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.     

Hair removal on dark‐skinned patients with pneumatic skin flattening (PSF) and a high‐energy Nd:YAG laser

Background: Permanent laser hair removal is normally performed with high‐energy densities and associated with acute pain. Pneumatic skin flattening (PSF) is a new technology, which helps to control the pain during laser aesthetic treatments. Based on the gate theory of pain transmission, it activates tactile and pressure skin receptors just before the laser shot to naturally block the transmission of pain to the brain while the laser is activated. Objective: To test the safety, pain reduction, as well as the efficacy of PSF in hair removal on patients with dark skin (mainly skin types IV, V and VI) with a high‐energy Nd:YAG laser and without skin chilling. Methods: Patients were treated for hair removal with a 1064‐nm laser (GentleYAG, Candela) at energy densities of 40–44 J/cm². Each patient was treated on both axillae: PSF on one side and without PSF (but with a chiller) on control sites. Pain was evaluated on a 1–10 scale. Hair re‐growth was counted after 12 weeks. A second treatment was delivered at that time for additional evaluation of pain and further efficacy evaluation. Post‐treatment erythema and adverse effects were also noted. Results: Pain reduction was demonstrated in all 28 patients: the average was 2.6 with PSF and 4.5 without PSF. Hair removal efficacy with and without PSF was identical: 78–79% hair reduction after 12 weeks (standard deviation 14% and 10% respectively, t‐test: 0.78). There were no cases of adverse effects and post‐treatment erythema was consistently lower with PSF. All patients preferred PSF over non‐PSF treatment. Conclusion: The PSF technology considerably reduces pain in hair removal with high‐energy Nd:YAG lasers on dark skins without side effects, while preserving efficacy. Analgesic creams and skin chilling are not required.     

Non‐sequential fractional ultrapulsed CO2 resurfacing of photoaged facial skin: Preliminary clinical report

This study evaluates results, adverse side effects and downtime of the protocol ‘ActiveFX’ for photodamaged facial skin. A non‐sequential fractional ultrapulsed CO₂ laser with specific settings is used in addition to a new computer pattern generator (CPG). From September 2006 to March 2007, 55 patients underwent this new ‘soft’ single‐session, single‐pass and full‐face ablative fractional treatment. The patients were evaluated at baseline and 1 and 3 months after the treatment using a five‐point scale. Seven aspects of photodamaged skin were recorded: global score, fine lines, mottled pigmentation, sallow complexion, tactile roughness, coarse wrinkles and telangiectasias. The results were compared with a non‐parametric statistical test, the Wilcoxon's exact test. Eight patients received a double‐pass treatment on the crow's feet regions and the improvement of the coarse wrinkles was analyzed with a quartile grading scale. Significant differences (p<0.05) between baseline and 1 and 3 months post‐treatment were observed for all features except telangiectasias. Coarse wrinkles presented a good improvement only in the regions submitted to a double‐pass. Minimal and isolated adverse side effects were noted and the downtime was very low. Non‐sequential fractional ultrapulsed CO₂ light treatment (‘ActiveFX’) can be considered an excellent alternative for photodamaged facial skin.     

Locobase Repair ® cream following CO 2 laser skin resurfacing reduces interstitial fluid oozing

BACKGROUND: The cosmetic result after laser resurfacing depends not only on the type of laser and the technique used, but also on post-treatment care. The efficacy of Locobase Repair ® cream, which improves skin barrier function due to its content of natural skin analogue fats and cholesterol, was investigated. METHODS: A total of 18 Caucasian patients underwent resurfacing for acne scars. Laser treatment was performed with a Sharplan 1020 CO 2 laser and a Silk Touch scanner. Locobase Repair cream (a water-in-oil cream with 63% lipids including natural components of stratum corneum: cholesterol, ceramide and free fatty acids) was applied daily to one side of the face and petrolatum was applied to the other. In addition, both sides were treated with a 2% fusidic acid cream. RESULTS: There was a significant reduction of oozing during the first 2 days after CO 2 laser treatment on the sides treated with Locobase Repair cream ( p < 0.05), CO 2 laser while from day 3 to day 7 no differences were demonstrated between the Locobase Repair cream and petrolatum. For the other parameters scored (scaling, oedema, erythema and pain), no significant differences between Locobase Repair cream and petrolatum were found. Furthermore, no significant differences were found between the two creams regarding the duration of wound healing and final cosmetic outcome. In all, 62% of the patients preferred to use Locobase Repair cream during the postoperative period, and 11% preferred petrolatum. The remaining 27% expressed no preferences. CONCLUSION: The use of Locobase Repair cream as a post laser resurfacing treatment reduces tissue fluid oozing during the first 2 postoperative days, indicating a quick restoration of skin barrier and hence possibly a reduction in the incidence of wound infections as well as enhancing patient compliance due to less fluid oozing.     

Measurement of home‐use laser and intense pulsed light systems for hair removal: Preliminary report

Background: Laser and intense pulsed light (IPL) devices are used routinely by healthcare professionals for hair removal, but laser and light technology devices intended for home use have so far had little impact in the consumer market. However, as multinational companies enter this market, there will be an explosion in the use of such devices by the consumer. Objectives: This investigation focuses on the technical performance of the devices tested and although no clinical data are presented, the measured parameters are those that will directly impact efficacy in hair reduction, efficient coverage of skin, and safety in terms of unintentional eye exposure to the light source or incorrect settings for a given skin type. Consumers will consult healthcare professionals with experience of light‐based therapies for guidance and this study provides useful reference information on available home‐use devices. Methods: Previously published standard test methods were used to evaluate the devices tested. Results: Some of the devices measured in this study showed significant discrepancies between claims made by the manufacturers and the parameters measured. Conclusions: There is an urgent need for early ratification of the draft international IEC 60601‐1 intense light standard, which will encompass manufacturing standards for both professional and home‐use hair removal devices.     

Facial skin rejuvenation: Ablative laser resurfacing,chemical peels,or photodynamic therapy? Facts and controversies

Patients and cosmetic surgeons continue to develop innovative devices and techniques in search of the elusive fountain of youth. Our efforts in the past decade can be distilled to three primary approaches: refinement of existing technologies (ablative lasers); refinement of tried-and-true techniques (chemical peeling); and innovative use of new technologies (photorejuvenation). In this contribution, the authors discuss how these three approaches are used to achieve facial skin rejuvenation. Specifically, the authors compare and contrast the clinical benefits and disadvantages of the ablative fractionated and unfractionated carbon dioxide resurfacing lasers, medium-depth and deep chemical peeling, and the combination of photodynamic therapy with intense-pulsed light.     

CO2 laser desiccation of urethral hair post‐penoscrotal hypospadias repair

Background: Proximal urethral defects account for approximately 20% of hypospadiac urethras. Previous surgical interventions involved hair‐bearing genital skin which consequently resulted in a hairy urethra, which is seen mainly in older patients. Objective: To evaluate the safety and effectiveness of the CO₂ laser for urethra hair elimination. Methods: Four men aged 18–20 years with hairy urethras, who failed electrolysis treatment, were treated with CO₂ laser desiccation at low fluences (2–5?watts). The treatments were performed at 1‐month intervals. Treatment was continued until no hair was seen. Visual assessment of the hair reduction was recorded. Results: Patients received two to four treatment sessions (average 3.2). On clinical assessment 3 months after the last treatment, outcome was rated excellent (no hair) in all patients. Conclusions: CO₂ laser desiccation should be considered as a therapeutic modality for a hairy urethra, especially after the failure of electrolysis.     

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.     

Treatment of traumatic tattoo with the Q‐switched Nd:YAG laser

Traumatic tattoos are undesirable tattoos caused by different foreign bodies such as fireworks' particles, sand, metals, glass, gunpowder, asphalt, dust, or petroleum products embedded forcefully in the dermis. We report the case of a 54‐year‐old man who presented with sand and asphalt tattooing on his face following a bomb explosion 15 years ago. Q‐switched Nd:YAG laser at a wavelength of 1064?nm with a spot size of 4?mm and a fluence of 7.96?J/cm² were applied to treat the patient. The patient tolerated the treatment very well. Most of the blue dots became whitened immediately after the procedure and remained almost clear after a 6‐month follow‐up.     

Expression of the collagen VI α5 and α6 chains in normal human skin and in skin of patients with collagen VI-related myopathies

Collagen VI is an extracellular matrix protein with critical roles in maintaining muscle and skin integrity and function. Skin abnormalities, including predisposition to keratosis pilaris and abnormal scarring, were described in Ullrich congenital muscular dystrophy (UCMD) and Bethlem myopathy (BM) patients carrying mutations in COL6A1, COL6A2, and COL6A3 genes, whereas COL6A5, previously designated as COL29A1, was linked to atopic dermatitis. To gain insight into the function of the newly identified collagen VI α5 and α6 chains in human skin, we studied their expression and localization in normal subjects and in genetically characterized UCMD and BM patients. We found that localization of α5, and to a lesser extent α6, is restricted to the papillary dermis, where the protein mainly colocalizes with collagen fibrils. In addition, both chains were found around blood vessels. In UCMD patients with COL6A1 or COL6A2 mutations, immunolabeling for α5 and α6 was often altered, whereas in a UCMD and in a BM patient, each with a COL6A3 mutation, expression of α5 and α6 was apparently unaffected, suggesting that these chains may substitute for α3, forming α1α2α5 or α1α2α6 heterotrimers.     

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.     

Treatment of active acne with an Er:Glass (1.54 µm) laser: A 2‐year follow‐up study

Background: To investigate the effects of the 1.54 µm wavelength on active lesions of the face and of the back at the 2‐year follow‐up. Methods: A 1.54 µm erbium:glass laser (Aramis, Quantel Medical, France) was used in combination with contact cooling set at +5°C to treat acne on the face with the following parameters (3 ms, four pulses, 10 J/cm², 2 Hz, cumulative fluence: 40 J/cm²). The laser spots were adjacent (maximum overlap: 20%) and delivered in rows in order to cover the entire area. Four treatments were performed at 4‐week intervals in 25 patients with acne severity greater than 3 on the Burton scale. Acne lesion counts (papules, pustules, nodules, comedones) were performed prior to each treatment, and at 2, 4, 12, 18 and 24 months after the final treatment. Results: Among the 25 patients, three were lost to follow‐up, four were retreated. So, 18 patients had acne lesions counts 2 years after the fourth treatment. The mean percent reduction was 71% at the 6‐month follow‐up, 79% at the 1‐year follow‐up and 73% at the 2‐year follow‐up. No side effects were reported. All patients commented that their skin was less prone to oiliness. Biopsies taken after treatment showed progressive rarefaction and miniaturization of sebaceous glands and pilosebaceous follicles without morphologic damage to epidermal and dermal structures. Conclusion: Active acne can be successfully treated by selective dermal heating with a 1.54 µm erbium:glass laser coupled to contact cooling, with no related side effects. Furthermore, this longer follow‐up study demonstrates long‐term acne clearing. Combined treatments with medications (oral or topical) or light (targeting Propionibacterium acnes) may also improve acne clearance.     

Pain inhibition in Q‐switched laser tattoo removal with pneumatic skin flattening (PSF): A pilot study

Background: Tattoo removal with a Q‐switched laser is often a painful procedure. The sensation of pain associated with the treatment is immediate and acute. Application of topical anesthesia to the treated area of the skin is time‐consuming, with only very moderate pain relief. Objective: To determine the efficacy of pneumatic skin‐flattening (PSF) technology which utilizes an evacuation chamber that generates skin compression and activates tactile neural receptors in the skin, resulting in afferent inhibition of pain transmission in the dorsal horn (the ‘gate theory’). Methods: Eleven young patients aged 17–25 years old (nine females, two males) who were treated for tattoo removal were enrolled in the study. The patients were treated by a Q‐switched Nd:YAG laser. Acute pain evaluation was performed on all 11 patients: one to two sites per patient with PSF and one to two control sites without PSF. When patients were treated with PSF, they knew they were being treated with a device that might reduce pain. This may have influenced patients' perception of pain. The evaluation was based on a modified McGill pain questionnaire. Results: All 11 patients completed the study. A lower pain score with PSF was observed in all but one patient (10/11 or 91%). The average reduction of pain is by two levels: from very painful to very mild pain. The energy transmission of the PSF window is 95%, resulting in essentially identical efficacy of the PSF treatment and the regular non‐PSF treatment. Conclusion: This pilot study indicates that PSF technology may reduce pain in tattoo removal with medium energy density Q‐switched lasers (3–5?J/cm²).     

Combined endovascular laser with ambulatory phlebectomy for the treatment of superficial venous incompetence: a 2‐year perspective

OBJECTIVE: Non‐invasive radiofrequency and endovascular technologies are becoming increasingly popular in the treatment of superficial venous incompetence. In conjunction with stab avulsion of truncal varicosities, these technologies have been able to address functional as well as cosmetic superficial venous incompetence in a non‐invasive fashion. The present study presents a 2‐year follow‐up of 30 patients with combined axial incompetence of the greater saphenous vein (GSV) in conjunction with truncal varicosities treated with combination diode laser technology and ambulatory phlebectomy.

METHODS: Thirty patients (mean age 49 years) with Sapheno‐Femoral Junction reflux associated with GSV incompetence (mean 9.2×8.5?mm) and enlarged branch varicosities, as documented by Duplex ultrasound, were enrolled. Patients were treated with an endovascular diode laser (810?nm, 14?W, continuous mode), followed by ambulatory phlebectomy of residual truncal varicosities. Patients were examined 3, 6, 12 and 24 months following this procedure to determine the long‐term efficacy of this procedure.

RESULTS: A 2‐year closure rate of 96.8% was documented by Duplex evaluation. All 273 ambulatory phlebectomy vein segments were eradicated. Two cases of transient hyperpigmentation and one case of telangiectatic matting were documented.

CONCLUSION: The combination of endovascular laser and ambulatory phlebectomy appear to be an effective and safe treatment approach for the management of combined saphenous and truncal varicose vein incompetence.     

Treatment of halo nevus with a 308‐nm excimer laser: A pilot study

Background: The treatment of halo nevus is controversial and ranges from observation requiring no therapy to excision biopsy. Objective: To assess the efficacy of excimer laser for the treatment of halo nevus. Methods: Four patients with halo nevus on the face were treated by excimer laser three times a week until they achieved 75% pigmentation or a maximum of 36 treatment sessions. They were assessed visually by comparing photographs taken before and at the end of treatment. Results: Two patients re‐pigmented completely and two showed 80% pigmentation. The number of sessions ranged from seven to 35. The study is limited by the small number of patients. Conclusion: Treatment with the 308‐nm excimer laser may be an effective treatment of halo nevi located on the face.     

Are lasers superior to lights in the photoepilation of Fitzpatrick V and VI skin types? – A comparison between Nd:YAG laser and intense pulsed light

Background and objectives: There are no large volume comparative studies available to compare the efficacy of lasers over lights for hair removal in Fitzpatrick V and VI skin types. This study is designed to compare the efficacy of Nd:YAG laser versus IPL in the darker skin types. Study design/materials and methods: Thirty-nine patients included in Group-1 were treated with Nd:YAG and 31 in Group-2 with IPL. Both groups received 5 sessions of treatment. The hair counts were assessed using digital photography and manual counting method before and after treatment and the results were analysed. Patient satisfaction scores and pain scores were recorded in each session and compared. Results: Mean hair reduction in the IPL group was 25.70 and Nd:YAG group was 24.12 (95% CI). In the Nd:YAG group, 59% of subjects had burning sensation while the figure was 32.3% in IPL group. Burning was less in IPL group (p < 0.023). There were no statistically significant differences noticed regarding hyperpigmentation in both the groups (p < 0.115). Conclusion: Both Nd:YAG and IPL are equally effective for epilation of the darker skin types. Nd:YAG is associated with mild burning sensation in a significant number of patients. Patient satisfaction scores were comparable in both the groups.