Hair dryer use to optimize pulsed dye laser treatment in rosacea patients

Rosacea is a common chronic inflammatory condition characterized by erythema, telangiectasias, papules, and pustules. While there are many effective treatment options for the papulopustular type, laser therapy remains the most effective modality to treat erythematotelangiectatic rosacea. Erythema and flushing associated with rosacea remains an uncomfortable and socially embarrassing problem for patients. Unfortunately, patients often do not have significant erythema or flushing when they present for laser treatment. With this in mind, we propose a novel technique aimed at enhancing the response of rosacea patients being treated for erythema with pulsed dye laser. Specifically, we present a split-face example of our clinical observation that pre-treatment with forced heated air prior to pulsed-dye laser leads to a greater response in rosacea patients with erythema and flushing.     

Successful treatment of erythematotelangiectatic rosacea with pulsed light and radiofrequency

Introduction: Many laser and light devices have reported to be successful in the treatment of the flushing, background erythema, and telangiectasias that characterize erythematotelangiectatic rosacea including pulsed dye laser, potassium titanyl phosphate, intense pulsed light, and dual-wavelength lasers. A technology called ELOS (electro-optical synergy) combines pulsed light or laser with bipolar radiofrequency. This combination, developed in 2000, was based on the premise that these two forms of energy could be synergistic. One such device (Aurora SRA-skin-rejuvenation advanced handpiece, Syneron Medical Ltd., Yokneam, Israel) has a light spectrum of 470 to 980nm, energy up to 45J/cm(2), and a range of radiofrequency energy of 5 to 25J/cm(3) and is indicated for the treatment of vascular and pigmented lesions. Methods: We attempted to quantify the improvement of moderate-to-severe type-1 rosacea after three and five full-face treatments with this modality. Twenty-one patients with moderate-to-severe rosacea underwent five monthly full-face treatments with this device. The patients were evaluated with high-resolution photographs (Canfield Visia CR, Canfield, Fairfield, New Jersey) and self-evaluated via the National Rosacea Society's official "Scorecard." Results: Erythema and telangiectasia (physician assessed) as well as flushing and global status (patient assessed) achieved improvement that was statistically significant. Five treatments were no more effective than three, although the photographs reveal subtle improvements. There were no significant adverse events. Conclusion: The results of this study suggest that the combination of optical and RF energies is effective for the treatment of rosacea. ELOS, as well as other vascular-focused lasers and light sources, provides an important treatment option for patients who fail medical therapy, reach a plateau in their response to medical therapy, or wish to avoid chronic oral therapy.     

Treatment of lupus erythematosus with pulsed dye laser

BACKGROUND AND OBJECTIVES: The treatment of cutaneous lupus erythematosus (CLE) with dye and argon laser has been evaluated in a number of articles in recent years. The improvement of telangiectasias and chronic erythema of the cutaneous lesions was based on the selective photothermolysis ablation of the dilated capillaries and venules. STUDY DESIGN/MATERIALS AND METHODS: We describe the results of the treatment of cutaneous lesions of 14 patients; eight with discoid lupus erythematosus (DLE) and six with systemic lupus erythematosus (SLE). Three patients received a treatment with flashlamp pulsed dye laser (FPDL) (585 nm, 450 microseconds) with fluences in the range from 5 to 7.75 J/cm(2); the other 11 patients were treated with long pulsed dye laser (LPDL) (595 nm, 1.5-10 milliseconds) with fluences in the range from 6 to 13 J/cm(2) depending on the pulse duration. RESULTS: During a median follow-up of 10 months, we observed an average improvement in over 60% of the lesions. A few side effects were observed in all patients: four had transient hyperpigmentation and one patient had light scarring. Three patients had a relapse after more than 1 year; they were then offered conventional treatment. CONCLUSIONS: We confirm that pulsed dye laser is a good alternative treatment for the erythema in active cutaneous lesions of lupus erythematosus (LE).     

Pulsed dye laser therapy for viral warts.

Twenty-eight patients with 103 recalcitrant and 20 simple viral warts were treated with the Cynosure PhotoGenica V pulsed dye laser at 585 nm, and fluencies of 6.0-9.0 J/cm(2). An eradication rate of 92% for recalcitrant warts after an average of 2.1 (range 1-7) treatments and 75% for simple warts after an average of 1.6 (range 1-2) treatments was achieved with a mean follow-up period of 7.2 (range 3-15) months. Mild hypopigmentation was noted in one patient and superficial infection in another. Unlike ablative treatment modalities, with pulsed dye laser therapy, no wound was created thus avoiding prolonged postoperative pain, disability and scarring. Treatment was well tolerated by patients, most of whom returned to work or normal activities immediately postoperatively. Pulsed dye laser is an effective treatment for both recalcitrant and simple warts. It is the treatment of choice for these lesions in cosmetically sensitive areas.     

Comparison of the 585 nm Pulse Dye Laser and the Short Pulsed CO2 Laser in the Treatment of Striae Distensae in Skin Types IV and VI

BACKGROUND: Striae distensae, or stretch marks, are a very common cosmetic problem. The successful management of stretch marks has long been a source of frustration and curiosity for both the clinician and the researcher. Recent studies suggest lasers may have a role in their management. As yet, no study has reported on the effects of either of these lasers in the treatment of stretch marks on persons with skin types 4 to 6. OBJECTIVE: To assess the efficacy of short pulsed CO2 laser and pulsed dye laser for the treatment of stretch marks in skin types 4, 5, and 6. METHODS: Four patients were initially enrolled in the study. All were female with abdominal stretch marks, present for a range of 8 to 19 years. The patients had skin types ranging from 4 to 6. The test area consisted of a stretch mark long enough to be divided into three contiguous 2 cm sections, labeled A, B, and C. Section A served as the short pulsed CO2 test site, section B served as a control, while section C served as the 585 nm pulsed dye site. Patients were seen for evaluation after 1 week, then every 4 weeks for a total of 20 weeks. Patients were evaluated subjectively by the investigators, and the patients' own self-evaluation was reported as well. RESULTS: Following the 585 nm pulse dye laser, at 20 week follow-up patients with type 4 skin showed no improvement, while type 6 skin showed hyperpigmentation. The short pulsed CO2 test site showed persistent erythema in type 4 skin and marked hyperpigmentation in type 6 skin. CONCLUSIONS: For patients with types 4, 5, and 6 skin, laser treatment of striae should be avoided or used with great caution.     

窄谱强脉冲光联合Nd:YAG激光治疗高原性毛细血管扩张症疗效分析

目的:探讨窄谱强脉冲光(DPL)联合Nd:YAG激光治疗高原性毛细血管扩张症的临床疗效。方法:回顾性分析2013年6月-2017年6月笔者医院收治的162例高原性毛细血管扩张症患者的临床资料,其中对照组给予单纯DPL治疗,观察组给予DPL、Nd:YAG激光联合治疗。采用视觉模拟评分法(VAS)、红斑指数、皮肤经皮水分丢失(TEWL)、中文版皮肤病生活质量指数(DLQI)分别对治疗前后患者皮损状况、红斑、皮肤屏障功能及生活质量进行评估。观察两组患者的治疗次数、临床疗效、VAS评分、红斑指数、TEWL、DLQI评分及安全性差异。结果:治疗后,两组患者各项VAS评分、DLQI评分、红斑指数、TEWL均显著改善,观察组改善程度显著优于对照组,差异具有统计学意义(P<0.05);观察组治疗次数明显低于对照组[(2.42±0.85)次vs(5.18±1.53)],差异有统计学意义(P<0.05);观察组治疗总有效率为95.06%,对照组总有效率为83.95%,观察组明显高于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率为9.88%,对照组为13.58%。两组比较差异无统计学意义(P>0.05)。结论:窄谱强脉冲光联合Nd:YAG激光治疗高原性毛细血管扩张症患者疗效显著,有助于皮肤屏障功能的恢复,美容效果好、安全性高,值得临床推广应用。     

凉血五花汤加减联合染料激光治疗玫瑰痤疮的临床效果

目的 分析对玫瑰痤疮患者采用凉血五花汤加减联合染料激光治疗的效果。方法 选取2023年 1月-2024年1月贵州中医药大学第一附属医院收治的76例玫瑰痤疮患者为研究对象,随机分为对照组和观 察组,每组38例。对照组给予凉血五花汤加减治疗,观察组给予凉血五花汤加减联合染料激光治疗,比 较两组皮损恢复情况、中医证候积分及不良反应发生情况。结果 观察组治疗后皮损评分低于对照组, 差异有统计学意义（P ＜0.05）;观察组治疗后红斑、干燥、丘疹、疼痛、皮肤潮红、瘙痒积分均低于对 照组,差异有统计学意义（P ＜0.05）;观察组不良反应发生率为2.63%,低于对照组的18.42%,差异有 统计学意义（P＜0.05）。结论 凉血五花汤加减联合染料激光治疗玫瑰痤疮的临床效果良好,能够有效促 进皮损恢复,改善痤疮症状,且治疗后不良反应发生几率较低,安全性较高,为玫瑰痤疮的治疗提供了新 思路、新方法。     

Flashlamp pulsed dye laser (FPDL) did not cure papulopustular rosacea

BACKGROUND AND OBJECTIVES: Pharmacological treatment has a fairly good effect on the papulopustular lesions in rosacea, but not as good an effect on the erythema and telangiectases. The aim was to treat rosacea patients with both erythematotelangiectatic and papulopustular lesions with flashlamp pulsed dye laser (FPDL) until telangiectases/erythema disappeared, and to evaluate whether the treatment might also be effective on papulopustular lesions. STUDY DESIGN/MATERIALS AND METHODS: Ten patients were treated on one side of the face with FPDL. The final examination was blinded and performed on the average 10 months after the last treatment. RESULTS: Two of the patients had more lesions after treatment, three were unchanged, three had only slightly less, and two had markedly less papulopustular lesions. CONCLUSION: Our conclusion from this small sample of patients is that FPDL probably has limited value on papulopustular lesions in rosacea. This indicates that the origin of rosacea may not be only vascular.     

Pulsed dye laser treatment of rosacea using a novel 15 mm diameter treatment beam

Background

The pulsed‐dye laser has been used to treat facial redness and rosacea for decades. Recent advances in dye laser technology enable 50% higher output energies supporting 50% larger treatment areas, and beam‐diameters up to 15 mm with clinically‐relevant fluences. In this study, we investigate this novel pulsed‐dye laser using a 15 mm diameter beam for treatment of rosacea.

Methods

Twenty subjects with erythemato‐telangiectatic rosacea were enrolled in the study. A total of 4 monthly treatments were administered, first treating linear vessels with a 3 × 10 mm elliptical beam, then diffuse redness with a 15‐mm diameter circular beam. Blinded assessment of digital, cross‐polarized photographs taken 2 months following the last treatment was performed using an 11‐point clearance scale.

Results

Nineteen subjects completed the study. Blinded reviewers correctly identified baseline photos in 55 out of the total of 57 images (96.5%). The blinded reviewers scored 17 of the 19 subjects with an improvement greater than 40%, and 11 of the 19 subjects greater than 50%. The average improvement was 53.9%. Side effects were limited to mild edema, mild to moderate erythema, and mild to moderate bruising.

Conclusion

This study demonstrates that a newly designed pulsed‐dye laser having a novel 15‐mm diameter treatment beam improves the appearance of rosacea with a favorable safety profile. Lasers Surg. Med. 50:808–812, 2018. © 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.     

Treatment of Elastosis Perforans Serpiginosa with the Flashlamp Pulsed Dye Laser

BACKGROUND: Elastosis perforans serpiginosa (EPS) is an uncommon and chronic dermatosis characterized by the transepidermal elimination of altered elastic fibers originating in the dermis. Frequently arranged in an arcuate or serpiginous pattern, the end stage of the disease is atrophic or stellate-shaped scars. OBJECTIVE: Prior therapy has primarily involved cryotherapy with liquid nitrogen which may cause scar or keloid formation. We present our experience using the flashlamp pulsed dye laser to treat EPS. METHODS: A young man with Down syndrome was referred by his primary care physician for treatment of a chronic dermatosis unresponsive to topical therapy. The clinical findings were consistent with EPS, and a biopsy specimen and elastic tissue stain confirmed the diagnosis histologically. After a successful test spot, treatment was begun on the erythematous papules using a flashlamp pulsed dye laser (585 nm) with a 5 mm spot size and fluences of 6.0-7.0 J/cm2. RESULTS: Treated areas showed moderate to marked improvement overall. There was less erythema, thickness, and scarring in treated areas compared with active or end-stage lesions. CONCLUSION: The flashlamp pulsed dye laser may be an effective treatment method for EPS.     

Treatment of Facial Scarring and Ulceration Resulting from Acne Excoriée with 585-nm Pulsed Dye Laser Irradiation and Cognitive Psychotherapy

BACKGROUND: Self-inflicted skin ulcers and scars are often observed in patients with compulsive skin picking. The term "neurotic excoriation" has been used to describe this condition and may or may not coexist with other true skin pathologies, such as acne. The condition poses a diagnostic and treatment challenge because patients often also have an undiagnosed underlying psychologic disorder. CASE REPORTS: Two patients with numerous linear and stellate facial ulcers and hypertrophic and erythematous scars were diagnosed with acne excoriée in the setting of an obsessive-compulsive disorder linked to emotional stress and anxiety. The scars were treated with a 585-nm flashlamp-pumped pulsed dye laser using a 7-mm spot size, 1.5-msec pulse duration, and fluence range of 4.5 to 6.0 J/cm(2). The patients received concomitant cognitive psychodynamic therapy to halt the cycle of impulse-driven skin picking and ulcer/scar formation. Marked clinical improvement of the scars and successful treatment of the acne excoriée were achieved with this combination approach. Relapses occurred when psychodynamic intervention was interrupted. CONCLUSION: The 585-nm flashlamp-pumped pulsed dye laser improves the appearance of hypertrophic erythematous facial scars and ulcers in patients with severe acne excoriée. Proper diagnosis of underlying impulse-control disorders and ongoing psychodynamic therapy is necessary to maintain improvement.     

Treatment of Striae Rubra and Striae Alba With the 585-nm Pulsed-Dye Laser

BACKGROUND: The treatment of striae distensae has recently been reported with various lasers such as the 585-nm pulsed dye laser. At lower fluences (2.0 to 4.0 J/cm2), this laser has been purported to increase the amount of collagen in the extracellular matrix. OBJECTIVE: To determine whether the 585-nm pulsed dye laser is effective in both striae rubra and striae alba after two treatments and, in addition, to determine whether there is a net effect on collagen density in treated samples. METHODS: Twenty patients (skin types II to VI) with either striae rubra (9) or striae alba (11) were treated at baseline and at week 6. The total length of the study was 12 weeks. Untreated striae on the same patient were used as control subjects. Striae clinical parameters such as color and area were measured before the first and after the last treatment by an independent examiner using a visual analog scale. A hydroxyproline assay was used to measure collagen changes in two of the striae quantitatively. RESULTS: The 585 nm had a moderate beneficial effect in reducing the degree of erythema in striae rubra. There was no apparent clinical change on striae alba. Total collagen per gram of dry weight of sampled tissue increased in striae treated with pulsed dye laser versus control subjects. CONCLUSION: We recommend the use of the 585-nm pulsed dye laser for striae rubra in patients skin types II to IV. Extreme caution or avoidance should be observed in pulsed dye laser treatments for patients with phototypes V to VI even with the use of low fluences. Tissue collagen changes measured may be an early change, which precedes significant clinical improvement.     

595 nm可调脉冲染料激光治疗皮肤血管异常性疾病疗效分析

目的观察595nm可调脉冲染料激光治疗皮肤血管异常性疾病(血管畸形与血管瘤)的临床疗效。方法应用595nm可调脉冲染料激光治疗396例皮肤血管异常性疾病,观察临床疗效。结果毛细血管扩张和蜘蛛痣疗效最好,有效率为100%,其次是草莓状血管瘤,有效率为92.4%,鲜红斑痣为82.8%。面积越小,年龄越小,疗效越好(P<0.05);性别与疗效无明显差异。术中疼痛较轻,术后副作用少。结论595nm可调脉冲染料激光治疗皮肤血管异常性疾病安全性高,疗效确切。     

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.     

Laser Treatment of Erythema and Telangiectasia Associated with Rosacea

The response of rosacea-associated erythema and telangiectasia to treatment with the pulsed tunable dye laser (PDL) was evaluated in 12 patients. Improvements in erythema, telangiectasia, flushing, the physician's and the patient's perception of overall severity, treatment tolerability, and the adverse side effects were examined. With the sole exception of the patient's assessment of overall severity we have found highly significant improvements in all other parameters evaluated, with excellent tolerance of treatment. We therefore conclude that the PDL is a safe and effective treatment for the erythemato-telangiectatic component of rosacea. Paper received 13 March 2001; accepted after revision 26 June 2001.     

Effect of the 585 nm Flashlamp-Pumped Pulsed Dye Laser for the Treatment of Keloids

BACKGROUND: Due to its potential effects on skin microcirculation and collagen metabolism, the 585 nm flashlamp-pumped pulsed dye laser has been proposed for treating abnormal scars. Indeed, one of the main problems with keloidal scars is their disfiguring erythematous color. OBJECTIVE: To assess the efficacy of the 585 nm pulsed dye laser on the appearance of keloids. METHODS: Eleven patients with skin phototypes II-IV and keloids were treated with the 585 nm pulsed dye laser. After one to three treatment sessions, clinical assessments of the scars were performed in combination with remittance spectroscopy measurements of the redness and melanin pigmentation. A group of nine keloids covered by silicone gel sheeting served as controls. Data were compared statistically. RESULTS: During laser treatments, a discrete decrease in redness of the scars was clinically reported. However, this improvement was not confirmed by the objective spectrophotometric data. No side effects, especially hyperpigmentation, were disclosed. The keloids redness was not improved in the control group. CONCLUSION: The 585 nm pulsed dye laser yields only minimal effects, if any, on the erythema of keloids. Similarly silicone gel sheeting does not modify the keloids redness.     

Treatment of Granuloma Annulare with the 585 nm Pulsed Dye Laser

BACKGROUND: Granuloma annulare is a chronic asymptomatic dermatosis that is typically manifested by annular papules arising on the dorsa of the hands, feet, elbows, and knees. Multiple treatment modalities have been used with variable efficacy, but no known cure exists. Obtaining long-term resolution of involved areas is often a therapeutic challenge. OBJECTIVE: We report the results of treatment of a patient with localized erythematous granuloma annulare with a 585 nm flashlamp-pumped pulsed dye laser. METHODS: A single granuloma annulare plaque present on the left wrist for 3 years was treated on three occasions with a 585 nm flashlamp-pumped pulsed dye laser initially and repeated at months 5 and 13. RESULTS: After initial pulsed dye laser treatment, significant flattening and reduction of erythema were evident within the treated area. After a second treatment at month 5 and a third treatment at month 13, further improvement was evident, and long-term remission was achieved. CONCLUSION: Localized granuloma annulare may be difficult to manage, presenting a therapeutic challenge. Thorough understanding of available treatment options, their relative efficacies, and risks of complication can facilitate successful management of this chronic disease. Pulsed dye laser therapy may be an effective and relatively safe treatment option for erythematous granuloma annulare, although prospective studies in additional patients would be desirable. Improvement of the condition in a single patient does not imply that others might improve, and variability in response is more likely.     

A newly modified 595-nm pulsed dye laser with compression handpiece for the treatment of photodamaged skin

BACKGROUND AND OBJECTIVES: The pulsed dye laser set the standard of care for the treatment of vascular lesions, and recent modifications have enabled improved efficacy with fewer side effects. An investigational high energy, variable pulse duration pulsed dye laser has been modified to treat both vascular and pigmented lesions associated with photoaging. Each laser pulse is comprised of a sequence of eight uniform micropulses, which evenly distribute the pulse energy, effectively increasing the purpura threshold at any given fluence. Pigmented lesions are treated with a compression handpiece (CHP) that removes competing vascular target from the field, and helps to prevent purpura. This pilot study was undertaken to determine the optimum laser settings, and to investigate the ability of this device to improve vascular and pigmented lesions associated with photoaging. STUDY DESIGN/MATERIALS AND METHODS: Twenty-four patients with photoaged skin and phototype I-III were enrolled in the study. Thirteen received treatment for vascular and pigmented lesions, and 11 subjects were treated for pigmented lesions alone. Subjects received one to three treatments at 3-4 weeks intervals, and underwent 3- and 12-week follow-up evaluation. The degree of improvement was assessed by subject evaluation as well as comparison of standardized digital photographs by three independent dermatologists. Background erythema was treated with a 12-mm spot size, at a fluence of 7 J/cm(2), and a pulse width of 10 ms. The cryogen cooling was set at 30 mseconds with a 30 ms delay. Individual telangiectasias were treated with a 5- or 7-mm spot size at fluences of 9-14 J/cm(2) and pulse widths of 6-20 mseconds. Pigmented lesions were treated using a 5- or 7-mm spot size, with energy of 9-15 J/cm(2) and a pulse width of 1.5-10 ms without cooling. The CHP had a 7-mm spot size, and fluences of 9-16 J/cm(2), and pulse widths of 1.5 or 3 ms were used in the treatment of pigmented lesions. RESULTS: The treatment was well tolerated without the use of topical anesthetic. All subjects noted improvement in the both vascular and pigmented lesions, and were satisfied with their outcomes. Objectively, there was moderate improvement in background erythema, telangiectasia, and pigmented lesions. Three subjects who were treated with sun tans developed transient hypopigmentation and two subjects developed a transient textural change following pulse stacking for the treatment of pigmented lesions with the conventional handpiece. Purpura was noted in all patients treated for pigment with the conventional handpiece at pulsewidths less than 6 mseconds, as compared to only one that was treated with the CHP. Three patients treated in rapid succession for vascular, and then pigmented lesions with the CHP exhibited purpura, which was prevented in future treatments with 1-2 minutes of topical ice cooling between passes. CONCLUSIONS: This novel 595-nm pulsed dye laser, with a modified pulse sequence and CHP, now has the versatility to safely treat both pigment and vascular changes associated with photoaging.     

铒点阵激光治疗玫瑰痤疮的临床效果及对皮肤状况的影响

目的 探讨采用铒点阵激光治疗玫瑰痤疮患者的临床效果及对皮肤状况的影响。方法 选取 2021年11月-2022年6月天津河西维美医疗美容医院收治的94例玫瑰痤疮患者，以随机数字表法分为研究 组与对照组，每组47例。对照组采用强脉冲光治疗，研究组采用铒点阵激光治疗，比较两组临床疗效、 皮肤状况及不良反应发生情况。结果 研究组治疗总有效率（97.87%）高于对照组（82.98%），差异有统 计学意义（P＜0.05）；两组治疗后瘙痒、红斑、丘疹脓疱评分低于治疗前，且研究组低于对照组，差异 有统计学意义（P＜0.05）；研究组不良反应发生率（4.26%）低于对照组（19.15%），差异有统计学意义 （P＜0.05）。结论 铒点阵激光治疗应用于玫瑰痤疮患者中，能够提高临床疗效，改善患者皮肤状况，减 少不良反应发生。