Intense pulsed light source for the treatment of dye laser resistant port-wine stains.

OBJECTIVE: The purpose of this clinical study was to evaluate the efficacy of an intense pulsed light (IPL) irradiator system for the treatment of port-wine stains (PWS) resistant to multiple pulsed dye laser (PDL) treatments. MATERIALS AND METHODS: Fifteen PWS patients, who were previously found to be resistant to multiple PDL treatments, were treated four times with a second generation IPL system. The clinical efficacy was evaluated on close-up photographs 2 months after the last treatment. RESULTS: Patients with dye laser resistant PWS could be divided into two groups: responders to IPL treatments (46.7%) and non-responders(53.3%). All responders obtained more than 50% reduction, and 85.7% of the responders obtained between 75% and 100% reduction of their lesions. The group of non-responders was defined as patients who obtained less than 25% clearance. CONCLUSIONS: Approximately half of a group of PWS patients, who did not respond to previous PDL treatments, obtained good or excellent clinical effect after four treatments with the IPL system. All PWS, except those located in the V2 area of the face, responded to the treatments. The IPL treatment modality was found to be safe and efficient for the treatment of PWS, except for those located in the V2 area.

Intense pulsed light source for treatment of facial telangiectasias.

OBJECTIVE: The purpose of this clinical study was to evaluate the effectiveness of the first intense pulsed light source (IPL) with dual mode light filtering for treatment of facial telangiectasias, and to evaluate the incidence of adverse including purpura, pigmentation and scars. MATERIALS AND METHODS: Twenty-four patients with facial telangiectasias were treated between one and four times with a new IPL system. This system differs from previous IPLs by eliminating wavelengths longer than 950 nm, which would otherwise lead to non-specific heating of tissue water. The treatments were performed at one-month intervals. Two months after the last treatment, the clinical effect was evaluated from close-up photographs. RESULTS: After one to four IPL treatments (mean: 2.54; SD: 0.96) for facial telangiectasias, 79.2% of the patients obtained a more than 50% reduction in number of vessels, and 37.5% obtained between a 75% and 100% reduction. Moderate erythema and oedema were the only adverse effects of the treatment. No purpura was registered and no long-term adverse effects such as scars or pigmentary disturbances occurred. CONCLUSIONS: An IPL with dual mode filtering is efficient and safe for treatment of facial telangiectasias.

Ultrasound investigation of port wine stains.

Congenital capillary malformation, or port wine stains (PWS), have been treated with the pulsed dye laser since the late 1980s. Some studies have shown better results when the malformation has been located on the lateral face, forehead, neck, trunk or shoulder and inferior results, with more treatments required, when it is located on the central face area, dermatome V2 or the extremities. The purpose of this study was to determine the depth of the lesion in various locations. A total of 55 patients with untreated PWS were investigated with a high-resolution 20 MHz ultrasound system. The mean maximum depth of all PWS that were measurable (45 out of 55) was 1.00 mm (+/- 0.50 SD), with a range of 0.2-3.7 mm. Lesions located on the forehead (1.26 +/- 0.44 mm) and on the medial face (1.23 +/- 0.65 mm), were deeper than lesions on the trunk and extremities. PWS involving areas that respond poorly to treatment were on average 0.14 mm deeper than PWS involving areas that responded well. The depth of the PWS, as determined with high-resolution ultrasound, seems to correlate only to some degree with the response to pulsed dye laser treatment. Since this treatment, with its superficial penetration, cannot reach the deeper vessels of a PWS, skin ultrasound could be a good complement in the prognostic investigation as well as for planning treatment.

Patients with port-wine stains and their psychosocial reactions after photothermolytic treatment.

BACKGROUND: Since the pulsed dye laser (PDL) was introduced in the late 1980s the question has been raised whether one should treat congenital capillary malformations, commonly called port-wine stains (PWSs), early or not. OBJECTIVE: There are pros and cons, but studies have mainly emphasized the clinical treatment results. The psychosocial importance of an early treatment needs also to be clarified. METHODS: This retrospective study includes 163 patients with PWS treated with the PDL until there was either total clearing or until there was no further improvement. When a period from a few months to 8 years had elapsed after the treatments, the patients were given a questionnaire, which had been developed in cooperation with a psychiatrist, in order to evaluate the psychosocial implications of the PWS and the consequences of treatment. RESULTS: . Eighty percent of the patients more than 7 years of age had not fully accepted their PWS with increasing age and 80% thought that their life would change for the better if their PWS could be eliminated. Eighty-five percent thought their PWS influenced their life in some negative way. Forty-five percent of the patients considered themselves to have a lower self-esteem than their own age group. The majority of the patients considered themselves negatively influenced by their PWS. Most psychosocial parameters, such as self-esteem, contact with the opposite sex, social relationships, school contacts, the need to cover their PWS with make-up or clothes, and meeting new people, improved significantly after PDL treatment. Older patients had higher negative scores than the younger ones, indicating the advantage of early treatment. Patients who were treated earlier with other methods producing less favorable results scored unfavorably compared to previously untreated patients. CONCLUSION: Patients with PWS treated at our clinic consider their psychosocial status to be improved after treatment. An early treatment seems to be favorable for these patients.

Hair reduction using a new intense pulsed light irradiator and a normal mode ruby laser.

OBJECTIVE: The main purpose of this clinical study was to compare the effectiveness of an intense pulsed light irradiator system (IPL) and a normal mode ruby laser for hair removal. MATERIALS AND METHODS: Thirty-one patients were treated 3 times with a new IPL system on one side of the chin and neck and with a normal mode ruby laser on the other side. After 6 months, nine of the patients received 3 additional IPL treatments and 11 patients received 3 additional ruby laser treatments. All treatment intervals were 2 months. Hair reduction was measured by hair counts on close-up photographs. RESULTS: Hair reduction was obtained by 93.5% of the patients after 3 IPL treatments and by 54.8% after 3 ruby laser treatments. The average hair count was reduced by 49.3% after IPL treatments and by 21.3% after ruby laser treatments. Three additional IPL treatments following 3 IPL treatments resulted in only 6.6% further hair reduction--in total 55.9%, whereas 3 IPL treatments following 3 ruby laser treatments resulted in an additional 35.5% hair reduction--in total 56.8%. CONCLUSIONS: The IPL was found to be 3.94 times more effective than the ruby laser for hair removal. In the chin and neck region, more than 3 treatments with the IPL did not improve the therapeutic result significantly.

Hair removal with a second generation broad spectrum intense pulsed light source--a long-term follow-up.

BACKGROUND: There is an increasing demand for safe and efficient hair removal. Although long-term hair removal has been demonstrated using lasers and non-coherent light sources, permanent hair removal has been difficult to claim due to the long growth/rest cycle of normal human hair follicles. OBJECTIVE: To evaluate bikini line hair removal with a second generation intense pulsed light (IPL) source. METHOD: Ten females (20 bikini lines) with dark hair and skin types II-IV were treated with an IPL (600 nm) four times with a 1-month interval. Counting of the hair follicles was carried out with a computer imaging system before treatment, and 4 and 8 months after the treatments. RESULTS: Hair reduction of 74.7% (SD +/- 18.3%) was seen 4 months after the treatments and 80.2% (SD +/- 20.3%) 8 months after the last treatment. Only minimal side effects were noted and no pain or other discomfort was registered during the treatments. CONCLUSION: The present study demonstrated that this new IPL system is both efficient and safe for hair removal. Because the follow up period of 8 months is twice the cycle time for hairs in the bikini line area, the obtained hair reduction in this study was long-lasting.

Potential psychological benefits from early treatment of port-wine stains in children.

There is a commonly held conception among referring doctors that very small children with congenital capillary malformations, so-called port-wine stains (PWS), should not be treated until they are older. Our experience leads us to believe that the flashlamp pulsed dye laser is a safe and effective treatment even for infants. We have not encountered any persistent pigmentation changes, post-treatment scarring or other adverse effects. It is important to quantify the psychological disabilities associated with this disorder to assess the need for and the benefits of treatment. Questionnaires were distributed to 259 patients and their families who visited our clinic because of their PWS. Patients who were on the waiting list for laser treatment, undergoing treatment or had completed their treatment received different questionnaires. The response rate was 89%. High emotional distress was encountered. During the age period 10-20 years, 73% (125 patients) were most disturbed by their PWS. That the PWS influenced their life negatively was experienced by 75% (171 patients), and 62% (106 patients) were convinced that their life would change radically if their PWS could be eliminated. Suffering from low self-esteem (in comparison with the same age group) was reported by 47% (87% patients). The PWS made their school life and education more difficult according to 28% (51 patients) of the sample. Of the families of patients, 76% (106 relatives) considered the patient to be negatively affected in some way by the PWS. After the laser treatment, all of these distress parameters were significantly relieved, together with a need to cover their PWS, their fear of going into conflict or quarrels, their social relationships, problems with the opposite sex, rage attacks, depressions and abnormal reactions from their peers. We believe there is potential psychological benefit in starting the treatments of PWS (including non-facial) at as early an age as possible.

Effective treatment of traumatic tattoos with a Q-switched Nd:YAG laser.

BACKGROUND AND OBJECTIVE: It is well known that the Q-switched Nd:Yag (QSNd:YAG) laser works well in the treatment of blue-black tattoos and benign pigmented lesions. It is less well known that this laser can also treat traumatic tattoos after accidents. MATERIALS AND METHODS: Twelve patients with traumatic tattoos were treated with a QSNd:YAG laser, 1064 nm. RESULTS: Gravel, mascara, high explosives, and older tattoos responded best with total clearance after 2-5 treatments. Hard materials such as asphalt, amalgam, and metal needed 6-11 treatments, and there was not always complete clearance. Transcient hypopigmentation but no scarring was seen. CONCLUSION: QSNd:YAG laser treatment of traumatic tattoos is effective, atraumatic, and a good alternative to mechanical dermabrasion or other conventional therapies.

Evaluation of port wine stains by laser Doppler perfusion imaging and reflectance photometry before and after pulsed dye laser treatment.

Treatment of choice for congenital capillary malformations of the port wine stain type is presently the pulsed dye laser. Although treatment results have usually been excellent or good, a few patients respond less well. Looking for a tool to predict and monitor the treatment we used laser Doppler perfusion imaging and reflectance photometry. Measurements with laser Doppler perfusion imaging were performed in 19 patients initially and after 1-3 treatments and with reflectance photometry initially and after 1-6 treatments. Before treatment, 15 of the patients had an increased bloodflow within the port wine stain in comparison with normal contralateral skin. After the laser treatments, 15 of 18 patients had decreased bloodflow within the lesion and all 18 had surrounding hyperemia. Reflectance photometry showed a successive increase in blanching and predicted within 6 weeks of the first treatment the eventual clinical result. The bloodflow, as measured with laser Doppler perfusion imaging, did not correlate well with the photometrically registered erythema. Reflectance photometry is a useful objective tool, which early in the treatment course indicates whether laser therapy will be successful. Laser Doppler perfusion imaging is less helpful in monitoring patients but may be of use in the study of port wine stain pathophysiology.

Reflectance spectrophotometry in the objective assessment of dye laser-treated port-wine stains.

At present, the treatment of choice for congenital capillary malformations of the port-wine stain type (PWS) is the flashlamp pulsed dye laser. Good results can be obtained in the majority of patients with this technique, but there is a group of poor responders. In the search for predictive tools to determine the therapeutic outcome, we have used a new photoelectric reflectance instrument. Sixty-six patients with PWS, mainly on the face, were treated with a pulsed dye laser during a 21-month period. Using a hand-held reflectance photometer, erythema indices were obtained for the PWS and normal skin. Based on these indices, a relative blanching effect could be calculated. The therapeutic result was judged to be excellent in 19, good in 20, fair in 14 and poor in 13 patients. There was a good correlation (r = 0.844) between the degree of blanching and the therapeutic result. In the 'excellent' category, an average blanching effect of 47% was present after the first treatment, and this increased to between 75 and 100% after successive treatments. In the 'poor' category, the blanching effect after one treatment averaged 14%, increasing to only 40% after up to six treatments. It thus seems to be possible to predict the outcome of therapy, which is of considerable help in treatment planning. Reflectance measurements, an objective estimate of blanching, correlate well with the clinical results, and are helpful in monitoring and predicting the therapeutic outcome in dye laser-treated PWS.

Evaluation of port wine stain perfusion by laser Doppler imaging and thermography before and after argon laser treatment.

Thirteen patients with port wine stains (PWS) were treated with argon laser therapy. Before and at different points in time following treatment, skin blood perfusion and temperature were mapped with laser Doppler imaging and thermography. In nine patients no elevation in blood perfusion was observed in the PWS in comparison with the surrounding normal skin before treatment. In the remaining four patients a significantly (p less than 0.01) higher blood flow was recorded within the PWS. Immediately after treatment nine patients showed elevated perfusion within the PWS. During the first two days following treatment, all patients showed a gradually decreasing hyperperfusion in the borderline between the PWS lesion and surrounding skin. Immediately after treatment 10 patients had a significantly (p less than 0.01) higher temperature in the PWS than in normal skin. During the first 24 h following treatment, an elevated perfusion was in general accompanied by a tissue temperature increase. Three and a half months after argon laser treatment, three patients showed excellent clinical results with no remaining PWS spots or scarring. Two of these patients had had both elevated perfusion and temperature in the PWS prior to treatment.

Unilateral eruption of endogenous eczema after hemiparesis.

Five patients with cerebrovascular hemiplegia developed an endogenous eczema (nummular eczema, pompholyx, allergids, atopic dermatitis). In all cases the dermatitis was mainly confined to the healthy side.