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At least 469 records · Page 26Linked to original sources
PubMed1997

Copper bromide laser treatment of facial telangiectasia: results of patients treated over five years.

BACKGROUND AND OBJECTIVE: Various yellow light lasers have been used over the past decade in an attempt to eradicate facial telangiectasia. Based on their power output, spot size, and pulsing characteristics, these lasers belong to one of two categories that exist at either end of a spectrum--high power, short pulse, and large spot size, or low power, long exposure, and small spot size. The copper bromide laser clearly belongs in the latter group, but with higher available power than most other lasers in this group, it exists further along the spectrum toward the region in which the laser parameters might be considered closer to theoretical ideals for treating certain cutaneous vascular pathologies. The objective of this study was to ascertain the role and efficacy of the copper bromide laser on treatment of a variety of facial telangiectasia. STUDY DESIGN/MATERIALS AND METHODS: A total of 570 patients with facial telangiectasia of different diameters and on different regions of the face were treated with the copper bromide laser one or more times and followed up over 5 years. RESULTS: More than 75% clearance was achieved in 70% patients, 50-75% clearance in 17.4% patients, and < 50% clearance in 12.6% patients. Poor results were correlated with anatomical location on the nasal alae and nasal tip and also with vessel size. Very small (< 100 microns) and very large (> 300 microns) vessels did not respond as well as vessels in the 100-300-micron diameter group. Very large vessels responded better to a combination of sclerotherapy and laser treatment. There were no reported long-term adverse effects. CONCLUSION: The copper bromide laser is a safe and effective modality for the treatment of the majority of facial telangiectasia. It is less suited to treating very small vessel lesions such as diffuse erythema, and conversely very large vessels as well as those of the nasal alae. These latter two groups respond better and more permanently to combined sclerotherapy and laser treatment.

Adult↗
PubMed1998

Minocycline-induced hyperpigmentation: treatment with the Q-switched Nd:YAG laser.

BACKGROUND AND OBJECTIVE: Cutaneous hyperpigmentations are well-documented, but nevertheless rare side-effects of high-dose or long-term minocycline therapy. The pigmental changes, may last for years, even though therapy has been abrogated. To date, no safe and effective therapy has been described to target this cosmetically disturbing sequela. STUDY DESIGN/MATERIALS AND METHODS: A 57-year-old female patient with extensive pigmental changes of the face due to long-term minocycline therapy was treated in eight consecutive sessions with the Q-switched Nd:YAG-laser (1,064-nm wavelength, 5- to 7-nsec impulse length). RESULTS: A 90% resolution of the pigmentation could be achieved after five treatments. After the last session the lesions were completely gone; no hypopigmentation scars, or other side-effects were observed. CONCLUSION: Treatment with the Q-switched Nd:YAG laser seems to be an effective, safe, and easily applicable strategy for the therapy of minocycline-induced hyperpigmentations.

Aluminum Silicates↗
PubMed2004

Minocycline-induced hyperpigmentation masquerading as alkaptonuria in individuals with joint pain.

Alkaptonuria, a rare autosomal-recessive disorder caused by mutations in the HGD gene and a deficiency of homogentisate 1,2-dioxygenase, is characterized by accumulation of homogentisic acid (HGA), ochronosis, and destruction of connective tissue resulting in joint disease. Certain medications have been reported to cause cutaneous hyperpigmentation resembling that of alkaptonuria. We present 5 such cases. Eighty-eight patients with a possible diagnosis of alkaptonuria were examined at the National Institutes of Health Clinical Center between June 2000 and March 2004. The diagnosis of alkaptonuria was confirmed or ruled out by measurement of HGA in the urine. Five patients with findings consistent with ochronosis, including pigmentary changes of the ear and mild degenerative disease of the spine and large joints, were diagnosed clinically as having alkaptonuria, but the diagnosis was withdrawn based on normal urine HGA levels. All 5 patients were women who had taken minocycline for dermatologic or rheumatologic disorders for extended periods. Minocycline-induced hyperpigmentation should be considered in the differential diagnosis of ochronosis. This could be of increased significance now that minocycline and other tetracyclines have been proposed as therapeutic options for rheumatoid arthritis, bringing a new population of patients with ochronosis and arthritis to medical attention with the potential, but incorrect, diagnosis of alkaptonuria.

Abscess↗
PubMedDate not supplied

Keloid scar of the face.

Although all the consultants agreed that this patient deserved to be treated, they disagreed as to the method. Dr. Wise suggested excision of the scar with postoperative irradiation. Dr. Thomas would excise the scar, inject the lesion with steroids intraoperatively and postoperatively, and apply a pressure dressing. Dr. Cook would not operate at all and favored intralesional injection of steroids. When used, Kenalog was the steroid preparation of choice. Dr. Wise would not use steroids in this situation because of the possible complications of skin atrophy, change in pigmentation, and telangiectasias. Dr. Thomas would avoid low-dose irradiation for fear of inducing a head and neck malignancy. Dr. Cook would avoid all surgical intervention, believing that it would only compound the present problem. All consultants agreed that the patient deserved close follow-up, and that he was at risk for similar scar formation in the future. They also pointed out the genetic predisposition for his offspring to have similar problems.

Adult↗
PubMed2003

IPL technology: a review.

BACKGROUND AND OBJECTIVES: Intense pulsed light (IPL) systems are high-intensity light sources, which emit polychromatic light. Unlike laser systems, these flashlamps work with noncoherent light in a broad wavelength spectrum of 515-1,200 nm. These properties allow for great variability in selecting individual treatment parameters and adapting to different types of skin types and indications. The purpose of this article was to critically review international medical publications of the many indication in which IPL technology can be used, including our own evaluations and experiences. STUDY DESIGN/MATERIALS AND METHODS: The range of therapeutic uses for high-intensity flashlamps was reviewed, ranging from benign cavernous hemangiomas, benign venous malformations, essential telangiectasias, leg telangiectasias, poikiloderma of Civatte, and port-wine stains to pigmented lesions, cosmetically undesired hypertrichosis, and facial rhydids. The relative benefits and risks were discussed in detail and compared with other laser systems. RESULTS: Because of the wide spectrum of potential combinations of wavelengths, pulse durations, pulse frequency, and fluences, a great deal of experience is required when using IPL technology. Proper patient selection and critical diagnostics serve to keep the adverse effects of the treatment to a minimum. CONCLUSIONS: The distinctive technical conditions involved combine to make IPL technology an alternative and auxiliary treatment option to existing laser systems and conventional therapies.

Facial Dermatoses↗
PubMed2001

Introduction of the flash-lamp pulsed-dye laser treatment of facial port-wine stains in childhood: A case of health care technology assessment.

BACKGROUND AND OBJECTIVE: Lasers have been used in the treatment of port-wine stains (PWS) for more than 30 years. With the introduction of the flash-lamp pulsed-dye laser (FPDL) it was assumed that infants could be treated safely, effectively, and probably more efficiently. Nowadays, FPDL treatment is an established form of treatment of PWS in childhood. STUDY DESIGN/MATERIALS AND METHODS: On the basis of the iterative Health Care Technology Assessment (HCTA) loop, we examined whether sufficient evidence from evaluations has been present to support the introduction of FPDL treatment for facial PWS at an early age. Such an assessment requires an interdisciplinary approach focusing on aspects of safety, efficacy, effectiveness, quality of life, costs, and the ethical issues of treatment. RESULTS: Assessment of the FPDL in PWS treatment of children did not follow the model of medical innovation and evaluation. Most assessments have been focused on laser applications that were already in clinical use. Efficacy and effectiveness of laser treatment have been the major concern in most assessments. Only a few studies have looked at costs and ethical aspects of treating children. CONCLUSIONS: The introduction and diffusion of the use of the FPDL in the treatment of PWS in childhood were uncontrolled, and the field was not prepared to use this technique properly. We believe that this nonadherence to the iterative HCTA model reflects the gradual way by which innovations find their way into clinical practice.

Adolescent↗
PubMed1993

Comparison of the flashlamp pulsed dye laser with the argon tunable dye laser with robotized handpiece for facial telangiectasia.

This prospective study compares the efficacy, side effects, and patient acceptance of the flashlamp pulsed dye laser (FPDL) with the argon tunable dye laser with robotized handpiece (ATDL/H) for facial telangiectasias. Seventeen adult patients with bilaterally symmetric facial telangiectasias were enrolled. The right cheek on each patient was treated in one session with the FPDL at a fluence of 6.0-6.75 J/cm2 and a spot size of 5 mm. The left cheek was treated at the same session with the ATDL/H at a power of 1 W, a fluence of 26-27 J/cm2, and a hexagonal treatment area of 13 mm (127 individual 1 mm spots grouped mechanically by the handpiece). Patients were evaluated subjectively and by the investigators at 2, 4, and 6 weeks for blistering, swelling, bruising, changes in pigment, scarring, overall efficacy, and patient preference. Average treatment times were 5.4 minutes for FPDL and 9.4 minutes for ATDL/H. Blistering, crusting, and discomfort were completely resolved on both sides by week 2 in all patients. Bruising occurred in all patients with FPDL but had resolved in 62.5% of patients at 2 weeks and 100% at 4 weeks. There was no bruising with ATDL/H. Postinflammatory hyperpigmentation was much more prominent with FPDL but had resolved in 88% of cases by week 6. As rated by the investigators 100% of the FPDL treated areas showed excellent clearing of telangiectasias, compared with 47% of ATDL/H treated areas.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Full face laser resurfacing: therapy and prophylaxis for actinic keratoses and non-melanoma skin cancer.

BACKGROUND: Although there are many effective treatment modalities for individual actinic keratoses (AKs), widespread lesions on the photoaged face pose a challenge due to inefficient and ineffective therapy resulting in high rates of recurrence after local destruction. Full face laser resurfacing offers an effective and efficient treatment option that successfully reduces the number of AK's on diffusely damaged skin and may show a prophylactic benefit for preventing non-melanoma skin cancers. OBJECTIVE: To assess the efficacy of full face laser resurfacing in reducing the number of facial AK's by comparing preoperative and postoperative numbers of lesions present and to observe the incidence of non-melanoma skin cancer after full face laser resurfacing. STUDY DESIGN: A retrospective chart review of 24 patients with widespread facial AK's (greater than 30) treated with full face UPCO(2) and/or Er:Yag laser resurfacing was performed. All patients were a minimum of 1 year post-operative following facial laser resurfacing. The recurrence of AK's and the occurrence of facial non-melanoma skin cancers in these patients was assessed through chart analysis. RESULTS: Widespread AK's were effectively eliminated in all patients. Twenty-one patients (87%) remained lesion free for at least 1 year. Fourteen of the 24 patients (58.3%) showed no new lesions during a 2-year follow-up. There was an overall 94% reduction in total number of AK's. Adverse effects included transient perioral scarring in one patient, S. aureus infection in two patients, and dyschromia in two patients. CONCLUSIONS: Full face laser resurfacing provides long-term effective prophylaxis against AKs and may reduce the incidence of AK related squamous cell carcinoma.

Adult↗
PubMed2005

Evaluation of different temperatures in cold air cooling with pulsed-dye laser treatment of facial telangiectasia.

BACKGROUND AND OBJECTIVES: Cold air cooling is widely used in dermatological laser therapy. We investigated the influence of cold air cooling at different skin temperatures on therapeutic outcome and side effects of pulsed dye laser treatment of facial telangiectasia. STUDY DESIGN/MATERIALS AND METHODS: From September 2002 to February 2003, 17 patients with previously untreated facial telangiectasia underwent a single treatment session with flash-lamp pulsed dye laser (3.5 J/cm(2), 585 nm, 0.45 milliseconds pulse length, 10 mm beam diameter, Cynosure V). The treatment area was divided into three sub-areas: no cooling, cold air cooling to 20 degrees C and to 17 degrees C skin temperature. The skin temperature was monitored by a prototype infrared sensor system which controlled the temperature of the cold air stream (Cryo5). In a prospective study, we collected data on purpura, pain, clearance, and patient satisfaction on numerical analog scales (NAS) from 0 (meaning "no") to 3 (meaning "high"). RESULTS: Without cooling, purpura (2.53), pain (2.41), and clearance (2.35) were rated medium to high. Cooling to 20 degrees C reduced purpura (1.12) and pain (1.06), whereas the clearance (2.12) was only slightly affected. Cooling to 17 degrees C reduced purpura (0.88) and pain (0.76) even more, the clearance (2.06) was lowered marginally. Most patients preferred cooling to 20 degrees C skin temperature. CONCLUSION: In dermatological laser therapy of facial telangiectasia, the use of cold air cooling can significantly reduce side effects and increase patient satisfaction while only slightly affecting clearance. Cooling to 20 degrees C skin temperature proved to be a well-balanced middle course. For the practical use of cold air cooling, we thus recommend cooling to a level which the patient can tolerate without problems and to try to increase the energy densities.

Adult↗
PubMed2006

Q-switched ruby versus long-pulsed dye laser delivered with compression for treatment of facial lentigines in Asians.

BACKGROUND AND OBJECTIVES: Q-switched lasers have been used for the treatment of lentigines but post-inflammatory hyperpigmentation (PIH) can be an issue especially in Asians. The 595 nm long-pulsed dye laser (LPDL) has been used for the treatment of vascular lesions and although it is well absorbed by oxyhemoglobin, it is also absorbed by melanin. To use this device for the treatment of facial lentigines, we attached a flat glass lens to the tip of the laser's handpiece, allowing compression of the skin during treatment. In doing so, eliminated the absorption by oxyhemoglobin. This prospective study aims to compare the efficacy and complications of such an approach to the use of Q-switched ruby laser (QSRL) in the treatment of facial lentigines in Asians. STUDY DESIGN/MATERIALS AND METHODS: Eighteen Asian patients (1 male, 17 female) with facial lentigines Fitzpatrick skin types III-IV were enrolled. One of the lentigines present was treated with LPDL by compression method and the other one was treated with QSRL. A LPDL emitting wavelength of 595 nm, spot size of 7 mm was used, with fluence between 10 and 13 J/cm(2) and pulse duration of 1.5 milliseconds. Cryogen spray cooling was not used. A 694 nm QSRL was used with a spot size of 4 mm, fluence of 6-7 J/cm(2), and pulse duration of 30 nanoseconds. Lightening of the lesions was assessed by reflectance spectrometer Erythema, hypo- or hyperpigmentation and scarring were also assessed by clinical examinators. RESULTS: The degree of clearing achieved with the two lasers was 70.3% and 83.3% for QSRL and LPDL, respectively. All QSRL treated areas developed erythema whereas only 4 of 18 LPDL treated areas developed erythema. Hyperpigmentation was seen in four patients after QSRL, but not after LPDL. There was no scarring or hypopigmentation. CONCLUSIONS: LPDL delivered with a compression method is more effective than QSRL for facial lentigines. Complications after LPDL treatment were substantially less frequent than after QSRL. The addition of compression technique may allow "vascular" pulsed dye laser to be used for treating a variety of pigmented lesions.

Adult↗