The efficacy and the adverse reactions of laser-assisted tattoo removal - a prospective split study using nanosecond and picosecond lasers.

BACKGROUND: Laser pulses with nanosecond duration (NSL) have been the golden standard to destroy the pigment particles in skin. It is still controversially discussed whether picosecond pulses (PSL) are superior for tattoo removal. OBJECTIVES: To compare the efficacy and the adverse reactions of nanosecond and picosecond laser pulses in a comparative study. METHODS: The prospective study included 23 subjects with 30 black or coloured tattoos, which were split into two halves treated with either a new PSL (532, 1064 nm) or standard NSL (694 nm). The lasers were applied at regular time intervals of 4 weeks for up to eight treatments. Tattoo clearance (primary endpoint), pain and adverse reactions (secondary endpoints) were appraised by physicians, blinded observers, and by subjects. The extent and duration of adverse reactions were additionally assessed by using a questionnaire and photo-documentation after each treatment session. RESULTS: The tattoo clearance appeared to be more effective for PSL compared to NSL but without statistical significance (P > 0.05). Pretreated tattoos responded better to laser treatments than previously untreated tattoos. Subjects felt significantly less pain with PSL than with NSL (P < 0.001). Transient adverse reactions were statistically less pronounced lasting shorter for PSL as for NSL, especially blistering, pruritus, and burning sensation. Hypopigmentation appeared after NSL treatments only, whereas hyperpigmentation was caused by both lasers. No scarring was detected with either laser. CONCLUSIONS: Both laser systems enable acceptable clearance of most tattoos in the present study. PSL cause less collateral skin damage as compared to NSL.

A randomized trial of early endovenous ablation in venous ulceration: a critical appraisal: Original Article: Gohel MS, Heatly F, Liu X et al. A randomized trial of early endovenous ablation in venous ulceration. N Engl J Med 2018; 378:2105-114.

AIM: Gohel et al. aimed to compare early endovenous ablation vs. deferred endovenous ablation of superficial venous reflux with regard to time to healing of venous leg ulcers, rate of healing at 24 weeks, recurrence rate, ulcer-free time and health-related quality of life. SETTING AND DESIGN: This multicentre, parallel-group (ratio 1 : 1), randomized controlled trial was conducted in a vascular surgery department setting at 20 participating centres across the U.K. STUDY EXPOSURE: A total of 450 patients with venous leg ulcers were randomly assigned to receive compression therapy and undergo early endovenous ablation of superficial venous reflux within 2 weeks after randomization (early-intervention group) or to receive compression therapy alone, with consideration of endovenous ablation deferred until after the ulcer was healed or until 6 months after randomization if the ulcer was unhealed (deferred-intervention group). OUTCOMES: The primary outcome was the time to ulcer healing. Secondary outcomes were the rate of ulcer healing at 24 weeks, the rate of ulcer recurrence, the length of time free from ulcers (ulcer-free time) during the first year after randomization, and patient-reported health-related quality of life. TRIAL INTERVENTIONS: Endovenous laser or radiofrequency ablation, ultrasound-guided foam sclerotherapy, or nonthermal, nontumescent methods of treatment (such as cyanoacrylate glue or mechanochemical ablation) were performed either alone or in combination. The treating clinical team determined the method and strategy of endovenous treatment. RESULTS: The time to ulcer healing was shorter in the early-intervention group than in the deferred-intervention group. Furthermore, more patients had healed ulcers with early intervention [hazard ratio for ulcer healing 1·38, 95% confidence interval (CI) 1·13-1·68; P = 0·001]. The median time to ulcer healing was 56 days (95% CI 49-66) in the early-intervention group and 82 days (95% CI 69-92) in the deferred-intervention group. The rate of ulcer healing at 24 weeks was 85·6% in the early-intervention group and 76·3% in the deferred-intervention group. The median ulcer-free time during the first year after trial enrolment was 306 days (interquartile range 240-328) in the early-intervention group and 278 days (interquartile range 175-324) in the deferred-intervention group (P = 0·002). The most common complications were pain and deep vein thrombosis (DVT) (early-intervention group: pain, six of 28; DVT, nine of 28; deferred-intervention group: pain, six of 24; DVT, three of 24). CONCLUSIONS: Gohel et al. conclude that early endovenous ablation of superficial venous reflux results in faster healing of venous leg ulcers than deferred endovenous ablation. Patients assigned to the early-intervention group also had longer ulcer-free time during the first year after randomization.

Laser assisted tattoo removal - state of the art and new developments.

Decorative tattoos including permanent make-up are very popular world-wide. However, some people regret tattooing and seek tattoo removal. Tattooed skin contains numerous solid particles of tattoo pigments. A major mechanism of tattoo removal is laser assisted fragmentation of these particles, which are then transported away from the skin. For many years, Q-switched lasers with nanosecond pulse durations at high light intensities have been applied to cause such fragmentation via rapid heating up while sparing the adjacent tissue. Despite the long-lasting use of such laser treatment, the exact mechanisms of laser assisted fragmentation are hardly investigated. Due to short and intense laser pulses applied, non-linear effects of light (e.g. photoacoustic and optical breakdown) and nonlinear thermal properties in tattoo particles may play a crucial role. In the past few years, lasers with even shorter pulse duration in the sub-nanosecond range were launched for tattoo removal. Theoretical considerations assumed that pulse durations shorter than nanoseconds allow even more effective fragmentation of tattoo particles. A couple of initial studies affirm the effectiveness of picosecond pulses in tattoo treatment, especially in clearing black tattoos. Furthermore, treatment with picosecond lasers seems to be less painful. Consequently, picosecond technology may be a new strategy for more effective removal of tattoo pigments at a lower rate of side effects. But there is an urgent need for more well-designed and randomized controlled trials to compare this treatment modality to the traditional nanosecond technology regarding efficacy and adverse reactions.

[Diagnosis and management of vascular malformations : Interdisciplinary teamwork in demand]. / Diagnostik und Management von Gefäßmalformationen : Interdisziplinäres Teamwork gefragt.

Vascular anomalies are very rare, but can occur in children and adults in almost every region of the body. Due to the complexity of this disease, the path to a definitive diagnosis is often difficult. It requires interdisciplinary teamwork with close exchange of information between the individual treatment partners to reach the correct diagnosis and then to start the best therapy. This article provides an overview of the main types of vascular malformations from a clinical, imaging, and histological point of view, following the current classification of the International Society for the Study of Vascular Anomalies (ISSVA).