Resolution of retracted scar after 585-nm pulse dye laser surgery.

BACKGROUND: Laser scar revision has been an effective method for improving several aspects of scarring through ablative and non-ablative sources. The 585-nm pulsed dye laser (PDL) is an important non-ablative instrument for reducing scar bulk and symptoms. OBJECTIVE: To describe the use of a 585-nm PDL for the treatment of a retracted and atrophic facial scar. METHODS: We report the case of a 26-year-old patient who presented with a retracted facial scar following surgical excision of an aggressive benign tumor. Treatment was carried out using the 585-nm PDL. RESULTS: Treatment of the scar using two low-level PDL therapies significantly altered the appearance of the scar and augmentation of the retracted defect was avoided. CONCLUSION: Treatment of this retracted and atrophic facial scar with the 585-nm PDL was very effective and safe.     

Comparative efficacy of short-pulsed intense pulsed light and pulsed dye laser to treat rosacea

Background: Laser and light-based therapies have often been used successfully to treat rosacea. Recently, short-pulsed intense pulsed light (IPL) that emitted pulse durations down to 0.5 ms was found to be effective for rosacea treatment.

Objective: This study evaluated the efficacy of short-pulsed IPL in the treatment of rosacea compared with pulsed dye laser (PDL) using same pulse duration and fluence.

Materials and Methods: Nine patients with rosacea were enrolled in a randomized, split-face trial. Each treatment consisted of four sessions at three-week intervals and followed up until three weeks after the last treatment. Efficacy was assessed by erythema, melanin index, physician’s subjective evaluation, and patient’s satisfaction.

Results: The mean change in erythema index was ?4.93 ± 1.59 for the short-pulsed IPL group and ?4.27 ± 1.23 for the PDL group. The mean change in melanin index was ?2.52 ± 2.45 for the short-pulsed IPL group and ?1.95 ± 1.41 for the PDL group. There was no significant difference in either melanin or erythema index between short-pulsed IPL and PDL treatments, and there were no noticeable adverse events.

Conclusions: There was no significant difference between PDL and short-pulsed IPL treatment using the same energies and pulse. Both PDL and short-pulsed IPL were satisfactory and safe for rosacea treatment.     

Effectiveness and safety of a narrow band spectrum intense pulsed-light dye with long pulse Nd:YAG laser for treating facial vascular lesions

Objective

Different devices are currently used for treating facial vascular lesions (FVL). This paper presents the aesthetic outcomes using different light-based and laser devices, including narrow band spectrum intense pulsed-light dye (NB-Dye-VL), Pulsed dye laser (PDL)–neodymium-doped yttrium-aluminum-garnet (Nd:YAG) dual-therapy, and either PDL or LP Nd:YAG for treating FVL in a clinical setting.

Methods

A retrospective and single-center study conducted on subjects ≥18 years with FVL. Patients underwent treatment with either PDL + LP Nd:YAG dual-therapy, NB-Dye-VL, PDL, or LP Nd:YAG, according to the patient and lesion characteristics. The primary outcome was the weighted degree of satisfaction.

Results

The cohort consisted of fourteen patients, nine women (64.3%) and five men (35.7%). The most prevalent FVL types treated were rosacea (28.6%; 4/14) and spider hemangioma (21.4%; 3/14). Seven patients underwent PDL + Nd:YAG (50.0%), three were treated with NB-Dye-VL (21.4%), and PDL or LP Nd:YAG was performed in two patients each (14.3%). Eleven patients rated their treatment outcome as excellent (78.6%), and three as very good (21.4%). Practitioners 1 and 2 classified treatment results as excellent in eight cases (57.1%) each. No serious or permanent adverse events were reported. Two (14.3%) patients, one treated with PDL and the other with PDL + LP Nd:YAG dual-therapy, had post-treatment purpura, which was successfully resolved with topical treatment after 5 and 7 days, respectively.

Conclusions

NB-Dye-VL and the PDL + LP Nd:YAG dual-therapy devices achieve excellent aesthetic outcomes for treating a wide range of FVL.     

Evaluation of the clinical and immunohistological efficacy of the 585-nm pulsed dye laser in the treatment of psoriasis

Background  The 585-nm pulsed dye laser (PDL) therapy is useful for the patients with psoriasis. PDL treatment is based on selective photothermolysis of the dermal vasculature.
Objective  The objectives of this study were to evaluate the clinical and immunohistological effects of PDL on psoriasis and to examine the association between psoriatic dermal vasculature and the clinical effects.
Methods  Eleven patients with recalcitrant psoriasis were treated with 585-nm PDL. Biopsy specimens obtained before and after treatment were stained with CD31. All microvessels to the depth of 400 µm from the rete ridge were counted and the internal diameters were measured.
Results  The mean percent reduction of plaque severity score was 42. The mean microvessel count decreased significantly from 63 to 35.6 ( P  < 0.001). There was a strong positive correlation between the plaque severity score and microvessel number ( P  < 0.001) and a strong negative correlation between the microvessel count of an untreated area and degree of the change in the microvessel count after treatment ( P  = 0.005).
Conclusions  The findings of this study suggest that PDL treatment improves psoriasis. Moreover, PDL treatment decreased the number of dermal papillary microvessels. Dermal papillary microvessels are important pathogenetic targets of psoriasis, and PDL therapy, which selectively targets superficial vessels, is therefore a valid therapeutic approach.

Conflicts of interest

None declared     

Pulsed dye laser vs. intense pulsed light for port-wine stains: a randomized side-by-side trial with blinded response evaluation

Background  Pulsed dye lasers (PDLs) are considered the treatment of choice for port-wine stains (PWS). Studies have suggested broadband intense pulsed light (IPL) to be efficient as well. So far, no studies have directly compared the PDL with IPL in a randomized clinical trial.
Objectives  To compare efficacy and adverse events of PDL and IPL in an intraindividual randomized clinical trial.
Methods  Twenty patients with PWS (face, trunk, extremities; pink, red and purple colours; skin types I–III) received one side-by-side treatment with PDL (V-beam Perfecta, 595 nm, 0·45–1·5 ms; Candela Laser Corporation, Wayland, MA, U.S.A.) and IPL (StarLux, Lux G prototype handpiece, 500–670 and 870–1400 nm, 5–10 ms; Palomar Medical Technologies, Burlington, MA, U.S.A.). Settings depended on the preoperative lesional colour. Treatment outcome was evaluated by blinded, clinical evaluations and by skin reflectance measurements.
Results  Both PDL and IPL lightened PWS. Median clinical improvements were significantly better for PDL (65%) than IPL (30%) ( P  = 0·0004). A higher proportion of patients obtained good or excellent clearance rates with the PDL (75%) compared with IPL (30%) ( P  = 0·0104). Skin reflectance also documented better results after PDL (33% lightening) than IPL (12% lightening) ( P  = 0·002). Eighteen of 20 patients preferred to receive continued treatments with PDL ( P  = 0·0004). No adverse events were observed with PDL or IPL.
Conclusions  Both the specific PDL and IPL types of equipment used in this study lightened PWS and both were safe with no adverse events. However, the PDL conveyed the advantages of better efficacy and higher patient preference.     

Complications of 585-nm pulsed dye laser therapy

Background Port-wine stains (PWS) are a congenital, progressive ectasia of the superficial cutaneous vascular plexus that occur in 0.3%–0.5% of children at birth. They should be considered a disease with physical and psychologic complications. Treatment with the flashlamp pulsed dye laser (FPDL) has proven to be effective. Because treatment results in selective vascular injury, the risk of complications is minimal. The purpose of this study was to determine the cutaneous side-effects and complications and their frequency in patients with PWS treated with the FPDL. Eighty-nine patients who had been treated with the FPDL for PWS were included in this study. Methods Patients were treated at 3-month intervals using slightly overlapping pulses with fluences of 6.0–9.0 J/cm². Treating physicians were responsible for evaluating the patients. All patients were reviewed and side-effects and complications were recorded. Results Pigmentary changes were the most frequently observed complications. Hyper-and hypopigmentation appeared in 16.8% and 2.4% of patients, respectively. Cutaneous depressions occurred in 2.2% of patients. One patient developed a hypertrophic scar, and another patient presented with transient cutaneous pustulosis. All these changes usually resolved spontaneously and completely in a few months. Conclusions Most of the side-effects and complications produced by the FPDL are usually transitory, and it is essentially a very secure technique.     

585nmQ开关激光与595nm可调脉宽激光治疗毛细血管扩张

目的　比较 5 85nmQ开关激光与 5 95nm可调脉宽激光治疗毛细血管扩张的疗效。方法　用 5 85nmQ 开关MedliteIV激光仪与 5 95nm可调脉宽Vbeam激光仪分组治疗毛细血管扩张共 2 3 8例 ,观察疗效和不良反应 ,并进行比较。结果　两组治愈率和有效率差异显著 ,术后色素改变发生率无显著性差异。结论　 5 95nm可调脉宽脉冲染料激光疗效明显优于 5 85nmQ 开关激光。     

Formation of arcuate crusted lesions after non-ablative 1450-nm diode laser treatment equipped with a dynamic cooling device

Abstract

Behçet's disease (BD) is a chronic systemic inflammatory disorder of unknown etiology with variable clinical manifestations. HLA-B51 allele is the most strongly associated known genetic factor. The mucocutaneous lesions (oral aphthae, genital aphthae, skin lesions such as pseudofolliculitis) constitute the hallmark of the disease, but also gastrointestinal, vascular, central nervous systems, and others may be involved. We report a case of a young man affected with Behçet's disease who presented facial telangiectasias and striae rubra in the inner region of his arms and at the level of his hips, as uncommon minor superficial vascular manifestations of BD. To manage them we have subjected the patient to a cycle of Intense Pulsed Light (IPL) therapy. Our findings showed that the use of IPL is a safe and effective treatment for telangiectasias and striae rubra, also in the complex clinical condition of Behçet's disease. In fact, the treatments were well tolerated, no sign of scarring or hyper/hypopigmentation was reported and we obtained a significant improvement of the lesions in terms of color and size of them.     

Treatment of post-pulsed dye laser purpura with pulsed dye laser

The pulsed dye laser (PDL) is used for the treatment of a variety of vascular and nonvascular disorders, and its therapeutic efficacy often depends on purpura as an endpoint. However, post-PDL purpura is an undesirable side effect of treatment as it may increase patient dissatisfaction and downtime. Recent studies have suggested that repeat treatment with PDL may speed the resolution of post-procedural purpura; however, there is paucity of data on using repeat PDL treatment specifically for post-PDL purpura. We report three cases of 585 nm PDL-induced purpura treated with 595 nm PDL with clinically significant improvement. We suggest that treatment with PDL, which targets hemoglobin and its breakdown products, after initial PDL treatment may reduce post-PDL purpura.     

强脉冲光治疗酒渣鼻疗效评价

目的:评价强脉冲光治疗酒渣鼻的疗效。方法:治疗组采用强脉冲光照射,每3周1次,4次为1疗程;对照组口服异维A酸10 mg,日2次,连续12周。结果:治疗组总有效率为89.74%,对照组为71.05%,差异有统计学意义(P0.05)。结论:强脉冲光治疗酒渣鼻疗效优于异维A酸。     

A comparative study of a 595-nm with a 585-nm pulsed dye laser in refractory port wine stains

BACKGROUND: The pulsed dye laser (PDL) is the treatment of choice for port wine stains (PWS); however, some patients' PWS become refractory to further treatments. Technological advances have enabled new machines with the advent of surface cooling devices to deliver longer wavelengths and higher fluence more safely. These advances have the potential to achieve improved response rates in refractory PWS. There are few studies comparing the efficacy of standard PDL treatments for refractory PWS with the wider choice of treatment variables available from newer PDL machines. OBJECTIVES: To determine if there is any advantage of using a longer wavelength (595 nm) and pulse widths (1.5 ms, 6 ms and 20 ms) over conventional PDL settings (wavelength 585 nm, pulse width 1.5 ms) in refractory PWS. METHODS: Eighteen consecutive consenting patients with Fitzpatrick skin types 1-4 with a mean age 35 years (range 17-59 years) with refractory PWS were treated routinely with three separate test areas using 595-nm PDL (using three different pulse width settings of 1.5 ms, 6 ms and 20 ms), compared with test areas treated with 585-nm PDL (pulse width 1.5 ms). All test areas were treated with an identical fluence (15 J cm(-2)), spot size (7 mm) and cooling setting (dynamic cooling 60 ms, delay 60 ms). RESULTS: We found a statistically significant advantage of 595-nm PDL (pulse width 1.5 ms) over 595-nm PDL (pulse width 6 ms) (P < 0.05) in the treatment of refractory PWS; however, we found no significant advantage using longer pulse widths of 20 ms compared with 1.5 ms with the 595-nm PDL. There was no statistically significant advantage in using a 595-nm PDL over a 585-nm PDL using identical pulse widths of 1.5 ms, spot size, fluence and cryogen cooling settings; however, the number of directly comparable test areas was smaller. Some individual patients in our study obtained a better response with certain 595-nm PDL settings (pulse width 1.5 ms and 6 ms) compared with 585-nm PDL (pulse width 1.5 ms). CONCLUSIONS: Our experience of high fluence PDL in the treatment of refractory PWS suggests patients treated with 585 nm (pulse width 1.5 ms) improve to a similar degree as patients treated with 595-nm PDL (pulse width 1.5 ms). However, the use of the 595-nm PDL with longer pulse widths yields no extra advantage. For those patients who have failed to improve with high-fluence 585-nm PDL (pulse width 1.5 ms), test areas using 595-nm PDL (pulse width 1.5 ms and 6 ms) should be undertaken to ascertain if individual patients may benefit from the longer pulse width 595-nm PDL.     

Genital angiokeratomas of Fordyce 595-nm variable-pulse pulsed dye laser treatment

Background: Angiokeratoma of Fordyce (AF) represents dark red or blue-black papules with a scaly surface located on scrotum, labia majora, and penis. Though usually asymptomatic, bleeding after mechanical trauma and sexual intercourse may occur. AF should be differentiated from malignant melanoma, angiosarcoma, and other pigmented lesions. The treatment, usually asked from patients as the result of anxiety and social embarrassment, should be performed in a non-aggressive manner. Objectives: To determine the safety and effectiveness of 595-nm variable-pulse pulsed dye laser (VPPDL) with a Dynamic Cooling Device (DCD) in the treatment of AF. Methods: Twenty-four patients (22 men and two women) aged 40.88 ± 12.48 years with AF were included in the retrospective study. Lesions located on scrotum, labia majora, and penis were treated with 595-nm VPPDL in the intervals of one to three months. Variable spot, fluence, and pulse-width parameters were used with and/or without DCD skin cooling. Results: AF were successfully removed in all patients in one to seven (mean ± SD = 3.38 ± 2.16) treatment sessions with no permanent side effects or complications such as dyspigmentations or scarring. Recidives were observed in four patients after 0.5–1 year intervals. Conclusions: 595-nm VPPDL with DCD represents an efficient and safe method for the removal of multiple lesions of AF in genital localization.     

Anetoderma treated with combined 595-nm pulsed-dye laser and 1550-nm non-ablative fractionated laser

Anetoderma is a skin disorder characterized by a focal loss of dermal elastic tissue whereby patients present with soft, depressible lesions. We postulated that a series of combination treatment using the 595-nm pulsed dye laser (PDL) and the 1550-nm non-ablative fractionated laser (NAFL) would improve the anetoderma lesions. Our patient with biopsy proven anetoderma received 3 treatments with a combination of 595-nm PDL and 1550-nm NAFL spaced 3 weeks apart. Skin biopsies were performed at baseline and immediately prior to the third treatment. Stains for hematoxylin and eosin and Verhoeff Van Gieson (VVG) were performed. Improvement in lesion color, texture, and overall appearance was noted after the second treatment and continued following the third treatment. Post-treatment VVG staining demonstrated an increase in dermal elastin fibers and a decrease in elastin fiber fragmentation. Thus, the combination of 595-nm PDL and 1550-nm NAFL should be considered as a treatment modality for anetoderma.     

红宝石点阵激光联合强脉冲光治疗黄褐斑102例疗效评价

目的:评价红宝石点阵激光联合强脉冲激光治疗黄褐斑临床疗效及安全性。方法:102例黄褐斑患者给予Q开关红宝石点阵激光治疗,能量密度2.5~3.5 J/cm2,2周后,行强脉冲光治疗。每4周治疗1次,共4次。治疗结束前后对患者进行黄褐斑皮损面积和严重程度指数(MASI)评分,记录复发情况及不良反应。治疗结束后6个月随访判定结果。结果:痊愈5例(4.90%),显效69例(67.65%),好转26例(25.49%),无效2例(1.96%),总有效率72.55%。未见明显不良反应。结论:红宝石点阵激光联合强脉冲光治疗黄褐斑安全、有效。     

铒激光联合585 nm脉冲染料激光治疗增生性瘢痕的疗效观察

瘢痕是组织创伤修复和愈合过程的产物,过度的增生性瘢痕和瘢痕疙瘩,统称为病理性瘢痕,影响正常组织的修复［１］。目前仍无明确有效的防治方法。我们采用Er:YAG激光联合脉冲染料激光治疗增生性瘢痕,获得良好效果,现报道如下……     

Recent advances in laser treatment of port-wine stains

The pulsed dye laser is the treatment of choice for port-wine stains, with proven efficacy and low incidence of side-effects. However, in the majority of cases complete clearance cannot be achieved, and a significant proportion of lesions is resistant to laser treatment. In recent years, increased understanding of the interaction between lasers and port-wine stains has led to modification of the original pulsed dye laser design, producing treatment responses even in those lesions resistant to first-generation pulsed dye lasers. Other lasers and noncoherent light sources also appear to have a potential role in treatment. In this review we discuss these recent developments.