Successful treatment of facial vascular skin diseases with a 577-nm pro-yellow laser.

BACKGROUND: Treatment of vascular skin diseases is one of the most important indications of the laser. AIMS: To evaluate the effectiveness of 577-nm pro-yellow laser in the treatment of some vascular skin diseases. PATIENTS/METHODS: Ninety-five patients with vascular skin diseases were included in this prospective monocentric study. They were classified into: port-wine stain birthmarks (n = 37), papulopustular rosacea (n = 20), facial telangiectasia (n = 16), and facial erythema (n = 22). All participants received a monthly session of 577-nm pro-yellow laser. Follow-up was done by comparing the photographs before and at every follow-up visit. RESULTS: At the final visit, there was a significant improvement (>50%) occurred in 24/37 (64.82%), 12/20 (60%), 10/16 (62.5%), and 19/22 (86.3%) cases and poor response occurred in 6/37 (16.2%), 2/20 (10%), 2/16 (12.5%), and 0/22 cases after a mean number of sessions 7.76 ± 2.28, 3.1 ± 1.8, 3.63 ± 1.12, and 1.8 ± 0.85 in port-wine stain, rosacea-, facial telangiectasia-, and facial erythema-treated groups, respectively. Transient irritation and erythema during the session were the only complications reported in the study. CONCLUSION: Facial port-wine stains, rosacea, telangiectasia, and erythema can be successfully treated with a single pass of 577-nm pro-yellow laser with a minimal side effect. Facial erythema showed the highest degree of success with the least number of sessions, while more sessions needed for the treatment of port-wine stain.

Nonconventional Use of Flash-Lamp Pulsed-Dye Laser in Dermatology.

Flash-lamp pulsed-dye laser (FPDL) is a nonablative technology, typically used in vascular malformation therapy due to its specificity for hemoglobin. FPDL treatments were performed in a large group of patients with persistent and/or recalcitrant different dermatological lesions with cutaneous microvessel involvement. In particular, 149 patients (73 males and 76 females) were treated. They were affected by the following dermatological disorders: angiokeratoma circumscriptum, genital and extragenital viral warts, striae rubrae, basal cell carcinoma, Kaposi's sarcoma, angiolymphoid hyperplasia, and Jessner-Kanof disease. They all underwent various laser sessions. 89 patients (59.7%) achieved excellent clearance, 32 patients (21.4%) achieved good-moderate clearance, 19 patients (12.7%) obtained slight clearance, and 9 subjects (6.1%) had low or no removal of their lesion. In all cases, FPDL was found to be a safe and effective treatment for the abovementioned dermatological lesions in which skin microvessels play a role in pathogenesis or development. Further and single-indication studies, however, are required to assess a standardized and reproducible method for applying this technology to "off-label" indications.

Cutaneous Collagenous Vasculopathy: A Rare Form of Microangiopathy Successfully Treated with a Combination of Multiplex Laser and Optimized Pulsed Light with a Review of the Literature.

Cutaneous collagenous vasculopathy (CCV) is a rare idiopathic microangiopathy of the cutaneous vasculature characterized histologically by the presence of dilated small blood vessels with flat endothelial cells and thickened walls containing hyaline material in the upper dermis. We report an elderly patient presenting with an extensive form of CCV involving the trunk, upper and lower limbs. She was treated with Multiplex PDL 595-nm/Nd:YAG 1,064-nm laser and optimized pulsed light. This approach, which has never been reported for CCV so far, resulted in a striking and almost complete clearance of the widespread lesions. We here review our knowledge about CCV and therapeutic options available with a survey of the literature.

Dermatologic lasers in the treatment of aging skin.

Skin aging includes intrinsic aging, a universal and inevitable process attributable to the passage of the time alone; and photoaging, changes attributable to chronic sun exposure, which are neither universal nor inevitable. The major clinical features of aging skin include xerosis, laxity, wrinkles, slackness, and the occurrence of benign neoplasms such as seborrheic keratoses and cherry angiomas. Photoaging is characterized by dryness (roughness), actinic keratoses, irregular pigmentation (freckling, lentigines, guttate hypomelanosis, persistent hyperpigmentation), wrinkling, stellate pseudoscars, elastosis (fine nodularity and/or coarseness), inelasticity, telangiectasia, venous lakes, purpura (easy bruising), comedones (maladie de Favre et Racouchot) and sebaceous hyperplasia. Current antiaging therapy consists of lasers, intense pulsed light as well as fillers, neurotoxins, radiofrequency, microdermabrasion and chemical peeling. Over the last 50 years, lasers applications in dermatology have become more specific and often irreplaceable. In this manuscript laser resurfacing and laser therapy of vascular and pigmented lesions of aging skin will be overviewed. Current trends show an increase in the number of nonablative and fractional resurfacing procedures because they are followed by less intense side effects and faster recovery rates compared to ablative laser rejuvenation, although producing mild improvement.

Progressive disseminated essential telangiectasia and erythrosis interfollicularis colli as examples for successful treatment with a high-intensity flashlamp.

BACKGROUND: Treatment of progressive disseminated essential telangiectasia and erythrosis interfollicularis colli by flashlamp pulsed dye laser frequently results in a mottled appearance and often leads to hypo- or hyperpigmentation after treatment. Furthermore, treatment is time-consuming due to the small spot size. OBJECTIVE: To report the successful removal of thin vessels in patients with the above-mentioned indications by an intense pulsed light (IPL) source. METHODS: Four patients with progressive disseminated telangiectasia on the extremities and 5 patients with erythrosis interfollicularis colli were treated with IPL. RESULTS: A clearance of up to 90% of the telangiectasias was achieved. CONCLUSION: The superficial, thin vessels of progressive disseminated essential telangiectasia and erythrosis interfollicularis colli can be successfully treated by IPL.

Update on lasers and light devices for the treatment of vascular lesions.

Patients frequently present to dermatologists for the treatment of vascular lesions, including facial telangiectases, diffuse redness, port wine stains (PWS), hemangiomas, and leg veins. There are many laser and light devices that can be used with excellent results. This article summarizes the available platforms that are commonly used for the treatment of superficial vascular lesions. Newer devices and techniques are highlighted with respect to the unique characteristics of individual lesions.

Future considerations in cutaneous photomedicine.

Laser and light technology and their use in dermatology are rapidly advancing. Radiofrequency devices have recently integrated lasers to augment the beneficial effects of both while minimizing potential complications of each. Laser-assisted liposuction is becoming more commonplace, and new investigations into the noninvasive selective destruction of fat with lasers have been undertaken. A better understanding of photobiology has generated renewed interest in the effects of low-level laser therapy on skin and wound healing. Lasers also are being used in novel ways for the purposes of in vivo diagnosis, producing some incredible imaging that may prove useful in the early diagnosis and evaluation of cutaneous disease. Finally, more recent work in the field of photochemical tissue bonding may be bringing us closer to sutureless and scarless surgery. Although not an exhaustive review, this article explores some recent advances in laser and light technologies for dermatologic applications and diagnosis.

Evaluation of the treatment of venous lakes with the 595-nm pulsed-dye laser: a case series.

Venous lakes (VLs) are common benign venous ectasias in the upper dermis. They are treated to improve cosmesis and occasionally to prevent bleeding. Numerous methods have been used, such as cryotherapy, infrared coagulation and various types of lasers. They are variable in their success and all can be complicated by scarring. We report our experiences of using the 595 nm pulsed-dye laser (PDL), which has not been previously described. Eight patients were treated but sufficient resolution was achieved in only three patients. The limited success with this laser could be attributed to insufficient thermal energy being generated to close all the blood vessels permanently. A large prospective study would provide further data regarding the efficacy of the PDL. The use of compression and longer pulse durations may improve the efficacy of the 595 nm PDL to treat VLs.

A newly modified 595-nm pulsed dye laser with compression handpiece for the treatment of photodamaged skin.

BACKGROUND AND OBJECTIVES: The pulsed dye laser set the standard of care for the treatment of vascular lesions, and recent modifications have enabled improved efficacy with fewer side effects. An investigational high energy, variable pulse duration pulsed dye laser has been modified to treat both vascular and pigmented lesions associated with photoaging. Each laser pulse is comprised of a sequence of eight uniform micropulses, which evenly distribute the pulse energy, effectively increasing the purpura threshold at any given fluence. Pigmented lesions are treated with a compression handpiece (CHP) that removes competing vascular target from the field, and helps to prevent purpura. This pilot study was undertaken to determine the optimum laser settings, and to investigate the ability of this device to improve vascular and pigmented lesions associated with photoaging. STUDY DESIGN/MATERIALS AND METHODS: Twenty-four patients with photoaged skin and phototype I-III were enrolled in the study. Thirteen received treatment for vascular and pigmented lesions, and 11 subjects were treated for pigmented lesions alone. Subjects received one to three treatments at 3-4 weeks intervals, and underwent 3- and 12-week follow-up evaluation. The degree of improvement was assessed by subject evaluation as well as comparison of standardized digital photographs by three independent dermatologists. Background erythema was treated with a 12-mm spot size, at a fluence of 7 J/cm(2), and a pulse width of 10 ms. The cryogen cooling was set at 30 mseconds with a 30 ms delay. Individual telangiectasias were treated with a 5- or 7-mm spot size at fluences of 9-14 J/cm(2) and pulse widths of 6-20 mseconds. Pigmented lesions were treated using a 5- or 7-mm spot size, with energy of 9-15 J/cm(2) and a pulse width of 1.5-10 ms without cooling. The CHP had a 7-mm spot size, and fluences of 9-16 J/cm(2), and pulse widths of 1.5 or 3 ms were used in the treatment of pigmented lesions. RESULTS: The treatment was well tolerated without the use of topical anesthetic. All subjects noted improvement in the both vascular and pigmented lesions, and were satisfied with their outcomes. Objectively, there was moderate improvement in background erythema, telangiectasia, and pigmented lesions. Three subjects who were treated with sun tans developed transient hypopigmentation and two subjects developed a transient textural change following pulse stacking for the treatment of pigmented lesions with the conventional handpiece. Purpura was noted in all patients treated for pigment with the conventional handpiece at pulsewidths less than 6 mseconds, as compared to only one that was treated with the CHP. Three patients treated in rapid succession for vascular, and then pigmented lesions with the CHP exhibited purpura, which was prevented in future treatments with 1-2 minutes of topical ice cooling between passes. CONCLUSIONS: This novel 595-nm pulsed dye laser, with a modified pulse sequence and CHP, now has the versatility to safely treat both pigment and vascular changes associated with photoaging.

Long-pulsed Nd:YAG laser treatment of venous lakes: report of a series of 34 cases.

BACKGROUND: Some venous lakes do not respond well to traditional vascular lasers. The Nd:YAG laser output at 1,064 nm is less well absorbed by hemoglobin but penetrates more deeply into tissue. OBJECTIVE: This study was undertaken to assess the effectiveness of the long-pulsed Nd:YAG on venous lakes. METHODS: Thirty-five consecutive adult patients presenting with a venous lake were studied. Four patients had failed to respond to polidocanol 1% sclerotherapy, and 1 patient to pulsed dye laser. Long-pulsed Nd:YAG was administered via a water-cooled tip. Either a 3-mm spot at 250 J/cm(2) and 55 ms or a 5-mm spot at 140 to 180 J/cm(2) was used depending on the size of the lesion. Clinical end points were characterized by hardening of the lesion, central blackening, minimal whitening of the periphery, and in most cases, an audible popping sound. Responses were assessed visually in 50% of cases or by phone contact in the remaining 50% if the lesion had completely disappeared. One patient was lost to follow-up. RESULTS: After a single treatment, 94% cleared completely; incomplete clearance occurred in 6%. There were no reported complications. CONCLUSIONS: The long-pulsed Nd:YAG laser is highly effective treatment for venous lakes of the lip and cheeks.

Laser treatment of vascular lesions.

Lasers and other light sources have been developed that remove or improve many vascular lesions that were previously untreatable. Port-wine stains are the most notable example. Vascular lasers and light sources represent a major advance in dermatology for cosmetic and non-cosmetic applications. This article reviews the common vascular conditions amenable to laser therapy and the approaches and devices used.

Treatment of vascular lesions with combined dynamic precooling, postcooling thermal quenching, and ND:YAG 1,064-nm laser.

The purpose of this study is to evaluate the effectiveness and safety of the newly developed neodymium:yttrium-aluminum-garnet (Nd:YAG) 1,064-nm laser system for nonablative laser treatment of vascular lesions in Asians. Five patients with vascular lesions in the periorbital area received serial treatments. The fluences were set between 80 and 90 J/cm(2). The patients were followed for 6 months. Improvements were noted in all patients. Transient erythema and swelling were noted in all patients during the postoperative period. Transient purpura occurred in one patient. The Nd:YAG 1,064-nm laser system, when coupled with dynamic precooling and postcooling thermal quenching, is effective and safe in treating periorbital vascular lesions even when multiple treatments are performed. No significant adverse effects were noted in this study.