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.     

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.     

Treatment of mild to severe acne with 1726 nm laser: A safe alternative to traditional acne therapies

Introduction

Acne is the most common reason for dermatology consultation in adolescents and young adults. Consultation is often delayed despite unsuccessful self-treatment. Postponing effective treatment places acne sufferers at higher risk for permanent acne scars and post-inflammatory pigment changes.

Aim

This review discusses clinical challenges with present therapeutic options for acne treatment and the role of a 1726 nm laser for acne.

Methods

Current acne treatment guidelines were reviewed. A literature review was conducted for trials of light-based acne therapy. The selectivity of previous light-based therapies was reviewed.

Results

Available acne therapy is effective, but treatment-related side effects are common. Acne treatment guidelines do not include recommendations for light-based treatments. Different types of light-based treatments have been tried but until now no wavelength specifically targeted sebaceous glands.

Conclusion

The 1726 nm laser is safe and effective for treating mild to severe acne in all Fitzpatrick skin types. Acne resolution is apparent within the first month and improves for up to 2 years beyond treatment.     

The assessment of moderate acne vulgaris face skin using blood perfusion and hyperspectral imaging–A pilot study

Background

Microcirculation is the flow of blood through the smallest vessels in the circulatory system. Capillaries respond to various pathologies much earlier than arteries and veins, the changes which indicate that the disease is already developing. Careful monitoring of the functioning of the capillary system often allows the detection of in vivo disorders at an early stage.

Aims

The aim of the study was to evaluate the microcirculation within acne lesions. A noninvasive method of semi-quantitative blood perfusion measurement based on laser speckle contrast analysis (LASCA) and a quantitative assessment of the acne severity using the hyperspectral imaging method supported by image analysis and processing methods were used.

Patients/Method

The acne lesion perfusion was compared to the healthy skin perfusion of the control group. The reflectance in the range from 400 to 1000 nm was also compared for acne lesions and healthy skin. A dedicated version of the algorithm based on the gray-level co-occurrence matrix was used to compare differences between acne lesions and healthy skin.

Results

Blood perfusion in acne lesions is on average 117% higher than in healthy skin. The reflectance of acne lesions was lower in the range of 400–600 nm compared to the healthy skin. A statistically significant decrease in the reflectance of acne lesions was demonstrated for wavelengths: 434, 549, and 588 nm.

Conclusions

Increased blood perfusion in acne lesions compared to healthy skin suggests increased chemotaxis of inflammatory cells and wound healing. Decrease points in skin reflectance resemble the absorption peaks for hemoglobin and coproporphyrin III produced by Cutibacterium acnes. Thus, the proposed methods may serve not only for the early detection of acne lesions, before they manifest themselves clinically for the naked eye, but may also be a tool for quantifying the effectiveness of acne treatment.     

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).     

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 inflammatory facial acne vulgaris: Comparison of the 1450‐nm diode laser and conventional physical treatment

The efficacy of the 1450‐nm diode laser in the treatment of inflammatory facial acne was evaluated by comparing it with conventional physical treatment. Seventeen patients received laser treatment on the right side of the face and conventional physical treatment on the other side. The two modalities were compared through photographs, inflammatory acne lesion counts, and a patient questionnaire. Clinical response was evaluated in 16 patients. Evaluation of baseline and follow‐up photographs indicated that more improvement was obtained after laser treatment than by physical treatment in six patients. In two patients, physical treatment yielded better results than laser treatment. Equal effect was obtained in eight patients. All patients had a reduction in the inflammatory acne lesion count on the laser‐treated side, which was statistically significantly greater on the laser‐treated side compared with the side treated physically (p = 0.039, Wilcoxon signed ranks test). By the assessment of patient satisfaction, seven patients preferred laser treatment, two patients preferred physical treatment and three patients found laser treatment equal to physical treatment. Questionnaire details could not be obtained in 4 patients. This study indicates that the 1450‐nm diode laser is a new option for local treatment of acne.     

Treatment of a café-au-lait macule with the erbium:YAG laser

The erbium:YAG laser is a relatively new instrument for skin rejuvenation. We present a case of a "Q-switched laser-resistant" café-au-lait macule that was successfully treated with the erbium:YAG laser.     

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.     

Treatment of recalcitrant plantar warts with long-pulsed Nd:YAG laser versus cantharidin–podophylline resin–salicylic acid

Background: Treatment for recalcitrant plantar warts remains a continuing challenge as the options for treatment have differing levels of success. long-pulsed Nd:YAG laser is considered a good treatment modality in resistant plantar warts. On the other hand, high cure rates have been reported with a topical proprietary formulation consisting of 1% cantharidin, 5% podophyllotoxin, 30% salicylic acid. Aim: To compare the efficacy of 1% cantharidin, 20% podophylline resin and 30% salicylic acid (CPS) versus long-pulsed Nd:YAG laser in the treatment of recalcitrant plantar warts. Methods: This study included 30 patients with single or multiple recalcitrant plantar warts; patients were assigned to two groups: the first group included 15 patients with 71 recalcitrant plantar warts who were treated by long-pulsed Nd:YAG laser (group I) and the second group included 15 patients with 78 recalcitrant plantar warts who received CPS (group II). The diagnosis of plantar warts was made by clinical examination. Results: Fourteen patients (93%) were completely cleared of their warts with topical CPS, while 11 patients (73%) showed complete clearance with long-pulsed Nd:YAG laser with statistically significant difference between the two groups. Conclusion: Topical CPS is safe and efficacious and represents a promising therapeutic modality than long-pulsed Nd:YAG laser in the treatment of recalcitrant plantar warts.     

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

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

Treatment of Melasma with low fluence,large spot size, 1064-nm Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser for the treatment of melasma in Fitzpatrick skin types II–IV

Abstract

Melasma is a common condition affecting over six million American women. Treatment of dermal or combined melasma is difficult and does not respond well to conventional topical therapies. Various light sources have been used recently in the treatment of melasma including fractionated ablative and non-ablative lasers as well as intense pulse light. We report the use of low fluence, large spot size Q-switched, Nd:Yag laser for the treatment of melasma in skin types II–IV.     

Treatment of dermatosis papulosa nigra with a 1064 nm Nd:YAG laser: Report of two cases

Dermatosis papulosa nigra (DPN) is a chronic skin condition characterized by verrucous hyperpigmented papules on the face, neck and upper trunk in African American patients. The lesions are more common in females and in older patients. Although the lesions are benign, treatment is often sought for cosmetic reasons. We report two cases of patients with facial DPN who achieved an excellent cosmetic result following a single treatment with a long‐pulsed 1064?nm Nd:YAG laser. We suggest this modality for consideration in treating patients with DPN.     

Treatment of Laugier–Hunziker syndrome with the Q-switched alexandrite laser in 22 Chinese patients

Laugier–Hunziker syndrome (LHS), a rare, acquired pigmentary disorder of the lips, oral mucosa, and fingers, is known to be an entirely benign disease with no systemic manifestations. In the past, the pigmentation has been treated efficiently in a few patients with the Q-switched neodymium: yttrium–aluminum–garnet (Nd:YAG) laser and the Q-switched alexandrite laser (QSAL). In order to evaluate the efficacy and safety of QSAL on Chinese patients of LHS, we treated 22 patients with QSAL in the past 5 years. Treatments were delivered on a bimonthly or trimonthly basis until the abnormal pigmentation totally disappeared. Patients were evaluated at each visit for evidence of dyspigmentation, scarring, or other untoward effects from the laser treatment. Our 22 subjects consisted of 18 females and 4 males with a mean age of 42.4 years. After only one session of laser treatment, the clearing on the lips was as follow: 18 (81.8%) excellent, 2 (9.1%) good, 1 (4.5%) fair and 1 (4.5%) poor. Eighteen patients (81.8%) with LHS, who had achieved excellent clearing after only one session of laser treatment, did not receive further treatment. Among the left four patients, three patients (13.6%) achieved complete results after three laser treatments. Only one patient required six sessions to achieve complete clearance. No scarring was noted after any of the treatments. The appearance of pigmentation on mucous membranes in a middle-aged patient without a significant family history for skin disorders should prompt consideration for the possible diagnosis of LHS. Our study has also demonstrated QSAL to be highly effective and safe in the treatment of LHS.     

Tazarotene versus tazarotene plus hydroquinone in the treatment of photodamaged facial skin: A multicenter,double‐blind,randomized study

Objectives: To compare the efficacy and tolerability of tazarotene plus hydroquinone versus tazarotene alone in the treatment of facial photodamage. Methods: Patients with facial mottled hyperpigmentation of at least moderate severity and an overall integrated assessment of photodamage score of at least moderate applied tazarotene 0.1% cream each evening and either hydroquinone 4% cream or placebo cream each morning for up to 24 weeks. Results: Among 131 patients enrolled, 114/124 (92%) with exit data completed. Both regimens were highly effective in reducing photodamage, with tazarotene plus hydroquinone showing superiority over tazarotene alone for some efficacy measures. The incidence of ?1‐grade improvement from baseline (on a scale of none, minimal, mild, moderate, or severe) was significantly greater with tazarotene plus hydroquinone than with tazarotene alone for lentigines (weeks 12–24, p?0.01) and mottled hyperpigmentation (week 16, p?0.05). The incidence of ?50% global improvement was also significantly superior with the combination regimen as early as week 8 (p?0.01). Both regimens were associated with good tolerability and high patient satisfaction (no significant between‐group differences). Conclusions: The adjunctive use of hydroquinone can enhance the efficacy of tazarotene in reducing dyspigmentation associated with photodamage.