595-nm Pulsed Dye Laser Research Articles

Prevention of unfavorable scars using early pulse dye laser treatments: a preliminary report.

Hypertrophic scarring occurs frequently in the trunk and extremities, and sporadically in other areas even under favorable circumstances. Unfortunately, the existing methods of scar manipulation have not been effective in preventing these unfavorable scars. Established hypertrophic scars have been treated by Anderson and Parrish, Alster, and others using the 585-nm pulse dye laser. The current study is the first report of prevention of hypertrophic scarring using the 585-nm pulse dye laser in a large group of elective and traumatic incisions. Treatment within the first few weeks resulted in faster resolution of scar stiffness and erythema, and less frequent development of hypertrophic scarring. An unexpected finding was the substantial improvement in the quality of scarring in all areas of the body, attributed to the excellent color match of the treated scars. These observations suggest that early pulse dye laser treatments can change fundamentally the physiology of wound healing if applied in the early phases. This report provides the first clinical correlation between prophylactic laser reduction of scar microcirculation and prevention of excessive scar formation.

Treatment of mature striae with the pulsed dye laser.

Striae are a common cosmetic problem with no effective treatment options. A recent study has shown improvement in the appearance of mature striae following a single 585-nm pulsed dye laser (PDL) treatment at low fluence. To evaluate the effectiveness of treating mature striae with the 585-nm PDL. Five patients with mature striae on the abdomen were prospectively treated with the 585-nm PDL at 2-month intervals for 1-2 years. The response of the striae to laser treatment was evaluated in each patient through sequential clinical, photographic, textural, and histologic assessment. All five patients reported a slight overall improvement in the appearance of the striae following multiple PDL treatments. Comparison of pre- and post-treatment photographs, however, failed to reveal improvement in any patients. Optical profilometry performed on striae impressions showed mild improvement in the surface texture of striae in three patients. Histologic comparison of pre- and post-treatment biopsy specimens failed to reveal normalization of skin architecture. Serial treatment of mature striae with the PDL results in mild, subjective, clinical improvement but no significant photographic, textural or histologic improvement.

Pulsed dye laser treatment of hypertrophic burn scars.

Hypertrophic burn scars are notoriously difficult to treat because of their extensive tissue involvement and tendency to worsen with hypertrophy and contracture formation. Various therapies have been advocated in the past, including surgical excision and grafting, dermabrasion, and corticosteroids, with distinct cosmetic limitations. The 585-nm pulsed dye laser has been shown previously to be effective in the treatment of a variety of traumatic and surgical scars with improvement in scar texture, color, and pliability with minimal side effects. Sixteen patients with 40 hypertrophic burn scars resulting from chemical peels, carbon dioxide laser procedures, and accidental thermal injury were treated with a 585-nm pulsed dye laser. Sequential photographic and clinical assessments were recorded in all patients. Histologic evaluations of skin punch biopsies before and after laser irradiation were performed when possible. Symptomatic improvement of scars was reported after one treatment. Decreased scar erythema with improved texture and pliability was observed after an average of 2.5 treatments. No correlation was found between scar duration, location, or etiology and response to treatment. Normal number of dermal fibroblasts with decreased sclerosis was observed on histologic examination of laser-irradiated scars. The 585-nm pulsed dye laser irradiation of hypertrophic burn scars can effectively improve scar pliability and texture and decrease erythema and associated symptoms yielding cosmetically and functionally acceptable clinical results.

The medical necessity for treatment of port-wine stains.

Port-wine stains are congenital vascular malformations that can be disfiguring and may lead to psychosocial as well as medical complications. The 585-nm pulsed dye laser is very effective in treating port-wine stains. Laser treatment is often viewed by insurance companies as a "cosmetic procedure" and not "medically necessary". Consequently many patients are denied coverage for treatment of their disfiguring birthmarks. To determine variability of insurance coverage for laser treatment of port-wine stains from state to state. Natural history, progression, and potential complications of port-wine stains are reviewed and rationale for consistent insurance coverage for laser treatment of port-wine stains is given. A questionnaire was mailed to 40 dermatologic surgeons in 22 states and the District of Columbia. We reviewed the literature regarding port-wine stains and their potential complications, and health care policy guidelines regarding "medical necessity" and "cosmetic procedures". Insurance coverage for laser treatment of port-wine stains varies from state to state. Based on current health care policy guidelines, laser treatment of port-wine stains should be regarded, and covered, as a medical necessity by all insurance providers.

Long-Pulsed Dye Laser for Treatment of Leg Telangiectasia

The 585-nm 450-μsec pulsed dye laser is an effective treatment for port-wine stains and other facial vascular abnormalities, but abnormalities of the

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. A 44-year-old woman with PAT was treated with the flashlamp-pumped pulsed dye laser at 585 nm, with fluences varying from 7 to 7.25 J/cm2. A successful outcome was obtained with this treatment approach, with no relevant adverse effects except for mild pigmentary changes. Although ectatic vessels on lower extremities are often resistant to dye laser therapy, superficial thin capillaries like those featuring PAT can be eliminated with the pulsed dye laser at 585 nm. Transient pigmentary changes occur on treated areas but they are expected to disappear in 6 to 12 months after treatment. Laser treatment should be considered in PAT despite the extension and location of the lesions.

Treatment of proliferative haemangiomas with the 585nm pulsed dye laser

Haemangiomas usually develop within the first few weeks of life, most regressing spontaneously before the age of 7 years. Some may ulcerate or compromise a vital function, in which case systemic corticosteroids, surgery or radiotherapy may be helpful. All of these treatment modalities are associated with significant morbidity. Treatment with the 585 nm flashlamp pulsed dye laser is safe and effective in the management of superficial vascular malformations. We report seven patients, under 12 months of age, who presented with proliferative haemangiomas, causing functional impairment. Ulcerated lesions were present in four patients. The patients were treated with the 585 nm pulsed dye laser (fluences 7.0-9.25 J/cm2), at intervals of 4-8 weeks. All of the lesions showed a significant reduction in size, together with improvement in the colour and integrity of the overlying skin. Treatment with the 585 nm pulsed dye laser should be considered in the management of infants with early proliferative haemangiomas, in whom intervention is indicated.

Treatment of proliferative haemangiomas with the 585nm pulsed dye laser

Treatment of proliferative haemangiomas with the 585nm pulsed dye laser

Failure of pulsed dye laser therapy for resistant verrucae

Treatment with the 585-nm pulsed dye laser was performed in seven patients with viral warts (six with plantar warts and one with a periungual wart) who had failed to respond to conventional therapeutic modalities, including keratolytics, formalin soaks, cryotherapy, curettage, CO2 laser and systemic retinoids. Each patient was and treated on six occasions, separated by intervals of 3 weeks, with fluences of 8.5-9.5 J/cm2. Final follow-up was performed 3 weeks after the final treatment. All patients showed some decrease in the thickness of their warts, this being of a small degree in five of the patients. In the remaining two, there was a moderate reduction in both thickness and wart size. None of the patients experienced complete resolution of their lesions. symptomatic improvement was obtained in all three patients who had previously complained of pain. These data indicate that treatment of resistant viral verrucae of the periungual and plantar skin with the pulsed dye laser is not curative although partial resolution and symptomatic improvement may occur.

Focal dermal hypoplasia (Goltz's syndrome). Treatment of cutaneous lesions with the 585-nm flashlamp-pumped pulsed dye laser

REPORT OF A CASE A 26-year-old white woman presented with widespread erythematous atrophic patches over the trunk, neck, and extremities, several of which were raised and roughened and arranged in a linear pattern ( Figure 1 ). Telangiectases were scattered over the body, and some of the erythematous patches at the neck and shoulders also appeared hyperpigmented. The patient was noted to have dystrophic and brittle fingernails. Symptoms included itching and burning of the skin lesions, especially those at the lower extremities. The clinical appearance and symptomatology of the skin lesions had noticeably worsened over the 5 years before presentation. Detailed history revealed that the cutaneous lesions had been present since birth and had unsuccessfully been treated through the years with a variety of topical emollients. A skin biopsy specimen of a typical lesion revealed dilated vessels without endothelial cell proliferation within a thinned dermis. Syndactyly of the first two toes of

585-nm pulsed dye laser for the treatment of cutaneous lesions

585-nm pulsed dye laser for the treatment of cutaneous lesions

Reducing Fire Risks of the Flashlamp Pumped 585-nm Pulse Dye Laser

Reducing Fire Risks of the Flashlamp Pumped 585-nm Pulse Dye Laser

Improvement of Erythematous and Hypertrophic Scars by the 585-nm Flashlamp-pumped Pulsed Dye Laser

Fourteen patients with erythematous and/or hypertrophic scars resulting from remote surgical excision or trauma were evaluated and subsequently treated with one to two flashlamp-pumped pulsed dye (585 nm) laser treatments over a 2-month period. Clinical assessments were performed before commencement and at the end of the study in all 14 patients. Skin surface texture analyses using optical profilometry were obtained from 5 of the patients before and after laser irradiation. A 57% to 83% clinical improvement was seen in the scars after one to two dye laser treatments, respectively. In addition, a change in the skin texture with return of skin markings approximating those of normal skin measured by optical profilometry was observed in the scars after the pulsed dye laser treatments. The degree of clinical improvement seen at the end of the study continued to be evident in each patient at the 6-month follow-up examination.

Lichen Sclerosus et Atrophicus Treatment With the 585-nm Flashlamp-Pumped Pulsed Dye Laser

To the Editor.— Lichen sclerosus et atrophicus has frequently been reported to occur in children, the most common sites involved being the genital areas in both girls and boys.1Although dermatologists are very familiar with this entity and its occurrence in prepubertal children, lichen sclerosus et atrophicus is often misdiagnosed by other clinicians, typically as sexual abuse,2as evidenced by this case. Symptomatology usually includes pruritus and sometimes pain, but significant bleeding has rarely been described in the literature. Topical fluorinated corticosteroids are prescribed most frequently, as topical testosterone is not indicated in prepubertal girls. This case demonstrates successful use of the 585-nm flashlamp-pumped pulsed dye laser for treating bleeding telangiectases of prepubertal lichen sclerosus et atrophicus. This form of treatment has not previously been reported for this condition. Report of a Case.— A 7-year-old girl presented in December 1990 for treatment of a vulvar hemangioma. Her parents

Treatment of Ulcerated Hemangiomas With the Pulsed Tunable Dye Laser

Hemangiomas are the most common tumor of infancy and are characterized by rapid growth during the first 6 months of life. During the rapid growth phase, approximately 5% to 10% of the hemangiomas ulcerate. Ulcerated lesions are painful, may bleed, and are at risk for bacterial infection. Previous therapy has included daily local wound care, topical antibiotics, and local and systemic steroids. We treated nine infants (eight female and one male) with ulcerated hemangiomas by means of a vascular-specific (585-nm) pulsed (450-microsecond) tunable dye laser. Eight of the nine patients had a single ulceration, whereas one patient had two ulcerations within a large hemangioma. Six of the ulcerations healed with a single laser treatment. One ulceration required two treatments to heal, and the remaining two required three treatments. Pain was subjectively decreased within 2 to 3 days in all patients after a single treatment. The pulsed tunable dye laser should be considered in the treatment of all ulcerated hemangiomas.