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PubMed1984

Patient's evaluation of argon laser therapy of port wine stain, decorative tattoo, and essential telangiectasia.

One hundred fourteen patients were studied to assess their perception of the results of argon laser therapy for port wine stains (PWS), tattoos, or essential telangiectasia of legs. At least 1 yr following treatment patients were surveyed using a 30-item mail questionnaire. A 91% response rate was achieved. The findings indicate that patients with PWS and tattoo treated with argon laser are moderately satisfied with the results and 85% of them would have treatment again. Laser therapy of these lesions should be continued. Treatment results of essential telangiectasia of the legs are disappointing and only 49% of patients would have treatment again. Discontinuance of argon laser therapy using the described techniques is recommended.

Adolescent↗
PubMed1984

Use of the argon and carbon dioxide lasers for treatment of superficial venous varicosities of the lower extremity.

Superficial telangiectasia of the lower extremity in 38 patients was treated with both argon and CO2 lasers. Results after five months revealed no change or worsening of the veins in 49% of the patients and good to excellent improvement or segmentation in 16% of the patients. The most common complication was brown hemosiderin bruising in almost half of the patients.

Adult↗
PubMed1986

Argon laser treatment of superficial vascular lesions in children.

The author's experience in the use of the argon laser in the treatment of superficial vascular lesions in children is reviewed. Deteriorating portwine stains, strawberry hemangiomas, other hemangiomas, telangiectasias, and other lesions are discussed. Their natural histories are discussed. Details are given regarding indications for therapy, techniques, and postoperative results.

Adolescent↗
PubMed1986

Treatment of cutaneous and deep vascular lesions with the Nd:YAG laser.

This study intends to document and evaluate the first compiled experience in the treatment of both cutaneous and deep vascular lesions using the Nd:YAG laser. Thirty-eight patients were treated over a 5-year period from 1979 to 1984 using the Nd:YAG laser with FDA approval. Lesions included capillary, cavernous, combined capillary-cavernous hemangiomas, portwine stains, arteriovenous malformations, lymphangiomas, multiple telangiectasias, and one case of Klippel-Trenaunay-Webber syndrome. The number of treatments per patient ranged from one to four. Partial or complete resolution of these various lesions, as evidenced by a decrease in size, and/or normalization of pathologic cutaneous changes was noted in a majority of patients. While both the argon and CO2 lasers have been well studied in the treatment of cutaneous vascular lesions, this is the first compiled series reporting results using the Nd:YAG for such problems. The Nd:YAG laser represents an alternative modality in the treatment of cutaneous hemangiomas and introduces an efficacious method in the treatment of cavernous vascular lesions.

Adolescent↗
PubMed1988

Robotized scanning laser handpiece for the treatment of port wine stains and other angiodysplasias.

Port wine stains are currently treated by the argon laser with the "point-by-point" technique, or the "painting technique." In both cases, the quality of the results depends greatly on the dermatologist's experience. Furthermore, the first technique is slow, and the second is painful and requires anesthesia. Therefore, we have decided to design a robotized system with the following specifications: easy, fast, non-painful treatment giving a homogeneous and reproducible blanching. The system is made of a handpiece with the scanning mechanism and a control box with the microprocessor. The system is independent of the laser (no electrical connection) and has its own power meter. The deposit of energy was optimized in function of heat diffusion in the skin. Over a 12-month period, 123 patients were treated with the robotized handpiece. The treatment modalities and the results conformed to the above-mentioned specifications. Hypertrophic scars were not reported. Therefore, we think that this system will be an interesting tool for the laser treatment of port wine stains and other cutaneous angiodysplasias.

Adolescent↗
PubMed1993

600 nm flash pumped dye laser for fragile telangiectasia of the elderly.

Since 1984, a continuum of controlled studies have been done on the use of the fragile, superficial telangiectasia of the elderly, which were utilized as a model for some of the basic studies of the effects of lasers on the cardiovascular system. We report the use of the 600 nm flash pumped dye laser for the fragile telangiectasia of the elderly in our classification of the Class 2 group. In some vessels studied, the special Teflon-insulated, intravenous electric needle of Kobayashi-Yamada was used. For the bluish vessels, the 600 nm flash pumped dye laser penetrated deeper into the vessel than the 585 nm, but multiple and repeated treatments were needed for clinical effect. Preliminary studies have also shown some initial response in port wine marks and facial telangiectasia.

Aged↗
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↗
PubMed1995

Clinical uses of lasers in dermatology.

The accessibility of the skin to examination and study has permitted dermatologists to play an extremely important role in defining the clinical usefulness and limitations of many laser systems as well as developing innovative concepts, techniques and devices that further improved the effectiveness of laser treatment. As new laser technology evolved over the years, dermatologists have also helped define the specificity of laser-tissue interaction and employed the newly developed laser technologies in innovative ways which further expanded the usefulness of these devices. One of the most important concepts to be developed by dermatologists--selective photothermolysis--has led to the creation of a series of laser systems which have provided numerous unique advantages in the management of many common vascular and pigmented conditions of the skin and mucous membranes, even in infants and children. The net result of these technologic advances has been the creation of new and effective treatment techniques which have been so profoundly superior to existing technology that they have been rapidly incorporated into the daily practice of most dermatologists.

Dermatologic Surgical Procedures↗
PubMed1995

Wavelengths for laser treatment of port wine stains and telangiectasia.

BACKGROUND AND OBJECTIVE: This report presents analytical modelling of the influence of wavelength on the amount of volumetric rate of heat produced in dermal blood vessels by millisecond laser radiation. STUDY DESIGN/MATERIALS AND METHODS: A new anatomical model is proposed that represents port wine stains as well as telangiectatic lesions. It consists of a target blood vessel, representing the deepest dermal blood vessel that requires irreversible injury, and a layer of whole blood, representing all other dermal blood vessels above the target vessel. The laser light that interacts with the blood vessels is assumed to be diffuse. Selective photothermolysis is the basis for the analysis. We consider wavelengths between 577 nm and 600 nm, the argon laser wavelengths at 488/515 nm, and the frequency doubled Nd:YAG laser wavelength at 532 nm. RESULTS: The rate of volumetric heat production of absorbed laser light in the target blood vessel is expressed analytically as a function of blood absorption, the concentration of additional dermal blood, and the depth of the target vessel. CONCLUSION: The model explains why 585 nm is a good compromise for treating port wine stains that vary widely in number of dermal blood vessels. It predicts that wavelengths between 577 nm and 582 nm are excellent for the treatment of port wine stains in young children, and it suggests a possible explanation as to why the argon laser is sometimes said to be capable of treating dark mature port wine stains. The copper vapour laser wavelength at 578 nm, and the frequency doubled Nd:YAG laser wavelength at 532 nm, are predicted to be suitable for the treatment of port wine stains that contain, respectively, a small to moderate and a moderate number of dermal blood vessels. When laser beam spotsize becomes smaller, the best wavelength for producing maximal rate of heat in the target vessel is predicted to shift to 577 nm.

Animals↗
PubMed2004

Facial photo rejuvenation using two different intense pulsed light (IPL) wavelength bands.

BACKGROUND AND OBJECTIVES: Intense pulsed light (IPL) systems are increasingly used for treatment of photo damaged skin. In the present study, we investigated the clinical efficacy and safety of two different wavelength bands generated by the same IPL device. STUDY DESIGN/MATERIALS AND METHODS: An IPL device was equipped with either a 555-950 nm filter (VL), or a 530-750 nm filter (PR). RESULTS: Fair, good or excellent clearance of visible telangiectasias was obtained in 81.8% of the patients (PR) and in 58.8% (VL). In the treatment of diffuse erythema, fair, good or excellent clearance was obtained in 72.7% (PR) and in 35.0% (VL). The PR filter was more efficient (P = 0.025) in reduction of diffuse erythema. The average number of treatments was 1.75 (PR) and 1.82 (VL). For the treatment of irregular pigmentation, fair, good or excellent clearance was obtained in 54.5% (PR) and in 61.9% (VL). Multiple treatments of irregular pigmentation were also evaluated. Using the VL filter more than two treatments did not induce further clinical improvement. The patients also scored their over-all satisfaction. Either fair, good or excellent results were reported by 66.7% (PR) and by 76.2% (VL). No skin atrophy, scarring or pigment disturbances were noted after the treatments. Swelling and erythema were registered by 2/3 (PR) and 1/3 (VL) of the patients. CONCLUSIONS: The two IPL wavelength bands were both found to be effective in the treatment of photo damaged facial skin. The clinical efficacy and safety of the two different treatment procedures were comparable to those reported in earlier studies, and finally treatment with these filter combinations required less than half the fluence, no active cooling and fewer treatments.

Adult↗
PubMed2004

Comparison and sequential study of long pulsed Nd:YAG 1,064 nm laser and sclerotherapy in leg telangiectasias treatment.

BACKGROUND AND OBJECTIVES: Millisecond pulsed 1,064 nm Nd:YAG lasers have been developed for the treatment of leg telangiectasias. To date there have been very few side by side comparison studies of laser versus the gold standard sclerotherapy in treating small leg veins. This study aims to compare a long pulsed Nd:YAG laser with contact cooling to sclerotherapy for treating small diameter leg telangiectasias by evaluating objective and subjective clinical effects. STUDY DESIGN/PATIENTS AND METHODS: Fourteen patients were selected with leg telangiectasias ranging from 0.5 to 2 mm at four comparable sites. One site was treated with long pulsed Nd:YAG alone, the second received sclerotherapy alone, the third laser then sclerotherapy, and the last one sclerotherapy then laser. The patients were followed up at 3 months after the last treatment. Photographs were taken pre-operatively and at 3 months after the last session. They were used for objective and comparative analysis. Statistical analysis was performed using Friedman's test controlling for subject. RESULTS: Improvement was tabulated from the photographic assessment on an improvement scale from 0 (no change) to 4 (greater than 75% clearing). There were clinical improvements in the laser group than sclerotherapy without statistical significance. Side effects were minimal and included hyperpigmentation. CONCLUSIONS: This pilot study demonstrates that the Smartepil LS long pulse Nd:YAG 1,064 nm laser can yield results similar to sclerotherapy in the treatment of small leg telangiectasias. Combination of both methods could increase response to treatment.

Case-Control Studies↗
PubMed2004

Treatment of leg veins with the long pulse dye laser using variable pulse durations and energy fluences.

BACKGROUND AND OBJECTIVES: Attempts at using the pulsed dye laser (PDL) operating at 585 nm wavelength and 0.45 milliseconds pulse duration to treat leg veins have been notably unsuccessful. The aim of this study is to evaluate the efficacy and complications of the 595 nm long PDL in the treatment of leg veins. STUDY DESIGN/PATIENTS AND METHODS: Fourteen patients with 38 lesions were treated using a long PDL equipped with a cryogen spray cooling (CSC) device. Variable pulse durations ranging from 1.5 to 20 milliseconds and energy fluences from 10 to 20 J/cm2 were utilized depending on the size of treated vessels. All patients received two laser treatments at an interval of 2 months. RESULTS: Of patients with veins type 1A and type 1, 6 (100%) and 3 (13%) had complete clearing, respectively. Of patients with veins type 1 and type 2, 18 (78.3%) and 2 (22.2%) lesions showed excellent response, respectively. Hyperpigmentation was the only observed complication lasting several months in 57.9% of treated sites. CONCLUSIONS: The long PDL operating at 595 nm is a safe and effective treatment for leg veins, especially in type 1A and type1 vessels.

Adult↗
PubMed2004

Long pulse Nd:YAG laser for treatment of leg veins in 40 patients with assessments at 6 and 12 months.

BACKGROUND AND OBJECTIVES: This study assessed subjectively and objectively the efficacy of a long-pulsed Nd:YAG laser system in clearing dermal leg veins, successful treatment of which remains problematic. STUDY DESIGN/PATIENTS AND METHODS: Forty female patients (24-58 years old, skin types II-IV) with leg veins were treated with synchronized micropulses from a long-pulsed 1,064 nm Nd:YAG laser, 6 mm diameter spot size, 130 and 140 J/cm2. One to three treatments were given at 6-week intervals, with post-treatment assessments at 6 and 12 months. Patients assessed improvement subjectively with a satisfaction index (SI). Objective assessment was based on the clinical photography, and in addition on computer-generated data from a Canny operator-based edge-detection program. RESULTS: The overall patient satisfaction rates and objective assessments at the 6 and 12 month assessments were 42.5 and 57.5%, and 75 and 82.5%, respectively. CONCLUSIONS: The long-pulsed Nd:YAG laser offered efficient treatment of leg veins. Side effects were minimal and transient. The edge-detection program may help patients appreciate better the actual results of the treatment.

Adult↗
PubMed2004

Methemoglobin formation during laser induced photothermolysis of vascular skin lesions.

BACKGROUND AND OBJECTIVE: Monitoring dynamic changes during laser induced photothermolysis of vascular skin lesions is essential for obtaining an optimal therapeutic result. Rapid photoinduced thermal damage occurs at a threshold temperature of about 70 degrees C. It is therefore, relevant to identify markers to indicate if this threshold temperature has been reached. Methemoglobin, which is formed by a photo-induced oxidation of hemoglobin, indicates that the temperature has reached this threshold value. This study presents a proof of concept of a method for monitoring the in vivo presence of methemoglobin immediately after laser exposure. STUDY DESIGN/MATERIALS AND METHODS: The present study was designed to investigate the in vivo temperature dependence of hemoglobin absorption in the 450-800 nm spectrum range. In vivo diffuse reflectance measurements of port-wine stain (PWS) and telangiectasia were performed prior to, and immediately after, laser treatment with a pulsed dye laser (PDL) at 585 nm wavelength. RESULTS: In vivo measurements following laser treatment of vascular skin lesions showed an immediate increase in the optical absorption of blood. This effect, caused by thermal stress, is a result of an increased dermal blood volume fraction and methemoglobin formation. The effect is light dose dependent, and reflectance spectra revealed methemoglobin formation in patients treated with fluences above 5 J/cm2 at 585 nm wavelength. CONCLUSIONS: It was proved that methemoglobin can be measured in vivo by reflectance spectroscopy. Measurements of the average methemoglobin concentrations immediately after laser exposure may be a valuable diagnostic tool to verify that the blood temperature has been sufficiently high to induce thermal damage to the vessel wall.

Adolescent↗
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↗