The dual 980‐nm and 1470‐nm diode laser for vascular lesions

Transcutaneous use of dual diode lasers is a new option in dermatology. The aim of the study was to demonstrate the transcutaneous application of a dual laser in dermatologic outpatients. We used a laser system that combines 980 nm and 1470 nm wavelengths for treatment of vascular lesions. Fifty‐six adult Caucasian patients of Fitzpatrick skin type I‐III, 32 females and 24 males with mean age of (41 ± 3.7) years were included. We treated 497 vascular lesions of skin and lips. Complete clearance was achieved in cherry angiomas, venous lakes, lip hemangioma, and spider nevi in 100% after a single treatment. Patients with couperose and/or facial telangiectasia needed several treatment sessions. Mild to moderate pain during the laser shots was noted in all patients. No adverse events were recorded. The dual 980‐nm/1470‐nm diode laser is a safe and effective tool for common vascular lesions.     

Treatment of oral lichen planus using 308‐nm excimer laser

Oral lichen planus (OLP) is a chronic inflammatory disease, has prolonged courses, repeated attacks and resistance to treatment. The traditional narrow spectrum UVB treatment has an established efficacy on skin lichen planus, and high safety. However, most of ultraviolet phototherapy devices have a huge volume, thereby cannot be used in the treatment of OLP. Lymphocytic infiltration is evident in the lesions of lichen planus, and the direct irradiation of 308‐nm excimer laser can induce apoptosis of the T lymphocytes in skin lesions, thereby has a unique therapeutic effect on the diseases involving T lymphocytes. This study aims to investigate the efficacy of 308‐nm excimer laser in the treatment of OLP. A total of six OLP patients were enrolled into this study, and further pathological diagnosis was conducted, then 308‐nm excimer laser was used in the treatment. The efficacy of 308‐nm excimer laser in the treatment of OLP was satisfactory. The clinical symptoms of five patients were significantly improved. In two patients, the erosion surface based on congestion and the surrounding white spots completely disappeared, and clinical recovery was achieved. Three patients achieved partial remission, that is, the erosion surface healed, congestion and white spot area shrunk by more than 1/2 of the primary skin lesions. In the remaining one patient, the erosion surface had not completely healed after treatment, and congestion and white spot area shrunk by less than 1/2 of the primary skin lesions. Only one patients had developed mild pain during the treatment, and this symptom alleviated by itself. The 308‐nm excimer laser therapy can serve as a safe and effective treatment for OLP.     

Treatment of angiokeratoma of Mibelli alone or in combination with pulsed dye laser and long‐pulsed Nd: YAG laser

Treatment of angiokeratoma of Mibelli is usually challenging because of the location, the pathogenetic condition and the cosmetic requirements. We present our characteristic treatment with the application of pulsed dye laser PDL and lpNd:YAG laser. All of these lesions were treated by topical anesthesia with Emla. Combined dual PDL‐lpNd:YAG (PDL: 595 nm, 5 mm/7 mm, 0.5 ms, 8–10 J/cm²; lpNd:YAG: 3 mm/5 mm, 15 ms, 90–120 J/cm²) treatment was used to treat lesions which with moderate to severe hyperkeratosis and hyperplasia. To the maculopapule ones, the energy density of lpNd:YAG might upgrade to 150 J/cm². Singular PDL (595 nm, 5 mm/7 mm, 0.5 ms, 9–12 J/cm²) treatment was used to treat lesions which with slight hyperkeratosis and hyperplasia. Continuous airflow cooling was always applied during the laser treatment. The treatment interval was 6–12 weeks. Of the 5 patients, 3 of them were cured and 2 of them were improved. All of them were satisfied with the cosmetic results. We recommended the combined dual PDL‐lpNd:YAG laser in treating severe hyperkeratotic and hyperplastic angiokeratoma of Mibelli. It can aid in achieving a desirable outcome whilst also reducing the required treatment sessions. However, most patients felt painful during the operation and experienced a severe long term recovery time after operation.     

Efficacy of 577‐nm Pro‐Yellow laser in port wine stain treatment

A port‐wine stain (PWS) is a congenital capillary malformation that is seen in 0.3–0.5% of newborns. Although many types of lasers have been used to treat PWSs, few studies have investigated the efficacy of 577‐nm Pro‐Yellow lasers. The aim of this study was to establish the efficacy of Pro‐Yellow lasers in PWS treatment. In total, 26 patients, comprising 15 females (57.7%) and 11 males (42.3%) with a mean age of 24.7 ± 11.8 (range 1–50) years were included in the study. All were treated with a 577‐nm Pro‐Yellow laser at 4‐week intervals, 3–10 times. The sessions initially used scan mode and a fluence dose of 24 J/cm² per session, on average. The mean dose was increased by 4 J/cm each session and the maximum dose administered was 44 J/cm². A mean regression of 68.8 ± 13.9% in the size of the lesions over 5.23 ± 2.7 sessions was observed. There was no statistically significant difference between the female and male patients when they were compared in terms of the number of treatment sessions (p = .789) and treatment success (p = .39). These case series demonstrate that the Pro‐Yellow laser is a safe and well‐tolerated treatment for PWSs. However, deep‐seated lesions required more treatment sessions and it was observed that clinically the lesions did not completely disappear.     

Treatment of periorbital wrinkles with 1550‐ and 1565‐nm Er:glass fractional photothermolysis lasers: a simultaneous split‐face trial

Objective This study aimed to compare the clinical efficacies of 1550‐ and 1565‐nm Er:glass lasers in the treatment of periorbital wrinkles and to evaluate histological changes after treatment. Methods Twenty patients received five treatments each at 3‐week intervals. The right periorbital area was exposed to the 1550‐nm Er:glass laser and the left periorbital area was exposed to the 1565‐nm Er:glass laser. Clinical improvement was evaluated by two blinded physicians who assessed comparative photographs using a four‐point scale at baseline and 3 months after the final treatments. Skin biopsies were performed in five volunteers before treatment and at 3 months after the final treatment. Results The mean improvement scores 3 months after treatment with the 1550‐ and 1565‐nm Er:glass lasers were 2.25 ± 0.62 and 2.28 ± 0.59 respectively. Histological examination revealed increased epidermal thickening and decreased solar elastosis 3 months after the final laser treatments. Conclusions Both 1550‐ and 1565‐nm Er:glass lasers are safe and effective modalities in the treatment of periorbital wrinkles with no significant differences between the two lasers.     

1927‐nm fiber‐optic diode laser: A novel therapeutic option for facial steatocystoma multiplex

Steatocystoma multiplex (SM) is a cutaneous disorder that presents with multiple yellowish intradermal cysts originating from the pilosebaceous ducts. Although various treatments have been attempted to improve cosmetic outcomes, no optimal treatment strategy has been established to date. A 41‐year‐old man presented with a 10‐year history of multiple skin‐colored papulonodules over his entire body. He was diagnosed with SM, and we treated his facial SM with a 1927‐nm diode laser. Two treatment sessions at a 5‐week interval led to cosmetically excellent outcomes. There was no recurrence at the 8‐month follow‐up. Herein, we present a case of SM that was successfully treated with a 1927‐nm fiber‐optic diode laser.     

“Drug‐resistant granuloma faciale”: treatment with carbon dioxide‐GaAs laser

Granuloma faciale (GF), also known as “eosinophilic granuloma,” is a rare benign leukocytoclastic vasculitis which most commonly occurs on the face of middle‐aged Caucasian males. Clinically, GF appears as single or multiple, slowly growing, reddish‐brown papules, nodules or plaques which may be cosmetically unpleasant. Its pathogenesis is unknown and GF is notoriously resistant to treatments. Both medical (dapsone, colchicine, gold injections, isoniazid, clofazimine, corticosteroids, psoralen ultraviolet radiation, and topical tacrolimus) and surgical therapies (excision, graft, dermabrasion, argon laser, carbon dioxide laser, pulsed dye laser, cryotherapy, and electrosurgery) have been used for GF but no effective treatment has yet been found. Furthermore, the typical facial location of GF requires an acceptable cosmetic result. We report two cases of drug‐resistant GF which were successfully treated with laser vaporization combining two different wavelengths: carbon dioxide (CO₂) 10,600 nm and GaAs 1540 nm.     

A cross‐sectional,multi‐center study on treatment of facial acne scars with low‐energy double‐pass 1450‐nm diode laser

Acne scars are the ultimate outcome of acne vulgaris, a prevalent skin disorder affecting the pilo‐sebaceous unit. Laser resurfacing has been demonstrated to be an efficient therapy option for acne scars. Hence, we adopted this concept and conducted a study to evaluate the safety and efficacy of low‐energy double‐pass 1450‐nm diode laser on acne scars. This study was conducted on 48 patients with acne scars, treated at 4‐week interval with low‐energy double‐pass 1450‐nm diode laser. Patients were evaluated clinically and with photographs, at day 0, first month and third month post the final treatment and during follow‐up visit. Five treatment sessions were completed by all patients. Approximately, 79.2% of patients showed around 30% improvement. At the end of third month follow‐up, 92.9% of the patients demonstrated >30% improvement. Vesicle formation was observed in two cases, with no post‐inflammatory hyperpigmentation and transient hyperpigmentation was observed in one case, which vanished within 2 months. Our study showed that 1450‐nm diode laser treatment was efficient and well endured in facial acne scars when used with double‐pass at low‐energy.     

308‐nm excimer lamp vs. 308‐nm excimer laser for treating vitiligo: a randomized study

Background The 308‐nm excimer laser and 308‐nm excimer lamp have both been shown to be effective in treating vitiligo but a direct comparison has never been performed. Objectives To test the equivalence of these two devices for treating nonsegmental vitiligo. Patients and methods A randomized monocentric study was undertaken. One lesion was treated with the 308‐nm excimer laser and its counterpart with the 308‐nm excimer lamp. Lesions were treated twice weekly with the same dose on both sides for a total of 24 sessions. The evaluation was done by two independent physicians blinded to the treatment on direct light and ultraviolet light photos. Results Twenty patients were included: 17 completed the study and 104 lesions were treated. The two treatments showed similar results in terms of efficacy for a repigmentation of at least 50% (P = 0·006). The lamp induced more erythema than the laser. Conclusions The 308‐nm excimer lamp and laser showed a similar efficacy in treating vitiligo. For the same fluence, the lamp induced more erythema suggesting photobiological differences between the two devices.     

Treatment of procedure-related postinflammatory hyperpigmentation using 1064-nm Q-switched Nd:YAG laser with low fluence in Asian patients: report of five cases

Postinflammatory hyperpigmentation (PIH) developing after cosmetic procedures, such as chemical peeling and laser therapies, are always a concern, especially in Asians. Some cases of PIH tend to be spontaneously regressed; however, certain forms of PIH need to be treated with several therapeutic attempts, including bleaching creams, several kinds of Q-switched lasers, and erbium-doped fractional photothermolysis system, with various treatment outcomes. A 1064-nm Q-switched Nd:YAG laser with low-fluence therapy is easily applicable, and the therapeutic trial in our case was revealed to have minimal downtime without post-therapy bleeding or crust formation; the post-therapy erythema spontaneously resolved within a few hours. The 1064-nm Q-switched Nd:YAG laser with low-fluence treatment should be considered in the treatment of PIH caused by procedures like laser surgery and chemical peeling in Asian patients.     

Efficacy and safety of 1064‐nm Q‐switched Nd:YAG laser with low fluence for keloids and hypertrophic scars

Background Several treatment modalities using laser devices have been used for the treatment of keloids and hypertrophic scars with various therapeutic outcomes. Objective The purpose of this study was to describe the efficacy and safety of 1064‐nm Q‐switched (QS) Nd:YAG laser with low fluence on keloids and hypertrophic scars. Methods Keloids and hypertrophic scars located at 21 anatomic sites in 12 Korean patients (10 men and 2 women; mean age 23.8 years, range 21–33) were treated using 1064‐nm QS Nd:YAG laser with low fluence at 1–2 week intervals. Treatment settings were 1.8–2.2 J/cm², 7‐mm spot size and 5–6 passes with appropriate overlapping. Results Follow‐up data collected 3 months after the final treatment revealed decreases in the mean score for the following lesion characteristics: pigmentation from 1.8 to 1.2; vascularity from 1.4 to 1.0; pliability from 3.0 to 2.0 and height from 2.3 to 1.8. The modified Vancouver General Hospital Burn Scar Assessment score decreased from 8.6 to 5.9 (P < 0.0001). Observed side‐effects were a mild prickling sensation during treatment, and mild post‐treatment erythema, both of which resolved within few hours. Conclusion Our results demonstrate that QS Nd:YAG laser with low fluence may be used for the treatment of keloids and hypertrophic scars.     

Case series of post‐purpuric darkness on the periorbital area after aesthetic surgery

Periorbital hyperpigmentation (POH) is a common condition encountered in dermatology practice. POH is caused by various exogenous and endogenous factors including excessive pigmentation, postinflammatory hyperpigmentation (PIH) secondary to eczema, periorbital edema, excessive vascularity, and aging. Recently, we have experienced several patients who complained of POH with an unusual pattern. Their pigmented lesions had several features in common. The pigmentation occurred bilaterally after aesthetic surgery involving the periorbital region. Periorbital post‐purpuric darkness should be distinguished from common POH. Practitioners should ask patients about history of prior aesthetic surgery and make their patients aware that the dark colors are composed of various pigments such as hemosiderin, which make treatment troublesome. Conservative management with expectations for gradual spontaneous regression or laser therapy with multiple wavelengths including 1,064‐nm laser for PIH and 650 or 694‐nm laser targeting heme‐derived pigments may be considered as treatment options.     

Side‐by‐side comparison of photodynamic therapy and pulsed‐dye laser treatment of port‐wine stain birthmarks

Background Pulsed‐dye laser (PDL)‐mediated photothermolysis is the current standard treatment for port‐wine stain (PWS) birthmarks. Vascular‐targeted photodynamic therapy (PDT) might be an alternative for the treatment of PWS. Objectives To compare clinical outcomes of PDT and PDL treatment of PWS. Methods Two adjacent flat areas of PWS lesions were selected from each of 15 patients (two male and 13 female; age 11–36 years) and randomly assigned to either single‐session PDL or PDT. PDL was delivered using a 585‐nm pulsed laser. PDT was carried out with a combination of haematoporphyrin monomethyl ether (HMME) and a low‐power copper vapour laser (510·6 and 578·2 nm). Clinical outcomes were evaluated colorimetrically and visually during follow‐up. Results A total of nine red PWS lesions and six purple PWS lesions were treated. For red PWS, colorimetric assessment showed that the blanching rates of PDL and PDT at 2 months ranged from ?11% to 24% and 22% to 55%, respectively. For purple PWS, blanching rates of PDL and PDT ranged from 8% to 33% and 30% to 45%, respectively. Overall, there was a significant difference between the blanching effect of single‐session PDL treatment and a single‐session PDT treatment. Conclusions This side‐by‐side comparison demonstrates that PDT is at least as effective as PDL and, in some cases, superior. The true value of PDT for the treatment of PWS deserves further investigation.     

An evaluation of the efficacy of a single‐session 577 nm pro‐yellow laser treatment in patients with postacne erythema and scarring

Erythema and scarring are among the most common complications of severe inflammatory acne. In this study, we aimed to share our experience with pro‐yellow laser and document the efficacy and safety of this treatment in postacne erythema and scarring. The study included 40 patients, 24 (60%) females, and 16 (40%) males with a mean age of 29.5 ± 8.16 (min. 18 years, max. 57 years). The pro‐yellow laser was applied to all patients as a single session with irradiation of 22 J/cm². Improvement in postacne erythema and scars were evaluated after the treatment. The study included 40 patients, 24 patients (60%) were females and 16 patients (40%) were males with the mean age of 29.5 ± 8.16 (ranged between 18 and 57 years old). A total of 21 patients (52.5%) had good improvement (51%‐75% regression), 10 patients (25%) had excellent improvement (76%‐100% regression), and a moderate improvement (26%‐50%) was detected in 9 patients (22.5%). Also, there were mild improvement (1%‐25%) in 20 patients (76.9%) and a moderate improvement (26%‐50%) in 6 patients (23.1%). We found that pro‐yellow laser is highly effective in the treatment of postacne erythema, while its effectiveness was mild to moderate in atrophic acne scars. Also, it has been observed that the pro‐yellow laser system can be used safely immediately after cessation of systemic isotretinoin treatment.     

Treatment of trichostasis spinulosa with a 755‐nm long‐pulsed alexandrite laser

Background Trichostasis spinulosa (TS) is a common disorder of hair follicle, characterized by spinous plugs. Topical treatments offer temporary relief but permanent removal of the abnormal follicles using hair removal lasers may result in a definite cure. Objective To evaluate the safety and efficacy of 755‐nm alexandrite laser for the treatment of TS lesions. Patients and methods Two consecutive 755‐nm alexandrite laser treatments were performed one month apart. The clinical response and adverse effects were assessed four weeks after the first and second treatments and 20 weeks after the second treatment. Results Thirty one patients with skin phototypes II to IV completed the study. At the last follow up visit, a decrease in dark‐plug density of greater than 50% was noted in 16 patients (51.3%), while only three patients (9.7%) had an improvement of greater than 75%. Ten of the 21 patients (47.6%) with skin type III and six of the seven patients (85.7%) with skin type IV achieved at least 50% improvement in lesions at the last follow up visit (P = 0.1). Conclusion The 755‐nm alexandrite laser can safely and effectively reduce TS lesions lasting for a relatively long time in patients with skin types III–IV.     

Efficacy and cosmetic results of contact gel cooling of the skin during non‐ablative laser procedures

Background: Aesthetic laser treatments of the skin result in collateral thermal damage to the adjacent tissue if it is not cooled.A recently developed gel cooling pad is designed to be applied to the treated area and then penetrated by the laser beam during treatment. Patients and methods: 97 treatments of 61 patients were documented.Vascular malformations (telangiectasia, hemangioma, spider nevi, nevi flammei, scars) were treated 52 times with the LBO laser Idas (532 nm).With the alexandrite laser Arion (755 nm), 13 treatments for hypertrichosis were evaluated. Pigmentation disorders (tattoos,lentigines,segmented melanocytic hyperpla‐sia, nevus of Ota) were treated 32 times with the ruby laser Sinon (694 nm). Additionally, we measured the energy of the laser systems through a glass plate with and without the hydrogel pad. Furthermore, we examined patient satisfaction as well as noting application experiences of the treating doctors. Results: Our examinations showed a negligible loss of energy in clinical use, with good patient satisfaction and good cosmetic results. Conclusions:Use of the hydrogel pad is recommended during non‐ablative cosmetic laser treatments of the skin.It is especially convenient for the treatment of vascular malformations of the face.     

Comparison of quality of facial scars after single low‐level laser therapy and combined low‐level with high‐level (PDL 595 nm) laser therapy

The main goal of our study was to compare the quality of resulting facials scar 12 weeks after single and combined laser therapy. Forty‐one children from age 1.5 to 5 years with facial scars after injury participated in the study. Thirty‐one underwent laser therapy, 14 were treated using single low‐level laser therapy (670 nm, fluence 3–5 J/cm^?2), and 17 underwent combined high‐level laser therapy with non‐ablative pulsed dye laser (PDL; 595 nm, spot size 7 mm, delay 0.45 ms or 1.5 ms, fluence 9–11 J/cm^?2, cryogen spray/delay 20/30 ms) and low‐level laser therapy. The control group consisted of 10 untreated children. Before treatment and at week 4, 8, and, 12 the scars were evaluated using the POSAS questionnaire. A statistically significant improvement in scars (between ratings before treatment and 4 weeks after therapy, before treatment and 8 weeks after therapy and before treatment and 12 weeks after therapy) was observed in all parameters in both treatment groups (p < 0.0001). For the HLLT+LLLT group the most significant enhancement in the quality of scars was found for all items and at all evaluations, except pigmentation and pliability. There was no improvement observed in quality of facial scars in the control group.     

Pilot Study of the Efficacy of 578 nm Copper Bromide Laser Combined with Intralesional Corticosteroid Injection for Treatment of Keloids and Hypertrophic Scars

Background

Treatments including intralesional corticosteroid injection, pressure therapy, cryotherapy, and various laser therapies have had limited success for keloids and hypertrophic scars.

Objective

This trial evaluated the efficacy of a combination of 578 nm copper bromide laser and the more traditional intralesional corticosteroid injection for the treatment of keloids and hypertrophic scars with respect to scar color.

Methods

Keloids or hypertrophic scars of 12 Korean patients were treated five times by the combined treatment at 4-week intervals. Clinical improvement was assessed by the physicians'' global assessment (PGA) comparing pre- and post-treatment photographs, as well as 4 weeks after the last treatment. Erythema intensity was quantified using a mexameter.

Results

Most scars showed significant clinical improvement in PGA and decreased erythema intensity after 5 treatments. All patients showed improvements in symptoms like pruritus.

Conclusion

The combined treatment is effective for keloids and hypertrophic scars, especially when the telangiectatic portion of the scars is prominent. The adjunctive use of 578 nm copper bromide laser decreased the telangiectatic side effects of an intralesional corticosteroid injection by reducing the vascular components of scars.     

Non‐ablative 1550‐nm erbium‐glass and ablative 10 600‐nm carbon dioxide fractional lasers for acne scars: a randomized split‐face study with blinded response evaluation

Background Non‐ablative 1550‐nm erbium‐doped fractional photothermolysis systems (FPS) and 10 600‐nm carbon dioxide fractional laser systems (CO₂ FS) have been effectively used to treat scars. Objective We compared the efficacy and safety of single‐session treatments of FPS and CO₂ FS for acne scars through a randomized, split‐face, evaluator‐blinded study. Methods Eight patients with acne scars were enrolled in this study. Half of each subject’s face was treated with FPS and the other half was treated with CO₂ FS. We used a quartile grading scale for evaluations. Results At 3 months after the treatment, the mean grade of improvement based on clinical assessment was 2.0 ± 0.5 for FPS and 2.5 ± 0.8 for CO₂ FS. On each side treated by FPS and CO₂ FS, the mean duration of post‐therapy crusting and scaling was 2.3 and 7.4 days respectively and that of post‐therapy erythema was 7.5 and 11.5 days respectively. The mean VAS pain score was 3.9 ± 2.0 with the FPS and 7.0 ± 2.0 with the CO₂ FS. Conclusion We demonstrated the efficacy and safety of single‐session acne scar treatment using FPS and CO₂ FS in East Asian patients. We believe that our study could be used as an essential reference when choosing laser modalities for scar treatment.     

Topical niacin cream‐assisted 595‐nm pulsed‐dye laser treatment for facial flushing: retrospective analysis of 25 Korean patients

Background Flushing is defined clinically as a transient reddening of the face and other areas. Due to the transient nature of flushing, a patient may not show signs of flushing during laser treatment. Objective The aim of this study was to evaluate the efficacy and safety of 595‐nm pulsed‐dye laser treatment of flushing or erythema after provocation of flushing by topical niacin cream. Methods We retrospectively reviewed a total of 25 Korean patients with facial flushing who were treated with three sessions of 595‐nm pulsed‐dye laser after the application of topical niacin cream. Results Follow‐up results revealed that 12 of the 25 patients demonstrated marked (51–75%) clinical improvement of baseline facial erythema. Eight patients had moderate (26–50%) improvement and three demonstrated near total (≥75%) improvement. Two patients showed minimal to no (0–25%) improvement. We observed that the reactivity to topical niacin cream was markedly reduced in 64% of our patients after 595‐nm pulsed‐dye laser treatments. Minimal post‐therapy facial oedema was noted in most of the patients, which usually resolved spontaneously within 2 days. Pronounced facial swelling was observed in four patients. Conclusion We suggest that 595‐nm pulsed‐dye laser treatment after provocation of flushing by topical niacin cream may provide a new treatment algorithm for facial flushing in Asians.