Vascular uses of LP1064 applicator on the harmony XL pro device.

INTRODUCTION: Vascular lesions of the lower extremities and face, such as varicose veins and telangiectasias, are a common dilemma for the dermatologist. In recent years, laser therapy has emerged as a viable treatment option for these vascular anomalies. MATERIALS AND METHODS: Although there are several types of lasers, the 1064-nm Nd:YAG in particular is popularly selected for its safety profile and versatility. The longer 1064 nm wavelength penetrates deeper into the skin while also being less absorbed by hemoglobin and melanin, thus resulting in minimized damage to surrounding structures and less pigmentation changes. The new LP1064 applicator on the Harmony XL Pro Device is one such laser. RESULTS: Numerous publications have corroborated the efficacy of 1064 nm Nd:YAG lasers. These studies cite at least over 75% of patients experiencing significant improvement in common vascular lesions. Efficacy of this laser is also seen for other vascular lesions such as port wine stains, hemangiomas, venous lakes, poikiloderma of Civatte, and angiokeratomas. Overall, the reported studies also show a low incidence of adverse events. CONCLUSION: The 1064 nm Nd:YAG laser, such as the Harmony LP1064 applicator, is a safe and effective tool to treat vein anomalies of the face and leg. Although commonly used for vein ablation, it has demonstrated a robust response in other indications as well.

Efficacy and safety of intense pulsed light for the treatment of facial erythema: a systematic review and meta-analysis.

INTRODUCTION: Facial erythema can be seen in many patients. Despite various clinical trials exploring the effect of intense pulsed light (IPL) in treating facial erythema, comprehensive evidence about the specific outcomes remains lacking. EVIDENCE ACQUISITION: We searched published studies in the Web of Science, PubMed, Embase, and Cochrane Library databases based on established inclusion criteria. We calculated odds ratios (OR) to evaluate the effectiveness of IPL in patients with facial erythema. We used Review Manager 5.4.1 software for statistical data analyses with a 95% confidence interval (CI). EVIDENCE SYNTHESIS: This review includes seven studies with 219 patients, of which five compared the efficacy of IPL with pulsed dye laser (PDL). IPL significantly improved facial erythema compared to no treatment (OR=56.64, 95% CI: 22.70-141.33; P<0.00001). However, there was no significant difference between IPL and PDL treatment (OR=1.00, 95% CI: 0.31-3.22; P=1.00). Moreover, there was no significant difference in patients with a >50% reduction in telangiectasias between IPL and PDL treatment (OR=1.00, 95% CI: 0.39-2.56; P=1.00). Furthermore, IPL therapy had no apparent adverse effects for most people besides transitory edema and erythema. CONCLUSIONS: Our meta-analysis indicated that IPL could effectively and safely improve facial erythema with similar efficacy to PDL. Based on its comprehensive function, light side effects, and long curative effect, IPL appears to be a good alternative for treating facial erythema. However, further prospective and high-quality studies are required.

LONG-PULSED ND:YAG LASER TO TREAT TELANGIECTASIA OF THE NOSE: A COMPREHENSIVE 5-YEAR SINGLE CENTER STUDY.

Telangiectases of the nose are of esthetic concern and treatment is warranted. The study provides the results of 5 years of treatment of telangiectases of the nose region with the long-pulsed Nd:YAG 1,064 nm laser. A retrospective analysis was conducted in patients of Fitzpatrick skin type II-V. Exclusion criteria were patients with a previous history of treatment of the nose region, pregnant or lactating patients or patients with unrealistic expectations regarding the treatment risks, limitations and results. Standardized photographs were obtained before each session and at least 2 months after the last treatment session. A long-pulsed Nd:YAG 1,064 nm laser was used with a spot size of 2.5mm, fluence of 100 - 175 J/cm2, pulse duration of up to 135ms and repetition rate of 2-4 Hz. The follow-up ranged from 2 months to 5 years. The number of laser sessions varied from 1 to 5 monthly. Assessment was made by comparing pre-treatment and post-treatment photographs by two independent specialists and also by the patients' own assessment. All patients presented improvement of the vascular alterations. Evaluation of independent specialists as well as the evaluation of the patients themselves showed a high degree of satisfaction with the treatment. The treatment presented only few transitory side effects. Treatment of telangiectasia on the nose skin with the long-pulsed Nd:YAG 1,064 nm laser demonstrated to be safe and effective even in darker pigmented skin. The major limitation of this study is its retrospective nature.

A Dynamically Cooled, Variable Spot-Sized 1,064 nm Neodymium-doped Yttrium Aluminum Garnet Laser as a Treatment Option for Facial Reticular Veins.

BACKGROUND: Facial reticular veins can be treated with laser therapy, sclerotherapy, or surgical removal. The use of a 1,064 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser has been reported to be successful in the treatment of facial reticular veins. OBJECTIVE: To report a large retrospective study examining the efficacy, side effects, and satisfaction of a dynamically cooled, variable spot-sized 1,064 nm Nd:YAG laser for the treatment of facial reticular veins in the periorbital and temporal area. PATIENTS AND METHODS: Contact was made with 100 patients from 2006 to 2019 who underwent treatment with a 1,064 nm Nd:YAG laser for facial reticular veins through office follow-up or telephone interviews. Percent resolution of veins, satisfaction, and adverse effects were evaluated. RESULTS: Eighty-nine of the 100 patients ranked their satisfaction with the treatment as 3 or very satisfied. Most patients reported 75% to 100% improvement. The most commonly reported adverse event seen after treatment was mild edema. Sixty-eight percent of patients reported no adverse effects at all. CONCLUSION: The dynamically cooled, variable spot-sized 1,064 nm Nd:YAG laser is a safe and effective treatment for facial reticular veins with minimal side effects. The results are usually immediate and, based on the long-term follow-up, tend to be long lasting.

Effect of 808-nm Laser Photobiomodulation Treatment in Blepharitis Rat Model.

PURPOSE: Blepharitis, simply defined as eyelid inflammation, is one of the common ocular conditions associated with discomfort and irritation. Because blepharitis causes meibomian gland dysfunction and dry eye, this study aimed to confirm the effect of photobiomodulation (PBM) on blepharitis. METHODS: A total of 20 rats were randomly assigned to 4 equal groups, including control, blepharitis, PBM, and eye drop. Blepharitis was induced in rats by injecting complete Freund's adjuvant in the eyelid margins. PBM intervention was given every 3 days after blepharitis induction. Clinical signs including tear volume, tear breakup time (TBUT), meibomian gland swelling, fluorescein, telangiectasia, and meibomian gland secretion scores were measured every week, and the rats were killed for histological analysis after 4 weeks. Immunohistochemistry was performed to compare the level of inflammatory cytokines, interleukin-1ß and tumor necrosis factor-α, and terminal deoxynucleotidyl transferase dUTP nick end labeling staining on retina was performed to observe any retinal damage. RESULTS: Tear volume and TBUT increased with PBM intervention, and with improved eyelid swelling, corneal staining, telangiectasia, and meibomian gland secretion scores increased. Hematoxylin and eosin staining showed no structural abnormalities of meibomian gland caused by blepharitis induction. Immunohistochemistry revealed that the levels of inflammatory cytokines interleukin-1ß and tumor necrosis factor-α were lowered with PBM treatment in both eyelid and conjunctiva. Terminal deoxynucleotidyl transferase dUTP nick end labeling staining showed no retinal damage. CONCLUSIONS: Laser PBM at 808 nm was effective in alleviating ocular signs and controlling inflammation in blepharitis rat model. The in vivo results suggest that PBM has the potential to be used in treating blepharitis patients.

Efficacy and Safety of Intense Pulsed Light With a KTP/PDLlike Filter for the Treatment of Facial Telangiectasias.

BACKGROUND: An intense pulsed light (IPL) narrowband "KTP/PDL-like" filter (525–585 nm) may combine the tolerability of the IPL with the precision of KTP and PDL lasers. This study evaluated the impact of IPL with a KTP/PDL-like filter on telangiectasias. METHODS: This was a single-center, prospective study of 17 subjects with facial telangiectasias and skin types I–III. Three monthly treatments were performed using this specific filter, with follow-up visits at 1, 3, and 6 months. Telangiectasia improvement was assessed by the investigator and subjects using a 5-point scale. Facial photographs and safety assessments were obtained at each visit. Subject discomfort was evaluated using a visual analog scale (VAS) immediately posttreatment, and subject downtime was recorded at each subsequent visit. RESULTS: All facial telangiectasias significantly improved. At 1-month follow-up, >50% lesion clearance was noted in 97.1% of facial (n=36) and 85.7% of non-facial (n=7) lesions, with 73% of subjects satisfied or very satisfied. An increase in mean social downtime (0, 2.3, and 3 days) and VAS scores (3.5, 4.5, and 4.8) with treatments 1, 2, and 3, respectively, mirrored a stepwise increase in fluence with subsequent sessions. CONCLUSIONS: The use of a novel IPL narrowband KTP/PDL-like filter can significantly improve facial and non-facial telangiectasias with minimal downtime. J Drugs Dermatol. 2020;19(9):844-850. doi:10.36849/JDD.2020.4834.

Frontiers in translational systemic sclerosis research: A focus on the unmet 'cutaneous' clinical needs (Viewpoint).

This viewpoint considers four cutaneous unmet clinical needs of patients with systemic sclerosis (SSc), namely the rapidly progressive skin thickening (scleroderma) which occurs early on in diffuse cutaneous disease; digital (finger and toe) ulcers; calcinosis; and cutaneous telangiectases. All four problems cause pain, disability and/or disfigurement, all impact on quality of life, and for each, we require effective treatments. For each unmet need, we give a brief description of the clinical problem (including clinical burden), pathophysiology and current treatment, followed by a personal viewpoint of the key questions which research must address. For the painful, debilitating skin thickening of early diffuse cutaneous SSc, studies are required to decide whether corticosteroids are effective and safe (current opinion is divided) and whether phototherapy approaches have a role. Also, we need to develop and validate reliable outcome measures for clinical trials of promising new therapies: these could be composite indices, novel non-invasive imaging methods and patient-reported outcome measures, possibly in combination as they provide complementary information. For digital ulcers, again we require validated outcome measures for clinical trials. We also need to explore local (including topical) treatments, which are free from systemic adverse effects, and preventative strategies for high-risk patients. For calcinosis, we need to better understand pathophysiology, to validate outcome measures and to develop topical treatments. For telangiectases, we need to "use" these highly accessible lesions to help unravel the vascular pathophysiology of SSc and explore their different properties as potential biomarkers.

Cutis marmorata telangiectatica congenita successfully treated with intense pulsed light and pulse dyed laser therapy: a case report.

Cutis marmorata telangiectatica congenita (CMTC) is a rare vascular disorder characterized by blue-purple reticulated patches and plaques that can be localized or generalized. Associated skin atrophy and soft tissue hypoplasia is common while ulceration is relatively uncommon. As CMTC is exceedingly rare and spontaneous remission in childhood can occur in mild cases, evidence for treatment of severe, refractory disease is limited. We present the case of a four-year-old female with CMTC and associated painful, recalcitrant ulcers successfully treated with a combination of pulsed dye laser and intense pulsed light therapy.

A retrospective analysis for facial telangiectasia treatment using pulsed dye laser and intense pulsed light configured with different wavelength bands.

BACKGROUND: Facial telangiectasia is one of the common skin vascular lesions characterized by dilated cutaneous vasculatures. The variety of diameters and difference in depths of lesional blood vessels are the major challenges for effective treatments for Facial telangiectasia. AIMS: To compare the efficacy and safety profiles of pulsed dye laser (PDL, 595 nm) with intense pulsed light (IPL) configured by three different wavelength bands in the treatment for facial telangiectasia in Asian populations. PATIENTS/METHODS: A retrospective analysis of hospital records and review on photographs were performed for those subjects with facial telangiectasia (n = 160) who were treated in our department from January 2017 to January 2019. Patients were received two sessions of one of the four following laser treatments: PDL (595 nm, n = 38), IPL with M22 vascular filter (530-650 nm and 900-1200 nm, n = 39), M22 560 (560-1200 nm, n = 42), and M22 590 (590-1200 nm, n = 41). RESULTS: The patients in all the four groups showed an overall and significant improvement of indexes of lesional severity and subjective discomfort as well as improvement score of facial telangiectasia after treatment as compared to baseline. In addition, PDL (595 nm) and IPL with vascular filter (530-650 nm and 900-1200 nm) treatments showed significantly better indexes of lesional severity, subjective discomfort, and improvement score of facial telangiectasia as compared with other two treatments. CONCLUSION: Light devices with various wavelength ranges showed different efficacies of treatment for facial telangiectasia, among which PDL (595 nm) and IPL with M22 vascular filter (530-650 nm and 900-1200 nm) had similar and the best clinical efficacy as compared to IPL with other wavelength bands.

Successful Treatment of Lower Extremity Telangiectasias Using 585-nm Pulsed-Dye Laser at Low Fluence Combined With Optical Coherence Tomography: A Case Report

Background: Significant advances have been made in using lasers and intense pulse light sources to treat common vascular lesions such as telangiectasias. However, the treatment of leg telangiectasia, specifically, is more challenging because it involves the clearing of smaller veins as well as the larger feeding veins. The latest guidelines recommend use of short wavelength pulse-dyed lasers (PDL) as an option to treat telangiectasia cases that are unresponsive to sclerotherapy. Methods: A 29-year-old white woman presented with persistent telangiectasia, with multiple telangiectasias ranging from 1 cm to 20 cm in size involving the dorsal feet and both ankles and legs, which developed 10 years prior, associated with paresthesia. Test spots were treated with a 585-nm pulsed dye laser with various energy settings, and treatment was performed at 5.5 J/cm2 with spot size 10 mm and 0.5ms pulse duration. Results: Near complete clearance was achieved 1 month after the single treatment without adverse effects. Optical coherence tomography (OCT) imaging demonstrated a reduction of cutaneous blood flow after treatment. Discussion: We report successful treatment despite using settings that were previously reported to lack efficacy. This treatment resulted in considerable improvement in aesthetics and symptomatology. Also, OCT confirmed decreased vascular flow and bulging. Conclusion: Our results suggest there is still much to learn about the use of PDL in treating telangiectasias of the lower extremities, and that the ideal parameters warrant further investigation. Moreover, the novel use of OCT in auxiliary imaging for identification of treatment spots, as well as monitoring response at a microvascular level, holds great potential for wider application. J Drugs Dermatol. 2019;18(11):1180-1182.

New Insight in Noninvasive Rejuvenation: The Role of a Rhodamine-Intense Pulsed Light System.

Background: Rhodamine-intense pulsed light (r-IPL) is a noncoherent, noncollimated, polychromatic light energy optimized for a double-peak wavelength emission, ranging between 550-680 and 850-1200 nm. Traditional IPL works within visible and infrared spectra, targeting hemoglobin and melanin, are effective to treat rosacea and pigmentary disorders. r-IPL, a new technology in dermatology, emits high-intensity light with a wavelength peak similar to the one of the pulsed dye lasers, showing a good safety and efficacy profile in nonablative photorejuvenation. Objective: Assess efficacy and safety of r-IPL on photodamaged facial skin showing hyperpigmentation, telangiectasias, fine lines, and textural changes. Methods: Five sessions of r-IPL treatment (fluence ranged between 13.5 and 14 J/cm2) have been performed on one 75-year-old lady affected by facial photodamaged skin. Efficacy of treatment was evaluated using the Fitzpatrick Elastosis and Wrinkles Scale (FEWS) and the Global Aesthetic Improvement (GAI) Scale assessed by an investigator, compared with baseline. Treatment safety and tolerance were also evaluated using the Visual Analog Scale (VAS). Results: Photographic and multispectral evaluation demonstrated relevant improvement (vascular, pigment, and texture) of photodamaged facial skin. One month after the last treatment, significant improvement in facial wrinkle and texture was noted. FEWS scores decreased significantly from 7 to 2. According to the GAI scale, the patient had an improvement in skin texture. Immediate response included mild-to-moderate erythema and only trace-mild edema in the treatment area. Pain during the treatment was minimal with a mean VAS pain score of 3/10. No other adverse events were reported. No post-treatment downtime was recorded. Conclusions: r-IPL may represent a valid therapeutic approach in noninvasive photorejuvenation.

Open-label study assessing the efficacy and tolerability of topical skin care and sun protection alone and in combination with intense pulsed light therapy.

BACKGROUND: Intense pulsed light therapy (IPL) decreases facial erythema and telangiectasias associated with rosacea. Topical skin care products decrease facial erythema by the action of active ingredients and masking effects. OBJECTIVES: To assess the efficacy and tolerability of combining a topical skin care regimen (TSCR) comprised of a multifunctional three-in-one facial cream and a mineral-based brush-on SPF50 powder sunscreen with a single IPL treatment for treating mild-to-severe facial redness associated with rosacea. METHODS: Twenty female subjects with Fitzpatrick skin types I-III received TSCR monotherapy for 12 weeks. At that time, subjects received a single IPL treatment and continued TSCR for 6 additional weeks. Subjects were evaluated at Baseline and at Weeks 4, 8, 12, and 18. RESULTS: Using a 7-point redness scale, the overall mean (SD) redness score significantly improved from 3.05 (0.97) at baseline to 2.05 (0.76) at Week 18 (P < 0.01). There was a decrease in investigator-rated erythema from baseline (bare skin) to Week 12 (bare skin, before IPL) when TSCR was used as monotherapy which did not achieve significance (P = 0.12). Most subjects (80%) were satisfied or Very satisfied with the TSCR at Week 18. All subjects (100%) agreed that it improved their baseline skin redness and most (85%) would recommend TSCR to others. TSCR was well-tolerated with no significant changes in skin dryness, scaling, or itching. Mild burning occurred immediately following the IPL treatment at Week 12. CONCLUSION: TSCR in combination with a single IPL treatment produced a significant improvement in overall facial redness in patients with rosacea. Longer-term treatment with TSCR may produce continued improvement.

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.

Treatment of telangiectasia on the cheeks with a compact yellow (585 nm) semiconductor laser and a green (532 nm) KTP laser: a randomized double-blinded split-face trial.

OBJECTIVES: The primary objective of this study was to compare a traditional green KTP laser to a new investigational yellow laser (PhotoLase) in the treatment of facial telangiectasia in terms of the treatment outcomes. The secondary objective was to assess the functionality and reliability of the PhotoLase system from the perspective of the user. STUDY DESIGN/METHODS: The study was a randomized split-face double-blinded study that compared the treatment efficacy of the 532-nm KTP laser and the investigational 585-nm PhotoLase laser. One or two treatments were given based on the response of the first treatment. The improvement of telangiectasia was graded according to a 7-point Telangiectasia Grading Scale (TGS) by the subjects and blinded physicians. The subjects assessed the amount of pain during the treatments using Visual Analogue Scale (VAS), and evaluated adverse effects 2-3 days after the treatment(s) using a self-assessment form. RESULTS: At least 50% improvement was seen in 15/18 subjects after the first PhotoLase treatment, and a similar result was observed for KTP, as assessed by the blinded physicians (P = 0.29). In the subjects' assessment, 7/18 subjects had at least 50% improvement after the first PhotoLase treatment, whereas at least 50% improvement was observed for 10/18 subjects in the KTP side, the difference being significant (P = 0.008). The amount of pain was higher with PhotoLase compared to KTP (67.7 vs. 34.6, P < 0.001). There was no difference in the frequency of erythema, crusting or purpura between the devices, but more blistering and less edema were seen after PhotoLase treatment (P < 0.05). Treatment with PhotoLase was evaluated to be 4.7-fold faster than with KTP and the PhotoLase system was more compact, narrower, lighter, and easier to carry than KTP. CONCLUSIONS: The investigational PhotoLase laser enables significantly faster treatments, but the process is somewhat more painful than with KTP, otherwise providing a similar clinical outcome in the treatment of facial telangiectasia. Treatment Protocol Lasers Surg. Med. 51:223-229, 2019. © Wiley Periodicals, Inc.

Treatment of poikiloderma of Civatte using a redesigned pulsed dye laser with a 15 mm diameter treatment spot.

OBJECTIVES: The pulsed-dye laser has long been a gold standard in the treatment of poikiloderma of Civatte. Recent advances in pulsed dye laser technology enable output energies 50% higher, enabling beam diameters of up to 15 mm with clinically relevant fluences. In this study, we investigate this new laser for treatment of this condition. MATERIALS AND METHODS: Twenty subjects were enrolled in the study. A total of four treatments were administered at monthly intervals. Blinded assessment of digital, cross-polarized photographs taken at baseline and two months following the last treatment was performed by blinded physician raters using an 11-point clearance scale. Subject reported pain scores immediately following treatment and side effects at all visits were recorded by the investigator. RESULTS: Seventeen subjects completed the study. Blinded reviewers correctly identified the baseline photo in 48 of 51 cases (94%). All three reviewers mis-identified the same subjects. The blinded reviewers scored 14 out of the 17 subjects with an improvement greater than 40% and 10 out of the 17 subjects greater than 50%. Average improvement was 49% for all 17 subjects. Side effects were limited to mild edema, and mild to moderate erythema and purpura. Pain scores averaged 3.5 on using an 11-point scale. CONCLUSION: This study demonstrates the safety and effectiveness of a new pulsed-dye laser with a 15 mm spot and 50% higher fluences for the treatment of poikiloderma of Civatte. Lasers Surg. Med. 51:54-58, 2019. © 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

The application of 595-nm pulsed dye laser for vascular anomalies in a Chinese population: a 10-year experience.

BACKGROUND: The 595-nm pulsed dye laser (PDL) has been used to treat vascular anomalies for about 30 years; however, there are insufficient data in Chinese patients concerning therapeutic efficacy, optimized parameters, and procedure techniques. OBJECTIVE: To study the efficacy and relevant factors in PDL therapy for vascular anomalies in Chinese patients. METHOD: We enrolled 431 patients with 8 different vascular anomalies and no previous treatment in this retrospective study. A detailed classification of vascular anomalies and various parameters and techniques of PDL were studied. The clinical outcomes were analysed using the Investigator Global Assessment. RESULTS: Improvements were significantly correlated with infantile haemangioma (IH) subtypes (p < 0.05). A significant correlation between efficacy and lesion colour, anatomical sites, and hypertrophic-type port-wine stain (PWS) was found (p < 0.05). There was no significant correlation between efficacy and age or sex (p > 0.05). CONCLUSION: PDL is an effective and safe therapeutic modality for managing vascular anomalies in Chinese patients. We determined that differentiating and identifying IH subtypes prior to treatment could be a useful parameter for predicting therapeutic results.  Lesion colour, sites, and hypertrophic changes in PWS are relevant therapeutic factors. PDL parameters and techniques differ according to the various vascular anomalies to achieve optimal results.