of face veins with a cryogen spray variable pulse width 1064 nm Nd:YAG Laser: a prospective study of 17 patients.

BACKGROUND: Through the 1990s laser treatment of leg veins has been a challenge. Newer, longer wavelength lasers with variable pulse width have shown promising results for both telangiectasia and reticular leg veins. Experience with these lasers for treatment of facial telangiectasia and periorbital reticular veins is scant. OBJECTIVE: To our knowledge this is the first prospective study to evaluate a variable pulse width, cryogen spray-equipped 1064 nm Nd:YAG laser for the treatment of facial telangiectasia and larger periorbital reticular veins. METHODS: Seventeen volunteers, ages 32-67 years, skin types I-IV, with facial telangiectasia and reticular periorbital/temporal veins were treated once with the Nd:YAG laser at fluences of 125-150 J/cm2 with a 6 mm spot size and pulse widths of 25 msec for small vessels and 75-100 msec for reticular veins. Patients were examined 1 week and 1 month after the treatment. Pre- and posttreatment 35mm photographs were taken. Improvement was judged by two experienced physicians, both visually on patients and by comparison of pre- and posttreatment photographs. Results were graded as percent resolution, in five groups: 0%, 0-25%, 25-50%, 50-75%, and 75-100%. RESULTS: All 17 patients completed the study. Thirty-two sites were treated (24 cheek, nose, and chin telangiectases, and 8 periorbital reticular veins). Greater than 75% improvement was observed in 97% of the treated sites. Greater than 50% improvement was observed in 100% of the treated sites. Notably, 100% of the facial reticular veins treated have essentially 100% resolution. Pain during treatment was variably perceived by patients, but occasionally sufficient for patients to express reservations about additional future treatment. Transient erythema and edema were common, but fine crusting was rare. Small areas of purpura were also quite rare. CONCLUSION: The cryogen spray-equipped 1064 nm Nd:YAG laser was remarkably effective and safe for skin type I-IV patients. It is an excellent tool for treatment of facial telangiectasia with minimal risk of purpura. For the first time we appear to have a simple, safe, and effective treatment for 1-2 mm periorbital reticular veins. The use of topical anesthesia may be needed for some patients.     

Treatment of acne scars using the plasma skin regeneration (PSR) system

BACKGROUND AND OBJECTIVES: Acne scarring is a common and difficult to treat condition. The plasma skin regeneration (PSR) system is a novel device that causes delayed ablation of the epidermis and controlled thermal modification to the underlying dermis. PSR has previously been shown to be a safe and effective treatment for facial rhytides and benign skin lesions. In this study, we investigated the safety and efficacy of single-treatment, high-energy, double-pass PSR for the treatment of acne scarring. STUDY DESIGN/MATERIALS AND METHODS: Ten patients with acne scarring and Fitzpatrick skin types I-III were included in the study. All patients underwent a single PSR treatment with two high-energy passes (3.5-4.0 J). Treatments were performed in an outpatient clinic setting. Nine patients completed 6 months of follow-up. Improvement was determined by patient questionnaires and physician evaluation of digital photographs taken prior to treatment and at 3 and 6 months post-treatment. RESULTS: On average, patients reported 34% improvement in their acne scarring at 3 months and 33% improvement at 6 months. Blinded physician ratings of patient photos demonstrated 19% improvement at 3 months and 34% at 6 months. Re-epithelialization was complete by 4-6 days after treatment, and no serious adverse events were encountered. CONCLUSION: PSR appears to provide a safe and effective single treatment, minimal downtime alternative for the treatment of acne scarring. Additional studies are warranted to further demonstrate the safety and efficacy of this device.     

强脉冲光联合调Q激光治疗色素增生性皮肤病

目的探讨强脉冲光联合调Q激光疗法对面部色素增生性皮肤病的疗效及安全性。方法根据患者面部色素性疾病的特点,对225例FitzpatrickⅢ、Ⅳ型皮肤的色素细胞增生性皮肤病患者,采用560nm强脉冲光联合调Q532nm激光治疗,首先使用560nm强脉冲光,能量密度30～40J／cm2的光子嫩肤治疗,每月1次,3个月后观察疗效。对于改善不品著的脂溢性角化斑、咖啡斑及眼睑、口唇周围残留的雀斑等,再使用调Q532nm激光,施行局部针对性治疗,能量密度70J／cm2。于激光治疗后2个月,对皮损的改善和满意度进行评估并记录不良反应。结果90％患者的雀斑、咖啡斑、脂溢性角化斑的色素均有50％～70％不同程度的消退,同时毛细血管扩张、毛孔粗大、细小皱纹均达到了60％以上的程度的改善。主要并发症为暂时性红斑和水疱。结论560nm强脉冲光联合调Q激光治疗面部色素增生性皮肤病安全有效,同时能有效改善肤质。     

5-Aminolevulinic Acid-based Photodynamic Intense Pulsed Light Therapy Shows Better Effects in the Treatment of Skin Photoaging in Asian Skin: A Prospective, Single-blinded, Controlled Trial

Objective: To investigate the effects of photodynamic intense pulsed light therapy on skin photoaging in Asian skin. Methods: This was a prospective, single-blinded, controlled, clinical trial with 40 patients enrolled. The enrolled patients applied 5% 5-aminolevulinic acid on the left side of the face while a placebo was applied on the right side of the face. After a one-hour incubation, the patients received intense pulsed light therapy. After four treatment cycles, the pH values, transepidermal water loss of the dermis of the forehead and canthus skin, as well as the moisture capacity of stratum corneum and the global score of photoaging were assessed. Results: The pH value of forehead and canthus skin, moisture capacity of stratum corneum, and the dermis of forehead and canthus skin of the photodynamic intense pulsed light therapy treated sides were significantly higher than those of the control sides in all of the patients. The photoaging score decreased after the therapy on both sides, with the photodynamic intense pulsed light therapy treated sides decreasing more than the control sides (P<0.01). Conclusion: 5-aminolevulinic acid photodynamic intense pulsed light therapy showed better effects in the treatment of skin photoaging compared to intense pulsed light therapy alone.Photoaging is caused primarily by sun exposure, especially ultraviolet light, UVA and UVB. It usually appears in patients before 30 years of age and may be characterized by pigmentation, deep wrinkles, large pores, telengiectasia, and skin relaxation.¹ Several methods have been reported to have positive effects in treating photoaging, such as intense pulsed light (IPL), surgery, drugs, and cosmetic therapy. In today''s experience, the IPL therapy is recognized as one of the most common methods to treat photoaging, as it is safe and effective.² To enhance the efficacy of the IPL, the photodynamic intense pulsed light therapy (IPL-PDT) is now widely performed, with the application of a photosensitizer, such as 5-aminolevulinic acid (ALA). However, data concerning the use of IPL-PDT in Chinese individuals are limited.In this study, the authors investigated the effects of IPL-PDT in the treatment of skin photoaging compared to IPL alone in Chinese patients.     

Variable pulse erbium:YAG laser skin resurfacing of perioral rhytides and side-by-side comparison with carbon dioxide laser

BACKGROUND AND OBJECTIVE: Laser resurfacing of facial rhytides has become a popular treatment option for many patients with wrinkles, photoaging, and acne scarring. Laser wavelength/pulse duration options and new techniques continue to shorten the healing phase associated with laser skin resurfacing while maintaining clinical efficacy. Variable pulse erbium:YAG (Er:YAG) laser systems are now available that offer the surgeon the ability to vary the Er:YAG pulse duration from a pulse that is primarily ablative to one that is more thermal. The objective of this study was to evaluate the histologic effects created with a variable pulse Er:YAG laser. To study prospectively the clinical effects on upper lip rhytides with a variable pulse Er:YAG laser when compared side by side with pulsed carbon dioxide (CO(2)) laser resurfacing. STUDY DESIGN/MATERIALS AND METHODS: Forty-two treatment sites on 21 patients were randomized and evaluated after treatment of the upper lip region with CO(2) laser resurfacing on one side and a variable pulse Er:YAG laser on the other. Patient diaries were maintained to assess erythema, crusting, pain, and pigmentary changes. Blinded objective grading of improvement was performed. Chromometer measurements were obtained to analyze erythema. RESULTS: The variable pulse Er:YAG laser treatment reduced the duration of crusting on average from 7.7 days with CO(2) to 3.4 days. Chromometer measurements noted decreased postoperative erythema. Grading by physicians in a blinded manner showed 63% improvement for the CO(2) treatment site and 48% improvement in the variable pulse Er:YAG site. No cases of permanent hyperpigmentation, hypopigmentation, or scarring occurred. CONCLUSION: The variable pulse Er:YAG laser resurfacing is a safe and effective resurfacing tool, which combines ablative and thermal modalities. The protocol used in this study approaches but does not equal the results we have traditionally seen with CO(2) laser resurfacing.