Cutaneous Compression for the Laser Treatment of Epidermal Pigmented Lesions with the 595-nm Pulsed Dye Laser

BACKGROUND The 595-nm pulsed dye laser has been the standard of care for many vascular lesions and has rarely been used in the treatment of epidermal pigmented lesions.
OBJECTIVE The objective was to investigate the effectiveness and safety of a compression technique for the treatment of epidermal pigmented lesion using a modified 595-nm pulsed dye laser with no epidermal cooling.
METHODS Twelve subjects (mean age 58 years) underwent treatments using a modified 595-nm dye laser with a compression handpiece and no epidermal cooling. Treatments were performed with radiant exposures of 7 to 12 J/cm², 7-mm spot size, and 1.5-ms pulse duration. Each subject received one to four treatments, 4 to 6 weeks apart. Follow-up evaluations were held before each treatment and 4 months after last treatment.
RESULTS Clearance of 75% to 100% was obtained in 43, 59, 76, and 79% of the lesions treated after one, two, three, and four treatments respectively. The fourth treatment was evaluated 4 months posttreatment. Side effects included immediate erythema and edema and rare cases of transient hyperpigmentation and atrophy. No purpura and long-lasting side effects were observed.
CONCLUSION The compression technique with a modified 595-nm pulsed dye laser system is effective and safe for the treatment of epidermal pigmented lesions.     

A Pulsed Dye Laser with a 10-mm Beam Diameter and a Pigmented Lesion Window for Purpura-Free Photorejuvenation

BACKGROUND AND OBJECTIVES In traditional pulsed dye lasers (PDLs), power limitations and pulse characteristics have compromised purpura-free procedures. This study evaluated a new PDL with a modified pulse structure and a 10-mm beam diameter for purpura-free photorejuvenation. A compression handpiece was used for targeting lentigines.
MATERIALS AND METHODS Twenty patients with skin types I to III were treated three times at 3- to 4-week intervals. The first pass was delivered through a 10-mm compression handpiece to target pigment dyschromias using fluences between 6.5 and 8.0 J/cm² with a 1.5-ms pulse duration. A second pass was then performed with a 10-mm spot with fluences between 9.5 and 10 J/cm², a 20-ms pulse duration, and cryogen spray enabled. Improvement was evaluated by comparing pre- and posttreatment photographs and live subjects 1 month after the third treatment.
RESULTS In the majority of patients, >90% reduction of fine telangiectasias (<0.6 mm) and dark lentigines was achieved. Pigmented dyschromias improved proportional to the degree of pigment at presentation. Avoidance of purpura with the compression handpiece was dependent on obtaining proper compression before laser emission. Mean textural improvement was 34%.
CONCLUSIONS The new 595-nm PDL is highly effective for two-pass purpura-free improvement of telangiectases, pigment dyschromias, and texture.     

Cooling gel improves pulsed KTP laser treatment of facial telangiectasia

BACKGROUND AND OBJECTIVE: Pulsed KTP lasers effectively treat facial telangiectasia without purpura production. Transient side effects following treatment include erythema, edema, and vesiculation leading to crust formation. The aim of this study was to investigate the utility of an aqueous gel in reducing side effects associated with pulsed KTP laser treatment of facial telangiectasia. STUDY DESIGN/MATERIALS AND METHODS: Nineteen patients with extensive facial telangiectasias were treated with a pulsed KTP laser (Versapulse, Coherent, Palo Alto, CA). The laser was used with the water cooled handpiece chilled to 4C, a 4 mm spot size, a 10-millisecond pulse duration and a fluence of 9.5 J/cm2. One side of the face was treated with the laser using the cooling handpiece alone. The other side was treated using the cooling handpiece applied to a 2-mm film of aqueous gel spread over the treatment area. RESULTS: Treatment side effects, including pain, erythema, edema, vesiculation, and crusting were scored following treatment with and without the aqueous gel. Use of the aqueous gel in conjunction with the cooling handpiece decreased the incidence and severity of pain, erythema, edema, and crusting following pulsed KTP laser treatment of facial telangiectasia. Most patients demonstrated 50-75% clearance of their telangiectasias 1 month after one treatment session, and use of the gel did not alter the treatment efficacy. CONCLUSIONS: The application of an aqueous gel during pulsed KTP laser treatment of facial telangiectasia improves treatment associated side effects without affecting vessel clearance.     

Q-switched ruby versus long-pulsed dye laser delivered with compression for treatment of facial lentigines in Asians

BACKGROUND AND OBJECTIVES: Q-switched lasers have been used for the treatment of lentigines but post-inflammatory hyperpigmentation (PIH) can be an issue especially in Asians. The 595 nm long-pulsed dye laser (LPDL) has been used for the treatment of vascular lesions and although it is well absorbed by oxyhemoglobin, it is also absorbed by melanin. To use this device for the treatment of facial lentigines, we attached a flat glass lens to the tip of the laser's handpiece, allowing compression of the skin during treatment. In doing so, eliminated the absorption by oxyhemoglobin. This prospective study aims to compare the efficacy and complications of such an approach to the use of Q-switched ruby laser (QSRL) in the treatment of facial lentigines in Asians. STUDY DESIGN/MATERIALS AND METHODS: Eighteen Asian patients (1 male, 17 female) with facial lentigines Fitzpatrick skin types III-IV were enrolled. One of the lentigines present was treated with LPDL by compression method and the other one was treated with QSRL. A LPDL emitting wavelength of 595 nm, spot size of 7 mm was used, with fluence between 10 and 13 J/cm(2) and pulse duration of 1.5 milliseconds. Cryogen spray cooling was not used. A 694 nm QSRL was used with a spot size of 4 mm, fluence of 6-7 J/cm(2), and pulse duration of 30 nanoseconds. Lightening of the lesions was assessed by reflectance spectrometer Erythema, hypo- or hyperpigmentation and scarring were also assessed by clinical examinators. RESULTS: The degree of clearing achieved with the two lasers was 70.3% and 83.3% for QSRL and LPDL, respectively. All QSRL treated areas developed erythema whereas only 4 of 18 LPDL treated areas developed erythema. Hyperpigmentation was seen in four patients after QSRL, but not after LPDL. There was no scarring or hypopigmentation. CONCLUSIONS: LPDL delivered with a compression method is more effective than QSRL for facial lentigines. Complications after LPDL treatment were substantially less frequent than after QSRL. The addition of compression technique may allow "vascular" pulsed dye laser to be used for treating a variety of pigmented lesions.     

Er:YAG Laser Treatment of Verrucous Epidermal Nevi

BACKGROUND: The term verrucous epidermal nevi refers to benign hyperplasia of the epidermis. Numerous treatment modalities have been tried, but no ideal treatment is yet available. We would like to present our experience with Er:YAG laser ablation in the treatment of verrucous epidermal nevi. OBJECTIVE: The purpose of this study is to assess the long-term results of Er:YAG laser treatment of verrucous epidermal nevi. METHODS: Twenty patients with verrucous epidermal nevi were treated with Er:YAG laser. Twelve patients were treated with the variable-pulsed Er:YAG laser, a 5-mm handpiece at the setting of 7.0 to 7.5 J/cm2, at a 500-micros pulse duration. The dual-mode Er:YAG laser, with a 2-mm handpiece at the setting of 6.3 J/cm2, at a 350-micros pulse duration (25 microns ablation), was used in eight patients. The laser was fired at 5 Hz until all epidermal nevi were removed. The results of treatment were evaluated for the changes of skin lesions, texture, and color by physicians over a 24-month period. RESULTS: After a single laser treatment, successful elimination of the verrucous epidermal nevi was observed in 15 patients. Five patients (25%) showed a relapse within 1 year after the treatment. Postoperative healing time was 7 to 10 days. Erythema occurred in all patients after the laser treatment and subsided in 2 months. Postinflammatory hyperpigmentation occurred in two patients (10%). One patient (5%) experienced transient hypopigmentation. Mild to moderate postoperative acne flare-up occurred in one patient (5%) with facial lesions. No other adverse effects, including scarring, were observed. CONCLUSION: The Er:YAG laser ablation is an effective, safe, and nonscarring method for the treatment of verrucous epidermal nevi.     

Long-Pulse Pulsed Dye Laser Delivered with Compression for Treatment of Facial Lentigines

BACKGROUND AND OBJECTIVE: The 595-nm long-pulsed dye laser (LPDL) has been used for the treatment of vascular lesions, and although it is well absorbed by blood, it is also well absorbed by melanin. To utilize this device for the treatment of facial lentigines, we attached a glass window to the tip of the laser's handpiece, allowing compression of the skin during treatment. This prospective study aims to evaluate the efficacy and complications of using a LPDL delivered with compression for the treatment of facial lentigines in Asian persons. MATERIALS AND METHODS: Fifty-four Asian patients with facial lentigines were enrolled in this study. The laser settings included fluences between 9 and 13 J/cm(2) and a constant pulse duration of 1.5 ms. Cryogen spray cooling was not used. RESULTS: Thirty-eight patients showed excellent results, 14 patients showed good results, and 2 patients showed fair results. Hyperpigmentation was seen in 1 patient. CONCLUSION: LPDL delivered with the compression method is effective in the treatment of facial lentigines in Asian patients, and the side effect profile is minimal. The compression technique allows the traditional "vascular" LPDL to be used for treating a variety of pigmented lesions.     

Comparison of the 595 nm Long-Pulse (1.5 msec) and Ultralong-Pulse (4 msec) Lasers in the Treatment of Leg Veins

BACKGROUND: Although several lasers and light sources are now available for vascular lesions, treatment of leg veins has not been very satisfactory. Lengthening the pulse width should theoretically result in improved response rates. OBJECTIVE: This study compared the efficacy and safety of 595 nm pulsed lasers at 1.5 msec and 4 msec in treating leg veins. METHODS: For group A, 27 healthy adult volunteers with leg veins measuring less than 1 mm in diameter were treated with a 2 mm x 7 mm elliptical handpiece. Each patient had three areas treated. The first two areas were treated with the 4 msec pulsed dye laser with fluences of 16 and 20 J/cm2, while the last area was treated with a 1.5 msec pulsed dye laser at fluences ranging from 14 to 16 J/cm2. For group B, 13 subjects were treated. Areas 1 and 2 were treated with the 4 msec pulsed dye laser using a 3 mm x 5 mm and 5 mm handpiece, respectively, while the third site was treated with a 1.5 msec laser using a 3 mm x 5 mm handpiece. Fluences ranging from 14 to 16 J/cm2 were used. Clinical evaluations were performed and photographs taken at 4-8 week intervals. RESULTS: Neither laser regularly induced satisfactory diminution or disappearance of these vessels after one treatment. In group A, more than 50% of patients had little to no improvement, while in group B little to no improvement was observed in 33% of patients following a single treatment. Although there was no significant difference in outcomes between the test sites, the 4 msec PDL with a 3 mm x 5 mm spot size appeared to be most effective. Transient hyperpigmentation was common following either treatment, while hypopigmentation was seen in group B subjects. No scarring was noted. CONCLUSION: Both the 4 and 1.5 msec flashlamp-pumped pulsed dye lasers were ineffective in treating leg telangiectasia following a single treatment.     

Treatment of facial vascular lesions with a 100-mu spot 577-nm pulsed continuous wave dye laser

The present study documents the treatment and follow-up of 25 patients treated for four different types of superficial facial vascular lesions with the continuous wave, mechanically pulsed, yellow (577-nm wavelength) tunable dye laser using a 100-mu spot diameter handpiece and pulse durations of 0.05 to 0.10 s. When absorbed, this wavelength generates heat specifically within superficial blood vessels and, if delivered in a brief, intense pulse to a small, focused spot, can cause selective damage without destruction of the adjacent epidermis or surrounding dermis. The results indicate that the physician can attain an excellent clinical outcome while significantly reducing potential adverse side effects seen in treating these lesions with more conventional laser systems.     

Laser treatment of pigmented and vascular lesions in the office

The treatment of vascular and pigmented lesions has been greatly improved since the introduction of laser technology. Utilizing the principles of selective photothermolysis, physicians can be very specific in their treatment, maximizing injury of the selected target and minimizing damage to surrounding structures. Treatment of vascular lesions is accomplished with a variety of wavelengths. The pulsed-dye laser system remains the gold standard with which all others are compared. A variety of advances in technology in recent years have greatly improved laser treatments. These include the addition of longer pulse widths, variable spot sizes, and a variety of skin-cooling techniques. With today's laser technology, most facial telangiectasias can be treated in a single session with minimal downtime. Angiomas often require more than one treatment. Port wine stains and hemangiomas still require multiple treatments, but treatment sessions are less painful and recovery is quicker. The treatment of pigmented lesions has also improved with new technology. Q-switched systems provide optimal treatment for most pigmented lesions. In general, superficial pigmented lesions are treated with shorter-wavelength systems, and deeper lesions are treated with longer-wavelength systems. The CO2 laser continues to have a role in difficult-to-treat lesions.     

Treatment of Spider Veins Using a 10 Millisecond Pulse-Duration Frequency-Doubled Neodymium YAG Laser

BACKGROUND: The pulsed dye laser has been the standard for treating vascular lesions. Although quite effective for treating facial vessels and port-wine stains, spider veins of the lower extremities are more difficult to treat. Recent studies have shown that lasers with longer pulse durations are more effective at treating spider veins. A new long-pulse frequency-doubled Neodymium:YAG laser has been developed with a 10-ms pulse duration and sufficient energy to enable treatment with a 3- or 4-mm diameter treatment beam. OBJECTIVE: To determine the effectiveness of the long pulse Neodymium:YAG laser for treating spider veins of the lower extremities. METHODS: Spider veins less than 0.75 mm in diameter on the legs of 15 female volunteers were treated in 1 or 2 areas. Treatments were administered through a water-cooled chill tip using the frequency-doubled Neodymium:YAG laser with a 10-ms pulse duration. A dose of 16 J/cm2 was administered, completing 3 passes over each visible vein during each session, for a total of 2 sessions administered 6 weeks apart. Photographs of treatment areas were digitally analyzed for degree of vessel clearance. RESULTS: Computer-based image analysis revealed clearing of over 75% of veins following 2 treatments with 16 J/cm2. Side effects were minimal, and the treatments were well tolerated. CONCLUSIONS: The 532 nm, 10 ms pulse duration, frequency-doubled Neodymium:YAG laser is safe and effective for treating spider veins of the lower extremities less than 0.75 mm in diameter, in patients with Fitzpatrick skin Types I-III.     

Treatment of Dermatofibroma with a 600 nm Pulsed Dye Laser

BACKGROUND: Dermatofibroma (DF) is one of the most basic and common dermatologic diseases treated by practicing dermatologists on a daily basis. Although benign, it can be pruritic or tender. Furthermore, it is difficult to treat effectively with optimal cosmetic outcomes. OBJECTIVE: We report a safe, effective, and cosmetically superior method of treating DF with the 600 nm pulsed dye laser (PDL). METHODS: We used a 600 nm PDL to treat 20 lesions from 18 Caucasian patients. The laser parameter was set at a fluence of 7 J/cm2, a spot size of 7 mm and a pulse duration of 1.5 ms. Each lesion was treated three times at a 6- to 8-week interval. For each treatment, the lesion was double pulsed with a 20 to 30% overlap. Clinical improvement was graded by a single examiner in evaluating three clinical parameters: color, size/volume, and symptoms. For each parameter, improvement was ranked as no improvement, partial improvement, and complete response. RESULTS: All 18 patients (17 women) completed the study. For the volume/size parameter, 15 of 20 lesions (75%) showed complete response. For improvement in color, 12 of 20 patients (60%) showed complete response. Only six lesions were symptomatic (i.e., tender and irritating), and all six lesions showed complete resolution of symptoms after the PDL treatments. After each treatment, all patients experienced blistering, crusting, and purpura that usually resolved after 10 days. CONCLUSIONS: We have demonstrated for the first time that PDL (600 nm and 1.5 ms pulse duration) is an effective and safe treatment of DF. It may provide superior cosmetic outcomes compared with other modalities such as surgical excision.     

532-nm Diode Laser Treatment of Seborrheic Keratoses with Color Enhancement

BACKGROUND Seborrheic keratoses (SKs) are benign cutaneous tumors of the epidermis. Localization in the head and neck areas can produce an unsightly appearance. Recurrence after curettage, shave excision, cryoablation, or chemical peel can be common.
OBJECTIVE The objective was to determine if laser ablation with the 532-nm laser and color enhancement is effective in removing SKs.
MATERIALS AND METHODS A total of 326 patients who presented with 1,567 benign SKs were treated with the DioLite (Iridex Corp.) and VersaPulse cosmetic (Coherent Inc.) 532-nm diode lasers with color enhancement using a red marker or ferric subsulfate. The DioLite was set at 27 to 30 J with a 2- to 3-mm spot size, and a 10-ms pulse width was used for ablation. The VersaPulse was set at a lower energy of 9.5 to 12 J/cm² with a 3-mm spot size, 3- to 6-Hz repetition rate, and 10-ms pulse duration for ablation. All patients were Caucasian.
RESULTS Complete resolution of the SKs occurred in 93% of lesions. Seven percent of SKs required a second round of laser treatment for incomplete ablation. There were no cases of hyperpigmentation or hypertrophic scar formation of the skin following laser treatment. Hypopigmentation occurred in 6% of patients and was associated with old, chronic, or recalcitrant lesions.     

High-Energy 595 nm Pulsed Dye Laser Improves Refractory Port-Wine Stains

BACKGROUND: Port-wine stains respond quite well to 585 nm pulsed dye laser treatment, but often clearance is not complete. We investigated a prototype, a high-energy 595 nm pulsed dye laser capable of delivering up to 9.5 J/cm2 using a 10 mm circular spot, with a 1.5 ms pulse duration. OBJECTIVE: This study was undertaken to determine if the high-energy, 595 nm, variable-pulse duration pulsed dye laser could improve port-wine stains that had become refractory to conventional treatment. METHODS: Twenty patients were entered into the study and treated with the high-energy, 595 nm, variable-pulse duration pulsed dye laser using fluences ranging from 7.5 to 9.5 J/cm2, a 1.5 ms pulse duration, and a 10 mm spot size. RESULTS: Average improvement was rated as 40% prior to the initiation of the study after an average of 8.8 treatments at an average energy of 7.9 J/cm2 with the 585 nm pulsed dye laser and 76% following an average of 3.1 treatments with the high-energy 595 nm pulsed dye laser using an average fluence of 7.9 J/cm2. Dermal spectrometer erythema measurements improved from 2.2-fold that of normal skin to 1.5-fold that of unaffected skin. CONCLUSIONS: The high-energy 595 nm pulsed dye laser improves port-wine stains that have become refractory to the conventional 585 nm pulsed dye laser.     

Use of a Long-Pulse Alexandrite Laser in the Treatment of Superficial Pigmented Lesions

BACKGROUND/OBJECTIVE Although the alexandrite 755-nm-wavelength laser is effective in the treatment of unwanted hair, there are no published studies gauging the efficacy of the variable long-pulse alexandrite laser in the treatment of superficial pigmented lesions.
STUDY DESIGN/METHODS Eighteen patients underwent a single treatment session using a variable pulse-width alexandrite laser. Test sites were performed using a 10-mm spot size and up to four pulse widths (3, 20, 40, 60 ms) with and without epidermal cooling. Full treatments were performed 3 weeks later using optimum test parameters. The patients were evaluated at 3 and 6 weeks.
RESULTS Patients with darker lentigines had greater lesion clearance than those patients with lighter colored lentigines. Shorter pulse widths and treatment without cryogen cooling both, independently, lowered the fluence threshold for lentigo clearance.
CONCLUSION A long-pulse alexandrite laser is effective in clearing solar lentigines in a single pass with minimal adverse effects.     

Treatment of Pigmented Hypertrophic Scars with the 585 nm Pulsed Dye Laser and the 532 nm Frequency-Doubled Nd:YAG Laser in the Q-Switched and Variable Pulse Modes: A Comparative Study

BACKGROUND: Pigmented hypertrophic scars are a difficult condition to treat. They may result from traumatic injuries or from surgical and cosmetic procedures. The 585 nm flashlamp-pumped pulsed dye laser (FLPDL) has been used to treat this condition, with significant improvement of varying degrees. It remains to be determined whether other laser modalities may have a similar or even greater success in the treatment of pigmented hypertrophic scars. OBJECTIVE: To determine the efficacy of the 532 nm frequency-doubled Nd:YAG laser in the treatment of pigmented hypertrophic scars as compared to the 585 nm FLPDL. METHODS: Six patients with pigmented hypertrophic scars and skin phototypes II-IV were chosen. A scar was selected for treatment in each patient and divided into four equal 2 cm segments. Three segments were each treated with a different laser modality and one was left untreated to serve as the control. A 585 nm FLPDL was used with an energy of 3.5 J, a pulse duration of 450 microsec, and a 10 mm spot size. A 532 nm Q-switched frequency-doubled Nd:YAG laser was set to an energy of 2.8 J, a 10-nsec pulse, and a 3 mm spot size. The same 532 nm laser was set to the variable pulse mode to treat a 2 cm scar segment, with an energy of 9.5 J, a 10-msec pulse, and a 4 mm spot size. An average of 3.3 treatments were performed on each scar segment, at intervals of 4-6 weeks and long-term follow-up at 22 weeks. Treatment outcome was graded by a blind observer using the Vancouver General Hospital (VGH) Burn Scar Assessment Scale. A SigmaStat t-test was used to determine the statistical significance of the values obtained. RESULTS: Treatment of pigmented hypertrophic scars with the 532 nm Q-switched Nd:YAG laser led to a significant improvement of 38% in the VGH scores when compared to baseline (P =.005). The 585 nm FLPDL also had a favorable effect on the scars, with an average improvement of 36.1% in the VGH scores. There was no significant difference noted between the outcome of treatment with either of these two lasers. Treatment with the 532 nm variable pulse Nd:YAG laser led to a 19% improvement in the VGH scores of scars, which did not differ significantly from the 16.1% improvement observed in control scars on the last follow-up visit. No side effects or complications from treatment were noted or reported during the course of the study. At the conclusion of the study, five of six patients chose the segment treated with the 532 nm Q-switched Nd:YAG laser as the best segment overall. CONCLUSION: The 532 nm Q-switched Nd:YAG laser and the 585 nm FLPDL offer comparable favorable results in the treatment of pigmented hypertrophic scars. The 532 nm Q-switched Nd:YAG laser may be preferred by patients particularly distressed by the dark color of their scars.     

Recalcitrant Adverse Reaction to Vitamin K: Response to Pulsed Dye Laser

BACKGROUND: Adverse cutaneous reaction to vitamin K manifests in sclerodermatous or erythematous plaque-like reactions. Most of the cases with erythematous plaque-like dermatitis arising at the site of intramuscular vitamin K injection were recalcitrant and did not respond to various attempts with topical and intralesional corticosteroid. OBJECTIVE: The objective was to describe a 25-year-old woman with recalcitrant adverse reaction owing to vitamin K who was successfully treated with pulsed dye laser. METHODS: Two consecutive pulsed dye laser treatments were performed 3 weeks apart with 450-microec pulse duration, 585-nm pulse width, and fluence of 5 and 7 J/cm(2), respectively, using a 7-mm handpiece. RESULTS: One week after the second treatment, her skin lesion was cleared and she was followed without recurrence for 7 months. CONCLUSION: Although the precise mechanism remains yet to be proven, we have demonstrated successful treatment of localized adverse cutaneous reaction to vitamin K in one patient with the pulsed dye laser.     

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.     

Laser Treatment With a 1064-nm Laser for Lower Extremity Class I–III Veins Employing Variable Spots and Pulse Width Parameters

BACKGROUND: The long-pulsed 1064-nm Nd:YAG laser (employing varying spot sizes, pulse widths, and fluences) has gained popularity for treating lower extremity blue and red vessels that are less than 4 mm in diameter. OBJECTIVE: To evaluate the efficacy of high-power 50-ms 1064 Nd:YAG laser in the treatment of class I-III lower extremity vessels. METHODS: Ten female patients (mean age of 39 years) had a 5-cm2 area of veins measuring 0.2 to 3 mm in diameter treated with up to three treatment sessions using a new 1064 Nd:YAG laser, with the end point being 100% vessel clearing after three treatments. Red vessels were treated with a spot size of 1.5 mm, a fluence of 400 to 600 J/cm2, a pulse width of 30 to 50 ms; blue vessels of 1 to 3 mm were treated with a spot size of 3 mm, a fluence of 250 to 370 J/cm2, and a pulse width of 50 to 60 ms. Macrophotographic imaging evaluations by blinded observers using a quartile scale and a patient satisfaction scale were employed to evaluate results. RESULTS: At month 3 after the final treatment session, 20% of all vessel types had 50% to 75% improvement. Equal clearing was noted for blue and red vessels. At month 6, 80% of patients had a greater than 75% clearing. Ninety percent of patients were highly satisfied with the treatment results at 6 months. CONCLUSION: By varying spot size, fluence, and pulse duration, a long-wavelength 1064-nm Nd:YAG laser can achieve excellent results for treating both blue and red lower extremity vessels that are less than 3 mm in diameter.     

Microvascular blood flow dynamics associated with photodynamic therapy, pulsed dye laser irradiation and combined regimens

BACKGROUND AND OBJECTIVES: Previous in vitro studies demonstrated the potential utility of benzoporphyrin derivative monoacid ring A (BPD) photodynamic therapy (PDT) for vascular destruction. Moreover, the effects of PDT were enhanced when this intervention was followed immediately by pulsed dye laser (PDL) irradiation (PDT/PDL). We further evaluate vascular effects of PDT alone, PDL alone and PDT/PDL in an in vivo rodent dorsal skinfold model. STUDY DESIGN/MATERIALS AND METHODS: A dorsal skinfold window chamber was installed surgically on female Sprague-Dawley rats. One milligram per kilogram of BPD solution was administered intravenously via a jugular venous catheter. Evaluated interventions were: control (no BPD, no light), PDT alone (576 nm, 16 minutes exposure time, 15 minutes post-BPD injection, 10 mm spot), PDL alone at 7 J/cm2 (585 nm, 1.5 ms pulse duration, 7 mm spot), PDL alone at 10 J/cm2, PDT/PDL (PDL at 7 J/cm2), and PDT/PDL (PDL at 10 J/cm2). To assess changes in microvascular blood flow, laser speckle imaging was performed before, immediately after, and 18 hours post-intervention. RESULTS: Epidermal irradiation was accomplished without blistering, scabbing or ulceration. A reduction in perfusion was achieved in all intervention groups. PDT/PDL at 7 J/cm2 resulted in the greatest reduction in vascular perfusion (56%). CONCLUSIONS: BPD PDT can achieve safe and selective vascular flow reduction. PDT/PDL can enhance diminution of microvascular blood flow. Our results suggest that PDT and PDT/PDL should be evaluated as alternative therapeutic options for treatment of hypervascular skin lesions including port wine stain birthmarks.     

脉冲染料激光治疗微静脉畸形的自身对照研究

目的通过应用第一代和第二代脉冲染料激光（Pulse dye laser,PDL）治疗微静脉畸形（Venular malformation,即Port wine stain,PWS）自身对照的前瞻性研究,比较两代PDL治疗PWS的差异。方法 50名未曾接受任何治疗的PWS患者,病灶中选取两处区域,分别使用第一代和第二代PDL进行治疗。第一代PDL:585 nm（Cynosure,USA）,光斑5 mm,脉宽0.45 ms,能量密度5～6.5 J/cm2,无冷却装置;第二代PDL:595 nm（Candela V-beam,USA）,光斑5 mm,脉宽1.5～3 ms,能量密度11～12.5 J/cm2,DCD（动态冷却系统）冷却剂喷射时间20 ms（间隔20 ms）。术后6周比较第一代和第二代PDL的疗效。结果两代PDL治疗不同类型及不同部位PWS的疗效均无统计学差异,但第一代PDL术后出现暂时性色素减退比例高于第二代PDL。结论第一代和第二代PDL治疗PWS的疗效无显著差异,但使用了皮肤冷却系统的第二代PDL可以有效减少副反应的发生。