Noninvasive Treatment of Bromidrosis by Frequency-Doubled Q-Switched Nd:YAG Laser

Axillary bromidrosis (osmidrosis) is a common and disgusting disorder in Asian communities. Current treatments are basically invasive resulting in varying degrees of success and complications. The objective of this study was to investigate the efficacy of frequency-doubled Q-switched Nd:YAG laser as a possible noninvasive technique for treating axillary bromidrosis. Sixty-four axillae of 32 patients were lased by a single session of green light energy at the fluence of 3.5 joules at a 4-mm spot size. The follow-up time was 6–18 months (mean 15). Twenty-six patients (81.2%) showed good to excellent results, 4 patients (12.5%) had fair results, and 2 (6.2%) patients had poor results. The only side effect was a temporary hyperpigmentation at the periphery of the treated area in a few patients with dark skin color. In conclusion, frequency-doubled Q-switched Nd:YAG laser is an effective noninvasive treatment for axillary bromidrosis.     

A Retrospective Analysis of Complications in the Treatment of Nevus of Ota with the Q-Switched Alexandrite and Q-Switched Nd:YAG Lasers

BACKGROUND: Studies on the use of Q-switched alexandrite (QS alex) and QS Nd:YAG lasers in the treatment of nevus of Ota were limited to case reports and small series. There was no study that looked at the complication rate of these systems. OBJECTIVE: To retrospectively study the complication rate of nevus of Ota patients that were treated with QS alex laser, QS Nd:YAG laser, or a combination of both. METHODS: The study was performed in a teaching hospital and a private hospital, where 513 patients with nevus of Ota had been treated since 1993. The 171 patients with 211 treatment sites were evaluated retrospectively following treatment with QS alex laser only (n = 58), QS Nd:YAG laser (n = 105) only, or a combination of both systems (n = 48). Patients were called back to be interviewed and examined by two independent clinicians to look for evidence of complications. RESULTS: Of the treatment sites, 15. 3% had hypopigmentation, 2.9% had hyperpigmentation, and texture changes and scarring were seen in 2.9% and 1.9%, respectively. The combined treatment group was associated with a significantly higher risk of complications. Thirteen patients had recurrence of their nevus after complete or near-complete clearance with laser treatment. CONCLUSION: Hypopigmentation is common after the use of QS laser for lightening of nevus of Ota. This particularly applies when alternate treatment with QS alex and QS Nd:YAG is used. Recurrence is an important issue and must be taken into consideration, especially when children are treated.     

Treatment of Acquired Bilateral Nevus of Ota-Like Macules (Hori''s Nevus) with a Combination of the 532 nm Q-Switched Nd:YAG Laser Followed by the 1,064 nm Q-Switched Nd:YAG Is More Effective: Prospective Study

BACKGROUND: Acquired bilateral nevus of Ota-like macules (Hori's nevus) is a common dyschromatosis among Asian women. Q-switched lasers have been used successfully as a treatment modality. OBJECTIVE: The purpose of this study was to compare the efficacy of using the Q-switched 532 nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser followed by the 1,064 nm laser versus the Q-switched 1,064 nm Nd:YAG laser alone in the treatment of Hori's nevus. METHODS: This is a prospective left-right comparative study. Ten women with bilateral Hori's nevus were recruited and treated with a combination of the Q-switched 532 and 1,064 nm Nd:YAG lasers on the right cheek and the Q-switched 1,064 nm Nd:YAG laser alone on the left cheek. Only one laser treatment session was performed. The degree of pigmentation was objectively recorded with a mexameter. Subjective assessment was made by both patients and two blinded, nontreating dermatologists. RESULTS: At 6 months, there was a statistically significant difference (p = .009) of 35.10 points using objective mexameter measurements between the two sides, favoring the side treated with a combination of 532 and 1,064 nm laser treatment. Subjective grading by the patients and blinded dermatologists also confirmed that combination therapy was more successful after one treatment. Although combination treatment had a higher incidence of mild postinflammatory changes, this disappeared within 2 months. CONCLUSIONS: Concurrent use of the Q-switched 532 nm Nd:YAG laser in combination with the 1,064 nm laser is more effective in pigment clearance than the Q-switched 1,064 nm Nd:YAG laser alone for Hori's nevi.     

Treatment of Pseudofolliculitis Barbae Using the Q-Switched Nd:YAG Laser with Topical Carbon Suspension

BACKGROUND: Pseudofolliculitis barbae (PFB) is a condition caused by ingrown hairs of the face. No treatment to date has shown long-term effectiveness without risk of side effects or ease of treatment. OBJECTIVE: The goal of this pilot study was to evaluate the use of the topical suspension-assisted Q-switched Nd:YAG laser in the treatment of PFB. METHODS: Nine patients were given two treatments 1 month apart and assessed by objective papule/pustule counts at 1 and 2 months after final treatment. Treatment sites were 9 cm2 regions on the mandible and neck, with contralateral controls. Patients also performed subjective evaluations. RESULTS: Reduction in the quantity of papules and pustules when compared with baseline was statistically significant for treatment of the mandibular region and combined sites at 1- and 2-month evaluations, as well as the neck region at the 2-month evaluation. CONCLUSION: Use of the Q-switched Nd:YAG laser with topical carbon suspension is an effective means of treating PFB, with results persisting at least 2 months after treatment.     

An Effective Treatment of Dark Lip by Frequency-Doubled Q-Switched Nd:YAG Laser

BACKGROUND: Dark lip is a common cosmetic problem in Southeast Asia. There is no known effective treatment. OBJECTIVE: To propose an effective method for treating dark lips of varying causes with frequency-doubled Q-switched Nd:YAG laser. METHODS: Seventy patients with dark lip, of which 22 were congenital, 24 acquired, and 24 of uncertain cause, were treated by frequency-doubled Q-switched Nd:YAG laser at a fluence of 2-3.5 J/cm2 (mode 2.5 J/cm2) after application of topical anesthesia. The endpoint of treatment was complete clearance of the pigment. Follow-up time was 24-36 months (mean 29 months). RESULTS: All patients attained complete clearance of the lesion after an average of 2.5 treatments in the congenital group, 2.2 treatments in the acquired group, and 1.8 treatments in the group with uncertain etiology. The mean (+/-SD) number of treatments required by the whole group was 2.1 +/- 1.4. Recurrence was observed in one case of congenital origin 3 months after the last treatment. In the remaining cases, results persisted up to the time of follow-up. Herpes simplex reactivation was noted in one case 3 days after treatment. There was no dyschromia, scar formation, or change of skin texture. CONCLUSION: Dark lip can be effectively treated by frequency-doubled Q-switched Nd:YAG laser without major adverse effects.     

Histologic Evaluation of a Q-Switched Nd:YAG Laser in the Nonablative Treatment of Wrinkles

BACKGROUND: A variety of nonablative dermal remodeling techniques are currently available. The Q-switched Nd:YAG laser, in addition to its role in tattoo removal, hair removal, and vascular and pigmented lesion treatment, may also play a role in dermal remodeling for the treatment of wrinkles. The histologic changes seen in human skin after Q-switched Nd:YAG laser exposure have yet to be evaluated. OBJECTIVE: To study histologic changes after the use of a Q-switched Nd:YAG laser in the nonablative treatment of photoaged skin. METHODS: Sun-damaged infrauricular skin from six female subjects was exposed to a Q-switched Nd:YAG laser at fluences of 7 J/cm2 with two laser passes. Histologic examinations were performed before laser treatment and 3 months later. RESULTS: Biopsy specimens showed slight fibrosis in the superficial papillary dermis with unremarkable epidermal changes. CONCLUSION: The Q-switched Nd:YAG laser produced morphologic changes similar to, but lesser in degree, than those seen with both CO2 and Er:YAG laser resurfacing.     

Treatment of Nevus of Ota by Q-Switched Ruby Laser

The effectiveness of the Q-switched ruby laser was investigated in 38 patients with nevus of Ota at more than 10 months after the first irradiation. In 14 patients who were followed-up for a mean of 25.2 months after the first treatment, the effectiveness was evaluated as ``excellent' in eight patients (57%), ``good' in four patients (28%), and ``fair' in two patients (14%). The mean number of irradiation treatments was 7.3 in the ``excellent' group, 4.2 in the ``good' group, and 3.0 in the ``fair' group. In 24 patients who were followed-up for a mean of 13.6 months after the first treatment, the effectiveness was evaluated as ``excellent' in eight patients (33%), ``good' in 12 patients (50%), and ``fair' in four patients (16%). The mean number of irradiation treatments was 5.7 in the ``excellent' group, 5.2 in the ``good' group, and 2.5 in the ``fair' group. Even after repetitive irradiations, good results without scarring were noted in all cases except one where a slight inverted scar was developed. The effective rate tended to be higher in patients who underwent more irradiation treatments and were observed for a longer period of time. Satisfactory cosmetic results were achieved after Q-switched ruby laser therapy for nevus of Ota.     

Treatment of Gunpowder Traumatic Tattoo by Q-Switched Nd:YAG Laser: An Unusual Adverse Effect

BACKGROUND: The Q-switched Nd:YAG laser can completely eliminate traumatic tattoos. OBJECTIVE: We report the results of the unsuccessful removal of traumatic tattoos among three patients with dermal inclusions of gunpowder who were shot at close range. METHODS: Treatment was tried in each patient with a Q-switched Nd:YAG laser at a medium fluence (4-6 J/cm2). RESULTS: During treatment of our patients, each pulse provoked sparks and the immediate formation of bleeding trans- epidermal pits. After the healing process was completed, we observed poxlike scars and the spreading of pigments in the skin around the initial points of the tattoo. CONCLUSION: We hypothesize that the rapid transfer of high-energy pulses to powder particles creates microexplosions of these fragments resulting in cavitation and provoking transepidermal holes and subsequent scars. This adverse effect was only produced if the tattoo resulted from gun powder being shot at a short distance from the skin.     

Evaluation of a Long-Pulse Q-Switched Nd:YAG Laser for Hair Removal

BACKGROUND: Hirsutism and hypertrichosis are common problems for which a permanent solution has been elusive. Laser-assisted hair removal is a promising technique. However, the optimal wavelength, pulse duration, and fluence continue to require further investigation. OBJECTIVE: To determine if the long-pulse Q-switched Nd:YAG laser is safe and effective in reducing facial and non-facial trunk hair. METHODS: Fifteen patients were treated with a 30 msec pulsed Q-switched Nd:YAG laser at fluences between 125 and 150 J/cm2. The reduction of hair density was assessed at baseline and at 7, 30, and 90 days after treatment. Potential complications were also evaluated. RESULTS: The average hair reduction was 36% at 7 days, 52% at 30 days, and 59% at 90 days. No significant complications or adverse events were reported. CONCLUSION: The long-pulse Q-switched Nd:YAG laser provides a safe and effective means of hair removal.     

An In Vivo Trial Comparing the Clinical Efficacy and Complications of Q-Switched 755 nm Alexandrite and Q-Switched 1064 nm Nd:YAG Lasers in the Treatment of Nevus of Ota

BACKGROUND: Q-switched 755 nm alexandrite (QS alex) and Q-switched 1064 nm Nd:YAG lasers are effective in the treatment of nevus of Ota. Our previous in vivo study indicated that patients better tolerate QS alex than QS 1064 nm Nd:YAG laser. However, in terms of clinical efficacy and long-term complications, the study did not indicate which laser is superior. Although both machines may appear to be similar in effectiveness, the low number of treatment sessions may contribute to this apparent lack of difference. OBJECTIVE: The aim of this study was to compare the clinical efficacy and complications of QS 755 nm alex and QS 1064 nm Nd:YAG lasers in the treatment of nevus of Ota after three or more treatment sessions. METHOD: Forty patients were recruited for this study and all had received three or more laser treatment sessions with an interval of at least 2 months between each. Half of the lesion was treated with QS alex and the other half with QS 1064 nm Nd:YAG laser. The degree of lightening was assessed subjectively by the patient using a visual analog scale and objectively by two independent clinicians. Patients were called back to be examined for evidence of complications. RESULTS: In terms of subjective degree of lightening, QS 1064 nm Nd:YAG laser was found to be significantly more efficacious than QS alex (P = 0.018). Both clinicians also found QS 1064 nm Nd:YAG laser to be more effective, but statistical significance was only detected in one, not both of their scores (P = 0.005 and 0.414 for observers 1 and 2, respectively). More patients that received QS Alex developed complications (4 for QS alex and 2 for QS Nd:YAG), but the difference was not statistically significant. CONCLUSION: QS 1064 nm Nd:YAG laser appears to be more effective than QS alex in the lightening of nevus of Ota after three or more laser treatment sessions. However, the majority (55%) of the patients reported no differences in results between the two lasers, and only one of the two observers noted statistically significant improvement of QS 1064 nm Nd:YAG over QS alex.     

Comparison of the Frequency-Doubled Q-Switched Nd:YAG Laser and 35% Trichloroacetic Acid for the Treatment of Face Lentigines

BACKGROUND: Face lentigines are one of the manifestations of photodamaged skin and often put people in socially embarrassing situations. Several lasers have been used to remove lentigines at vast expense. However, trichloroacetic acid (TCA) is an alternative for treating lentigines that costs much less. OBJECTIVE: To compare the efficacy of the frequency-doubled Q-Switched Nd:YAG laser (532 nm) and 35% TCA for the treatment of face lentigines. METHODS: Twenty patients (Fitzpatrick skin Types III-IV) with a total of 37 lentigines on faces were randomly collected; each lentigo was divided into medial and lateral halves. Frequency-doubled Q-switched Nd:YAG laser (532 nm) and 35% TCA were applied to the medial and lateral halves of each lentigo respectively. The efficacy after 1 treatment was compared after 6 months. RESULTS: The frequency-doubled Q-switched Nd:YAG laser (532 nm) had a better result than that of 35% TCA for the treatment of facial lentigines. CONCLUSION: In order to get a better result after one treatment, the authors suggest the frequency-doubled Q-switched Nd:YAG laser (532 nm) rather than 35% TCA for treating lentigines even though the cost of frequency-doubled Q-switched Nd:YAG laser (532 nm) is greater than that of 35% TCA for both physician and patient.     

Recurrent Pigmented Macules after Q-Switched Alexandrite Laser Treatment of Congenital Melanocytic Nevus

BACKGROUND: Q-switch-mode laser treatment of congenital nevi does not result in complete histological clearance, and many patients have partial repigmentation within several months. In addition, the number of recurrent pigmented macules (RPMs) may increase, a major drawback to good cosmetic results. While the mechanism of recurrence is not known. OBJECTIVE: To help elucidate the mechanism of RPM development, we evaluated the expression of TNF-alpha and E-cadherin on RPM after treatment of congenital nevi with a Q-switched alexandrite laser (QSAL). METHODS: Thirteen Korean subjects with congenital nevi received QSAL treatment at intervals ranging from 2 to 6 months (mean, 4.5 treatments). Two-millimeter punch biopsy specimens were obtained at their first visit and from RPMs 3-6 months after the last treatment. Expression of E-cadherin and TNF-alpha were determined histochemically in the original nevi and RPM. In addition, one RPM was examined by electron microscopy. RESULTS: Reduced pigmentation in the treated areas was seen in all cases, but partial repigmentaion was seen as black spots within 6 months after the last QSAL treatment. Compared to the original nevi, the RPMs had increased numbers of melanocytes in the epidermis and reduced nevomelanocytic nests in the dermis. The expression of TNF-alpha and E-cadherin was downregulated in the RPMs compared to the original nevi. Electron microscopy confirmed the increase in melanocytes in the epidermis of RPMs. CONCLUSION: Our findings suggest that the down-regulation of E-cadherin and TNF-alpha may induce the proliferation of melanocytes, resulting in the formation of RPMs.     

Treatment of Lichen Amyloidosis (LA) and Disseminated Superficial Porokeratosis (DSP) with Frequency-Doubled Q-Switched Nd:YAG Laser

BACKGROUND: Under normal practice, the full thickness of the epidermis is peeled off when treating pigmented lesions with a frequency-doubled Nd:YAG laser. Based on this observation, it is postulated that this laser may be effective for treating lichen amyloidosis (LA) and disseminated superficial porokeratosis (DSP) for which the pathologic changes are limited to the epidermis and papillary dermis. OBJECTIVE: To investigate the clinical effect of frequency-doubled Nd:YAG laser treatment for one patient with LA and for one patient with DSP. METHODS: Frequency-doubled 532 nm Nd:YAG laser pulses were delivered to the lesions on the limbs of a patient with LA and the face and forearms of a patient with DSP. Lesions of LA were treated two or three times, and those of DSP were treated four times, treatment sessions being 1 month apart. For this investigation, biopsies were taken from untreated lesions prior to treatment, lesions immediately after laser treatment, and lesions present at a 9-month follow-up investigation. RESULTS: Both the patient with LA and the patient with DSP responded well to treatment, the results of which remained unchanged at a follow-up conducted 9 months after the final treatment session. CONCLUSION: Frequency-doubled Nd:YAG laser treatment provided excellent results for the patient with LA as for the patient with DSP. The effectiveness of this method deserves further study in a larger group of test patients.     

Nd:YAG Laser Treatment of Recalcitrant Folliculitis Decalvans

BACKGROUND: The scarring follicular disorders pose challenging therapeutic dilemmas. OBJECTIVE: Hair removal lasers have recently been shown to be efficacious in the management of these disorders. METHODS: We present a young, Fitzpatrick skin type VI African-American patient with recalcitrant folliculitis decalvans, whom we treated with the neodymium:yttrium aluminum garnet (Nd:YAG) laser. RESULTS: A remission of folliculitis decalvans was successfully achieved using the Nd:YAG for laser depilation. CONCLUSION: Based on the optical properties of light in skin, the Nd:YAG laser is the best for laser depilation in dark individuals.     

Variable-Pulse Nd:YAG Laser in the Treatment of Facial Telangiectasias

BACKGROUND: Variable-pulse 1,064 nm wavelength lasers have been used with good effectiveness on leg telangiectasias and reticular veins and have shown promising results on facial telangiectasias as well. OBJECTIVE: To investigate the effectiveness of a variable-pulse neodymium:yttrium-aluminum-garnet (Nd:YAG) laser using a small spot size in the treatment of facial telangiectasias. METHODS: Eight male patients (mean age 75 years) underwent a single treatment session using a variable-pulse 1.5 mm spot size Nd:YAG laser with epidermal cooling. Telangiectasia diameters were 0.3 to 2.0 mm. Test sites were performed using three pulse widths (3, 20, and 60 ms), with fluences varying depending on vessel size and response. Full treatments were performed using test parameters giving the best response. Thirteen weeks later, the patients returned for final evaluation and satisfaction rating. RESULTS: Fluences ranged from 226 to 425 J/cm2, with smaller vessels requiring larger energies. Pulse duration was equally divided between the 20 and 60 ms settings. The shortest pulse width (3 ms) was inferior in all patients. Longer pulse durations achieved superior vessel elimination with minimal immediate purpura and no postinflammatory hyperpigmentation. The average mean vessel clearance was 26 to 50% in half of the patients and 51 to 75% in the other half as evaluated by three unbiased dermatologists with extensive laser experience. CONCLUSION: A small-spot size Nd:YAG laser using a pulse width of 20 ms or higher appears to be effective in clearing a significant percentage of facial telangectasias with a single pass. The side effects were minimal.     

调Q开关Nd:YAG激光治疗色素性皮肤病1051例临床观察

目的探讨调Q开关Nd∶YAG激光治疗色素性皮肤病的疗效和不良反应。方法回顾性分析调Q开关Nd∶YAG激光治疗1 051例色素性皮肤病的临床疗效和不良反应,其中太田痣365例、雀斑103例、咖啡斑106例、褐青色痣43例、雀斑样痣37例、文身128例、外伤性文身57例、斑痣96例、脂溢性角化116例。结果太田痣、雀斑、脂溢性角化疗效最好,总有效率均为100%,褐青色痣、文身和外伤性文身亦有上佳疗效,总有效率均在90%以上。咖啡斑、雀斑样痣、斑痣亦有不同程度疗效,总有效率分别为63.2%、51.4%、45.8%。结论调Q开关Nd∶YAG激光治疗色素性皮肤病安全性高,对绝大多数太田痣、雀斑、脂溢性角化、褐青色痣、文身、外伤性纹身可达到治愈的效果,对咖啡斑、雀斑样痣、斑痣亦有一定程度的疗效。     

Stretch Marks: Treatment Using the 1,064-nm Nd:YAG Laser

BACKGROUND Striae are frequent skin lesions that cause considerable aesthetic concern. The 1,064-nm long-pulsed Nd:YAG laser has been used to promote an increase in dermal collagen and is known to be a laser that has a high affinity for vascular chromophores.
OBJECTIVE This study aims to verify the efficacy of the long-pulsed Nd:YAG laser in the treatment of immature striae.
MATERIALS AND METHODS Twenty patients who had immature striae, i.e., red striae, were treated using the 1,064-nm long-pulsed Nd:YAG laser. The analysis of treatment efficacy was performed by the comparison between the images taken before and after each treatment session as well as through a subjective assessment carried out by the patients themselves.
RESULTS Results were considered satisfactory to both patients and doctors. A higher number of patients (55%) considered the results excellent when compared to the same assessment made by the doctor (40%).
CONCLUSION The clinical improvement of immature striae can be obtained with the use of the 1,064-nm long-pulsed Nd:YAG laser. The low incidence of side effects makes this laser a good alternative in the treatment of these common skin lesions.     

Transurethral Canine Prostatectomy with the Nd:YAG Laser

Although laser energy in combination with conventional techniques has been used to ablate prostatic tissue in the dog, the use of the Nd:YAG laser alone to perform transurethral prostatectomies has not been feasible because of the difficulty of directing the laser energy into the prostate. In this study, a 600-μm quartz laser fiber with an attached gold-plated metal alloy reflector and a 1.06-μm Nd:YAG laser were used to perform transurethral laser prostatectomies in 10 mongrel dogs. Each dog received approximately 3600 J to each quadrant of the prostate. No signs of urinary incontinence were noted in any of the dogs postoperatively. Transurethral laser prostatectomies can be performed safely and effectively in the dog and can significantly decrease the incidence of postoperative urinary incontinence.