Effects of a fractional picosecond 1,064 nm laser for the treatment of dermal and mixed type melasma

Background: Picosecond laser is a novel modality for pigmented skin disorders with extremely short pulse duration. Little is known about the effects of the picosecond laser in melasma. Objective: This study aimed to investigate the efficacy of fractional picosecond 1,064?nm laser in melasma treatment. Study design: A prospective, randomized, assessor-blinded, intra-individual split face comparative study. Methods: Female subjects with melasma were enrolled and received fractional picosecond 1,064?nm laser plus 4% hydroquinone cream on one randomly assigned side of the face; the results were compared to the use of hydroquinone cream only on the contralateral side. The modified melasma area severity index (mMASI) score, melanin index by Mexameter MX18®, participant satisfaction score by quartile rating scale, and the quality of life by the dermatology life quality index (DLQI) were evaluated over 12 weeks. Results: Thirty female subjects completed the protocol. The mean (± standard deviation, SD) mMASI score at the 12-week visit was significantly reduced in the picosecond laser-treated areas compared to controls (3.52 ± 1.4 and 4.18 ± 2.03 respectively; p = 0.035). No differences were observed in the mean Mexameter melanin index, participant satisfaction score, and DLQI score. The observed adverse effects included transient mild erythema and mild skin desquamation. Conclusion: The addition of fractional picosecond 1,064?nm laser to 4% hydroquinone was effective and significantly better than 4% hydroquinone alone for the treatment of melasma.     

A preclinical study testing “Focused multiple laser beams,” a new concept of irradiation with the 1064-nm Nd:YAG laser for skin rejuvenation

Introduction: In order to avoid epidermal heat damage, we developed a novel irradiation method termed “Focused multiple laser beams (FMLB),” which allows long-pulse neodymium:yttrium aluminum garnet (Nd:YAG) laser beams to be irradiated from several directions in a concentric fashion followed by focusing into the dermis without epidermal damage. This study aimed to assess whether FMLB achieves the desired dermal improvement without epidermal damage. Materials and methods: The dorsal skin of New Zealand White rabbits was irradiated with FMLB. Macroscopic and histological analyses were performed after 1 hour and 1, 2, 3 and 4 weeks. Real-time PCR analysis of type I and III collagen expression was performed at two and four weeks. Results: Control groups exhibited skin ulcers which were healed with scar formation whereas FMLB groups remained intact macroscopically. Histologically, FMLB group showed increase in dermal thickness at four weeks while the epidermis remained intact. Real-time PCR demonstrated that both type I and III collagen increased at two weeks but decreased at four weeks. Conclusions: FMLB can deliver the target laser energy to the dermis without significantly affecting the epidermis.     

A study of fractional CO₂ laser resurfacing: the best fluences through a clinical, histological, and ultrastructural evaluation

Background Fractional resurfacing is a laser treatment modality to create numerous microscopic thermal injury zones of controlled width, depth, and density that are surrounded by a reservoir of spared epidermal and dermal tissue, allowing rapid repair of laser‐induced thermal injury. Objective To evaluate the safety and efficacy of a fractional CO₂ laser system in the treatment of photo‐damaged skin with clinical, histological, and ultrastructural evaluation, with special attention to one of the parameters of this laser system: the fluences. Materials and methods Twelve patients with Fitzpatrick skin types II to III with photo‐damage skin underwent fractional laser treatment with one single‐pass superficial on the face and forearm. Clinical outcome and histological and ultrastructural changes were assessed. Results  Light microscopy of biopsies gave important information about skin changes at three different times after fractional treatment, especially revealing some differences between the fluences used in the three groups of patients. Conclusion Fractional resurfacing offers significant surgical advantages allowing to achieve excellent esthetic results in balance with the biological structure. Besides, our study shows already that with 2.07 and 2.77 J/cm², instead of 4.15 J/cm², it is possible to reach a biological response without scar formation.     

Comparison of effectiveness of 1,064-nm Nd:YAG laser and Nd:YAG laser–IPL combination treatments in hand skin rejuvenation

Objective: Evaluation of the efficacy and side effects of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser and Nd:YAG laser–intense pulsed light (IPL) combination treatments in photorejuvenations of skin of the hand, and determining their impacts on patient satisfaction. Materials and Methods: Thirty-five female patients with signs of photoaging on the skin of their hands were included in the study. Three sessions of IPL and four sessions of Nd:YAG laser treatment were applied to the right hand in total with 2-week intervals between each session, whereas six sessions of Nd:YAG laser treatment were applied to the left hand of patients with 2-week intervals between each session. Results: The patients’ ages ranged between 31 and 78, and mean age was 60.77 ± 9.48. While there was no difference in pigment distribution, fine wrinkles, coarse wrinkles, and global scores between the right and left hand prior to treatment (p > 0.05), average pigment tone score was higher in the right hand with a statistically significant difference (p < 0.05). There was greater improvement in scores of pigment distribution, fine wrinkles, sallowness, pigment tone parameters, and global score on the right hand compared to left hand, which was statistically significant (p <0.001). Conclusion: In rejuvenation of photoaged dorsal skin of the hand, IPL–Nd:YAG laser combination treatment surpasses Nd:YAG laser treatment.     

Defocused diode laser therapy (830 nm) in the treatment of unresponsive skin ulcers: a preliminary trial

BACKGROUND: Skin ulcers with compromised healing remain a major problem for plastic and dermatological surgeons. Low incident levels of laser energy have been shown to increase the blood flow rate and volume and to accelerate the wound healing process, thus raising the possibility in augmenting treatment for skin ulcers.

METHODS: Preliminary controlled experiments with a 830?nm GaAlAs diode laser in axial pattern flap survival in the rat model showed statistically significant improvement in survival for the irradiated versus unirradiated control animals. In the present study, a newly developed defocused GaAlAs diode laser (830?nm, continuous wave, 669?mW/cm²) was applied once or twice per week in an uncontrolled study of five patients (aged between 5 and 81 years old, average 46.6 years old, doses from 6.3?J/cm² to 21?J/cm²) with previously unresponsive ulcers of various aetiologies.

RESULTS: In all five patients, the ulcers healed completely between 3 weeks and 7 months (22.8±19.3 weeks), without recurrence during a minimum 12‐month follow‐up.

CONCLUSIONS: Defocused 830?nm diode laser therapy was well tolerated, and was very effective in the treatment of this small number of compromised skin ulcers of different aetiologies and in a large range of patient ages. Further controlled studies in larger populations are required. Defocused diode laser therapy nonetheless appears to be a very useful adjunctive method in the treatment of slow‐to‐heal and non‐healing skin ulcers.     

Fractional non-ablative laser treatment at 1410 nm wavelength for periorbital wrinkles – reviscometrical and clinical evaluation

Objective: The aim of the research was to establish the influence of 1410-nm fractional non-ablative laser treatment on skin aging in the eye area. The reviscometer reference test is an objective method of estimating the flexibility of the skin. The photographic records were used as the auxiliary method of the therapy quality effectiveness. Materials and methods: The study involved the group of 13 people (12 females and 1 male, aged 33–47 with prototype II and III according to the Fitzpatrick scale), who underwent two sessions of fractional non-ablative laser therapy (wavelength of 1410 nm) with a 2-week interval. In order to evaluate the effectiveness of the quality of the treatment a reviscometer probe was used to measure the skin elasticity (Reviscometer RVM 600). The measurements were taken twice: directly before and two weeks after the treatment. Furthermore, to facilitate the clinical evaluation an anonymous photographical documentation was prepared. Results: An improvement of the skin flexibility in the eye area was observed and the fact was confirmed by values obtained using the reviscometer probe (significant statistic differences: P < 0.0001) as well as clinical assessment based on photographical records. Conclusion: On the basis of the reviscometer measurements analysis and photographical records, 1410-nm fractional non-ablative laser treatment appears to be an efficient method contributing to the improvement of the skin flexibility of the eyes area as well as to the reduction of the number of wrinkles. The post-treatment observation proves that the method is well-tolerated in the sensitive eyes area and does not cause any significant side effects.     

High‐frequency ultrasound evaluation of cellulite treated with the 1064 nm Nd:YAG laser

Objectives: To investigate non‐invasive laser treatment for cellulite using the 1064?nm Nd:YAG laser and to correlate clinical results with high‐frequency skin ultrasound images. Methods: Twelve individuals of normal weight were treated on either the left or right posterior side of the thigh with the following parameters: fluence 30?J/cm, 18?mm spot size and dynamic cooling device pulse duration of 30?ms. Three treatments were performed at intervals of 3–4 weeks, and followed‐up 1 and 3 months after the last session. Photographs and ultrasound imaging were assessed before each session. Results: The 1064?nm Nd:YAG laser resulted in a tightening of the skin and an improvement in cellulite. No side effects were reported. High‐resolution ultrasound imaging showed a significant improvement in dermis density and a reduction of dermis thickness. The method is described in detail in Appendix 1. Conclusion: Infra‐red lasers may constitute a safe and effective treatment for cellulite and high‐frequency ultrasound imaging provides a quantitative and objective measurement of the treatment efficacy.     

Optimising the design of a broad‐band light source for the treatment of skin

Phototherapy has become a treatment of choice in many areas of medicine. Light can be used to deliver energy to tissue selectively targeting specific structures in order to induce the desired therapeutic outcome. The choice of optical parameters for a specific application is not simple. Wavelength, energy, exposure time and fluence can be varied and induce a wide range of tissue effects. The treatment of the skin with light is probably the one phototherapy application that is most developed in terms of technology and market maturity. White light systems are extensively used to address a range of skin conditions. However, different conditions have different physiology and hence require differing optical parameters. The technology standard is based upon systems, which have a number of different optical filters allowing the output to be tailored to the specific application. This paper discusses the advantages of a diferent type of system, namely the iPulse i300 (Cyden Ltd, Swansea, UK), which uses a single dichroic reflectance filter and whose optical output is changed by varying other parameters in a carefully controlled manner.     

Accelerated reduction of post‐skin‐resurfacing erythema and discomfort with a combination of non‐thermal blue and near infrared light

The prolonged crusting and erythematic phases following chemical and laser skin resurfacing create discomfort and aggravate patients. Depending on the aggressiveness of the procedure, post‐procedure erythema may last from three weeks to several months. iClearXL (CureLight Ltd) is a non‐contact, non‐thermal blue (405–420?nm)/near infrared (850–900?nm) dual‐band light source emitting up to 60?J/cm² on a 30?cm by 30?cm treatment area. The blue component of the light source has been proven to have a significant anti‐inflammatory effect, whereas the near infrared component enhances vascular circulation as well as lymphatic drainage in the thin, necrotized papillary layer.

Facial skin laser resurfacing was performed on twelve patients. Starting one day after resurfacing, six patients received a daily 20‐minute treatment of blue (405–420?nm)/near infrared (850–900?nm) light for six consecutive days, and six control patients were treated with the usual topical care protocol. Twelve days after the procedure, the treated group had a weighted average erythema score of 0.33 as compared to 1.33 in the control group. Two months after the procedure, the treated group had a weighted average erythema score of 0.16 as compared to 0.83 in the control group. Twelve days after the procedure, the treated group had a weighted average discomfort score of 0.33 as compared to 0.83 in the control group.

The tested combination of non‐thermal blue (405–420?nm)/near infrared (850–900?nm) dual‐band light was found to significantly shorten the duration of post‐laser‐resurfacing erythema and discomfort with no side effects.     

Intense pulsed light (IPL) treatment for the skin in the eye area – clinical and cutometric analysis

Objective: The aim of the research was to establish the influence of IPL treatment on skin ageing in the eye area. Material and methods: This study included 24 women, aged 38–63 years (mean age was 48.04) with Fitzpatrick skin type II and III who underwent five successive treatment sessions with an IPL in two-week intervals. The Cutometer (Courage + Khazaka electronic) reference test was an objective method for the assessment of the biomechanical properties of the skin. The measurements were made in three places around the eye. The photo documentation was used to compare state of skin before and after three months of treatments. Additionally, patients filled in a questionnaire, which contained questions concerning self-assessment of the procedure effects. Results: Cutometric analysis showed significant improvement of skin elasticity (statistical significance level is mostly < 0.0001). The comparison of clinical changes in the therapy, based on photo documentation, showed a 25% improvement. Conclusions: This treatment was used in order to improve skin elasticity and decrease the amount and depth of wrinkles. It is a non-invasive treatment, with low risk of complications.     

Frequency of excisions and yields of malignant skin tumors in a population-based screening intervention of 360 288 whole-body examinations

OBJECTIVE To explore the frequency of excisions and yields of histopathologically confirmed skin cancer. DESIGN A population-based skin cancer screening intervention (the SCREEN project) in the German state of Schleswig-Holstein (July 1, 2003, to June 30, 2004). SETTING Physician offices. Participants could choose between nondermatologist physicians and dermatologists for their initial whole-body skin examination. All screening physicians received a mandatory 8-hour training course. PARTICIPANTS Inhabitants of Schleswig-Holstein 20 years or older with statutory health insurance (N?=?360?288). MAIN OUTCOME MEASURES Frequency of excisions and yields of malignant skin tumors (malignant melanomas [MMs], basal cell carcinomas [BCCs], and squamous cell carcinomas [SCCs]), stratified by sex and age. RESULTS Overall, 15?983 excisions were performed (1 of 23 screenees). A total of 3103 malignant skin tumors were diagnosed in 2911 persons: 585 MMs, 1961 BCCs, 392 SCCs, and 165 other malignant skin tumors. Overall, 116 persons (3103 of 360?288) had to be screened to find 1 malignant tumor, with 1 of 620 for MM, 1 of 184 for BCC, and 1 of 920 for SCC. Twenty excisions were performed to find 1 melanoma in men 65 years and older, but more than 50 excisions were required to find 1 melanoma in men aged between 20 and 49 years. CONCLUSIONS The results of SCREEN suggest a high yield of malignant skin tumors in a large-scale population-based screening project. We found that a high number of excisions was performed in the youngest screenees with an associated low yield, suggesting a need in screener training to emphasize a more conservative attitude toward excisions in young screenees.