Pulsed dye laser versus long-pulsed Nd:YAG laser in the treatment of hypertrophic scars and keloid: A comparative randomized split-scar trial

Introduction: Keloids and hypertrophic scars are benign fibrous growths that occur after trauma or wounding of the skin and present a major therapeutic problem. Objective: The purpose of this study is to evaluate and compare the effectiveness of pulsed dye laser (PDL) versus Nd:YAG laser in hypertrophic scar and keloid. Methods: Twenty patients with hypertrophic scars and keloid were included in this prospective, randomized, split-scar study. Half of each scar was randomized to treatment with a 595-nm PDL and the contralateral half with the 1064-nm Nd:YAG. Each patient received 6 laser treatment sessions at 1-month intervals. The scars were evaluated at baseline and one month after the last laser session using the Vancouver scar scale (VSS). Results: One month after the last laser treatment, final total VSS analysis of treated sites by PDL and long-pulsed Nd:YAG laser revealed significant improvements (p < 0.001), whereas the average percentage of improvement in the total VSS was 55.14% for PDL and 65.44% for Nd:YAG laser. However, there were no statistically significant differences between PDL- and long-pulsed Nd:YAG laser-treated sites for total VSS (p = 0.074). Limitations: This was a single-center non-controlled trial, which included a small number of patients and subjective outcome measures. Conclusion: PDL and long-pulsed Nd:YAG laser treatments for keloid and hypertrophic scar provide significant improvement with insignificant difference between both modalities.     

Combination 532-nm and 1064-nm lasers for noninvasive skin rejuvenation and toning

BACKGROUND: Noninvasive techniques for skin rejuvenation are quickly becoming standard in the treatment of mild rhytids and overall skin toning. Multiple laser wavelengths and modalities have been used with varying degrees of success, including 532-nm, 585-nm, 1064-nm, 1320-nm, 1450-nm, and 1540-nm wavelengths. OBJECTIVES: To evaluate a combination technique using a long-pulsed, 532-nm potassium titanyl phosphate (KTP) laser and a long-pulsed 1064-nm Nd:YAG laser, separately and combined, for noninvasive photorejuvenation and skin toning and collagen enhancement and to establish efficacy and degree of success. DESIGN: Prospective nonrandomized study with longitudinal follow-up. SETTING: Private dermatologic surgery and laser practice. METHODS: A total of 150 patients, with skin types I through V, were treated with long-pulsed KTP 532-nm and long-pulsed Nd:YAG 1064-nm lasers, separately and combined. For the KTP 532-nm laser, the fluences varied between 7 to 15 J/cm2 at 7- to 20-millisecond pulse durations with a 2-mm handpiece and 6 to 15 J/cm2 at 30- to 50-millisecond pulses with a 4-mm handpiece. The 1064-nm Nd:YAG laser fluences were set at 24 to 30 J/cm2 for a 10-mm handpiece. These energies were delivered at 30- to 65-millisecond pulse durations. All subjects were treated at least 3 times and at most 6 times, depending on patient satisfaction level, at monthly intervals and were observed for up to 18 months after the last treatment. MAIN OUTCOME MEASURES: All patients were asked to fill out a "severity scale" on which redness, pigmentation, rhytids, skin tone/tightness, texture, and patient satisfaction were noted before and after each treatment. Redness, pigmentation, rhytids, skin tone/tightness, and texture were also evaluated by the physician and another observer. RESULTS: After 3 to 6 treatments, 50 patients treated with the 532-nm KTP laser alone showed improvement of 70% to 80% in redness and pigmentation, 30% to 50% in skin tone/tightening, 30% to 40% in skin texture, and 20% to 30% in rhytids. Another 50 patients treated with the 1064-nm Nd:YAG laser alone showed improvement of 10% to 20% in redness, 0% to 10% in pigmentation, 10% to 30% in skin tone/tightening, 20% to 30% in skin texture, and 10% to 30% in rhytids. The third group of 50 patients treated with both KTP and Nd:YAG lasers showed improvement of 70% to 80% in redness and pigmentation, 40% to 60% in skin tone/tightening, 40% to 60% in skin texture, and 30% to 40% in rhytids. Skin biopsy specimens taken at 1-, 2-, 3-, and 6-month intervals demonstrated new collagen formation. CONCLUSIONS: All 150 patients exhibited mild to moderate improvement in the appearance of rhytids, moderate improvement in skin toning and texture, and great improvement in the reduction of redness and pigmentation. The KTP laser used alone produced results superior to those of the Nd:YAG laser. Results from combination treatment with both KTP and Nd:YAG lasers were slightly superior to those achieved with either laser alone.     

Evaluation of 532-nm KTP laser treatment efficacy on acne vulgaris with once and twice weekly applications

Abstract

Background: Light-based therapies and lasers have been proposed for the treatment of acne vulgaris but the efficacy and application periods of 532-nm KTP laser treatment are not clear. Objective: To evaluate the efficacy and safety of 532-nm KTP laser and compare the effects of once and twice weekly applications in the treatment of mild to moderate acne vulgaris. Methods: Totally 38 patients were treated once weekly and twice weekly in group I and in group II respectively. One half of the face of each patient was treated with 532-nm KTP and the other half was remained as untreated. Patients were evaluated at the beginning, one and four weeks after the last treatment session with Michaëlsson acne severity grading score (MASS). Results: Statistically significant improvement was found at second control (p = 0.005) in group I, and at the first (p = 0.004), and second (p < 0.001) controls in group II for treated sides. For both groups, changes of MASS were insignificant for untreated sites. Improvement of MASS of treated sides was not statistically significant between two treatment groups for both controls. Conclusion: 532-nm KTP laser treatment may be an alternative method in selected acne vulgaris patients. No significant difference was noted between once and twice weekly applications.     

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.     

Comparison of a single treatment with Q-switched ruby laser and Q-switched Nd:YAG laser in removing black-blue Chinese tattoos

Abstract

Background: Black and blue are two popular colors in Chinese tattooing. Two Q-switched lasers, ruby and Nd:YAG, are effective for tattoo removal. No reference with regard to a comparison of the effects and adverse reactions in Chinese individuals has been made in the literature. Objective: To compare a single treatment of black-blue tattoos with the Q-switched ruby laser and Q-switched Nd:YAG (1064 nm) laser. Methods: A total of 35 Chinese patients with black-blue tattoos at the laser center of the Institute of Dermatology, Chinese Academy of Medical Sciences were enrolled into a self-control study. Tattoos were split into two parts or two nearby tattoos on the same body part were used; one side was treated with the Q-switched ruby laser and the other with the Q-switched Nd:YAG laser. Immediate response, treatment outcome and adverse effects were compared. The statistical significance level was set at p< 0.05. Results: Edema and exudation were more common immediately after ruby laser treatment (p< 0.05). The Q-switched Nd:YAG laser had a significant difference in tattoo lightening versus the Q-switched ruby laser after a single treatment (p<0.05). There was no significant difference in adverse effects between the two lasers. Conclusion: The Q-switched Nd:YAG laser is more effective at tattoo lightening for Chinese individuals. Its immediate response after treatment is slighter than the Q-switched ruby laser.     

Treatment of onychomycosis with a 1,064-nm long-pulsed Nd:YAG laser

Abstract

Background: There are various treatment modalities of onychomycosis. Of these, however, oral antifungal therapies are complicated by potential drug interactions and systemic effects, and the surgical treatment can result in prolonged pain. Therefore, a new, safe and effective therapy is needed that can improve the aesthetic appearance of the nails. Objective: The purpose of this study was to evaluate the effect of treatment of onychomycosis with a 1,064-nm long-pulsed Nd:YAG laser. Methods: 13 patients (31 toenails, 12 fingernails) received five treatment sessions at 4-week intervals with a 1,064-nm long-pulsed Nd:YAG laser. Parameters for each treatment were 6 mm spot size, 5 J/cm² fluence, 0.3 ms pulse duration and 5 Hz pulse rate. Results: Of the 13 patients, 8 (61.5%) were women and 5 were men. The mean age of the patients was 62. Of the 43 nails, 4 (9.3%) achieved a complete cure (9.3%), 8 had excellent treatment outcomes (18.6%) and 31 had good treatment outcomes (72%). None of the 13 patients experienced any discomfort except for a mild burning sensation and there were no adverse effects. Conclusions: Our results demonstrate that the 1,064-nm long-pulsed Nd:YAG laser could be a safe and effective treatment modality in the management of patients with onychomycosis.     

A Randomized,Prospective, Split-Face Pilot Study to Evaluate the Safety and Efficacy of 532-nm and 1,064-nm Picosecond-Domain Neodymium:Yttrium-Aluminum-Garnet Lasers Using a Diffractive Optical Element for Non-Ablative Skin Rejuvenation: Clinical and Histological Evaluation

BackgroundThe advent of fractionated picosecond (ps) lasers has provided an opportunity to explore new ways of creating microinjuries in the skin to induce skin rejuvenation.ObjectiveTo compare the efficacy and safety of diffractive optical element (DOE)-assisted ps neodymium: yttrium-aluminum-garnet (Nd:YAG) lasers with 532-nm and 1,064-nm wavelengths (532-nm and 1,064-nm Nd:YAG P-DOE) using a novel fractional handpiece for the treatment of photoaged skin.MethodsAn ex vivo guinea pig skin experiment was performed by evaluating the histology of the skin after 532-nm Nd:YAG P-DOE irradiation. A randomized, prospective, split-face study was performed on eight subjects with 532-nm and 1,064-nm Nd:YAG P-DOE.ResultsBased on the histological evaluation using ex vivo guinea pig skin, a reasonable safety profile and the potential to generate effective skin rejuvenation was observed using the 532-nm Nd:YAG P-DOE. Results demonstrated that both 532- and 1,064-nm Nd:YAG P-DOE were similarly effective in improving skin texture and skin pores; however, 532-nm Nd:YAG P-DOE was more effective in treating dyspigmentation.ConclusionAt a preliminary level, this study revealed that 532-nm and 1,064-nm ps Nd:YAG lasers using DOE fractional technology may improve photoaged skin. In conclusion, 532-nm Nd:YAG P-DOE may be especially beneficial for skin with epidermal pigmentary lesions.     

A split-face,evaluator-blind randomized study on the early effects of Q-switched Nd:YAG laser versus Er:YAG micropeel in light solar lentigines in Asians

Abstract

Background: Asians are prone to develop epidermal pigmentary lesions as a result of photoaging. Solar lentigines, especially those which are light in color, show somewhat limited response to pigment lasers and intense pulsed light sources. Objectives: We sought to compare the early effects as well as side effects of Q-switched Nd:YAG and Er:YAG micropeel in treating light solar lentigines in Asians. Patient and methods: This was a split-face, evaluator-blind, randomized controlled study. A single session of treatment was performed on Asian patients with light facial lentigines. Q-switched Nd:YAG laser was allocated to one half of the face, and Er:YAG micropeel to the other half. The response to therapy was evaluated by two independent dermatologists with standardized photographs taken 2 weeks and 1 month after the laser treatment. Patients’ satisfaction and preference in treatment were also assessed. Results: Fifteen patients completed the study and were analyzed. A reduction in pigment was observed with both lasers during the study period. The degree of pigment reduction in the Q-switched Nd:YAG treated side of the face was significantly higher than that of the Er:YAG micropeel treated side at 2-week follow-up (p < 0.001). The degree of pigment reduction between the Q-switched Nd:YAG-treated side and the Er:YAG micropeel-treated side was similar at 1-month follow-up (p = 0.110). Conclusion: While there is no perfect therapy for light solar lentigines, a single session of Q-switched Nd:YAG laser and Er:YAG micropeel was shown to reduce pigmentation. The immediate effects (2-week follow-up) were better with the Q-switched Nd:YAG laser but there was no great difference between the two laser types at 1-month follow-up due to the greater degree of post-inflammatory hyperpigmentation following Q-switched Nd:YAG. Both laser types could be applied either singly in turns, or in combination for maximal efficacy in future.     

Comparison of Q-switched Nd:YAG laser alone versus its combination with ultrapulse CO2 laser for the treatment of black tattoo

Background: Q-switched lasers are conventionally used for the treatment of black tattoo. However, they require multiple sittings, and the response may be slow due to competing epidermal pigment in dark skin. Objective: To compare the efficacy of Q-switched Nd:YAG laser alone with its combination with ultrapulse CO₂ for the removal of black tattoo. Materials and methods: Sixty patients with black tattoo were randomized into two groups viz., group A and group B. Group A was treated with QS Nd:YAG laser (1064 nm) alone, and group B received combination of ablative ultrapulse CO₂ followed by fixed-dose QS Nd:YAG laser (1064 nm), at 6-week interval for a maximum of 6 sittings. After each sitting, 3 independent physicians noted percentage of improvement that was evaluated using visual analogue scale (VAS) and grading system for tattoo ink lightening (TIL). Results: Combination laser (group B) showed statistically significant improvement in mean VAS score in the last 2 noted visits as compared to 1st session (p < 0.007, p < 0.001) and TIL mean score in last three noted visits as compared to 1st session (p < 0.008, p < 0.020, and p < 0.004). There was no statistically significant difference in the side effect profile of both the groups. Conclusion: For refractory professional tattoos, combination of ultrapulse CO₂ laser and QS Nd:YAG laser is superior to QS Nd:YAG laser alone.     

Treatment of early-stage erythematotelangiectatic rosacea with a Q-switched 595-nm Nd:YAG laser

Erythematotelangiectatic rosacea presents as persistent erythema and telangiectasia with frequent flushing and blushing on the facial and extrafacial skin. Additionally, papulopustular rosacea shows acneiform papules, pustules, and nodules with persistent plaque-form edema. Despite garnering only grade-C or -D level recommendations, a 585-nm or 595-nm flashlamp-pumped pulsed-dye laser can be considered as an effective therapeutic modality for the treatment of rosacea in patients who are refractory to topical and/or systemic treatments. In this report, treatment with a Q-switched 595-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser with low non-purpuragenic fluence proved to be safe and effective in treating early-stage erythematotelangiectatic rosacea in two female Korean patients. Laser treatment for rosacea was delivered with the settings of pulse energy of 0.4–0.5 J/cm², pulse duration of 5–10 ns, 5-mm spot size, 5 Hz, and 500 shots. Additionally, we found that remarkable therapeutic effects were achieved for both rosacea and melasma by combining Q-switched quick pulse-to-pulse 1,064-nm Nd:YAG and Q-switched 595-nm Nd:YAG laser treatments, which required only the changing of handpieces equipped with solid dye. In conclusion, we suggest that treatment with a Q-switched 595-nm Nd:YAG laser with low fluence may provide an additional therapeutic option for treating early-stage erythematotelangiectatic rosacea.     

Effects of the Nd:YAG 1320-nm laser on skin rejuvenation: Clinical and histological correlations

Abstract

The neodymium:yttrium-aluminum-garnet (Nd:YAG) laser is a popular non-ablative treatment used for skin rejuvenation. The purpose of this prospective study was to evaluate the clinical effects, coupled with a quantitative assessment, of the histological changes in response to Nd:YAG 1320-nm laser treatment of periocular wrinkles. Six volunteers with Fitzpatrick skin types III and IV and Glogau class I–II wrinkles were subjected to 3 months of Nd:YAG 1320-nm treatment in the periocular area (six sessions at 2-week intervals). Volunteers were photographed, and skin biopsies were obtained at baseline as well as 3 and 6 months after the start of treatments. Quantitative evaluation of total elastin, newly synthesized tropoelastin, collagen types I, III and VII, and newly synthesized collagen was performed using a computerized morphometric analysis. A noticeable clinical and histological improvement was observed after Nd:YAG 1320-nm treatment. Collagen types I, III and VII, as well as newly synthesized collagen, together with tropoelastin showed a statistically significant increase in response to treatment, while the mean level of total elastin was significantly decreased after treatment. Our data suggest that Nd:YAG 1320 nm is an effective treatment for skin rejuvenation as it stimulates the repair processes, and reverses the clinical, as well as the histopathological, signs of skin aging.     

Are lasers superior to lights in the photoepilation of Fitzpatrick V and VI skin types? – A comparison between Nd:YAG laser and intense pulsed light

Background and objectives: There are no large volume comparative studies available to compare the efficacy of lasers over lights for hair removal in Fitzpatrick V and VI skin types. This study is designed to compare the efficacy of Nd:YAG laser versus IPL in the darker skin types. Study design/materials and methods: Thirty-nine patients included in Group-1 were treated with Nd:YAG and 31 in Group-2 with IPL. Both groups received 5 sessions of treatment. The hair counts were assessed using digital photography and manual counting method before and after treatment and the results were analysed. Patient satisfaction scores and pain scores were recorded in each session and compared. Results: Mean hair reduction in the IPL group was 25.70 and Nd:YAG group was 24.12 (95% CI). In the Nd:YAG group, 59% of subjects had burning sensation while the figure was 32.3% in IPL group. Burning was less in IPL group (p < 0.023). There were no statistically significant differences noticed regarding hyperpigmentation in both the groups (p < 0.115). Conclusion: Both Nd:YAG and IPL are equally effective for epilation of the darker skin types. Nd:YAG is associated with mild burning sensation in a significant number of patients. Patient satisfaction scores were comparable in both the groups.     

Clinical analysis of port-wine stain in 130 Chinese patients treated by long-pulsed 1064-nm Nd: YAG laser

Abstract

Background: The long-pulsed 1064-nm Nd: YAG laser is effective for treating port-wine stain (PWS). This study evaluated the efficacy and safety of Nd: YAG laser in treating PWS in Chinese patients. Methods: A retrospective study of 130 PWS patients treated with long-pulsed 1064-nm Nd: YAG laser from 2009 to 2011. Results: After treatment, 2, 15, 64, and 19 percent of patients experienced < 25%, 25–49%, 50–75%, and > 75% lesion clearance, respectively. Purple lesions showed more significant improvement than pink lesions. The initial response was blistering, dark gray coloration, or light gray coloration, the best improvement occurred in 100% (27/27), 82.5% (52/63), and 72.5% (29/40), respectively. Patients older than 20 years showed the best improvement (37/38, 97.4%), followed by those 10–20 years old (20/24, 83.3%), 1–9 years old (23/29, 79.3%) and less than 1 year old (28/39, 71.8%). Patients with neck lesions had the best outcome (47/48, 97.9%), followed by those with lesions on the face (43/53, 81.2%), extremities (13/18, 72.2%), and trunk (5/11, 45.5%). The common adverse side effects were blistering and pigment changes. Conclusions: 1064-nm Nd: YAG laser is effective and safe for the treatment of PWS. The efficacy is affected by the age of the patient, the color and location of the lesions, and immediate responses to the laser.     

Genotoxic effects of 1064‐nm Nd:YAG and 532‐nm KTP lasers on fibroblast cell cultures

Background. Several different laser types are used in cutaneous surgery. The neodymium:yttrium–aluminium–garnet (Nd:YAG) and frequency‐doubled Nd:YAG (KTP, potassium titanyl phosphate) lasers are widely used in dermatology. Objectives. To investigate the possible genotoxic effects on fibroblasts of irradiation with a 1064‐nm Nd:YAG laser and a 532‐nm KTP laser. Methods. Fibroblast cell cultures were exposed to each of the lasers, using 10‐mm spot size at 60 ms pulse duration with 10, 20, 40 J/cm² and 3, 6, 12 J/cm² fluences, respectively. Fibroblasts in passages 1–6 were used. During laser irradiation, 96‐well microplate cultures were kept on a cooling block and transported on ice and in the dark, and processed immediately for single‐cell gel electrophoresis (SCGE) assay (also known as a comet assay). Results. DNA damage was determined by computerized assessment of comet assay. There was increasing damage with increasing numbers of passages. For the Nd:YAG laser, the greatest damage occurred on passages 5 and 6, whereas the greatest damage appeared at passages 3 and 4 for KTP and returned to baseline at passages 5 and 6. Damage also increased with each dose increment for both wavelengths. At the highest dose for both wavelengths (Nd:YAG 40 J/cm² and KTP 12 J/cm²), damage was higher with the Nd:YAG laser. Conclusions. Different patterns of cellular damage were seen for different cell‐culture passages, treatment doses, and laser wavelengths. These dose ranges are generally used for the treatment of vascular and pigmented lesions and for rejuvenation purposes. As replicative ageing or cell senescence is one of the critical factors determining the extent of cell damage induced by laser therapy, these results may have important implications for clinical practice.     

Effect of piroxicam gel for pain control and inflammation in Nd:YAG 1064-nm laser hair removal

Background Laser‐assisted hair removal is a variably uncomfortable and painful procedure. Objective The aim of this study was to investigate the efficacy of piroxicam gel on pain control and subsequent inflammation in Nd:YAG 1064 nm laser hair removal in women volunteers. Methods Fifty women volunteers were enrolled in this prospective, randomised, placebo‐controlled study over a 6‐month period. Subjects were randomly assigned to receive piroxicam gel as Group P or saline as a control group. Topical analgesic and saline were applied to the treatment sites for 45 minutes. The pain scores (VAS) and side effects were recorded before the hair removal, during the hair removal, at the end of the hair removal, and after 1 hour, 2 hours and 24 hours after the hair removal. Results Subject characteristics and treatment settings in Nd:YAG 1064 nm laser were similar in both groups. The pain scores (VAS) were significantly lower in the Group P than those of the control group during the hair removal (p < 0.001). Inflammatory side effects such as erythema, edema, and folliculitis, were more frequent in the control group than those of Group P during the procedure (p < 0.001). Conclusion This study showed that piroxicam gel provided adequate pain relief after Nd:YAG 1064 nm laser hair removal in women volunteers. Piroxicam gel was associated with lesser inflammatory side effects when compared to placebo because of its anti‐inflammatory effect after the procedure.     

A rapid tattoo removal technique using a combination of pulsed Er:YAG and Q-Switched Nd:YAG in a split lesion protocol

Background: Tattoo removal has evolved over the years and though Q-switched laser is the ‘workhorse’ laser, it invariably requires multiple sittings, which are dependent on numerous factors, including the skin colour, location of the tattoo, age of the tattoo, colour of pigment used, associated fibrosis and the kind of tattoo treated. Though ablative lasers, both pulsed CO2 and Er:YAG, have been used for recalcitrant tattoos, very few studies have been done comparing them with pigment-specific lasers. Our study was based on the premise that ablating the epidermis overlying the tattoo pigment with Er:YAG could help in gaining better access to the pigment which would enable the Q-switched laser to work effectively with less beam scattering. Objective: A study of rapid tattoo removal (RTR) technique using a combination of pulsed Er:YAG and Q-Switched Nd:YAG in a split lesion protocol. Materials and methods: This prospective study was undertaken during 2010–13 at a laser Clinic in the Maulana Azad Medical College, New Delhi. A total of 10 patients were recruited, 5 of amateur tattoo and 5 of professional tattoo. After informed consent each tattoo was arbitrarily ‘split’ into two parts. One part was treated with QS Nd:YAG laser(1064 nm) and the other part with Er:YAG laser immediately followed by the QS Nd:YAG. The laser treatments were repeated at 6-week intervals until the tattoo pigment had cleared. On the combination side in subsequent sittings only the QS Nd:YAG was used, to minimize repetitive ablation. To ensure consistency in the intervention methods a trained dermatologist who was independent of the treatment delivery randomly rated 10% of the procedures. Results: The mean improvement achieved by the Q-switched laser (2.93) was less than the combination laser (3.85) side (p = 0.001) and needed more sessions (3.8 vs. 1.6; p = 0.001). There was a statistically significant difference in the improvement on the combination side till the second session. On the combination side patients required a maximum of 2 sessions, while the Q-switched laser required 3–5 sessions for appreciable lightening. Conclusion: From our study it was concluded that use of a pulsed ablative laser may help in rapid removal of tattoos in conjunction with QS lasers with minimal side effects and can be used as a RTR.     

Intradermal tranexamic acid injections to prevent post-inflammatory hyperpigmentation after solar lentigo removal with a Q-switched 532-nm Nd:YAG laser

Introduction: Post-inflammatory hyperpigmentation (PIH) after solar lentigo removal using a Q-switched (QS) 532-nm Nd:YAG laser is a cause for concern. This study aimed to evaluate the efficacy and safety of intradermal injections of tranexamic acid (TA) at reducing the risk of PIH after QS 532-nm Nd:YAG laser treatment of solar lentigines. Methods: Twenty-five patients with 50 solar lentigines on forearms underwent QS 532-nm Nd:YAG laser treatment. Then, TA (50 mg/mL) was injected randomly into one lesion and 0.9% normal saline was injected intradermally into another lesion. Two blinded dermatologists and a Mexameter® evaluated photographs at baseline, and at weeks 2, 4, 8, and 12. Results: At the end of the study, the mean melanin index (MI) had decreased significantly in both groups. The TA group showed a significant reduction in the mean MI compared with that in the control group at week 4 (p = 0.025). The overall PIH rates were 16% and 28% in the TA and control groups, respectively. The side effects of TA were minimal and they were resolved within 1 h. Conclusion: Single dose of intradermal TA (50 mg/mL) injected can reduce the risk of developing PIH 4 weeks after 532-nm QS Nd:YAG laser treatment of solar lentigines.     

Comparison of pulsed dye laser versus combined pulsed dye laser and Nd:YAG laser in the treatment of inflammatory acne vulgaris

Background: Both pulsed dye laser and combined 585/1064-nm (sequential dual-wavelength PDL and Nd:YAG) laser improves inflammatory skin disorders including acne vulgaris. Objective: To compare the efficacy of 585-nm pulsed dye laser versus sequential dual-wavelength PDL and Nd:YAG in treatment of acne vulgaris. Patients and method: Thirty patients with acne vulgaris were treated by PDL alone on half of the face while contra lateral half was treated by combined 585/1064 nm laser. Results: The study showed that inflammatory acne lesions count was significantly reduced by 82.5% (p 0.0001) on PDL sides and by 83.5% (p 0.00001) on combined 585/1064-nm side after 8 weeks, while reduction of non-inflammatory acne lesions was observed at 8 weeks by 58.4% and 71.5% respectively. However, difference between the two modalities was not statistically significant. Conclusion: PDL and combined PDL/Nd:YAG laser treatment were found to be an effective, safe and well-tolerated treatment option for inflammatory and non-inflammatory acne vulgaris.     

A randomized,split-face clinical trial of Q-switched alexandrite laser versus Q-switched Nd:YAG laser in the treatment of bilateral nevus of Ota

Different types of Q-switched (QS) lasers have been used successfully to treat nevus of Ota. The purpose of this study was to compare the clinical efficacy and complication of QS alexandrite (QS Alex) laser versus QS neodymium:yttrium aluminum garnet (Nd:YAG) (QS Nd:YAG) laser for bilateral nevus of Ota. Seventeen patients with bilateral nevus of Ota were treated randomly with QS Alex in one half of face and QS Nd:YAG in the other half with an interval of at least 3 months between each. Subjective assessment was made by both patients and dermatologists. Patients were also examined for evidence of complications. All patients experienced improvement (p < 0.05). There was no statistically significant difference between the two sides (p > 0.05). The pain after a short period of laser therapy was more severe for QS Alex than for QS Nd:YAG laser. Vesicles developed in 1 patient after QS Alex therapy. Both QS Alex laser and QS Nd:YAG laser were equally effective at improving bilateral nevus of Ota. Patients tolerate QS Nd:YAG laser better than QS Alex laser.     

Combination of CO2 and Q-switched Nd:YAG lasers is more effective than Q-switched Nd:YAG laser alone for eyebrow tattoo removal

Background: The eyebrow tattoo removal using Q-switched lasers is usually prolonged. Other modalities may be required to enhance the efficacy and shorten the treatment course. Objective: To compare the efficacy of Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser alone versus combination of Q-switched Nd:YAG and Ultrapulse CO₂ lasers for eyebrow tattoo removal after a single session. Patients and methods: After local anesthesia, the right eyebrow of 20 patients was treated with Ultrapulse CO₂ laser with the parameters of 4 J/cm² and 3.2 J/cm² for the first and the second passes. Both eyebrows were then treated with 1064-nm and 532-nm Q-switched Nd:YAG laser. The spot size and pulse duration were 3 mm and 5 nanoseconds for both wavelengths, and the fluence was 7 J/cm² for 1064 nm and 3 J/cm ² for 532 nm. Results: The side treated with combination of Q-switched Nd:YAG and CO₂ lasers improved 75–100% in 6 of 20 patients versus only 1 of 20 in the side treated with Q-switched Nd:YAG alone. Similarly, the right side in 13 of 20 patients showed more than 50% improvement with combination therapy versus the left side (the monotherapy side), where only 6 of 20 cases showed more than 50% improvement. The Mann–Whitney test was 2.85 for the right side and 1.95 for the left side (P value = 0.007). Conclusion: Using Ultra pulse CO₂ laser enhances the efficacy of Q-switched Nd:YAG laser in eyebrow tattoo removal.