High-power diode laser use on Fordyce granule excision: a case report

Background Fordyce granules are conventionally considered to be a developmental oral lesion with a higher incidence in men. Objective To report a clinical case of surgical lip Fordyce granule excision in a 19‐year‐old male. Methods Fordyce granules were excised using a high‐power diode laser (gallium arsenide [GaAs], Diode Vision^®, MDL, 10 Dental Laser Unit, GmbH, Lower Saxony, Germany) with wavelength emission at 980 ± 10 nm, in a continuous wave mode, pulse width of 0.5 μs, fiber optic delivery system of 400 μm in diameter, at 2.5 W. Subsequently, low‐intensity laser therapy was applied (gallium‐aluminum‐arsenide [GaAlAs], at 670 nm, 50 mW, at 4 J/cm²; Dentoflex^®, São Paulo, Brazil] in order to stimulate a faster wound tissue–healing process and less postoperative pain and inflammation. Conclusion The excellent esthetic result demonstrated the effectiveness of both high‐ and low‐intensity laser therapy on the excision of Fordyce granules.     

Laser therapy of a dermal nevus in the esthetic zone of the nasal tip: A case report and comprehensive literature review

This case report demonstrates the ablation of a dermal nevus using a diode laser in the esthetically very demanding facial area of the nasal tip. The clinical outcome shows good results and a high level of patient satisfaction. Due to effective wound granulation and healing, elaborate skin grafts could be avoided. The application of the contact laser ensures safe treatment in highly perfused areas thanks to haptic feedback and good coagulative effect. The method should therefore be considered as an alternative to other ablative procedures for benign lesions in the facial area.     

Histological hair removal study by ruby or alexandrite laser with comparative study on the effects of wavelength and fluence

BACKGROUND: Several different laser systems are currently used to remove unwanted hairs. In this study, we studied follicular changes following hair removal with ruby or alexandrite lasers at different fluences.

METHODS: Unwanted hairs were treated with a ruby laser (Chromos 694, ICN PhotonIcs, UK) at 10, 14 or 18?J/cm² or with an alexandrite laser (LPIR, Cynosure, USA) at 11, 14 or 17?J/cm². A 3?mm skin punch biopsy was taken immediately after each laser exposure and also 1 month later. Specimens were stained for histological observation. They were observed using immunohistochemistry with antibodies recognizing factor VIII related antigen or PCNA, and also by the TUNEL method. Similarly, electron microscopic observation was examined.

RESULTS: Immediately after the laser exposure, moderate follicular damage was observed following treatment with either type of laser. One month later, cystic formation of hair follicles and foreign body giant cells were observed in skin treated with either type of laser. A similar fluence with either laser treatment resulted in similar histological changes.

CONCLUSION: In this study, the histological changes following treatment with a ruby or an alexandrite laser at the same fluence are similar.     

Management and prevention of laser complications in aesthetic medicine: An analysis of the etiological factors

Growing popularity of laser treatment has understandably resulted in increased incidence of potential complications. The analysis of complications, taking into account the causes of their occurrence, is of particular interest. The identification of etiological factors and the development of a step‐by‐step prophylactic algorithm with their consideration is the way to reduce the number of possible complications in future practice. In this article, we present a classification of the causes of complications associated with various types of laser procedures. This classification was developed on the basis of a review of last 20 years' literature and our own experience in a network of clinics “Linline” in Russia. We identified six groups of the etiological classification of laser complications: errors of patient selection, errors of treatment tactics, wrong choice of device and technology, neglect of treatment protocol, inadequate post‐procedural care, individual response of the patient. The causes of all specified groups of complication, except the last one, are preventable causes.     

Treatment of gingival pigmentation with a 755-nm alexandrite picosecond laser

ABSTRACT

Hyperpigmentation of the gums can be associated to several etiological factors. Although it is physiological in most cases it can cause esthetic concerns in some patients. The objective of our study was to evaluate the clinical efficacy and patient satisfaction with the treatment of gingival hyperpigmentation with picosecond alexandrite laser of 755 nm. We selected two patients with gingival hyperpigmentation on the anterior face of the upper and lower gums of years of evolution. Malignancy, drug ingestion, exposure to tobacco and underlying genetic and endocrine alterations were ruled out. Clinical photographs were taken before treatment and 2 weeks after the procedure. In both cases, anterior gingival areas were depigmented with satisfaction. The patients did not complain of severe pain or discomfort. Two weeks after the procedure the gingiva showed almost complete depigmentation. In conclusion, the 755-nm alexandrite picosecond laser seems to be safe and effective for the esthetic treatment of gingival hyperpigmentation.     

Laser resurfacing today and the ‘cook book’ approach: a recipe for disaster?

Background Laser ablative skin resurfacing achieves skin rejuvenation by precise ablation of photoaged skin and subsequent re‐epithelialisation and dermal remodelling. Carbon dioxide (CO₂) and Erbium:YAG (Er:YAG) lasers are the established choice. A wide range and many sets of parameters have been proposed as the gold standard for each system but results have varied. Aims To show that this single system ‘cook book’ approach must be rejected in favour of a more comprehensive approach. Subjects and methods The author has experience of ablative skin resurfacing in over 1200 patients and has used both systems. A more flexible approach, using a combined wavelength system, is presented. It comprises precise ablation of the epidermal with the Er: YAG (to create an epidermal window), followed instantaneously with subablative heating of the exposed dermis with the CO₂ laser. Results Since adopting the dual wavelength/dual modality approach, more than 600 patients have been treated, with excellent results and a very high patient satisfaction index, currently around 90%, obtained from the sum of the very satisfied and satisfied patients using a five‐grade scale. Possible resurfacing‐related complications have included prolonged erythema, hyper or hypopigmentation, scarring and viral infections, which were more common with single system resurfacing. The author's complication rate remains under 1%, without any prophylactic use of antiviral agents. Conclusions The cook book approach, whereby a particular set of fixed laser resurfacing parameters for a specific single laser system are adopted and rigidly applied in all patients, will not achieve the best treatment effects and may even produce a bad result and dissatisfied patients. The dual modality approach allows a combination of the favourable elements of each of the two wavelengths with excellent and consistent results.     

Ablative treatment of photoaging

Despite the burgeoning options available for skin rejuvenation, the benefits of laser skin resurfacing in trained hands remains unequaled. This article will review the preoperative evaluation, lasers and techniques used, postoperative course, and possible complications.     

Lasers and laser‐like devices: Part two

Part two of this review series evaluates the use of lasers and laser‐like devices in dermatology based on published evidence and the collective experience of the senior authors. Dermatologists can laser‐treat a wide range of dermatoses, including vascular, pigmentary, textural, benign proliferative and premalignant conditions. Some of these conditions include vascular malformation, haemangioma, facial telangiectases, café‐au‐lait macules, naevi of Ota, lentigines, acne scarring, rhytides, rhinophyma and miscellaneous skin lesions. Photodynamic therapy with lasers and intense pulsed light is addressed, with particular reference to actinic keratosis and actinic cheilitis. A treatment algorithm for acne scarring based on scar morphology and severity is comprehensively outlined. Following from part one, the various devices are matched to the corresponding dermatological conditions with representative pictorial case vignettes illustrating likely clinical outcomes as well as limitations and potential complications of the various laser and light therapies.     

ED2000®: 585 nm collagen remodelling pulsed dye laser

The wavelength of 585nm corresponds to an absorption peak of haemoglobin. The heating effect in these skin layers triggers the release of various growth factors that stimulate collagen remodelling and tightening. We report our experience with a 585nm collagen remodelling, double flashlamp excited pumped dye laser was used (ED2000^®, Deka MELA, Calenzano, Italy), spot size 5?mm, energy density (fluence J/cm²) from 2 to 4?J/cm², emission modality (repetition rate) at 0.5?Hz, with a short pulse duration of 250?μsec. The efficiency of 585?nm collagen remodelling pulsed dye laser is controversial in only one session. It is probably reasonable to inform patients that 3–4 treatment sessions are necessary, and that 10% of the patient have no response to nonablative photorejuvenation.

Because of its low fluence and is shorter pulse duration, the 585?nm collagen remodelling pulsed dye laser has limited efficacy for the treatment of port wine stains. However, it may offer patients with erythematous, raised or hypertrophic acne scars or striae distensae a permanent cosmetic solution. This laser is safe and effective in the treatment of surgical scars starting as soon as possible, on the day of suture removal if possible. We found that 96.3% of molluscum contagiosum healed after the first treatment, the other 3.7% after the second.     

Histologic analyses on the response of the skin to 1,927-nm fractional thulium fiber laser treatment

Background: The histologic responses to varied parameters of 1,927-nm fractional thulium fiber laser treatment have not yet been sufficiently elucidated. Objective: This study sought to evaluate histologic changes immediately after 1,927-nm fractional thulium fiber laser session at various parameters. Methods: The dorsal skin of Yucatan mini-pig was treated with 1,927-nm fractional thulium fiber laser at varied parameters, with or without skin drying. The immediate histologic changes were evaluated to determine the effects of varying laser parameters on the width and the depth of treated zones. Results: The increase in the level of pulse energy widened the area of epidermal changes in the low power level, but increased the dermal penetration depth in the high power level. As the pulse energy level increased, the increase in the power level under the given pulse energy level more evidently made dermal penetration deeper and the treatment area smaller. Skin drying did not show significant effects on epidermal changes, but evidently increased the depth of dermal denaturation under both high and low levels of pulse energy. Conclusion: These results may provide important information to establish treatment parameters of the 1,927-nm fractional thulium fiber laser for various skin conditions.     

激光治疗白癜风的研究进展

现阶段白癜风的激光治疗方法主要有308 nm准分子激光、CO2点阵激光以及氦氖激光,与传统疗法相比,具有快捷、可调控、不良反应少等优点,在局限型白癜风治疗中越来越受到重视,本文将激光治疗白癜风的进展做一综述。     

Histologic comparison of microscopic treatment zones induced by fractional lasers and radiofrequency

Abstract

Introduction: Fractional photothermolysis induces microscopic, localized thermal injury in the skin surrounded by undamaged viable tissue in order to promote wound healing. Objective: This study evaluated acute histologic changes following each single pass of various fractional lasers and radiofrequency (RF). Methods: Three male domestic swine were used. We used fractional Erbium:glass (Er:glass), Erbium:yttrium-aluminum-garnet (Er:YAG), CO₂ lasers, and fractional ablative microplasma RF. We analyzed features and average values of the diameter, depth, and vertical sectional areas treated with each kind of laser and RF. Results: The microscopic treatment zone (MTZ) of fractional Er:glass resulted in separation of dermoepidermal junction with no ablative zone. Fractional Er:YAG provided the most superficial and broad MTZ with little thermal collateral damage. Fractional CO₂ resulted in a narrow and deep “cone”-like MTZ. Fractional RF resulted in a superficial and broad “crater”-like MTZ. Conclusions: This study provides the first comparison of MTZs induced by various fractional lasers and RF. These data provide basic information on proper laser and RF options. We think that these findings could be a good reference for information about fractional laser-assisted drug delivery.     

Effect of hair removal by Nd:YAG laser on the recurrence of pilonidal sinus

Background  Pilonidal sinus (PNS) is chronic inflammatory process of the skin in the natal cleft. Management of PNS is mainly surgical. Although different types of surgery have been performed, the recurrence rate is still high.
Objective  To evaluate the effectiveness of laser hair removal (LHR) in the natal cleft area on the recurrence rate of PNS as an adjuvant therapy after surgical treatment.
Methods  Twenty five patients with PNS were included in this study. Fifteen patients underwent LHR treatment using Nd:YAG laser after surgical excision of PNS (Patients group) while ten subjects with PNS did not do LHR and served as a control group.
Results  All of the patients were male patients. Their age ranged from 17 to 29 years with a mean of 21.60 ± 3.13 years. They had Fitzpatrick skin type III, IV and V. The patients have got 3 to 8 sessions of LHR (mean 4.87 ± 1.64). Follow up period lasted between 12 to 23 months. None of the patients, who underwent LHR, has required further surgical treatment to date. Seven patients out of ten in the control group have developed recurrent PNS. Pain was the most frequent side effect and it was seen in 6 patients (40%).
Conclusion  LHR can prevent the recurrence of PNS. LHR should be advised as an essential adjuvant treatment after surgical excision of PNS. In non-complicated recurrent PNS, LHR is strongly advocated to be started before and continued after doing surgical treatment.     

Disseminated superficial actinic porokeratosis improved with fractional 1927-nm laser treatments

Disseminated superficial actinic porokeratosis (DSAP) is an inherited disorder of keratinization readily diagnosed through clinical and histologic examination. While generally benign in nature, the lesions can have profound psychosocial implications for patients. Although no cure exists, a number of treatment modalities, from topical medications to laser and light devices, have been reported with variable success. The authors report two cases of DSAP treated with the 1927-nm thulium fiber fractional laser along with a review of the treatment literature for DSAP. This therapy is convenient and safe with nearly no downtime or morbidity associated with pigment or textural changes.     

激光疗法在雄激素性脱发中的应用

近年来,国内外研究表明光疗法治疗雄激素性脱发效果良好。波长650~785 nm的低能量光、波长1550 nm和1927 nm的非剥脱性点阵激光以及剥脱性二氧化碳点阵激光治疗雄激素性脱发有效,其中,655 nm激光的疗效证据最充分。本文对不同波长的低能量激光和高能量点阵激光在雄激素性脱发治疗中的应用进行综述。     

Removal of amateur blue-black tattoos in Arabic women of skin type (III-IV) with Q-switched alexandrite laser

Background and Objectives Tattoos in Arabic society used to have a cosmetic importance on the face of females. These were usually amateur tattoos done by non‐professional women in the tribe. Because Islam as a religion prohibited its practice and its application, people became concerned about removing the old tattoos by any means. Nowadays, laser is considered an effective method of tattoo removal. Here, we report our experience in the removal of tattoos in Arabic women of skin type III–IV using the Q‐switched alexandrite laser. Study Design/Materials and Methods Twenty female subjects aged 35–50 years from similar racial and ethnic background with amateur tattoos were treated using the Q‐switched alexandrite laser. Fluence threshold was determined and a spot test was made. Q‐switched alexandrite laser with a fluence range 4.0–7.5 J/cm² (mean 6.05) was used at 6–12‐week intervals. Total treatment numbers ranged from three to six sessions (mean 4.15) with single‐pulse technique application. Results More than 95% lightening was achieved in five patients after three to six sessions at fluence range of 6–7.5 J/cm² and > 75% lightening in 10 subjects after three to six sessions of treatment at fluence range of 4–7.5 J/cm². Pinpoint bleeding was observed in one case but no pigmentary alteration or scarring was seen. Conclusion Tattoo pigment removal by Q‐switched alexandrite laser is an effective method in skin type (III–IV) with minimal side effects, which gives high patient satisfaction.     

Erbium:YAG laser resurfacing in patients with inflamed cystic acne

Background: Inflammatory cystic acne has been treated by a variety of modalities including antibiotics, topical agents, isotretinoin and chemical peels with variable degrees of success. Erbium:YAG lasers have been used for the treatment of acne scarring and photoaged skin but have not been thought of as treatment for actively inflamed lesions. Objective: We sought to ascertain the effectiveness of using low fluence erbium:YAG settings without topical anesthesia for the treatment of two patients with inflamed cystic acne. Methods: Two female patients with type 4 skin of Hispanic (32 years old) and south Asian (21 years old) origin were treated with the 2940 erbium:YAG LaserPeel laser. The Hispanic patient was treated twice with a 2‐month interval between treatments using the 200 mJ setting. The Asian patient had a combination of 200 and 400 mJ settings for her first treatment and 400 mJ for the subsequent two treatments. She was treated three times with an interval of 1 month between the first two treatments and a 2‐month interval between the second and third treatments. Results: Both patients healed within 6 days of each treatment and demonstrated progressive improvement. Results were excellent in both. Conclusion: Low fluence erbium:YAG facial resurfacing was effective for the treatment of inflamed cystic acne. Its use as a treatment modality should be further explored.     

Superficial erbium:YAG laser resurfacing of photodamaged skin

Background: Light chemical peels and microdermabrasion have enjoyed recent popularity for the treatment of mild photoaging. However, clinical improvement from these modalities is often minimal from both a patient's and physician's perspective. Erbium:YAG lasers have been effective in treating mild to moderate photoaging, but the need for either regional or general anesthesia, as well as the significant post‐treatment recovery period has limited its use.

Objective: We sought to utilize a very low fluence approach to erbium:YAG laser resurfacing, with topical anesthesia, to ascertain its efficacy in treating mild to moderate photoaging.

Methods: A total of 250 subjects aged 28–80 years with skin types 1–4 and mild to moderate facial rhytids were treated with topical anesthesia and subsequently one pass of a 2940?nm erbium:YAG laser, using between 5 and 17.5?J/cm². In addition, 58 of the treated facial subjects underwent neck resurfacing with fluences between 5 and 15?J/cm² and eight treated facial subjects underwent upper chest resurfacing at fluences of 5–7?J/cm². A single treatment was received by 246 subjects; four subjects were treated a second time after a 1‐month interval.

Results: Most subjects completely re‐epithelialized by 3–4 days; healing time was depth dependent. Most subjects were able to start skin care regimens within 1–2 weeks after the procedure. Results were judged to be excellent in individuals with thin skin and good in subjects with thicker skin.

Conclusions: One pass of low fluence erbium:YAG resurfacing, under topical anesthesia, was effective for the treatment of mild to moderate photoaging.