595-nm Pulsed Dye Laser Research Articles

The effect of different pulse durations in the treatment of nail psoriasis with 595-nm pulsed dye laser: A randomized, double-blind, intrapatient left-to-right study

Several studies have proven the efficacy of pulsed dye laser (PDL) in the treatment of plaque type psoriasis. However, only two published studies indicate the effectiveness of PDL on nail psoriasis. We sought to study the effect of different pulse durations in the treatment of nail psoriasis with the 595-nm PDL to determine the optimal pulse duration. Twenty patients with bilateral fingernail psoriasis were recruited and completed a 6-month trial. PDL was applied on the proximal and lateral nailfolds based on random assignment. Forty nails were treated with 6-millisecond pulse duration and 9 J/cm(2) whereas 39 nails were treated with 0.45-millisecond pulse duration and 6 J/cm(2). Patients were blinded to pulse durations. One blinded dermatologist used the Nail Psoriasis Severity Index (NAPSI) to assess the clinical outcome from pretreatment and posttreatment photographs. Patients were monitored for adverse events. Pain was evaluated after the procedure using a visual analog scale assessed by the patient. After 6 months of first treatment, there was a significant reduction in overall NAPSI, nail matrix NAPSI, and nail bed NAPSI scores from baseline in both groups; however, no significant difference was found between the two pulse duration groups. Side effects were mild including transient petechiae and hyperpigmentation. There was no placebo group. PDL was found to be an effective and well-tolerated option in the treatment of nail psoriasis. No significant difference in terms of efficacy was found between the longer and shorter pulse duration treatment groups.

Treatment of infantile hemangiomas with the 595‐nm pulsed dye laser using different pulse widths in an Asian population

The pulsed dye laser (PDL) using varying fluences and pulse durations have been used to treat hemangiomas. This study aims to examine the efficacy and safety of the 595-nm PDL for the treatment of infantile hemangiomas using short (1.5-3 milliseconds) versus long (10 milliseconds) pulse durations and high fluences. This is a retrospective study of patients with hemangiomas (n = 23) treated with the 595-nm PDL from 2003 to 2007. The parameters used for the short pulse duration group (n = 15) were 7-mm spot size, fluence 10-13.5 J/cm(2) and dynamic cooling device (DCD) spray duration of 50 milliseconds and delay of 30 milliseconds. For the long pulse duration group (n = 8), parameters were 7-mm spot size, fluence 10.5-14.5 J/cm(2) and DCD spray duration of 40 milliseconds and delay of 20 milliseconds. The number of treatments required to achieve complete or near complete resolution of the hemangioma ranged from 3 to 14 for the short pulse duration group (mean: 8) and for the long pulse duration group, 4-14 treatments (mean: 9). For both groups, more treatments were needed to achieve clearance of mixed hemangiomas (n = 13) compared to superficial hemangiomas (n = 10) (on average, 4-5 treatments more). Erythema, edema, and purpura lasted for about a week in the short pulse duration group but only 2 days in the long pulse duration group. There was no ulceration or hypertrophic scarring noted in both groups. Both short and long pulse durations using moderately high fluences are equally effective in the treatment of infantile hemangiomas. Shorter pulse durations had a slightly higher incidence of side effects compared to longer pulse duration in our patients with darker phototypes. Hemangiomas are tumors with relatively large diameter blood vessels and this provides the basis for the use of longer pulse durations.

Pulsed dye laser treatment with different onset times for new surgical scars: a single-blind randomized controlled trial

In humans, regeneration of wounds is limited and the wound repair process leads to a nonfunctioning mass of fibrotic tissue known as a scar, which can be more or less visible [1]. The final appearance of a surgical incision is an important concern for patients and physicians. Scarring can cause discomfort and psychological stress for patients. Surgical scars can be flat, hypertrophic or atrophic. The etiology and mechanism of scarring are not fully understood. Scars are thought to be difficult to treat and almost impossible to prevent. Several nonsurgical (pressure garments, topical and systemic corticosteroids, silicone gel sheeting, 5-fluorouracil, radiotherapy, interferon, bleomycin, topical retinoic acid, colchicine, D-penicillamine) and surgical interventions (laser, cryosurgery, skin grafting, scar revision, dermatography) have been investigated for the treatment of scars [2–6]. Laser treatment may provide an alternative to the long list of current treatment options. Different laser systems have been used to prevent or treat scars. The argon laser was introduced in 1978 [7]. Abergel et al. showed the effectiveness of the 1,064 nm Nd:YAG laser in the treatment of scars [8]. Castro et al. [9] found that the effect of the Nd:YAG laser (at an energy level of 1.7×10 J/cm) could be due to selective inhibition of collagen production with no effect on DNA synthesis or cell viability. The diode laser has also been used for the treatment of scars. A preliminary study has suggested that treatment with the diode at 810 nm in the early phases can change the physiology of wound healing significantly, and thus prevent scar formation [10]. In 1993, Alster reported that the flashlamp pulsed dye laser (PDL) at 585 nm significantly improves erythematous and hypertrophic scars [11]. PDL is currently the laser of choice for the treatment of scars. The exact mechanism by which PDL exerts antiscarring effect remains unclear. The majority of the lasers including PDL emit light energy that is absorbed by hemoglobin, generating heat and resulting in damage to the microvasculature [12]. It has been reported that the 585-nm PDL can decrease fibroblast proliferation and collagen type III deposition [13]. McCraw et al. were the first to describe the use of laser therapy of postsurgical scars. In an uncontrolled study they found that early laser therapy was safe and effective [14]. Nouri et al. in a controlled study found that the 585-nm PDL on the day of suture removal is effective and safe in the treatment of fresh surgical scars [15]. This finding was confirmed again in another study using a cryogen-cooled 595-nm PDL laser [16]. On the other hand it seems that one single pass of the PDL on the day of suture removal does not improve the appearance of surgical scars and more than one pass is recommended [17]. In a trial comparing the 585-nm with the 595-nm PDL, Nouri et al. found that 585 nm was the preferred wavelength, as it markedly normalized the height, vascularity and elasticity of scars [18]. Additionally, Nouri et al. reported that both shortand long-pulse PDL started on the day of suture removal effectively and safely improve the quality and cosmetic appearance of surgical scars [19]. Although laser treatment on the day of suture Clinical trial registration number: NCT00506363 P. Davari : F. Gorouhi : P. Hashemi : F. Behnia : M. Nasiri-Kashani :A. Firooz (*) Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, 415 Taleghani Ave, Tehran 14166, Iran e-mail: firozali@sina.tums.ac.ir

Granuloma Faciale Treated with 595-nm Pulsed Dye Laser

Granuloma Faciale Treated with 595-nm Pulsed Dye Laser

Enhancing effect of pretreatment with topical niacin in the treatment of rosacea-associated erythema by 585-nm pulsed dye laser in Koreans: a randomized, prospective, split-face trial

Enhancing effect of pretreatment with topical niacin in the treatment of rosacea-associated erythema by 585-nm pulsed dye laser in Koreans: a randomized, prospective, split-face trial

595nm Pulsed Dye Laser: An Alternative to Treat Basal Cell Carcinomas

Background: Basal cell carcinoma (BCC) is the most common cutaneous malignancy. Proffered treatment for these lesions is surgery. Based on patient’s age, drug allergies, and place of lesions, surgery may not be the best option, and alternative treatments should be considered. Pulsed dye laser (PDL) may be a good alternative therapy. The aim of the present study was to determine the effectiveness and safety of this laser in the treatment of BCCs in Iranian patients. Methods: Patients with definite diagnosis of BCC enrolled in the study. For each patient, one lesion proved to be superficial, or nodular BCC via histopathology was treated with PDL for four sessions and after the last session, re-biopsy was done to determine any remnant of tumor. All patients were followed for 6 to 13 months to capture any recurrence of as soon as possible. Results: A total of 12 patients including eight male and four female were selected. All patients completed the study in accordance to the treatment protocol. All patients cleared clinically resulting flat hypo pigmented scar, but in pathology, two patients showed remnants of tumor and were referred for surgery. No side effects, but mild erythema and irritation were noted in all patients. No recurrences were found during the follow up period. Conclusion: It seems that PDL may be an effective alternative therapy for some subtypes of BCCs with acceptable safety profile. Further studies with larger sample sizes are required to support this opinion.

The pulsed dye laser for the treatment of basal cell carcinoma

Basal cell carcinomas (BCC) have a specialized microvasculature system that can be targeted by the 585-nm pulsed dye laser (PDL) utilizing the theory of selective photothermolysis. Seven volunteers with nine well-defined, biopsy-proven BCCs, were treated with the PDL (585-nm wavelength, a single 450-μs pulse, 7-mm spot size, and 9.0 J/cm(2) energy). The lesions, along with a 4-mm border of normal skin were treated. Pain assessment was carried out immediately after the laser treatment. A deep shave biopsy with histological examination occurred 4 weeks after the laser treatment. Pain was assessed on a scale of 0 (no pain) to 10 (worst pain possible). The average patient score was 2.1 (range 1-4). On histology, 5/9 (55.6%) sites demonstrated no evidence of BCC; however, 4/9 (44.4%) sites showed residual BCC. Although the PDL was able to clear over half of the BCCs in this study, there was an unacceptably high persistence rate of 44.4%. The PDL did not achieve the clearance rate that can be attained with current standard BCC treatment modalities. At this time, we do not recommend that a single treatment with the 585-nm PDL can be used as a primary therapy for BCC.

Use of laser-assisted photodynamic therapy for leukoplakia in the larynx

Photodynamic therapy is a method for achieving selective tissue destruction of neoplastic and atypical proliferative cells using a chemical photosensitizer, which accumulates within the tumor, and a light source to activate a free radical cascade. This method has been used for a variety of malignant and premalignant conditions. We have been using photodynamic therapy in the larynx for intractable and difficult keratosis with atypia using a nebulized formulation of aminolevulinic acid activated with the 585-nm pulse dye laser (Cynosure, Chelmsford, MA). We can perform this procedure in the office under local anesthesia using a flexible nasopharyngoscope with a 2.5-mm working channel. We have found it to be a valuable adjunct for patients with widespread keratosis and dysplasia. In this article, we describe our methodology and application of this technology.

Topical niacin cream‐assisted 595‐nm pulsed‐dye laser treatment for facial flushing: retrospective analysis of 25 Korean patients

Flushing is defined clinically as a transient reddening of the face and other areas. Due to the transient nature of flushing, a patient may not show signs of flushing during laser treatment. The aim of this study was to evaluate the efficacy and safety of 595-nm pulsed-dye laser treatment of flushing or erythema after provocation of flushing by topical niacin cream. We retrospectively reviewed a total of 25 Korean patients with facial flushing who were treated with three sessions of 595-nm pulsed-dye laser after the application of topical niacin cream. Follow-up results revealed that 12 of the 25 patients demonstrated marked (51-75%) clinical improvement of baseline facial erythema. Eight patients had moderate (26-50%) improvement and three demonstrated near total (≥ 75%) improvement. Two patients showed minimal to no (0-25%) improvement. We observed that the reactivity to topical niacin cream was markedly reduced in 64% of our patients after 595-nm pulsed-dye laser treatments. Minimal post-therapy facial oedema was noted in most of the patients, which usually resolved spontaneously within 2 days. Pronounced facial swelling was observed in four patients. We suggest that 595-nm pulsed-dye laser treatment after provocation of flushing by topical niacin cream may provide a new treatment algorithm for facial flushing in Asians.

Angiolymphoid hyperplasia with eosinophilia treated with vascular laser

Angiolymphoid hyperplasia with eosinophilia is a rare, benign disorder characterized by reddish-brown nodules and plaques in the dermis and the subcutaneous tissues, typically occurring on the neck and head. Surgical excision, corticosteroids, radiotherapy, and other therapies have been used, however, recurrences are common. Treatment with vascular lasers such as pulsed dye laser (PDL) or Nd:YAG seems to be a promising therapeutic option. To assess the efficacy and safety of PDL and combined sequential PDL-Nd:YAG laser in patients with ALHE. Three patients with ALHE were treated with PDL at 595-nm wavelength or with a combined sequential application of 595-nm PDL and 1,064-nm Nd:YAG wavelengths. Topical anesthetic was applied before laser treatment. Complete resolution of the lesions was achieved in two patients with ALHE; a partial response was seen in one patient. No significant side-effects were reported. We consider that PDL should be a first-line therapy for AHLE. Sequential application of PDL and Nd:YAG laser seems to show promising results, so it could be an interesting new treatment option.

Enhancing effect of pretreatment with topical niacin in the treatment of rosacea-associated erythema by 585-nm pulsed dye laser in Koreans: a randomized, prospective, split-face trial

Rosacea is a chronic dermatosis that is usually confined to the face. A pulsed dye laser (PDL) system has been proven to be effective in treating rosacea-associated erythema and telangiectasias. Niacin is a cutaneous vasodilator that can increase the chromophore through increased blood flow. We hypothesized that increased blood flow by pretreatment with topical niacin could enhance the effect of PDL in the treatment of rosacea. Eighteen Korean patients with rosacea were recruited. Three sessions of 585-nm PDL using a subpurpuragenic dose with and without pretreatment with niacin cream were performed on randomly assigned half-faces at 3-week intervals. Erythema was assessed objectively by a polarization colour imaging system, and evaluations were also made by three blinded dermatologists. Patient satisfaction was evaluated using a 10-point visual analogue scale. Fifteen patients completed this study. All patients showed an improvement in erythema after three sessions of PDL treatment both with and without niacin pretreatment (P = 0·023 and P = 0·009, respectively). There was no significant difference in the improvement of objective erythema between the two sides. However, based on physician assessment the overall clinical improvement on the niacin side was significantly higher (P = 0·005), and patient satisfaction was also higher on the niacin-pretreated side (P = 0·007). There were no remarkable side-effects, with the exception of transient erythema and oedema. Pretreatment with topical niacin safely enhanced the effect of 585-nm PDL treatment of rosacea-associated erythema in Koreans. Application of niacin can be helpful in overcoming the relatively lower effect of subpurpuragenic PDL in dark-skinned Asians.

New approaches in light/laser therapies and photodynamic treatment of acne

Acne is a domain in which the technology and understanding of light/laser therapeutic procedures have advanced considerably. The aim of the paper was to revisit adjunctive physical treatments of acne, including light/laser treatments and photodynamic therapy. This review summarizes findings about such treatment modalities with particular emphasis on efficacy and safety. A number of laser/light-based modalities have been developed to meet the increasing demand for new acne treatments. The current devices correspond, on the one hand, to light-emitting diode therapy and, on the other hand, to the 532-nm potassium titanyl phosphate laser, the 585- and 595-nm pulsed dye laser, the 1450-nm diode laser, the 1320-nm Nd:YAG laser and intense pulsed light. Photodynamic therapy is also available. It is claimed that light/laser treatments might induce a faster response compared with the 1 – 3 months needed for response to traditional oral and topical treatments. In conclusion, pulsed dye laser shows efficacy in some patients with mild to moderate acne. The relative effectiveness compared with other treatments is unconfirmed; from the published information, evidence-based efficacy assessment of light/laser therapies in acne remains almost impossible.

Efficacy and safety of long-pulse pulsed dye laser delivered with compression versus cryotherapy for treatment of solar lentigines

Background:Although cryotherapy is still the first-line therapy for solar lentigines, because of the side effects such as post-inflammatory hyperpigmentation (PIH), especially in patients with darker skin types, pigment-specific lasers should be considered as a therapy for initial treatment.Aim:The aim of this study is to evaluate the efficacy and safety of cryotherapy compared with 595-nm pulsed dye laser (PDL) with cutaneous compression in the treatment of solar lentigines.Materials and Methods:Twenty-two patients (skin type II–IV) with facial or hand lentigines participated in this study. Lesions of one side of the face or each hand were randomly assigned and treated with either cryotherapy or PDL. Treatments were performed with radiant exposures of 10 J/cm2 , 7-mm spot size and 1.5 ms pulse duration with no epidermal cooling. Photographs were taken before treatment and 1-month later. The response rate and side effects were compared.Results:PDL was more likely to produce substantial lightening of the solar lentigines than cryotherapy, especially in skin type III and IV (n = 8, n = 9; P < 0.05), but might be no difference in type II (n = 5; P > 0.05). PIH was seen only in cryotherapy group. PDL group had only minimal erythema. No purpura was observed.Conclusion:PDL with compression is superior to cryotherapy in the treatment of solar lentigines in darker skin types.

Pulsed dye laser treatment of pigmented lesions: a randomized clinical pilot study comparison of 607‐ and 595‐nm wavelength lasers

The 595-nm pulsed dye laser has been used for the treatment of benign epidermal pigmented lesions (EPLs), but there is a risk of inducing undesirable purpura with treatment. To compare a 607-nm laser with a commercially-available 595-nm laser for the treatment of EPLs. Monte-Carlo simulations were performed to characterize laser interaction with skin. Ten patients with EPLs were treated with a 607-nm study prototype laser and the 595-nm pulsed dye laser twice at 2- to 4-week intervals on the left or right side on a randomized basis. Study endpoints included clearance rate of lesions, side effects immediately after treatment and at final follow-up, and patient discomfort/pain. Monte-Carlo simulations show that the 607-nm is absorbed more specifically by melanin than the 595-nm wavelength. Both lasers were effective in treatment of EPLs. The average degree of improvement overall was 41.2% with the 607-nm laser and 40% with the 595-nm laser. Patients reported less discomfort/pain during treatment with the 607-nm laser. Our findings suggest that the 607-nm laser is safe and at least as effective as the 595-nm laser in treatment of EPLs. There was less patient discomfort/pain during treatment using the 607-nm laser.

Granuloma Faciale Treated with 595-nm Pulsed Dye Laser

Granuloma Faciale Treated with 595-nm Pulsed Dye Laser

Strategies for prevention of scars: what can we learn from fetal skin?

Fetal wound healing occurs rapidly and without scar formation early in gestation. Studying the mechanisms of scarless repair can lead to novel scar-preventive approaches. In fetal wounds, collagen is deposited early and is fine and reticular with less cross-linking. Several important differences of fetal vs. postgestational wound-healing response have been determined, such as the presence of less inflammation, higher hyaluronic acid concentration and a greater ratio of collagen type III to type I. Compared with typical wounds, there are also altered ratios of signaling molecules, such as higher ratios of transforming growth factor (TGF)-β3 to TGF-β1 and -β2, and matrix metalloproteinases to tissue inhibitors of metalloproteinases. Furthermore, fetal fibroblasts do not exhibit TGF-β1-induced collagen production compared with their mature counterparts. Patterning genes (homeobox genes) involved in organogenesis are more active in the fetal period and are believed to be the "first domino" in the fetal cutaneous wound repair regulatory cascade. The recommended scar-preventive agents, such as Scarguard MD®, silicone gel and sheet, Seprafilm® Bioresorbable Membrane, topical hyaluronan, onion extract, oral tamoxifen and 585-nm pulsed dye laser are reviewed in this study. Despite the lack of supporting evidence, there is a widespread false presumption that the acceleration of healing with the widely assumed scar-preventive commercial agents is associated with decreased scar formation. Humans are erroneously inclined to make a negative correlation between the healing rate and the degree of scar formation, while such a correlation does not exist in reality. Despite the importance of scar prevention, no FDA-approved therapy for this purpose is available in the 21st century, which reflects the important challenges, such as the presence of redundant pathways, that these approaches are facing.

Accelerated resolution of laser-induced bruising with topical 20% arnica: a rater-blinded randomized controlled trial

Dermatological procedures can result in disfiguring bruises that resolve slowly. To assess the comparative utility of topical formulations in hastening the resolution of skin bruising. Healthy volunteers, age range 21-65 years, were enrolled for this double (patient and rater) blinded randomized controlled trial. For each subject, four standard bruises of 7 mm diameter each were created on the bilateral upper inner arms, 5 cm apart, two per arm, using a 595-nm pulsed-dye laser (Vbeam; Candela Corp., Wayland, MA, U.S.A.). Randomization was used to assign one topical agent (5% vitamin K, 1% vitamin K and 0·3% retinol, 20% arnica, or white petrolatum) to exactly one bruise per subject, which was then treated under occlusion twice a day for 2 weeks. A dermatologist not involved with subject assignment rated bruises [visual analogue scale, 0 (least)-10 (most)] in standardized photographs immediately after bruise creation and at week 2. There was significant difference in the change in the rater bruising score associated with the four treatments (anova, P=0·016). Pairwise comparisons indicated that the mean improvement associated with 20% arnica was greater than with white petrolatum (P=0·003), and the improvement with arnica was greater than with the mixture of 1% vitamin K and 0·3% retinol (P=0·01). Improvement with arnica was not greater than with 5% vitamin K cream, however. Topical 20% arnica ointment may be able to reduce bruising more effectively than placebo and more effectively than low-concentration vitamin K formulations, such as 1% vitamin K with 0·3% retinol.

Treatment of Superficial Infantile Hemangiomas of the Eyelid Using the 595-nm Pulsed Dye Laser

Despite the proven effectiveness of the 595-nm pulsed dye laser (PDL) in treating superficial infantile hemangiomas, many physicians are reluctant to treat such lesions involving the eyelid. OBJECTIVE To examine the safety and efficacy of the 595-nm PDL for the treatment of superficial infantile hemangiomas of the eyelid. Records were reviewed for patients with superficial infantile hemangiomas of the eyelid treated with 595-nm PDL. Pre- and post-treatment photographs were compared. Reviewers rated the degree of improvement of the hemangioma as excellent (76-100%), good (51-75%), moderate (26-50%), or poor (0-25%) and indicated whether the hemangioma was 100% clear. Side effects of scarring, atrophy, hyperpigmentation, and hypopigmentation were assessed. Twenty-two patients met the study criteria. Eight (36.4%) demonstrated complete clearance of their hemangioma, 17 (77.3%) received an improvement rating of excellent, and five (22.7%) received a rating of good. No scarring, atrophy, or hypopigmentation was noted. Two patients (9.1%) were noted to have hyperpigmentation in the treated area. Early treatment with the 595-nm PDL can safely and effectively diminish proliferative growth and hasten resolution of superficial infantile hemangiomas of the eyelid.

Unilateral nevoid telangiectasia—response to long-pulsed Nd:YAG laser and pulsed dye laser: a case report

Unilateral nevoid telangiectasia (UNT) is a rare disease characterized by punctuate and stellate telangiectasias that follow dermatomal distribution.1 Its etiology remains elusive; no standard treatment currently exists. We describe a 14-year-old Asian female (skin type IV) with UNT, who underwent treatment with long-pulsed 1064-nm Nd:YAG laser and 595-nm pulsed dye laser for her disease. The patient came to our clinic with linearly arranged, punctate telangiectasias over right side of back, shoulder, and arm (Figure 1). The lesions appeared at the age of 10. The diagnosis of UNT was made based on the clinical manifestations and telangiectasias in superficial dermis (as shown on a histologic exam done previously at another hospital). Angioma serpiginosum is an important differential diagnosis of UNT in this case. Three sessions of treatment with long-pulsed 1064-nm Nd:YAG laser (GentleYAG Laser; Candela Laser, Wayland, MA, USA) were given with parameters (fluence-spot sizepulse width) of 240 J/cm2-3 mm-10 ms (first week), 240 J/ cm2-3 mm-10 ms (second week), and 280 J/cm2-3 mm-10 ms (third week). The interval between each session was 4 weeks. However, there was only slight improvement. Histologic exam performed 2 weeks after the third session revealed marked telangiectasias in papillary dermis (Figure 2). Next, two sessions of pulsed dye laser with 595 nm wavelength (Vbeam Perfecta; Candela Laser) were given with parameters of 13 J/cm2-7 mm-40 ms (fluence-spot sizepulse width) for both sessions. Significant lightening of lesions (> 90%) was observed after the second session (Figure 3). The only adverse reaction was transient purpura that lasted for approximately 2 weeks. There was no hypoor hyper-pigmentation after treatment. There are two forms of UNT, the rarer congenital form and the more common acquired form.2 Telangiectasia develops during puberty in most of the acquired cases, as in our patient. Several reports point out the systemic association of acquired UNT, such as hyperestrogenemia and chronic liver disease.2 In out patient, there was no evidence of high serum level of estrogen or hepatic disease. Both long-pulsed 1064-nm Nd:YAG laser and pulsed dye laser have been shown to be effective in treating vascular lesions.3,4 Major et al3 reported good response with the former for facial and leg telangiectasias. However, it does not seem to be a good treatment modality for UNT for the current case. One possible explanation is that while the 1064-nm Nd:YAG laser beam tends to penetrate to deeper dermis, due to its long wavelength and lesser absorption Figure 1 Clinical picture before treatment.

Patient Tolerance of the Flexible CO2 Laser for Office-based Laryngeal Surgery

The OmniGuide flexible carbon dioxide (CO(2)) laser can be readily used in the office but patient tolerance has not been established. The aim of this pilot study was to determine patient tolerance of the flexible CO(2) laser. As a reference point, the 585-nm pulsed-dye laser (PDL) was selected for comparison because it is the only office-based laser in which patient tolerance has specifically been studied. Prospective pilot study involving office-based surgery candidates with benign laryngeal pathology. Via flexible laryngoscopy, half of each lesion was treated with the CO(2) laser and the remaining half with the PDL, alternating the order of the lasers (to account for potential thermal injury from the first laser) and blinding the patient to treatment. Patients rated their discomfort immediately after each laser treatment and then completed postoperative questionnaires for discomfort and voice quality. Ten patients with benign laryngeal disease were included. All patients tolerated the office-based laser surgeries without difficulty. The CO(2) laser was extremely well tolerated, with mean pain and burning scores of 2.0 and 2.3, respectively, on a scale of 1-10 (10 being intolerable pain). Postoperative pain questionnaires demonstrated minimal discomfort after the laser treatment. Those with resolution of laryngeal disease had significant voice improvement. Flexible CO(2) laser laryngeal surgery is well tolerated in an office-based setting.