Pablo Boixeda

Treatment of resistant port-wine stains with a pulsed dual wavelength 595 and 1064 nm laser: a histochemical evaluation of the vessel wall destruction and selectivity.

BACKGROUND AND OBJECTIVES Pulsed dye laser (PDL) is the current treatment of choice for port-wine stains (PWS), but 25-50% of treated lesions do not demonstrate a significant improvement. Hybrid lasers may improve treatment efficacy, especially those using the synergies between PDL and Nd:YAG 1064 nm laser. The objectives of this study were to assess vessel wall damage and epidermal sparing after a dual wavelength treatment with the two lasers, using different laser parameters. MATERIAL AND METHODS Post-treatment biopsies, after using a laser platform that allows sequential pulses of PDL and Nd:YAG 1064 nm lasers, were performed in five patients with PWS resistant to PDL. The biopsies were stained with nitroblue-tetrazolium chloride (NBTC), using enzymatic activity that stops immediately after cell death and allows a better identification of viable cells. RESULTS Five patients with PWS and a median age of 33 years were enrolled in this study. Selectivity and efficacy was observed with this dual wavelength approach, with the best results observed with PDL pulses shorter than 10 ms, use of the 10 mm spot, and a second pass with PDL only. CONCLUSIONS Histochemical studies with NBTC stain can help the laser surgeon establish the best treatment parameters and understand some of the unwanted side effects. The dual wavelength used in this study showed efficacy, but better assessment of treatment parameters, such as the delay between the two lasers, is needed to avoid side effects.

Complications of 585-nm pulsed dye laser therapy

Background

Venous malformation of the eyelid treated with pulsed-dye-1064-nm neodymium yttrium aluminum garnet sequential laser: an effective and safe treatment.

Venous malformations of the skin and subcutaneous tissue are compressible, blue-purple tumors that are present at birth. According to the location and symptoms caused, venous malformations can be treated with surgery, sclerotherapy, or a combination of both. Laser therapy can also be used, especially when surgery is contraindicated. We report the case of a 24-year-old man who presented with a venous malformation on the upper and lower left eyelids, which provoked a mechanical ptosis. Treatment with sequential pulsed-dye neodymium yttrium aluminum garnet (PDL-Nd:YAG) laser was performed. After 2 treatments, a marked reduction of volume and blanching of the venous malformation was observed, with satisfactory cosmetic results. The sequential PDL-Nd:YAG laser seems to be an effective and safe therapy for the treatment of cutaneous venous malformations. It penetrates deeper than pulsed-dye laser alone, and because it allows the use of lower fluencies than Nd:YAG laser alone, it reduces the risk of adverse effects.

Progressive ascending telangiectasia treated with the 585nm flashlamp-pumped pulsed dye laser

Progressive ascending telangiectasia (PAT) is a distinct entity with telangiectatic superficial vessels on lower extremities as its main clinical feature. A relationship with occult infections and response to antibiotic and antifungal drugs have been described, although not all cases can be successfully managed with these therapies. Our objective was to treat a woman with PAT that had failed to respond to systemic antibiotic and antifungal drugs.

Seguimiento a largo plazo de angiofibromas tratados con láser de CO2 en 23 pacientes con esclerosis tuberosa

Resumen Introduccion La esclerosis tuberosa es una enfermedad autosomica dominante que determina la formacion de hamartomas en multiples organos. Los cambios cutaneos son una de las caracteristicas primarias de esta enfermedad. Dentro de estos, los angiofibromas constituyen una forma comun de presentacion que causa importantes problemas cosmeticos y medicos. El laser de CO 2 se ha utilizado satisfactoriamente en el tratamiento de estas lesiones, pero existen escasos estudios que evaluen sus resultados a largo plazo. El objetivo de nuestro estudio es valorar la respuesta del tratamiento de los angiofibromas en el largo plazo. Metodos Se realizo un estudio retrospectivo en 23 pacientes con angiofibromas tratados con laser de CO 2 . Los pacientes fueron tratados entre los anos 1991 y 2000 inclusive con laser de CO 2 continuo o superpulsado. Clasificamos los angiofibromas de acuerdo a su tamano, resultados iniciales del tratamiento y edad de los pacientes ( Resultados El rango de edad vario entre 12 y 39 anos, con una media de 22,5 anos. Despues del tratamiento los pacientes fueron controlados durante un periodo de 6 meses a 10 anos. En el analisis a largo plazo encontramos que un 30,1 % mantuvo el resultado inicial y el 60,9 % mostro diferentes grados de recidiva con un tiempo medio de recurrencia de 3 anos. Cuando analizamos los resultados a largo plazo segun tamanos de angiofibromas, resultado inicial y edad de los pacientes, no encontramos diferencias estadisticamente significativas entre los diferentes grupos. El analisis de supervivencia, con curvas de Kaplan-Meier, de los grupos de edad mostro que los pacientes mas jovenes ( Conclusiones El tratamiento con laser de CO 2 logra buenos resultados a corto plazo. Por otro lado, uno de los mayores problemas es la recaida en el largo plazo, ya que probablemente debido a la naturaleza de las lesiones, estas no se pueden eliminar permanentemente. Este trabajo coincide con estudios previos que no han encontrado factores que permitan predecir la recurrencia de las lesiones. Sin embargo, podemos concluir que los pacientes de mayor edad recaen mas tardiamente y tienen por tanto mejores resultados cosmeticos a largo plazo.

Recientes avances en láser y otras tecnologías

Laser technology and other energy sources are rapidly finding a place in dermatology clinics. In the field of skin rejuvenation by fractional photothermolysis, although few controlled studies have been undertaken, several devices have emerged in recent years that appear less effective than laser ablation techniques but that are safer. The aim of this short article is to provide an introduction, though not treat in depth, the different emerging technologies in dermatology. We will focus particularly on lasers and light sources in improving applications such as the treatment of vascular lesions, acne, and encapsulated ink tattoos; light-emitting diodes; developments in the treatment of cellulitis; photodynamic therapy; suction methods; scarring; and finally the recent and doubtlessly future introduction of home devices for use in a range of dermatologic applications (depilation, rejuvenation, treatment of acne, etc).

Histopathology and immunohistochemistry of cutaneous lupus erythematosus after pulsed dye laser treatment.

BACKGROUND Cutaneous lupus erythematosus (CLE) is a heterogeneous autoimmune disorder with a wide range of skin manifestations. Current treatment options include topical and systemic approaches. Few controlled prospective studies have been performed using the pulsed dye laser (PDL). Based on previous experience that supported the efficacy of PDL treatment of CLE, we decided to study the histological changes induced by PDL. OBSERVATIONS A prospective study was performed on nine patients with histologically confirmed CLE treated with PDL. Biopsies were taken before, immediately after, and 4 weeks after treatment and stained with hematoxylin and eosin and with commercially available antibodies to intercellular adhesion molecule (ICAM)‐1 and vascular cell adhesion molecule (VCAM)‐1. Evaluation after PDL treatment showed a significant reduction of the dermal lymphocytic infiltrate in six of nine patients (66.7%) and an important reduction of the basal damage in six of seven patients (85.7%). Other epidermal changes improved in four of six patients (66.7%). Mucin deposition persisted in two patients. ICAM and VCAM expression was reduced in seven of seven patients (100%) and five of six patients (83.3%) (p<.05). Clinical improvement was present in eight of nine patients (88.9%), without side effects. CONCLUSIONS PDL therapy is an effective treatment for CLE. Immunohistologic improvement has been confirmed in this study. The authors have indicated no significant interest with commercial supporters.

Keratosis pilaris rubra and keratosis pilaris atrophicans faciei treated with pulsed dye laser: report of 10 cases.

Background  Keratosis pilaris rubra (KPR) and keratosis pilaris atrophicans faciei (KPAF) are both keratinization disorders characterized by erythema and keratotic follicular papules usually located on cheeks, forehead, chin and eyebrows. Topical keratolytics, vitamin D3 analogues, antibiotics, topical and oral retinoids have been used with limited results. As this condition can be socially very limiting, the need for an effective treatment has led to the use of other technologies such as pulsed dye laser (PDL) or intense pulsed light.

Successful treatment of large venous malformation with dual wavelength 595 and 1064 nm system

Venous malformations (VMs) are congenital soft, compressible, non‐pulsatile blue‐purple masses. VMs present a therapeutic challenge. They can be treated with surgery or sclerotherapy as well as with several lasers. We report the successful treatment of two patients with large VMs with combined sequential application of 595 nm pulsed dye laser and 1064 nm Nd:YAG wavelengths. At the end of the treatment course, total volume reduction was observed in both. All sessions were well tolerated without anesthesia. In our patients, using this sequential laser device achieved an almost complete clearance of the VM with no scarring.

Pulsed dye laser treatment for facial flat warts

The facial flat wart is not only a contagious viral disease, but also a cause of a distressing cosmetic problem. Although there are many therapeutic options, including salicylic acid, imiquimod, cryotherapy, retinoids, intralesional immunotherapy, and topical 5‐aminolevulinic acid photodynamic therapy among others, no monotherapy has been proved to achieve complete remission in every case. Treatment with pulsed dye laser (PDL) seems to be a promising therapeutic option. To assess the efficacy and safety of PDL in a series of patients with viral flat warts on the face, in this prospective study, 32 patients were treated with PDL at 595‐nm wavelength, a laser energy density of 9 or 14 J/cm2 with a spot size of 7 or 5 mm, respectively, with air cooling and a pulse duration of 0.5 millisecond. A complete response was noted in 14 patients (44%), and an excellent response was observed in 18 patients (56%) with 1‐year follow‐up, with only four recurrences. No significant side effects were reported except intense transitory purpuric response. We consider that PDL is a good option of treatment for flat warts on the face due to its good clinical results, fast response, and low incidence of side effects.