Effects of 1064-nm Nd:YAG long-pulse laser on polidocanol microfoam injected for varicose vein treatment: a controlled observational study of 404 legs, after 5-year-long treatment.

Sclerotherapy continues to be the treatment of choice for varicose veins in the legs. However, isolated treatment using microfoam or lasers requires a high number of sessions to eliminate them. In 2013, we published results about the efficacy and safety 3 years after the combined treatment with microfoam injections and subsequent application of Nd:YAG laser. The aim of this paper is to clinically evaluate the treatment of varices in a control visit after 5 years, when polidocanol microfoam is used and is immediately irradiated in the tissue with 1064-nm Nd:YAG laser beam. The outcome persistence after 5 years was studied in the legs that had received combined treatment and had been studied 3 years after treatment. Patients were contacted by phone, interviewed, and examined with echo-Doppler. Out of the 259 patients who were contacted, 221 agreed to make the appointment, although in the end, only 202 came, which meant analysing 404 legs. At 5 years, the clearance rates were very high: patients were included in class CEAP C1 showing vessels of from 0.5 to 3 mm diameter. The patients showed a high level of satisfaction. Regarding adverse effects, only 4 cases of hypopigmentation described in the previous publication persisted. Although the action mechanisms between the microfoam and the Nd:YAG laser must still be elucidated, it is notable that combining microfoam with laser exposure obtained a complete, effective treatment of legs in only 2 sessions, with high clearance rates and high level of satisfaction among patients.

Clinical assessment of a new 755 nm diode laser for hair removal: Efficacy, safety and practicality in 56 patients.

BACKGROUND AND OBJECTIVE: Recently, the first diode laser with a wavelength of 755 nm for in-motion hair removal came on the market. The objective of this study was to check its efficacy, safety, and practicality under different options for its use. METHODS: A prospective study in a heterogeneous group of 56 patients who had hair removed from various areas of their bodies using three different treatment methods. Four sessions were scheduled in all cases, with a gap of 3 months between each session. Efficacy was assessed by counting of hairs per cm2 and the adverse effects in each session were recorded in detail in the patients' clinical histories. RESULTS: The three tested options achieved a significant reduction in the number of hairs (P < 0.0001). The average clearances achieved using the conventional method (HR), the in-motion method (SHR) and the stacking method were 75.5%, 70.1%, and 41.9%, respectively. The degree of satisfaction of the participants on a scale of 0-10 was 7.7, 8.1 and 6.8, respectively. Erythema and perifollicular edema, which are characteristic responses in laser hair removal, were observed. The incidence of burns was 1.33%. CONCLUSION: The 755-nm diode laser performed efficiently and safely in all the tested areas, using high total accumulated energy per surface unit. Based on our prior experience with other equipment, the results are promising. Lasers Surg. Med. 49:355-360, 2017. © 2016 Wiley Periodicals, Inc.

Cuttlefish Ink Melanin Encapsulated in Nanolipid Bubbles and Applied Through a Micro-Needling Procedure Easily Stains White Hair Facilitating Photoepilation.

BACKGROUND: Photothermolysis of unwanted hair depends on the presence of melanin in the hair follicle as the chromophore, but is not effective in patients with non-pigmented, melanin-sparse hair shafts and follicles. This split-scalp, double-blind study was to monitor the efficacy of melanin bound in nanosomes to inject exogenous melanin into the hair follicles thus potentiating successful photothermolysis.
MATERIAL AND METHODS: Twelve patients, phototypes II-III, with white or very fair hair, were treated with a compound containing melanin encapsulated in nanosomes (Melaser®) together with a fluorescent marker. Two equal 6 cm² areas were marked on each side of the occiput of the subjects. The compound was applied to a randomly selected experimental side on each patient (area A), and a saline solution applied in the same manner to the contralateral control side (area B). Penetration of the melanin into the hair follicle was assessed using optical and fluorescence microscopy. Also, condition of hair structure was checked in vivo after standard laser settings used for epilation.
RESULTS: A slight transient erythema was observed in those areas where the compound was applied with some perifollicular edema. No such effects were noticed in those areas where saline solution was applied. No persistent complications such as scarring, hypo- or hyperpigmentation were observed in any of the experimental or control areas. Under fluorescence microscopy, the hair structures in the areas to which the compound had been applied showed a clear melanin deposit confirmed by the immunofluorescence intensity, which was highest at 2 hours after application. By optical microscopy, external melanin was deposited in hair follicles. Tests with standard settings for epilation were efficacious in damaging melanin-marked white hair.
CONCLUSION: This study strongly suggests the safety and efficacy of the application of nanosomes encapsulating melanin for the introduction of melanin into hair follicles. Changes noticed in the hair structure compromising its viability indicated potential application of this external melanin marker for white hair photoepilation.

J Drugs Dermatol. 2016;15(5):615-625.

Efficacy and safety of laser therapy on axillary hyperhidrosis after one year follow-up: a randomized blinded controlled trial.

INTRODUCTION: Hyperhidrosis is a debilitating problem that is not only uncomfortable and inconvenient, but also embarrassing in work and social situations. In spite of the availability of several options for the treatment of axillary hyperhidrosis, recently, there has been an increasing interest in the use of laser therapy. This study aims to evaluate the efficacy of a laser diode device emitting at wavelengths of 924 and 975 nm and classical curettage either alone, simultaneously or in combination. MATERIAL AND METHODS: A randomized prospective controlled trial was carried out on 100 patients divided into four groups, each with a different protocol: Laser alone at 975 nm (group 1), laser alone at 924/975 nm simultaneously (group 2), curettage alone (group 3), and finally laser at 924/975 nm followed by curettage (group 4). HDSS, starch test and GAIS were used to assess treatment efficacy. The follow-up extended to one year. Statistical analysis (SPSS) was used to determine the accuracy of the results. RESULT: Two patients of group 1 experienced burns during treatment, which took over a month to heal. This group of patients achieved the worst results: The starch test scale results after treatment were 2.48 ± 0.51 and 2.76 ± 0.44 (at 1 and 12 months). The GAIS results were 1.04 ± 0.35 and 0.92 ± 0.28 (1 and 12 months). In group 2 the starch test scale results after treatment were 1.36 ± 0.49 and 1.48 ± 0.51 (at 1 and 12 months). The GAIS results were 2.36 ± 0.49 and 2.72 ± 0.46 (at 1 and 12 months). In group 3, the starch test scale results after treatment were 1.56 ± 0.51 and 1.76 ± 0.60 (at 1 and 12 months), which corresponds to small to substantially smaller dark areas. The GAIS results were 2.28 ± 0.46 and 2.64 ± 0.49 (at 1 and 12 months). The best results were obtained in group 4: HDSS scores were reduced from 3.88 ± 0.33 before treatment to 1.24 ± 0.44 and 0.48 ± 0.51 at the 1 and 12 months controls. The starch test scale results after treatment were 0.40 ± 0.50 and 0.44 ± 0.51 (at 1 and 12 months). The GAIS results were 3.72 ± 0.54 and 3.76 ± 0.44 (at 1 and 12 months). CONCLUSION: In this study, the laser at 924/975 nm combined with curettage was determined to be the optimal treatment option of those tested for axillary hyperhidrosis. This treatment was safe, with few side effects and improvement that persisted to one year follow-up.

Optimal and safe treatment of spider leg veins measuring less than 1.5 mm on skin type IV patients, using repeated low-fluence Nd:YAG laser pulses after polidocanol injection.

Treatment of micro-veins of less than 1.5 mm with laser and with chemical sclerosis is technically challenging because of their difficulty to remedy. Laser treatment is even more difficult when dark phototypes are involved.Three groups of 30 patients each, skin type IV, and vessels measuring less than 1.5 mm in diameter, were enrolled for two treatment sessions 8 weeks apart: group A, polidocanol (POL) micro-foam injection; group B, Nd:YAG laser alone; and group C, laser after POL injection. Repeated 8-Hz low-fluence pulses, moving the hand piece over a 3-cm vein segment with an average of five laser passes maximum and with a total time irradiation of 1 s were used. Sixteen weeks after the second treatment, statistically, degree of clearance after examining photographs and patients satisfaction index, plotted on a visual analogue scale and comparing results of all three groups, results were significantly better for group C (p<0.0001). No significant differences in complications were noticed between the three groups. Efficacy of combining POL and laser proved safe and satisfactory in 96 % of patients using low-fluence laser pulses with a total cumulative energy in the 3 cm venous segment, lower than that of conventional treatment. Very few and transient complications were observed. POL foam injection followed by laser pulses is safe and efficient for vein treatment in dark-skinned patients.

Six-month follow-up multicenter prospective study of 368 patients, phototypes III to V, on epilation efficacy using an 810-nm diode laser at low fluence.

Laser hair removal is currently a popular cosmetic procedure. Traditional high-fluence laser treatment for hair elimination is associated with discomfort and adverse events and it is restricted to low phototype skins. A multicenter study of hair epilation with low fluences and high repetition pulse rate using an 810-nm diode laser was carried out on 368 patients (phototypes III to V) to test its efficacy in a 6-month follow-up after five treatments on the face and various body areas. Objective and subjective assessment as well as histologies show a high index of patient satisfaction due to high efficacy of hair elimination, also proved histologically by the damage observed at hair structure level. Results obtained a high degree of patient satisfaction and a low index of adverse events. Laser epilation was well accepted regarding discomfort and was also complication-free for dark and tanned skins. Treatment is easy to conduct and requires adapting the movement of the hand-piece to a constant speed in order to achieve high-energy deposit on tissue avoiding risks of burning.

1064 nm Nd:YAG long pulse laser after polidocanol microfoam injection dramatically improves the result of leg vein treatment: a randomized controlled trial on 517 legs with a three-year follow-up.

OBJECTIVE: To assess the efficacy and safety of a new method of clearing varicose veins in the long term. It consists of applying the long-pulsed Nd:YAG laser following the injection of polidocanol microfoam, in two consecutive sessions, treating both legs in full in each session. METHOD: Randomized, Polidocanol-controlled, blind evaluation clinical trial comparing the results between 79 legs treated with Polidocanol and 517 treated with Polidocanol + Laser. Photographs were taken preoperatively and at three months, two years and three years after treatment, as well as patient self-assessments. RESULTS: Polidocanol + Laser is much more effective than polidocanol microfoam in clearing venulectasias with a diameter under 4 mm (p < 0.001). After three years, clearing percentages of 89% (Class I veins), 94% (Class II veins) and 95% (Class III veins) are observed, in comparison to 15%, 18% and 17%, respectively when only polidocanol was applied. No unexpected adverse effects were found and 86% of patients stated they were Satisfied or Very Satisfied. CONCLUSION: The method leads to safe, fast and apparently permanent results. The treatment session lasts less than 1 h, and could become a first-choice treatment for the removal of all types of varicose veins with a diameter under 4 mm.