Experience with non-ablative fractional photothermolysis with a dual-mode laser device (1,440/1,320 nm): no considerable clinical effect on hypertrophic/acne scars and facial wrinkles.

In the literature, non-ablative fractionated photothermolysis (nFP) is accredited with improvement of wrinkles and scars combined with a reduced downtime. The purpose of this work was to evaluate the impact of a combination laser (1,320/1,440 nm) for nFP on hypertrophic scars, acne scars, and facial wrinkles. Thirty-six patients suffering from hypertrophic scars (n = 7), acne scars (n = 9), and wrinkles (n = 20) were treated using a combination Nd:YAG laser [λ(em) = 1,320 and 1,440 nm, pulse duration: 3-ms single pulse, fluence: 8.0-9.0 J/cm(2) (1,320 nm); 2.0-2.5 J/cm(2) (1,440 nm)]. The appearance of the treated condition was evaluated in a retrospective study by two blinded investigators based on follow-up photographs and by patient self-assessment. The frequency of side-effects was also assessed. Both patients and blinded observers rated the treatment results for hypertrophic scars and acne scars as slight improvement, and for wrinkles as equal as compared to baseline. No serious side-effects were reported. The light device used did not lead to a considerable clinical improvement of hypertrophic scars, acne scars, or wrinkles in this study.

Split-face comparison of intense pulsed light with short- and long-pulsed dye lasers for the treatment of port-wine stains.

BACKGROUND: So far, pulsed dye lasers have been regarded as the gold standard in the treatment of port-wine stains (PWS). Recently, intense pulsed light (IPL) has been reported to achieve more pronounced fading in some patients. OBJECTIVES: To evaluate the efficacy and the side effects of IPL treatment of PWS in a direct comparison to the short-pulsed dye laser (SPDL) and the long-pulsed dye laser (LPDL). METHODS: Test spots (n = 158) were applied with IPL (λ(em) = 555-950 nm, pulse duration: 8-14 milliseconds (single pulse), fluence: 11-17.3 J/cm(2)), the SPDL (λ(em) = 585 nm, pulse duration: 0.45 milliseconds, fluence: 6 J/cm(2)), and the LPDL (λ(em) = 585/590/595/600 nm, pulse duration: 1.5 milliseconds, fluence: 12/14/16/18 J/cm(2)) in a side-by-side modus in untreated (n = 11) and previously treated (n = 14) patients with PWS. Lesion clearance was evaluated by three blinded investigators based on follow-up photographs 6 weeks after treatment. Incidence of side effects was assessed. RESULTS: In previously untreated PWS as well as in pretreated PWS, IPL treatments were rated significantly (P<0.05) better than treatments with the SPDL. In both groups, IPL and LPDL treatments did not differ significantly. Side effects were few in all settings. CONCLUSIONS: In PWS resistant to dye laser therapy, IPL showed additional lesion clearance. The use of IPL increases the therapeutic possibilities in PWS.

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.

Early recurrence of eruptive vellus hair cysts after Er:YAG laser therapy: case report and review of the literature.

BACKGROUND: Therapy of eruptive vellus hair cysts (EVHCs) often leads to unsatisfying results or recurrences. Recently, erbium:yttrium-aluminum-garnet (Er:YAG) laser therapy has been recommended in this condition. OBJECTIVE: To report the results of Er:YAG laser treatment and discuss the treatment options in EVHC, presenting a review of the literature. METHODS: Full-face Er:YAG laser therapy was performed in a 30-year-old female patient with a 15-year history of cosmetically bothersome facial EVHCs. RESULTS: Immediately after the laser treatment, the ablated skin showed an even surface, presenting no residual signs of EVHCs. After reepithelialization, however, early recurrence of EVHCs occurred. Recurrence was also observed in the previously treated test spot, where slight atrophy indicated deeper ablation. CONCLUSION: Er:YAG laser therapy might be a treatment option for distinct lesions of EVHCs but proved to be ineffective in a case of EVHCs in the face, where the depth of ablation is limited owing to the risk of atrophy or scarring and where deep enucleation of distinct single cysts was not possible owing to the dense dissemination of the lesions. Despite numerous treatment options reported in the literature, therapy for EVHCs is still challenging owing to recurrences or side effects.

Results of nonablative wrinkle reduction with a 1,450-nm diode laser: difficulties in the assessment of "subtle changes".

BACKGROUND AND OBJECTIVE: Nonablative resurfacing has proven its efficacy in vascular and pigmented lesions, while its capacity of substantial wrinkle reduction is still discussed controversially. We present the treatment results of a 1,450 nm diode laser for facial rhytides. METHODS: Thirty facial regions were treated with a 1,450 nm diode laser. Pre- and post treatment pictures were compared by the treating physician and two blinded observers. RESULTS: Even if mild improvement was rated in up to 35% of the post treatment pictures, a discrepancy shows up in the assessments of the three observers, presenting almost no congruency in the rating of improvement. CONCLUSIONS: Our study failed to provide convincing data on the efficacy of nonablative treatment of rhytides with the 1,450 nm diode laser. In this respect, we challenge objective judgment in the assessment of subtle changes in nonablative wrinkle reduction.

Variable pulse frequency-doubled Nd:YAG laser versus flashlamp-pumped pulsed dye laser in the treatment of port wine stains.

The flashlamp-pumped pulsed dye laser (FPDL) is regarded as the gold standard in the treatment of port wine stains. The purpose of this prospective, intra-individual, comparative clinical study was to investigate whether a frequency-doubled variable pulsed Nd:YAG laser (frequency-doubled Nd:YAG) is equally as safe and effective as established lasers. Forty-three patients with port wine stains were included in the study. Test treatments were performed using the frequency-doubled Nd:YAG laser (532 nm; 4 mm psi; 5-50 ms; 5.5 to 15 J/cm2) versus the FPDL (585 nm; 450 micros; 7 mm psi; 6 J/cm2). After 6 weeks, a full lesional treatment was performed using the device and the parameters showing the best clearance and the fewest side effects. The clearance of the lesions was generally good to fair. With the exception of poor results at 5 ms and 5.5 J/cm2 with the frequency-doubled Nd:YAG laser, there were no significant differences between the two laser devices. Scar formation, nevertheless, occurred in only 3% of the FPDL-treated sites versus up to 18% of the frequency-doubled Nd:YAG sites, increasing with pulse duration. In port wine stains, the FPDL remains the therapy of choice because of the somewhat better results and a lower frequency of side effects, especially scarring.

Evaluation of the long pulsed high fluence alexandrite laser therapy of leg telangiectasia.

BACKGROUND AND OBJECTIVES: The treatment of larger leg veins with laser or intense pulsed light often shows varying degrees of success and inconsistent clinical response rates. Aim of this study was to evaluate the effectiveness and safety of the 755 nm long pulsed high fluence alexandrite laser in the treatment of larger leg veins. STUDY DESIGN/MATERIALS AND METHODS: Twenty female volunteers aged 25-51 years (mean 39) with 0.3-1.3 mm leg telangiectasias received laser treatment, 10 of them with an additional pass done right after the first pass. Their skin type ranged from 1 to 3 (five type 1, seven type 2, eight type 3). After test spots with increasing fluences (40-90 J/cm(2)) to determine the individual safe fluence, the maximum fluence of 90 J/cm(2) could be used in all 20 subjects. The spot size was 3 x 10 mm, a spray cooling system was used with 80 milliseconds spray and delay time, respectively. The number of pulses administered ranged from 30 to 467 per subject (mean 139). The treated area was controlled 1 day, 1 month, and 3 months post-treatment and the side effects were quantified. At each visit, the treatment area was photographed. The percent clearance in the treated areas was scored by two observers. Subject satisfaction was evaluated at the 3 months post-treatment visit. RESULTS: After 3 months, in all 20 test subjects some clearance was visible. It ranged from low-grade to complete clearance. Most subjects (15 of 20) had a clearance between 26 and 75%. Hyperpigmentation was observed in 15 subjects. Hypopigmentation was seen in two subjects. No edema, no purpura, no erythema, no scarring, no blistering, and no crusts were observed. Mean subject satisfaction score was assessed and all volunteers reported to be "satisfied." CONCLUSIONS: The long pulsed high fluence alexandrite laser is effective and safe in the treatment of leg veins 0.3-1.3 mm in diameter.