Treatment of a café-au-lait macule with the erbium:YAG laser.

The erbium:YAG laser is a relatively new instrument for skin rejuvenation. We present a case of a "Q-switched laser-resistant" café-au-lait macule that was successfully treated with the erbium:YAG laser.

Accessibility and reliability of cutaneous laser surgery information on the World Wide Web.

The World Wide Web has provided the public with easy and affordable access to a vast range of information. However, claims may be unsubstantiated and misleading. The purpose of this study was to use cutaneous laser surgery as a model to assess the availability and reliability of Web sites and to evaluate this resource for the quality of patient and provider education. Three commercial methods of searching the Internet were used, identifying nearly 500,000 possible sites. The first 100 sites listed by each search engine (a total of 300 sites) were compared. Of these, 126 were listed repeatedly within a given retrieval method, whereas only 3 sites were identified by all 3 search engines. After elimination of duplicates, 40 sites were evaluated for content and currency of information. The most common features included postoperative care suggestions, options for pain management or anesthesia, a description of the way in which lasers work, and the types of lasers used for different procedures. Potential contraindications to laser procedures were described on fewer than 30% of the sites reviewed. None of the sites contained substantiation of claims or referrals to peer-reviewed publications or research. Because of duplication and the prioritization systems of search engines, the ease of finding sites did not correlate with the quality of the site's content. Our findings show that advertisements for services exceed useful information.

Spontaneous bullae over laser resurfaced skin.

We report 2 cases of facial bullae occurring subsequent to full-face carbon dioxide laser skin resurfacing. Although the cause is unknown, both responded to potent topical corticosteroid treatment. Laser resurfacing is a relatively new procedure, and physicians should be aware of this complication.

Comparison of the 595 nm long-pulse (1.5 msec) and ultralong-pulse (4 msec) lasers in the treatment of leg veins.

BACKGROUND: Although several lasers and light sources are now available for vascular lesions, treatment of leg veins has not been very satisfactory. Lengthening the pulse width should theoretically result in improved response rates. OBJECTIVE: This study compared the efficacy and safety of 595 nm pulsed lasers at 1.5 msec and 4 msec in treating leg veins. METHODS: For group A, 27 healthy adult volunteers with leg veins measuring less than 1 mm in diameter were treated with a 2 mm x 7 mm elliptical handpiece. Each patient had three areas treated. The first two areas were treated with the 4 msec pulsed dye laser with fluences of 16 and 20 J/cm2, while the last area was treated with a 1.5 msec pulsed dye laser at fluences ranging from 14 to 16 J/cm2. For group B, 13 subjects were treated. Areas 1 and 2 were treated with the 4 msec pulsed dye laser using a 3 mm x 5 mm and 5 mm handpiece, respectively, while the third site was treated with a 1.5 msec laser using a 3 mm x 5 mm handpiece. Fluences ranging from 14 to 16 J/cm2 were used. Clinical evaluations were performed and photographs taken at 4-8 week intervals. RESULTS: Neither laser regularly induced satisfactory diminution or disappearance of these vessels after one treatment. In group A, more than 50% of patients had little to no improvement, while in group B little to no improvement was observed in 33% of patients following a single treatment. Although there was no significant difference in outcomes between the test sites, the 4 msec PDL with a 3 mm x 5 mm spot size appeared to be most effective. Transient hyperpigmentation was common following either treatment, while hypopigmentation was seen in group B subjects. No scarring was noted. CONCLUSION: Both the 4 and 1.5 msec flashlamp-pumped pulsed dye lasers were ineffective in treating leg telangiectasia following a single treatment.

A clinical overview of hair removal using lasers and light sources.

The tremendous demand for removal of unwanted hair has led to the development of a wide range of noninvasive, user-friendly laser and light source systems; however, despite considerable advances in this field, these devices still have the potential to cause injury when used improperly. It is important to follow precise treatment guidelines in order to attain optimal results. This article gives an overview of the currently available lasers and light sources. It focuses on the practical aspect of laser hair removal by discussing patient selection, safety precautions, techniques using the different systems, pre- and post-laser treatment care, proper treatment endpoints, expected outcome, and possible side-effects and complications.

A clinical and histologic prospective controlled comparative study of the picosecond titanium:sapphire (795 nm) laser versus the Q-switched alexandrite (752 nm) laser for removing tattoo pigment.

BACKGROUND: Theory predicts that picosecond lasers should be more effective than the currently available nanosecond lasers in removing tattoo ink. In addition to thermal confinement, such pulse widths cause optimal photomechanical disruption of the target. OBJECTIVE: This study compared the efficacy of the picosecond titanium:sapphire (795 nm, 500 psec) laser and the Q-switched alexandrite (752 nm, 50 nsec) laser in the treatment of tattooed guinea pigs. METHODS: Six albino guinea pigs, each with 6 uniformly 1 cm circular black tattoos, were treated. Three of the tattoos were divided into 2; one half was treated with the titanium:sapphire laser and the other half with the alexandrite laser. Fluences used for both lasers were 6.11, 4.24, and 2.39 J/cm2 with spot sizes of 1.25, 1.5, and 2 mm, respectively. The remaining spots served as control. Clinical evaluation and biopsies were performed at baseline and at 11 and 16 weeks after a single laser treatment. RESULTS: Greater clearance of tattoo was observed in titanium:sapphire laser-treated areas in 2 of the 4 surviving guinea pigs. In some areas total clearing was observed after the single titanium:sapphire laser treatment. Clearing improved with higher fluences. No scarring was present. Histologic results showed similar findings. CONCLUSION: Our findings suggest that the picosecond titanium:sapphire laser is more effective than the Q-switched alexandrite laser in removing tattoo pigment and may be of significant clinical utility.

Lasers for vascular lesions.

Recent developments in laser technology have revolutionized the treatment of various cutaneous disorders. Lasers provide effective and safe treatment of many conditions for which previous therapy was either unavailable, ineffective, or unacceptable. Basic laser principles, laser safety, available laser systems for treatment vascular lesions, clinical applications, preoperative considerations, anesthesia, postoperative changes, side effects/complications, nursing measures, and patient education are described.

Solar urticaria: case report and phototesting with lasers.

Solar urticaria (SU) is a rare photosensitivity disease characterized by itching, erythema, and whealing immediately after exposure to sunlight or artificial radiation. A 28-year-old female whose history was strongly suggestive of SU, but who failed to demonstrate any photosensitivity on standard light testing with a slide projector as well as UVA and UVB broadband bulbs, developed urtication when provoked with the argon-pumped dye laser at 610 nm, 650 nm, and 690 nm. Lasers may be useful tools in performing visible phototesting, especially at longer wavelengths, in patients with SU because they are powerful and efficient, whereas slide projectors have relatively little emission toward the red wavelengths and consequently may fail to evoke an urticarial response in patients, such as ours, with high-threshold, red light-induced SU.

CO2 laser resurfacing of psoriatic plaques: a pilot study.

BACKGROUND AND OBJECTIVE: Laser resurfacing can precisely remove epidermis and papillary dermis, sites pivotal to the pathogenesis of psoriasis. Our objective was to determine the efficacy and safety of superficially ablating carbon dioxide (CO2) lasers for treating isolated, recalcitrant psoriatic plaques. MATERIALS AND METHODS: Twelve adult subjects with stable, plaque-type psoriasis were recruited. In six volunteers, the quadrants received different numbers of passes with a 60 microsec pulsed CO2 (Tru-Pulse) laser. In the remaining patients, one quadrant underwent curettage prior to resurfacing, the second resurfacing with a scanned continuous wave (Sharplan Silktouch) CO2 laser and the last curettage alone. RESULTS: Despite clinical and histological evidence of complete ablation of the epidermis and papillary dermis, most quadrants recurred within 8 weeks. Surprisingly, two patients showed no recurrence after 4 months. CONCLUSION: Ablation of the entire epidermis and papillary dermis with either pulsed or scanned CO2 lasers appears generally ineffective in treating recalcitrant psoriatic plaques, although the clearing seen in two patients suggests potentially successful future research directions.

Total body heliotherapy.

Sunlight has long been known to be beneficial for a variety of skin diseases. Patients with psoriasis and eczema frequently employ ambient heliotherapy to control their conditions. However, social norms do not permit a person to expose the entire body in public, thus placing severe restrictions on the utility of this modality for the treatment of generalized psoriasis, for example. Tan-Thru bathing suits, designed to attract those who wish to tan without an accentuated "tan line", are reported to absorb ultraviolet (UV) rays up to a maximum equivalent of a sun protection factor (SPF) 10 sunblock, thus offering approximately 89% protection while in use, according to their manufacturer. If so, this bathing suit may allow patients with UV-responsive skin dermatoses to achieve full body exposure in a socially acceptable manner. The objective of this study was to verify the SPF and to determine the actual transmittance to skin covered by a Tan-Thru bathing suit. Ten healthy adult subjects were recruited for this investigation. UVB minimal erythema dose (MED) was determined on unaffected gluteal or lower back skin, once with and once without the swimsuit on. Our results showed that the mean SPF afforded by the bathing suit was in fact 4.9 (range 4.5-5.6). In conclusion, theoretically, the Tan-Thru bathing suits could allow enough UVB penetration under ambient conditions to be beneficial for patients with UVB responsive conditions.