Evaluación funcional de los parámetros del Oculus KERATOGRAPH 5M posterior a la realización de luz pulsada intensa (IPL). Pacientes con disfunción de la glándula de Meibomio (período de enero a diciembre del 2018). En el Instituto Scorsetti / FUNCTIONAL EVALUATION OF THE PARAMETERS OF OCULUS KERATOGRAPH 5M AFTER THE REALIZATION OF INTENSE PULSED LIGHT in patients with gland dysfunction Mebomio during the period January-December 2018 in the Institute Scorsetti

Objetivo: Evaluar los cambios funcionales obtenidos en el KERATOGRAPH 5M posterior a la terapia de luz pulsada intensa (IPL), durante el periodo de enero a diciembre del 2018 en el Instituto Scorsetti de la Ciudad de Buenos Aires ­ Argentina Introduccion: El ojo seco es una patología crónica muy frecuente en la edad adulta que puede ocasionar disminución en la productividad y es de muy alto costo en nuestro medio, existen diferentes terapias para el manejo del ojo seco (1); Este trabajo está enfocado al ojo seco de tipo evaporativo con disfunción de la glándulas de Meibomio y su manejo con la terapia de luz pulsada intensa con el equipo Thermaeyes que ha mostrado muy buenos resultados en algunos artículos científicos (Toyos R,Mcgill W, Briscoe D. . Tratamiento con luz pulsada intensa para la enfermedad de ojo seco debido a disfunción de la glándula de Meibomio)(2) Diseño: Estudio retrospectivo de cohorte trasversal de fuentes secundarias. Materiales y métodos: Este estudio fue realizado en el Instituto Scorsetti de la Ciudad de Buenos Aires ­ Argentina de la base de dato del OCULUS KERATOGRAPH 5M durante el año 2018, que incluyo 50 ojos de 25 paciente con antecedentes de ojo seco evaporativo y disfunción de la glándulas de Meibomio con un rango de edad de 50-80 años, de diferentes sexos, que realizaron terapia completa de IPL durante el periodo del 2018. Resultados: En la medición de la altura del menisco lagrimal: El 64% presentaron mejoría posterior a la terapia con luz pulsada, 24% no mostraron cambios significativos y 12% empeoraron. En el tiempo de ruptura de la lagrimal: 52% mostraron una mejoría posterior a la terapia con luz pulsada, 40% no obtuvo cambio y 8% empeoraron. En el enrojecimiento conjuntival: el 48% mostraron una mejoría posterior a la terapia con luz pulsada, 48% no obtuvo cambio y 4% empeoró. Y en la encuesta sintomática (DEQ ): el 48% mostraron una mejoría posterior a la terapia con luz pulsada, 32% no obtuvo cambio y 20% empeoraron. Conclusiones: La terapia de IPL es una excelente opción de tratamiento del el ojo seco evaporativo con disfunción de la glándula de meibonio mostrando mejoría objetiva con estabilización de la película lagrimal, en la altura del menisco lagrimal, enrojecimiento conjuntival, tinción de superficie, así como también mejoría subjetiva en los síntomas.

Objective: To evaluate the functional changes obtained in the KERATOGRAPH 5M after intense pulsed light therapy (IPL), during the period from January to December 2018 in the Ophthalmological Institute Prof. Dr. Daniel Scorsetti of the City of Buenos Aires ­ Argentina Introduction: The dry eye is a chronic pathology very frequent in adulthood that can cause decrease in productivity and is very high cost in our environment, there are different therapies for the management of dry eyes; This work is focused on evaporative dry eye with dysfunction of the meibomian glands and its management with intense pulsed light therapy with Thermaeyes equipment that has shown very good results in some scientific articles. Design: Retrospective study of cross-sectional cohort of secondary sources. Materials and methods: This study was conducted in the Ophthalmological Institute Prof. Dr. Daniel Scorsetti of the City of Buenos Aires - Argentina of the data base of OCULUS KERATOGRAPH 5M during the year 2018, which included 50 eyes of 25 patients with a history of evaporative dry eye and dysfunction of the meibomian glands with an age range of 50-80 years, of different sexes, who performed complete IPL therapy during the period of 2018. Results: In the measurement of tear meniscus height: 64% showed improvement after pulsed light therapy, 24% did not show significant changes and 12% worsened. At the time of rupture of the lacrimal: 52% showed a subsequent improvement to the therapy with pulsed light, 40% did not obtain change and 8% worsened. In the conjunctival redness: 48% showed an improvement after the pulsed light therapy, 48% did not change and 4% got worse. And in the symptomatic survey (DEQ ): 48% showed an improvement after pulsed light therapy, 32% did not change and 20% worsened. Conclusions: IPL therapy is an excellent treatment option for evaporative dry eye with dysfunction of the meibonio gland, showing objective improvement with stabilization of the lacrimal film, in the height of the lacrimal meniscus, conjunctival reddening, surface staining, as well as also subjective improvement in symptoms.

Qualidade de vida e nível de satisfação dos sujeitos submetidos ao tratamento dermatológico com laser e luz intensa pulsada em clínicas da Grande Vitória/ES / Quality of life and satisfaction of patients after dermatological treatment with laser and intense pulsed light in clinics at Vitória/ES

Introdução: Laser é formado através da amplificação de luz por emissão estimulada da radiação já a Luz Intensa Pulsada (LIP) é uma fonte que alcança um comprimento de onda na faixa de 400 a 1.400 nm, uma luz não coerente, porém, não é um laser, abrange comprimento de onda amplo absorvido pelo cromóforo desejado; ambos são usados para tratamentos dermatológicos que são definidos de acordo com a finalidade terapêutica. Objetivo: Avaliou-se a qualidade de vida e o nível de satisfação dos sujeitos submetidos ao tratamento dermatológico com laser e LIP. Métodos: Estudo de corte transversal e qualitativo, realizado em clínicas de estética da Grande Vitória/ES. Indivíduos com idade entre 18 e 80 anos, ambos os sexos, submetidos à intervenção com laser e LIP para tratamento de afecções dermatológicas ou necessidade estética. Oito clínicas foram selecionadas. Aplicou-se questionário de dados sociodemográficos e clínicos, elaborado pelos pesquisadores e a versão brasileira do questionário Índice de Qualidade de Vida para Dermatologia (IQVD). Resultados: 85 sujeitos, média de idade 39,78 ± 14,95 anos, sendo 90,58% sexo feminino e 9,41% sexo masculino. Maioria de indivíduos do fototipo III 45,88%. Não houve influência na qualidade de vida de mais da metade dos participantes e a satisfação foi de 81,17%. Conclusão: Nessa amostra as alterações dermatológicas ou estéticas não influenciaram diretamente na qualidade de vida e a maioria fica satisfeita com os resultados obtidos. (AU)

Introduction: Laser is formed through the amplification of light by stimulated emission of radiation, and the Intense Pulsed Light (IPL) is a source that reaches a wavelength in the range of 400 to 1,400 nm, a non-coherent light, but it is not a laser, covers wide wavelength absorbed by the desired chromophore; both are used for dermatological treatments that are defined according to the therapeutic purpose. Objective: The quality of life and level of satisfaction of patients undergoing dermatological treatment with laser and IPL were evaluated. Methods: Crosssectional and qualitative study, performed at esthetics clinics in Grande Vitória/ES. Individuals aged between 18 and 80 years, both sexes, underwent laser and IPL intervention for the treatment of dermatological conditions or aesthetic needs. Eight clinics were selected. A questionnaire on sociodemographic and clinical data was prepared by the researchers and the Brazilian version of the questionnaire Quality of Life Index for Dermatology (IQVD). Results: 85 patients, mean age 39.78 ± 14.95 years, being 90.58% female and 9.41% male. Majority of individuals of phototype III (45.88%). There was no influence on the quality of life in more than half of the participants and the satisfaction was 81.17%. Conclusion: In this sample dermatological or aesthetic alterations did not directly influence the quality of life and most are satisfied with the results. (AU)

Complicaciones y manejo de procedimientos dermatoestéticos: una actualización para el dermatólogo / Complications associated with cutaneous aesthetic procedures: an update for the dermatologist

En las últimas décadas se han desarrollado nuevas técnicas e indicaciones de los procedimientos estéticos mínimamente invasivos, presentando cada vez mejores resultados con un alto nivel de seguridad, sin embargo, estos no se encuentran exentos de complicaciones, las que pueden ser transitorias o permanentes. El conocimiento, abordaje, tratamiento y prevención de las distintas complicaciones son esenciales para los dermatólogos y cirujanos plásticos. Los procedimientos más utilizados son: administración de rellenos, peeling químicos, láser, luz pulsada intensa y ultrasonido de alta frecuencia. La siguiente revisión tiene como objetivo reconocer las principales complicaciones de estos procedimientos y su manejo.

In recent decades, new techniques and indications of minimally invasive aesthetic procedures have been developed, presenting increasingly better results with a high level of safety, however these are not exempt from complications, which may be transient or permanent. The knowledge, approach, treatment and prevention of the different complications are essential for the dermatologist and plastic surgeons. The most used procedures are the administration of fillers, chemical peels, lasers, intense pulsed light and high frequency ultrasound. The following review aims to recognize the main complications of these procedures and their management.

Intense Pulsed Light Alone and in Combination with Erbium Yttrium-Aluminum-Garnet Laser on Small-to-Medium Sized Congenital Melanocytic Nevi: Single Center Experience Based on Retrospective Chart Review

BACKGROUND: Treatment of congenital melanocytic nevi (CMN) with intense pulsed light (IPL) has recently produced promising results. OBJECTIVE: To evaluate the clinical and histological outcomes of small-to-medium sized CMN treated with IPL alone and in combination with erbium: yttrium-aluminum-garnet (Er: YAG) laser. METHODS: We performed a retrospective chart review of 26 small-to-medium sized CMN treated as described above. The reduction in visible pigmentation, signs of recurrence and any adverse skin changes were evaluated by two independent clinicians. RESULTS: Seventeen patients completed treatment and were followed-up. Nine were not able to complete treatment due to work, change in residence, and treatment related stress. Ten patients received IPL alone (mean: 10.5 sessions) and 7 underwent treatment with IPL (mean: 7.7 sessions) and Er: YAG/IPL combination therapy (mean: 4.7 sessions). The initial treatment outcome was cleared in 5 patients and excellent in 12. Fourteen patients (82.4%) showed CMN recurrence one year after treatment completion. The histological results from a patient with an excellent clinical outcome showed remnant nevus cells nests in the deep dermis. CONCLUSION: IPL treatment alone and in combination with Er: YAG laser are not definitive treatments for CMN and should not be considered as first-line treatment.

Intense Pulsed Light Alone and in Combination with Erbium Yttrium-Aluminum-Garnet Laser on Small-to-Medium Sized Congenital Melanocytic Nevi: Single Center Experience Based on Retrospective Chart Review

BACKGROUND: Treatment of congenital melanocytic nevi (CMN) with intense pulsed light (IPL) has recently produced promising results. OBJECTIVE: To evaluate the clinical and histological outcomes of small-to-medium sized CMN treated with IPL alone and in combination with erbium: yttrium-aluminum-garnet (Er: YAG) laser. METHODS: We performed a retrospective chart review of 26 small-to-medium sized CMN treated as described above. The reduction in visible pigmentation, signs of recurrence and any adverse skin changes were evaluated by two independent clinicians. RESULTS: Seventeen patients completed treatment and were followed-up. Nine were not able to complete treatment due to work, change in residence, and treatment related stress. Ten patients received IPL alone (mean: 10.5 sessions) and 7 underwent treatment with IPL (mean: 7.7 sessions) and Er: YAG/IPL combination therapy (mean: 4.7 sessions). The initial treatment outcome was cleared in 5 patients and excellent in 12. Fourteen patients (82.4%) showed CMN recurrence one year after treatment completion. The histological results from a patient with an excellent clinical outcome showed remnant nevus cells nests in the deep dermis. CONCLUSION: IPL treatment alone and in combination with Er: YAG laser are not definitive treatments for CMN and should not be considered as first-line treatment.

Intense Pulsed Light and Q-Switched 1,064-nm Neodymium-Doped Yttrium Aluminum Garnet Laser Treatment for the Scarring Lesion of Discoid Lupus Erythematosus

Discoid lupus erythematosus (DLE) is a chronic form of cutaneous lupus that can cause permanent scarring. Treatment of DLE includes protection from sunlight and artificial sources of ultraviolet light, as well as systemic and topical medications. The first-line standard therapies are antimalarials and topical steroids. Other systemic therapies include systemic steroid, azathioprine, dapsone, and immunosuppressive agents. Topical tacrolimus and pimecrolimus have also been evaluated. Recent studies reported that several treatments, including pulsed dye laser, CO₂ laser, intense pulsed light (IPL), and 1,064-nm long-pulse neodymium-doped yttrium aluminum (Nd:YAG) have been used for the cosmetic treatment of DLE. Here, we report a case of a DLE scar that was successfully treated with a combination therapy of IPL and Q-switched 1,064-nm Nd:YAG laser.

Efeitos fisiológicos e terapêuticos da luz intensa pulsada / Physiological and therapeutic effects of intense pulsed light

Os dispositivos de luz intensa pulsada promovem o princípio básico de absorção de fótons por cromóforos endógenos ou exógenos encontrados na pele. A luz pulsada é convertida em energia calorífica, a qual coagula o alvo desejado (foto-termólise seletiva). Essa tecnologia envolve um sistema de lâmpadas paralelas de xenônio e capacitores contidos, que é aplicada diretamente à superfície da pele. Seu espectro de emissão varia de 500 a 1300 nm, apresentando assim, uma grande versatilidade de tratamentos. Para a construção deste artigo de revisão, a metodologia adotada foi uma pesquisa bibliográfica em revistas científicas da área de saúde indexadas no Pubmed (entre os anos de 1989 a 2016) que abordam os efeitos terapêuticos e fisiológicos da terapia de luz intensa pulsada. Dentre os efeitos terapêuticos aplicados à terapia com luz intensa pulsada, destacamos a remoção de pelos, tratamento de lesões pigmentadas, lesões vasculares, acnes, e rejuvenescimento da pele. Uma das maiores vantagens dos dispositivos de luz intensa pulsada é em relação à sua versatilidade e a economia. Esses dispositivos são mais vantajosos devido a sua capacidade em tratar grandes áreas de pele. No entanto, mais ensaios controlados comparativos com um período de acompanhamento estendido são necessários para determinar diferenças significativas da LIP e outras terapias. (AU)

The devices of intense pulsed light, similar to lasers, has the basic principle to absorption of photons by endogenous or exogenous chromophores in the skin. The pulsed light is converted into heat energy, which coagulates the desired target (photo-selective thermolysis). The intense pulsed light technology involves a system of parallel xenon lamps and capacitors contained in an articulated arm that is applied directly to the skin surface. Its emission spectrum ranges from 500 to 1,300 nm, thus presenting a great versatility of treatments. For the construction of this review, the methodology adopted was a literature search in scientific journals healthcare indexed in Pubmed (between the years 1989 to 2016) that address the physiological and therapeutic effects of intense pulsed light therapy. Among the therapeutic effects of the intense pulsed light therapy, we highlight hair removal, pigmented lesions, vascular lesions, acnes treatment, and finally skin rejuvenation. One of the major advantages of the intense pulsed light is in relation to its versatility and economy. Moreover, the devices of intense pulsed light are more advantageous due to their ability to treat large areas of skin. However, more comparative controlled trials with extended follow-up period are needed to determine significant differences between the intense pulsed light and other therapies. (AU)

Tratamento de cicatriz de queimadura com luz intensa pulsada e laser ablativo fracionado Erbium: YAG / Treatment of burning scars with intense pulsed lip and fractionated ablative laser Erbium: YAG / Tratamiento de cicatrices por quemaduras con luz intensa pulsada y láser ablativo fraccionado Erbio: YAG

Cicatrizes decorrentes de queimadura acarretam grandes danos físicos e emocionais aos pacientes. Seu tratamento permanece um desafio na prática clínica. O uso atual de tecnologias a laser e luz, como o laser ablativo fracionado e a luz intensa pulsada (LIP), tem se mostrado eficaz na recuperação estética e funcional da pele acometida. Este trabalho tem por objetivo a demonstração do resultado do tratamento de cicatriz de queimadura extensa com LIP e laser ablativo fracionado Erbium: YAG a partir do relato de caso de uma paciente de 38 anos vítima de queimadura por chama direta aos 6 anos de idade. A paciente apresentou melhora clínica significativa no aspecto estético e funcional da lesão. O uso desses métodos combinados apresenta resultados favoráveis para o tratamento desses casos.

Scars resulting from burning causes great physical and emotional damage to patients. Its treatment remains a challenge in clinical practice. Current use of laser and light technologies, such as fractional ablative laser and intense pulsed light (ILP), have been shown to be effective in aesthetic and functional recovery of affected skin. This work aims to demonstrate the results of the treatment of extensive burn scarring with ILP and fractional ablative laser Erbium:YAG relating the case report of a 38-year-old female victim of direct flame burn at 6-years-old. The patient presented significant clinical improvement in the aesthetic and functional aspect of the lesion. The use of these combined methods presents favorable results for the treatment of these cases.

Las cicatrices resultantes de quemaduras causan grandes daños físicos y emocionales a los pacientes. El tratamiento sigue siendo un reto en la práctica clínica. El uso actual de tecnologías láser y de luz, tales como el láser ablativo fraccionado y la luz pulsada intensa (LPI) han demostrado ser herramientas eficaces para la recuperación estética y funcional de la piel afectada. Este trabajo tiene como objetivo mostrar el resultado del tratamiento de una cicatriz extensa por quemadura usando LPI y láser ablativo fraccional Erbio:YAG a partir del caso clínico de una paciente de 38 años de edad víctima de quemaduras por fuego directo (llama) a los 6 años de edad. La paciente mostró una mejoría clínica significativa en el aspecto estético y funcional de la lesión. El uso de estos métodos combinados mostró resultados favorables para el tratamiento de este tipo de casos.

The Efficacy of Intense Pulsed Light for Treating Erythematotelangiectatic Rosacea Is Related to Severity and Age

BACKGROUND: Rosacea is a chronic cutaneous disease. Therapeutic modalities should be chosen based on the identified sub-types and clinical features in each patient. Vascular lasers, including intense pulsed light (IPL), are reportedly safe and effective in treating erythematotelangiectatic rosacea (ETR). OBJECTIVE: In this study, we assess the comparative efficacy of IPL related to several factors including clinical severity and the age of patients with ETR. METHODS: Patients with ETR were classified into two groups according to the National Rosacea Society Severity Guideline. Severity score and erythema index (EI) were measured using a clinical scorecard and mexameter. For additional evaluation of therapeutic efficacy, investigator and patient global assessments (IGA, PGA) were checked. Efficacy of IPL was analyzed according to severity score, EI, IGA, and PGA related to sex, age, lactic acid stinging test, and severity. RESULTS: Analyses of the efficacy of IPL according to severity score, EI, IGA, and PGA based on sex, age, lactic acid stinging test, and severity revealed significant differences with age and severity only. CONCLUSION: This study supports the efficacy of IPL treatment for patients with ETR. IPL may be more effective in patients with more severe ETR and in younger patients with ETR.

Atrofia de íris após tratamento estético facial com luz intensa pulsada / Iris atrophy after aesthetic treatment with intense pulsed light

Relato de um caso de complicação ocular, em consequência do uso de luz intensa pulsada, para tratamento facial cosmético. A lesão consistiu em atrofia iriana no setor temporal, com grande área de transiluminação, sinéquias posteriores, deformidade e redução da dilatação pupilar. O objetivo é alertar para os riscos do procedimento para os olhos, caso não sejam tomadas as medidas adequadas de proteção ocular.

The authors report a case of ocular complication, following Intense Pulsed Light for cosmetic facial treatment.The lesion was iris atrophy with a large transilumination area, posterior synechiae, deformity and reduced dilation of the pupil, on the temporal side. The aim is to alert for the risk of ocular lesion related to this procedure, if adequate measures to protect the eyes are not taken.

Rejuvenecimiento no ablativo / Non ablative rejuvenation

La estética facial y el rejuvenecimiento se han desarrollado rápidamente debido a cambios en los productos, procedimientos y datos demográficos de los pacientes. Los clínicos pueden beneficiarse guiando en el uso de los productos, adaptando tratamientos a pacientes individuales, tratando múltiples áreas faciales, usando las combinaciones de productos para optimizar resultados. Cuando estas técnicas son combinadas, los resultados son superiores al empleo de terapias individuales. Las terapias posibles de combinar son: toxina botulínica, agentes de rellenos, peelings químicos, luz pulsada intensa láser ablativo y no ablativo. Recientemente, una variedad de sistemas de láser está disponible, que permiten un remodelamiento dérmico selectivo sin la disrupción de la superficie epidérmica. Más recientemente, el expertisse de los médicos con los sensibilizantes tópicos y las fuentes luminosas empleadas en la terapia fotodinámica ha conducido a mayores usos, incluyendo su empleo para la mejoría de los signos visibles del fotoenvejecimiento.

Facial aesthetics and rejuvenation are evolving rapidly due to changes in products, procedures and patients demographics. Clinicians can benefit from ongoing guidance on products, tailoring treatments to individual patients, treating multiple facial areas, using combinations of products to optimize outcomes. When these techniques are combined, the results are superior to the use of individual therapies alone. The possible combination therapies are: botulium toxin, fillers agents, chemicals peels, intense pulsed light, nonablative and ablative lasers. A variety of laser systems have recently become available that allow for selective dermal remodeling without disruption of the epidermal surface. More recently, increasing physician expertise with the topical sensitizers and light sources employed in photodynamic therapy has led to expanded applications, including its use for improvement of the visible signs of photoaging.

Acné un nuevo aprote terapéutico / Acne: a new therapeutical approach

El acné es una patología que afecta casi al 80% de la población en algún momento de la vida. Múltiples terapéuticas locales y generales han sido utilizadas. En el presente estudio evaluamos la eficacia y seguridad del tratamiento de las lesiones activas de acné con luz pulsada como única terapéutica. Fueron tratados 91 pacientes y los resultados indican que la fototerapia es una opción terapéutica local con pocos efectos colaterales que evitaría el uso de drogas por vía general. Estos resultados fueron obtenidos en un período promedio de 4 semanas

Acne is a very common disease which affects a lot of people around the world. Multiple treatments options are available nowadays. In this study we evaluate the efficacy of IPL in active lesions of acne, as unique therapy. We treated 91 patients and results show the reduction of lesions in periods of follow-up between 4 to 6 weeks and provide a non-invasive alternative with drugs with potential secondary effects