40 years of lasers in dermatology

Written by on January 2, 2006 in laser therapy with 0 Comments

Here Dr. Lazoff has done the hard work of reading and summarising a detailed paper on lasers in dermatology. The paper contains highly detailed background and history from four decades of research into the myriad of laser technologies and their application to dermatology.

Additionally the article interviews 2 prominent laser specialists on their approaches to treating rosacea. Dr. Lazoff has directed some of her comments specifically towards rosacea sufferers.

Skin411 Digest, Light on Lasers, October 2003, Summaries and commentaries from recent dermatologic journals. Medical editor: Marjorie Lazoff M.D.Elizabeth I. McBurney, M.D, Slidell, Louisiana ;

“For patients with persistent redness and flushing, very small vessels and fair colored skin the intense pulsed light (IPL) source devices can be quite beneficial. These light sources have the advantage of being relatively mild causing minimal to no side effects. They do require multiple sequential treatments, numbering up to five at three-week intervals. Although the clearing is gradual, up to 80% improvement can be achieved.

However if a patient is looking for a minimal number of treatments (one or two per se), the pulsed dye laser (PDL) remains the gold standard. It has the distinct disadvantage of causing purpura, or bruising. When the laser energy is absorbed by the blood vessel, it shatters causing the blood to be released in the tissue, forming a temporary bruise. Bruising may last seven to ten days.

If the patient has very large caliber vessels, which frequently occurs around the sides of the nose, these can be next to impossible to eradicate with IPL sources. In my opinion, it is necessary to use a pulse dye laser with extended pulse duration or a KTP laser. The KTP laser has a fairly high reoccurrence rate however.

The more common case is that a patient has a variety of different types of vessels. They may have very persistent erythema or flushing with very fine vessels over the cheeks and chin and larger caliber vessels around the nose and on the outer margins of the cheek. My current approach would be to first do a series of five treatments with the IPL and to follow this with one or two treatments with a PDL. The advantage is that the majority of the vessels can be removed with no bruising or downtime. The larger remaining vessels can be eradicated with the pulsed dye laser and thus limit the bruising to very localized areas.

Recently the PDLs with longer wavelengths and extended pulse duration have been developed which minimize the bruising but sacrifice overall efficacy. There has also been research in “stacking” laser pulses of lower energies and an attempt to minimize the purpura and obtain vessel eradication. The early results are promising. So as is so often the case in life, there is no one-size-fits-all answer; each patient is a unique individual requiring an evaluation to select the treatment that is best for him or her.”

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About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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