532-nm potassium titanyl-phosphate laser versus 595-nm pulsed dye laser for port-wine birthmarks: A prospective, randomized, split-side study.

BACKGROUND: Pulsed dye lasers (PDL) are currently the first-line treatment of port-wine birthmarks (PWB). Due to high maintenance costs and instable technology, alternative methods are needed. OBJECTIVES: To compare clinical outcomes of a variable-sequenced, long-pulsed 532-nm potassium titanyl-phosphate (KTP) laser and PDL on treating PWB. METHODS: A prospective, randomized, split-side study. Patients were treated with a KTP laser and PDL with 1 to 5 sessions at intervals of 6-8 weeks. A follow-up visit was scheduled 6 weeks post-treatment. Efficacy was evaluated through colorimetric analysis, area reduction measurements and clinical evaluations by two blinded investigators based on photo documentation. Subjects provided rating of pain intensity during treatment, post-treatment reactions and satisfaction. Safety was measured by adverse events. Maintenance issues of the laser systems were documented. RESULTS: A total of 35 patients (mean age 42.1 years) were enrolled. 63% were female. Patients received 2.4 (SD 1.4; 1-5) treatment sessions. Colorimetric analysis indicated a comparable clearance effect in PWB of both KTP laser and PDL. Independent investigators rated clinical appearance to be significantly improved compared to baseline. No significant difference was observed between both laser systems. Regarding post-treatment reactions, the KTP laser caused less swelling, purpura and crusts. 96% would recommend both treatment modalities. Patients were satisfied with both laser systems. During the study, PDL systems malfunctioned for 6.6 months in total. For the KTP laser, we did not observe any system failures. CONCLUSION: Our data indicate that the KTP laser of the latest generation with large-spot sizes, subpulse technology and cryogen cooling has a comparable efficacy to the PDL in treating PWB. In addition, KTP laser is associated with greater tolerability, fewer technical failures and lower repair costs. Further prospective studies are required to determine the true effectiveness of the KTP laser in PWB treatment. This study was preregistered in Clinicaltrials.gov (NCT05771298).

S2k guideline: Laser therapy of the skin.

This guideline aims to improve the efficiency and safety of lasers and optical radiation sources with similar effects (especially IPL). Laser therapy of skin lesions with an increased amount of melanocytes should be performed with caution. Laser treatment of pigmented melanocytic nevi is not recommended. The guideline contains recommendations regarding the treatment of lentigines and café-au-lait spots, non-pigmented dermal nevi, Becker nevus, nevus of Ota/Hori/Ito and melasma. Further recommendations focus on the treatment of skin lesions without an increased amount of melanocytes (ephelides, postinflammatory hyperpigmentation including berloque dermatitis, seborrheic keratoses, traumatic/decorative tattoos and metallic deposits), hypopigmentation (vitiligo), benign non-pigmented neoplasms (fibrous papule of the nose, nevus sebaceus, epidermal nevus, neurofibroma, sebaceous gland hyperplasia, syringoma, xanthelasma palpebrarum), inflammatory dermatoses (acne papulopustulosa/conglobata, acne inversa, granuloma faciale, lichen sclerosus, lupus erythematosus, psoriasis vulgaris, rosacea, rhinophyma), wrinkles/dermatochalasis/striae, hypertrichosis, scars (atrophic, hypertrophic; keloids, burn/scald scars), laser-assisted skin healing, onychomycosis, precancerous lesions and malignant tumors (actinic keratoses/field cancerization, cheilitis actinica, basal cell carcinoma), vascular skin lesions (angiokeratoma, angioma, hemangioma, malformation, spider veins, granuloma telangiectaticum (pyogenic granuloma), rubeosis (erythrosis interfollicularis colli, ulerythema ophryogenes), nevus flammeus, telangiectasias and Osler's disease (hereditary hemorrhagic telangiectasia) and viral skin lesions (condylomata acuminata, mollusca contagiosa, verrucae planae juveniles/vulgares/ verrucae palmares et plantares).

Sequential facial skin rejuvenation with intense pulsed light and non-ablative fractionated laser resurfacing in fitzpatrick skin type II-IV patients: A prospective multicenter analysis.

BACKGROUND: While skin aging is triggered by multiple factors and typically presents with multiple manifestations, conventional treatment regimens deploy a single treatment modality. Typical approaches exploit ablative techniques, which involve considerable patient discomfort and downtime and can induce adverse events. Non-ablative fractionated laser (NAFL) resurfacing promotes neocollagenesis, with significantly fewer complications and discomfort. At the same time, intense pulsed light (IPL) therapies have a marked impact on skin tone, with an effect on collagen deposition. This study evaluated the combined effect of same-day, sequential IPL-NAFL treatment on photoaging of the face. DESIGN: In this prospective study, 30 patients presenting Fitzpatrick skin types II-IV, elastosis scores 3-6 and mild to moderate pigmentation, underwent three sessions, of full-face IPL therapy, followed immediately by NAFL treatment, conducted at 4-6 weeks intervals. Wrinkle/elastosis and skin qualities were scored at 1, 3, and 6 months after the last treatment session. Immediate responses were evaluated up to 30 min following treatment and adverse events were monitored throughout the study period. RESULTS: Wrinkle/elastosis scores gradually improved over the treatment period, with 59% of patients presenting a ≥1-point improvement in FES scores by the 1-month follow-up session, which persisted also at the 6 months follow-up visit. Good to excellent pigmentation responses were recorded for ≥63% and improvements in texture, brightness, and tightness were recorded for ≥80% of patients throughout the follow-up period. Over 90% of the treated patients exhibited improved or much improved overall appearance. Patient scorings and satisfaction level reflected physician assessments. Treatments were well tolerated and the social downtime observed was of 1.5 ± 0.25 days. CONCLUSION: The same-day combined IPL-NAFL regimen proved safe and elicited a significant skin rejuvenating effect, in a similar manner to that shown in other same-day combined therapies, without prolonging downtime of each individual modality. Lasers Surg. Med. 51:141-149, 2019. © 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Neue Laser und Strahlquellen - alte und neue Risiken?

Die Entwicklungen im Bereich dermatologischer Laser, hochenergetischer Blitzlampen, LED und neuer Energie- und Strahlquellen der letzten Jahre haben gezeigt, dass mit neuen Wellenlängen, Konzepten und Kombinationen zusätzliche, zum Teil über den ästhetischen Bereich hinaus gehende therapeutische Optionen für den Dermatologen erschlossen werden konnten. Wurden bisher zum Beispiel mit fraktionalen Lasern Falten behandelt, sind eben diese Systeme heute in Kombination mit Medikamenten wichtige Werkzeuge bei der Behandlung von Narben, bei Feldkanzerisierung und epithelialen Tumoren. Die Anforderungen an den die Indikation stellenden und vorzugsweise therapierenden Arzt steigen mit der immer komplexer werdenden Technik und den zunehmenden Komorbiditäten und Komedikationen einer älter werdenden Patientenklientel. Parallel etabliert wurden, zunächst für einige wenige Indikationen, Geräte für die Heimanwendung, die sich durch geringe Leistung und spezielle Sicherheitsvorkehrungen zur Vermeidung von Unfällen, Risiken und Nebenwirkungen auszeichnen. Trotz der reduzierten Effizienz solcher Selbstbehandlungsmaßnahmen steigt die Wahrscheinlichkeit einer Fehlanwendung, da die Grundvoraussetzung für eine korrekte Therapie, nämlich die exakte Diagnose und Indikationsstellung, nicht vorausgesetzt werden kann. Bei einer Haarentfernung können so Pigmenttumoren, bei einer Faltentherapie neoplastische Hautveränderungen adressiert und zu erwartende, unvorhergesehene und neue Nebenwirkungen und Komplikationen induziert werden. In diesem Szenario ist es wichtig, alle potenziellen Anwender dieser neuen Technologien vor deren Einsatz so zu qualifizieren, dass den Therapierten maximale Therapiesicherheit bei höchster Effizienz unter dem Leitbild diagnosis certa - ullae therapiae fundamentum garantiert wird.

New lasers and light sources - old and new risks?

Recent developments (new wavelengths, treatment concepts, and combinations) in the field of lasers, intense pulsed light (IPL), LED, as well as new energy and light sources have opened up new therapeutic options that extend beyond mere aesthetic indications. Thus, while fractional lasers used to be employed to merely treat wrinkles, the same devices - in the context of laser-assisted drug delivery - have now become important tools in the treatment of scars, field cancerization, and epithelial tumors. The requirements posed to physicians, both with respect to establishing the indication and conducting treatment, have been growing along with the increase in technological complexity as well as the rising number of comorbidities and comedications in a patient population that continues to age. At the same time, home-use devices have been introduced for a variety of indications. These devices are characterized by low power and special safety features aimed at preventing accidents, risks, and side effects. Despite the reduced efficacy of such self-treatment devices, there is an increased risk of misuse, given that the basic prerequisite for adequate treatment cannot be ensured, to wit, the exact diagnosis and therapeutic indication. Consequently, during hair removal or anti-wrinkle treatment, pigmented lesions and cutaneous neoplasms may be altered, thus giving rise to expected, unexpected and new side effects and complications. In the aforementioned setting, it is important that all potential users of these new technologies be properly trained in a manner that ensures those treated a maximum of safety and efficacy in accordance with the guiding principle "diagnosis certa - ullae therapiae fundamentum".

Validation of a Photonumeric Scale for Evaluation of Telangiectasia in Rosacea.

BACKGROUND: Telangiectasia is a prominent feature of rosacea leading to a high demand for effective treatment. To ensure consistent clinical and scientific evaluations and assess treatment response accurately, standardized assessment tools are necessary for grading the severity of telangiectasia. However, no validated grading scales for this condition are currently available. AIM: To develop and validate a photonumeric scale for assessing the severity of telangiectasia in rosacea patients. METHODS: The five-point photonumeric Telangiectasia in Rosacea Severity Assessment (TRoSA) scale was developed for the severity of telangiectasia in rosacea. Sixteen experts participated in the validation process, evaluating 50 images of rosacea patients in two rounds. Interrater and intrarater reliability were analyzed using the intraclass correlation coefficient (ICC) and weighted kappa, respectively. RESULTS: Interrater reliability was found to be "almost perfect" in both validation rounds (Round 1: ICC 0.847; Round 2: ICC 0.828). The mean weighted kappa indicated "substantial" intrarater reliability between the two rounds with a weighted kappa of 0.719. A bubble plot of the two rounds illustrated a diagonal order, confirming the consistency of the intrarater agreement. CONCLUSIONS: The TRoSA scale demonstrated high interrater and intrarater reliability indicating that it is a consistent and reproducible tool for grading the severity of telangiectasia in rosacea. This scale can standardize clinical assessments, assisting in diagnosis, treatment planning, and evaluation of therapeutic efficacy.

Treatment of resistant port wine stains (PWS) with pulsed dye laser and non-contact vacuum: a pilot study.

The blanching of resistant port wine stains (PWS) with a pulsed dye laser (PDL) requires a large number of treatments, resulting in substantial discomfort to patients, many of them children. Pneumatic skin flattening (PSF - Serenity Pro) is a new technology that generates a vacuum over the skin and reduces pain in laser-based treatments of the skin, while creating contact between the skin and an upper window. The same technology can be utilized to increase skin blood fraction while operated in a non-contact mode. The objective of this study was to test the enhancement in the efficacy of PWS treatment with PDL and Serenity Pro while vacuum is being utilized in the non-contact, blood-enrichment mode. Fifteen patients with resistant PWS underwent 1-4 treatments (interval of 5-20 weeks) under general anesthesia with a 595-nm PDL at 10-14 J/cm(2), 1.5-3 ms pulse duration, and 7-mm spot size. Lesion blanching with DCD chilling and with vacuum were photographed and compared. Better blanching of various degrees was observed on resistant PWS with the blood-enrichment technique in seven out of 11 patients who returned for follow-up. There were no cases of decrease in efficacy. Blood enrichment with the Serenity Pro non-contact vacuum technology has the potential of enhancing the capability of treating resistant port wine stains in over 50% of cases. Further studies will better quantify the number of treatments necessary for better lesion clearance. The vacuum-assisted technique may be of particular importance in view of the fact that achieving complete lesion clearance remains a challenge in PWS treatments.