Combined CO2 and dye laser technique in the treatment of outcomes due to flap necrosis after surgery for basal cell carcinoma on the nose.

BACKGROUND AND OBJECTIVE: Basal cell carcinoma (BCC) is the most frequent cutaneous cancer worldwide, and the nasal area is the most commonly affected region. Skin flaps are usually performed to achieve radical results, but various adverse events often occur. The necrosis of the skin flap is one of the most frequently observed, resulting in scars and anti-aesthetic outcomes. Ablative and non-ablative lasers have been proposed to improve scars resulting from surgical failure and skin flap necrosis. STUDY DESIGN/MATERIALS AND METHODS: This study aims to evaluate a new laser protocol combining ablative CO2 -laser with flashlamp pulsed dye laser for the treatment of nasal scars resulting from the necrosis of flap that occurred after surgery. Twelve patients were enrolled in the study, and a total of five laser sessions were planned, spaced from 14 days to 1 month apart. RESULTS: Seven out of 12 patients underwent all the five laser sessions planned, while 5/12 patients achieved optimal cosmetic results within the fourth session. Eighty percent of the patients reported good/optimal cosmetic results, and no significant side effects were observed during the study. CONCLUSION: Combining fractionated CO2 laser with flashlamp pulsed dye laser represents a new effective modality for treating skin flap necrosis after BBC removal, representing a valid alternative to other surgical procedures.

Combination of Specific Vascular Lasers and Vascular Intense Pulsed Light Improves Facial Telangiectasias and Redness.

Background and objectives: Facial telangiectasias are dilated blood vessels that can represent a cosmetic issue for patients. They may be associated with other conditions, such as rosacea. Laser and light treatments are nowadays becoming a cornerstone in the management of these lesions. Materials and Methods: In total, 68 patients seeking medical treatment for facial telangiectasias were enrolled from 1 March 2019 to 1 March 2020 at the Dermatological Unit of Magna Graecia University (Catanzaro, Italy). A protocol consisting of a 1064 Nd:YAG laser for darker blue telangiectasias and 532 nm Nd:YAG for red lesions followed by intense pulsed light with an optimized spectrum for vascular lesion 3 weeks after the first procedure was proposed. A three-month follow-up visit assessed patient's satisfaction using a visual analog scale (VAS). Two dermatologists measured clinical results using a 4-point scale, comparing pictures before treatment and at follow-up. Results: A total of 68 patients (32 males and 36 females) completed the study, performing all requested treatments. No severe side effects were reported. Patient satisfaction was very high (8.15 ± 1.05 out of a 10-point VAS scale), as well as dermatologists' clinical evaluations (2.19 ± 0.74 out of 3). Conclusions: The combination of vascular lasers and Vascular Intense Pulsed Light acting specifically on small blood vessels may help to improve the aesthetic outcome, reducing side effects. A prospective study with a larger number of participants will be necessary to confirm this study's findings.

Sequential Use of CO2 Laser Prior to Nd:YAG and Dye Laser in the Management of Non-Facial Warts: A Retrospective Study.

Background and Objectives: Warts are benign lesions of viral etiology characterized by a hyperkeratotic appearance tending to spread across the skin surface. Various treatments have been proposed to manage this condition, such as acids, imiquimod, photodynamic therapy, cryotherapy, and various lasers. Materials and Methods: In this paper, we describe a combination protocol using CO2 laser prior to Nd:YAG laser for lesions interesting the palmoplantar areas or dye laser for lesions on other skin surfaces in the management of non-facial warts resistant to traditional therapies. In total, 34 patients with 103 warts suffering from wart infection resistant to traditional therapies treated from 1 January 2019 to 1 June 2020 were retrospectively enrolled at the Dermatological Unit of Magna Graecia University (Catanzaro, Italy). Two dermatologists measured clinical results, classifying lesions with complete resolution, partial resolution, or non-responding. Patients at four months follow-up were asked to evaluate their degree of satisfaction with a visual analog scale (VAS). Results: Almost all patients reported the complete resolution of lesions, with no patient reporting scarring. Five patients reported hypopigmentation in the treated areas. The mean satisfaction level was high. Only three patients experienced a relapse of the condition. Conclusions: Using a vascular laser following a CO2 superficial ablation of warts may help reduce the risk of scarring and decrease the incidence of relapses for lesions resistant to traditional therapies. Therefore, more extensive studies will be necessary to confirm the obtained results.

Fractional Q-Switched 1064 nm Laser for Treatment of Atrophic Scars in Asian Skin.

Background and Objectives: Asian patients with Fitzpatrick skin type III-IV are a less studied subtype of patients in the medical literature. Q-Switched, 1064 nm neodymium-doped yttrium aluminum garnet (Nd: YAG) laser with a fractionated beam profile (QSF) is a new modality that was reported to be effective in the treatment of scars. This study aims to evaluate the efficacy and safety of QSF Nd: YAG laser in treating scars in Asian patients. Materials and Methods: A total of 29 Subjects were treated with 1064 nm QSF laser. Each patients had three treatments with a fractionated microlens array handpiece every 8 weeks). Efficacy of treatment was evaluated using the Goodman and Baron's quantitative grading scale before and 3 months after the last treatment. Results: All 29 patients treated had significant improvement of acne scars according to Goodman and Baron's Quantitative Global Acne Scarring Grading System. No side effect has been observed except some minor erythematous reactions in three patients. Conclusions: Our results confirm that the 1064 nm QSF Nd: YAG laser is a safe and effective technique for treating scars in Asians.

Comparing Traditional and in Motion Nd:YAG Laser in Hair Removal: A Prospective Study.

Background and Objectives: Hair removal is a common cosmetic problem interesting more and more patients nowadays. Various laser treatments are currently available. Alexandrite and Nd:YAG laser are the most effective procedures in lighter and darker skin phototypes, respectively. Materials and Methods: A total of 40 patients seeking hair removal in one or more body areas with skin phototypes 2-6 was recruited to perform this study. Patients were divided into two groups. One group was treated with the standard Nd:YAG hair removal procedure, while the other group was treated with a new "in motion" Nd:YAG technology. Results and hair removal rates were evaluated six months after the last treatment. Results: Out of 40 patients treated, all patients experienced hair reduction. No statistically significant difference in hair removal was noted between the two groups; however, a statistically significant reduction in pain during the procedure was observed in the group treated with the "in motion" technique. Conclusions: While traditional and "in motion" Nd:YAG techniques have similar result outcomes in hair removal, the "in motion" technology seems to guarantee a better safety profile compared with the traditional technique. A more extensive clinical study will be necessary to confirm our study's results.

Synergistic Sequential Emission of Fractional 10.600 and 1540 nm Lasers for Skin Resurfacing: An Ex Vivo Histological Evaluation.

Background: Fractional ablative and non-ablative lasers are useful treatments for skin rejuvenation. A procedure that provides the sequential application of fractional ablative followed by non-ablative laser treatment may reduce patients' downtime and deliver better cosmetic results than with either laser alone. Objective: The purpose of the current study was to demonstrate the ameliorative and therapeutic effects in skin remodeling of the synergistic use of the two laser wavelengths (fractional ablative CO2 and non-ablative 1540 nm) with three different types of pulse shapes, S-Pulse (SP), D-Pulse (DP) and H-Pulse (HP), through which the CO2 laser can emit, performing an ex vivo histological evaluation. Methods: In this prospective study, ex vivo sheep inner thigh skin was chosen due to its similarity to human skin tissue, and a histological evaluation was performed. Three irradiation conditions, using all of the three CO2 pulse shapes (alone or averaged), were investigated: (1) 10.600 nm alone, the sequential irradiation of the two wavelengths in the same perfectly controlled energy pulses (DOT) for the entire scan area; ((2) 10.600 nm followed immediately by 1540 nm; and (3) 1540 nm followed immediately by 10.600 nm). Results: When comparing ablative to sequential irradiations, the synergy of the two wavelengths did not alter the typical ablative pulse shape of the 10.600 nm laser alone. With the same CO2 pulse shape, the lesion depth did not vary with the synergy of the two wavelengths, while thermal lesion width increased compared to CO2 alone. The ablation rate was achieved, while the total thermal lesion coverage in the scanning area of CO2 - 1540 lasers was greater than when using CO2 alone and then the other sequential irradiation. Conclusions: This study provides important preclinical data for new and early uses of the novel 10.600/1540 nm dual-wavelength non-ablative fractional laser. The synergy of the two wavelengths enhanced all the benefits already available when using CO2 laser systems both in terms of tone strengthening, thanks to a greater shrinking effect, and in terms of stimulation and collagen remodeling thanks to a greater volumetric thermal effect.

A giant epidermal nevus of the face treated with a CO2 and dye laser combination: a case report and literature review.

Epidermal nevi (EN) are cutaneous hamartomas present at birth, usually occurs in the trunk, the face, or the limbs, appearing as a patch of overgrowing skin. They may be small and localized, but they may interest extensive areas of the body. A 20 years old man came to our attention for an EN interesting all the face. The treatment protocol consisted of a session of CO2 laser in order to vaporize thicker areas, followed by a session of dye laser on the area to prevent scarring. This treatment was performed under local anesthesia and sedation in three surgical sessions spaced 3 months from each other. Two sessions of dye laser spaced apart 6 months were performed during follow-up to further improve the esthetic outcome. The patient was followed for 2 years with no recurrence. Although surgery is still considered the gold standard in EN management, it is not always feasible. This novel combination technique can obtain optimal cosmetic results with no relapse within the period of follow up. Although further trials on a more significant number of patients are required, the combination of CO2 and dye laser promises to become a valid therapeutic alternative when treating giant EN of the face.

Fractional CO2 laser-assisted topical rifamycin drug delivery in the treatment of pediatric cutaneous leishmaniasis.

Cutaneous leishmaniasis is challenging to treat. Various drugs have been proposed to manage this condition, with variable results. In this case report, we describe laser-assisted delivery of rifamycin to treat this infection. Two sessions of fractional CO2 laser were performed one month apart. Each was followed by a topical application of rifamycin for three days. Resolution with minimal scarring was obtained, suggesting this technique might be safe and effective in treating cutaneous leishmaniasis.

A new 675-nm laser device in the treatment of acne scars: an observational study.

PURPOSE: Acne scarring represents a common problem that negatively impacts patients' quality of life. Different types of treatments are currently available for this dermatological condition. This study evaluates the efficacy of a new 675-nm laser source system on acne scars with the use of established parameters that guarantee minimum pain and the absence of side effects such as hyperpigmentation, hypopigmentation, and blistering. METHODS: A total of 24 subjects (all women, aged 21-42 years), with Fitzpatrick skin types I-IV and facial acne scars, were treated with three sessions of a 675-nm laser system. Efficacy of treatment was evaluated using the Goodman and Baron's quantitative grading scale before and 3 months after the last treatment. RESULTS: All 24 patients treated with this new 675-nm laser had significant improvement of acne scars according to Goodman and Baron's Quantitative Global Acne Scarring Grading System. No side effect has been observed except some minor erythematous reactions in three patients. CONCLUSION: The 675-nm laser system we used appears to be effective and well-tolerated in patients with acne scars, and it involves a simple post-treatment management.

Q-switched Nd:YAG laser for cosmetic tattoo removal.

Laser is a widely accepted tool for tattoo removal, with standardized treatment protocols. Nevertheless, cosmetic tattoo removal may be challenging, because tattoos are performed in proximity of "sensitive" areas and because the ink used in cosmetic tattoos may contain substances that are not standardized and may modify their color at a high temperature. In this case series, we aim to evaluate the effectiveness of Q-switched (QS) Nd:YAG laser for cosmetic tattoo removal. Our study included 20 patients with cosmetic tattoos of lips, eyebrows, and eyeliners treated with QS Nd:YAG laser. Before treatment, an accurate preoperative assessment was performed, taking into account both patient and tattoo characteristics. Complete tattoo removal was obtained in all the cases and no major complications occurred. Adverse events were mild, mostly represented by erythema. All patients reported a high level of satisfaction. Selective photothermolysis enables complete tattoo removal, even in the case of cosmetic tattoos. However, cosmetic tattoos require a personalized treatment based on an accurate preoperative assessment which takes into account both patient and tattoo characteristics. QS Nd:YAG laser may be considered a good choice in the treatment of cosmetic tattoos, because it enables complete removal with acceptable secondary effects.

Rhodamine intense pulsed light versus conventional intense pulsed light for facial telangiectasias.

Facial telangiectasias represent the major aesthetic alterations of several chronic inflammatory disorders arising on facial skin. We herein report on relevant clinical results of a new subtype of intense pulsed light treatments, the so-called rhodamine intense pulsed light (r-IPL), in comparison with conventional IPL (c-IPL) treatments on forty-five patients affected by facial telangiectasias. The aim of this study is to determinate whether r-IPL represents an effective and safe treatment for the most common superficial vascular alterations and could be advised as a first choice therapy for facial telangiectasias.

Efficacy of Rhodamine Light in the Treatment of Superficial Vascular Lesions of the Face.

OBJECTIVE: The aim of this work was to verify the usefulness and efficacy of treating superficial vascular lesions of the face using rhodamine intense pulsed light (r-IPL). SUBJECTS AND METHODS: Fifty patients suffering from telangiectasias of the face were enrolled and subsequently treated 4 times (every 20 days) with a new intensified r-IPL system optimized at the same wavelength as the dye laser (595 nm). The outcome was assessed using photographs, and clinical evaluations were made based on the percentage of fading of the erythema and telangiectasias in the lesions after treatment. RESULTS: Marked clinical improvements (70-100%) were observed in 31 (62%) patients after the second session of r-IPL, while 46 (92%) showed a marked improvement after the fourth session. No patients had to resort to topical or systemic drugs. CONCLUSION: r-IPL was effective in treating superficial vascular lesions, no side effects were observed and the patients readily accepted the treatment. Hence, r-IPL could be promising for the treatment of superficial vascular lesions of the face. Future study would be necessary to confirm the long-term efficacy of this technique.

Dermatosis Papulosa Nigra and 10,600-nm CO2 laser, a good choice.

Dermatosis Papulosa Nigra (DPN) is a common skin condition observed in black people and considered a benign epithelial tumor, and more specifically, a particular topographic form of seborrheic keratosis. We treated five female patients affected by DPN with 10,600-nm CO2 laser. We propose the 10,600-nm CO2 laser as a valid therapeutic option in patients affected by DPN, since the treatment is well tolerated, causes no major side effects, and is effective and long lasting.

Trunk hair removal treatment with diode laser 810 nm in men population.

In the last years, hair removal has been one of the most common treatments performed for aesthetic purposes, especially in women. Nevertheless, even if it is less popular, the demand within men population has risen. The study aimed to assess the acceptability of the diode 810 nm treatment for hair removal on the back and chest area in men thanks to the speed of treatment and the absence of undesirable effects. For this study, 20 patients were treated for hair removal. They were men with a mean age of 30.5 (±7.3). They underwent 4 treatment sessions at 40-day intervals on the trunk (chest and back area). Patients ranged between a Fitzpatrick phototype I (20%, 4/20) to IV (15%, 3/20) (40% were type II and 25% type III). Moreover, patients were asked to report pain intensity sensation with a visual analogue scale. Overall, in the study population, a hair reduction of 80.6% (±2.8) was registered in the treated areas. The device described in this study was demonstrated to be highly efficient in extended body areas and on difficult-to-treat hair follicles like on the back and chest in the men population.

Spectral morphological analysis of skin lesions with a polarization multispectral dermoscope.

Dermoscopy is the conventional technique used for the clinical inspection of human skin lesions. However, the identification of diagnostically relevant morphologies can become a complex task. We report on the development of a polarization multispectral dermoscope for the in vivo imaging of skin lesions. Linearly polarized illumination at three distinct spectral regions (470, 530 and 625 nm), is performed by high luminance LEDs. Processing of the acquired images, by means of spectral and polarization filtering, produces new contrast images, each one specific for melanin absorption, hemoglobin absorption, and single scattering. Analysis of such images could facilitate the identification of pathological morphologies.