Successful treatment of late-onset nevus comedonicus with Er:YAG laser.

Nevus comedonicus, a rare congenital hamartoma of the pilosebaceous unit, is characterized by keratotic plugging. It usually occurs after birth and during early childhood. It rarely appears in adulthood. Despite the benign nature of the condition, it usually requires treatment due to aesthetic reasons. Several treatments have been reported in nevus comedonicus, most of them resulting with recurrences. Here, we report a case of nevus comedonicus with adult onset, successfully treated with erbium-doped yttrium aluminum garnet (Er:YAG) laser therapy.

Reduction of pain in the treatment of vascular lesions with a pulsed dye laser and pneumatic skin flattening.

The treatment of vascular lesions, including port wine stains (PWSs), with a pulsed dye laser is very painful and often requires general anaesthesia. This is particularly problematic with children. Pneumatic skin flattening (PSF) is a new technology that naturally reduces pain in laser-based aesthetic treatments. The objective of this study was to test pain reduction, as well as lesional clearance, by combining pneumatic skin flattening (PSF) technology with a pulsed dye laser in the treatment of vascular lesions. Twenty-one patients (three of them children) were treated for vascular lesions, mostly PWSs (13 patients). The patients were treated with a 595 nm pulsed dye laser operated at energies of 5.75-13.25 (median 9.25) J/cm(2). Acute pain was evaluated in all 21 patients. Topical anaesthetic (EMLA cream) was applied before treatment in six cases. Identical energies were applied to both sites. The pain during PSF treatment was compared to pain during regular treatment without PSF. Blanching response to treatment was evaluated in 18 patients after 6-12 weeks. Significant pain reduction was observed in 21/21 patients (100%). The average reduction in pain score was from 10 without PSF (painful) to 2.6 with PSF (comfortable). Follow-up examination of 18 patients after 6-12 weeks showed identical blanching of tissue in both the PSF-treated areas and those not treated with PSF in all patients. It was concluded that the PSF technology significantly reduced pain in the treatment of vascular lesions with a pulsed dye laser without affecting efficacy.

Láser y otras fuentes de luz en el tratamiento de manchas en vino de Oporto / Laser treatment of Port wine stain

El tratamiento con láser de lesiones vasculares cutáneas está avanzando rápidamente en los últimos años. La mancha en vino de Oporto (Port wine stain [PWS]) es una de las primeras lesiones tratadas con láser con éxito. El láser de colorante pulsado (PDL) se ha desarrollado basándose en el concepto de la fototermólisis selectiva y ha supuesto una revolución en el tratamiento de PWS. Sin embargo, la respuesta obtenida es variable, alcanzándose un aclaramiento sustancial del color de la lesión tras varias sesiones. Diversos estudios demuestran que la modificación de parámetros del PDL como el aumento en la amplitud de pulso, mayor longitud de onda, o fluencias más altas asociadas a un sistema de enfriamiento, consiguen un aumento en la selectividad y mejoran la respuesta. Por otra parte, lesiones profundas, gruesas o sobreelevadas responden pobremente a los tratamientos convencionales. El objetivo de nuestro estudio es la revisión de los distintos tipos de láser así como otras fuentes de luz que se están desarrollando para el tratamiento de éstas y otras lesiones vasculares

Laser treatment of vascular skin lesions is rapidly improving. Port wine stain (PWS) is one of the first lesions successfully treated with laser. The pulsed dye laser (PDL) has been developed on the concept of selective photothermolysis and has revolutionized PWS treatment. Eventhough the response is variable, substantial blanching can be obtained after several sessions. Greater selectivity and better response have been achieved by modifying PDL parameters such as longer pulse width, longer wavelength, or higher energy fluencies with cooling skin devices. It is known that thick, deep or raised lesions present poor response to conventional treatments. The aim of this study is to review the different lasers and other light sources which are developing for the treatment of PWS and other vascular lesions