Combination Of Pulsed Dye Laser Research Articles

Perianal Plasmoacanthoma After BCG-Immunotherapy: Case Report and Review of Literature

Plasmoacanthoma is a rare verrucous tumor classified as a form of reactive plasmacytosis. We present the first reported case of plasmoacanthoma following exposure to bacillus Calmette-Guérin (BCG) and a comprehensive review of the literature to better illustrate the patients’ characteristics and proposed risk factors, clinical features, diagnosis, treatment, and outcome of current reports. A 64-year-old female presented with a perianal hyperkeratotic plaque and diffused inflammatory macerated erosions in the intergluteal cleft and adjacent to the plaque after intravesical BCG immunotherapy. Laboratory studies disclosed systemic abnormalities and local infection or malignancies. Biopsy showed intradermal polyclonal plasma cell infiltration with acanthosis. The lesions were successfully treated with carbon dioxide laser ablation followed by the combination of pulsed dye laser and intralesional corticosteroid. Diagnosis of cutaneous reactive plasmacytosis should be confirmed by excluding the systemic causes of plasmacytosis and malignancies. It responds well to intralesional corticosteroids; however, in severe cases and large sizes, other treatments such as carbon dioxide laser ablation and pulsed dye laser should be considered as a combined therapy. Identification of causative factors is impractical while skin irritants with subsequent inflammation seem to be involved; as in the current report, BCG contact with skin initialized the pathologic process.

Combination of pulsed dye laser and verapamil in comparison with verapamil alone in the treatment of keloid

Background and objective: Many modalities of treatment have been advocated for Keloid ,but the success rates of these have been variable. The present study is an attempt to evaluate and compare the efficacy of a combination of pulsed dye laser (PDL) and intralesional verapamil against intralesional verapamil alone in the treatment of keloids.Methods: 40 Patients with keloids were divided into two groups randomly of 20 each receiving four sessions of therapy. Group A intralesional verapamil alone 2.5mg/ml. Group B received a combination of PDL and intralesional verapamil alone 2.5mg/ml. Pretreatment measurements and photographs were taken.Results: Statistically significant improvement was seen in the height and length of the lesions. Overall appearance criteria of modified MQS showed an improvement of more than 50% in 43.3% of the lesions by the end of four sessions. The improvement of these parameters in the verampil only group was significantly lower than the improvement seen in the PDL+ intralesional verapamil group.Conclusion: Combination therapy with PDL+ intralesional verapamil was superior in efficacy when compared to intralesional verapamil alone, in the treatment of keloids.

Early intervention with pulse dye and CO2 ablative fractional lasers to improve cutaneous scarring post-lumpectomy: a randomized controlled trial on the impact of intervention on final cosmesis.

Light-based modalities appear to be effective for ameliorating surgical scar appearance; however, protocols for achieving such outcomes have yet to be established. We studied the safety and efficacy of a combination of pulsed dye laser (PDL) and fractional ablative CO2 laser (FACL) for the attenuation of post-lumpectomy scarring. We conducted a prospective, evaluator-blinded, comparative split-scar study in post-lumpectomy patients. One-half of the scar was treated with three sessions of 595-nm PDL and FACL at 1-month intervals, starting within 6weeks after suture removal. The entire scar was also treated with standard moisturizers and silicone gels. Six months after the last treatment, the two halves of the scar were assessed by three uninvolved physicians who used the Observer Scar Assessment Scale as well as by the patients who used the Patient and Observer Scar Assessment Scale. Eighteen female patients (mean age, 51.3years) with a mean scar length of 7.8cm completed the treatment and follow-up. Six months after the last treatment, both the physician evaluators and the patients noted significant improvements for all assessed scar parameters in the laser-treated scar area compared with the untreated scar area. The treatment was well tolerated, and no remarkable adverse events were reported. All 18 participants were satisfied with the treated scar areas. A combination PDL and FACL protocol starting up to 6weeks after suture removal is a safe and effective method for the attenuation of post-lumpectomy scar formation.

Combination of pulsed dye laser and propranolol in the treatment of ulcerated infantile haemangioma

Abstract Introduction Ulceration is the most common complication of infantile haemangioma, occurring in 15.8% of cases, usually in the proliferative phase. It can be managed in several ways. We present our experience in the treatment of ulcerated haemangioma with the combination of pulsed dye laser and propranolol. Material and methods A retrospective observational study was conducted on patients with ulcerated infantile haemangioma treated with pulsed dye laser in association with propranolol. The study included 7 patients, 3 cases in the labial area and 4 cases in the nappy area. A review was also performed on a historical cohort of 5 children with ulcerated haemangiomas with the same features, but treated only with propranolol, topical agents and occlusive dressings. Results The median size of the ulcer was 1.0 cm, with mean time from onset to treatment of 2 weeks. Pain and bleeding was present in all patients. After 2 weeks of combined propranolol and laser treatment, all lesions healed. The pain disappeared after the first laser session. Patients with ulcerative haemangioma in the labial area obtained a better response than patients with haemangioma in the nappy area. The cohort of patients treated with propranolol required a mean healing time of 5.2 weeks, with the addition of an occlusive dressing with ointment. Conclusions We believe that our results suggest that combined treatment, laser and propranolol has synergistic effects that accelerate the healing of ulcerated haemangioma, as observed in our patients. Further studies with larger numbers of patients are needed to confirm this finding.

Combinación de propranolol oral y láser de colorante pulsado en el tratamiento de los hemangiomas infantiles ulcerados

IntroductionUlceration is the most common complication of infantile haemangioma, with 15.8% of them usually appearing in the proliferative phase. They can be managed in several ways. We present our experience in the treatment of ulcerated haemangioma with the combination of pulsed dye laser and propranolol. Material and methodsA retrospective observational study was conducted on patients with ulcerated infantile haemangioma treated with pulsed dye laser in association with propranolol. The study included 7 patients, 3 cases in labial area and 4 cases in the nappy area. A review was also performed on a historical cohort of 5 children with ulcerated haemangiomas with the same features, but treated only with propranolol, topical agents and occlusive dressings. ResultsThe median size of the ulcer was 1.0cm, and there was a mean time of onset pre-treatment of 2 weeks. Pain and bleeding was present in all patients. After 2 weeks of combined propranolol and laser treatment, all lesions were healed. The pain disappeared after the first laser session. Patients with ulcerative haemangioma in the labial area obtained a better response than patients with haemangioma in the nappy area. The cohort of patients treated with propranolol required a mean healing time of 5.2 weeks, with the addition of an occlusive dressing with ointment. ConclusionsWe believe that our results suggest that combined treatment, laser and propranolol, has synergistic effects that accelerate the healing of ulcerated haemangioma, as observed in our patients. Further studies with larger numbers of patients are needed to confirm this fact.

Topical timolol maleate 0.5% for infantile hemangioma; it’s effectiveness and/or adjunctive pulsed dye laser – single center experience of 102 cases in Korea

Although oral beta-blocker, propranolol, was shown excellent outcome for infantile hemangioma (IH) up to date, concern of side effects and reluctance of treatment-related cumbersome evaluations are major obstacles to employ. Instead, topical beta-blockers were recently introduced as an effective alternative, but few studies are reported. So we performed a retrospective study of IH treated with topical beta-blockers, timolol maleate 0.5%, and adjunctive role of pulsed dye laser from 2011 to 2014. Among 102 IH enrolled, 61 patients (59.8%) treated with only timolol maleate and 41 (40.2%) patients treated with combination of pulsed dye laser. A clinical review of medical records and evaluation at 4–8 weeks intervals using the physicians’ Global Assessment Scores (GAS) and patients’ parents’ GAS at the latest visit. Physicians’ GAS was used to grade the lesions compared with the baseline photo by two physicians’ evaluation. And parents’ GAS was assessed by direct or telephone interview. In the only timolol treatment group, mean change was within 47.0% improvement from baseline by physicians. In addition, adjunctive treatment of pulsed dye laser group showed 66.5% improvement. No side effects were found on both groups, and mean change was 54.5% improvement by overall parent assessments.

Combination therapy of infantile hemangioma with pulsed dye laser with topical propranolol: a randomized clinical trial.

The combination of pulsed dye laser (PDL) and topical propranolol are used with variable effectiveness for the treatment of infantile hemangiomas (IH), particularly for superficial lesions. The aim of this study was to investigate whether the therapeutic efficacy of prescribing topical propranolol along with PDL was superior to PDL therapy alone in the treatment of IH. A total of 19 patients with IH were recruited to the study. Among them, nine patients were treated with PDL, 3 sessions 4 weeks apart, and 10 patients underwent PDL treatment alongside with topical propranolol for 12 weeks. The therapeutic efficacies of each regimen were assessed by comparing photographs of skin lesions before and after the treatment based on the cessation of the lesion growth, reduction in the lesion size, and lightening of the lesion color. No side-effect was reported by the parents. Among nine patients in PDL group, only two (22%) had excellent clearance, one (11%) had good, three (30%) had weak, and three (30%) had no responses. On the other hand, among 10 patients who were treated with both the PDL and topical propranolol, five (50%) showed excellent responses and five (50%) displayed good responses. Statistical data analysis with Mann-Whitney test revealed a significant difference in the clinical response between two treatment groups. The combination of PDL and topical propranolol seem to be a safe and effective therapy, and results in better clinical responses in the treatment of IH than PDL therapy alone.

Comparison of the fractional CO2 laser and the combined use of a pulsed dye laser with fractional CO2 laser in striae alba treatment.

Background:No ideal treatment has been established for Striae distensae (SD), particularly in the late phase (Striae Alba (SA)). Various types of lasers have been recently proposed as treatment options for SD. This study aims to compare the clinical efficacy of a fractional CO2 laser as well as a combination of fractional CO2 laser and Pulsed dye Laser (PDL) in the treatment of SA.Materials and Methods:Eighty-eight SA lesions in three female patients were included. Lesions on each half of the body were randomly enrolled in each group. Group 1 (n = 44) were treated by Fractional CO2 laser resurfacing and group 2 (n = 44) by a combination of PDL and Fractional CO2 laser, alternately. Digital Photographs were taken and the surface area of each lesion was measured digitally (using the PictZar Digital Planimetry Software) at the baseline and four weeks after treatment. The clinical improvement was assessed by comparison of the pre- and post-treatment photos and the participants’ views about their degree of improvement, using a 10-point verbal analog scale (VAS).Results:The mean surface area decreased significantly in both groups after treatment. The mean difference between the pre- and post-treatment surface area was 0.62 ± 053 for group 2 and 0.41 ± 0.43 for group 1 (P-value = 0.03). Mean VAS and dermatologist assessed improvement scale in group 2 (6.68 ± 0.77 and 2.2 ± 0.76 respectively) were significantly higher than those in group 1 (5.45 ± 0.90 and 1.8±0.72 respectively, P-value <0.001 and 0.04 respectively).Conclusion:The combination of PDL and fractional CO2 laser was more effective than fractional CO2 laser alone and could be suggested as a clinical option in the treatment of SA.

Treatment of basal cell carcinoma using a combination of pulsed dye laser and imiquimod – Case report and review

AbstractObjective:To evaluate the feasibility and efficacy of a pulsed dye laser (PDL) during a 5-week course of 5% topical imiquimod application in a patient with a nodular basal cell carcinoma (BCC) and to review the literature for data on PDL treatment of BCC.Methods:A 74-year-old patient with a 7-mm biopsy-proven BCC on his nose was treated with topical daily imiquimod for 2 weeks. Subsequently a laser session was performed with a flash lamp-pumped dye laser at 595 nm (Dermobeam 2000; Deka M.E.L.A., Florence, Italy) employing one pass with the following parameters: fluence 15 J/cmResults:Topical imiquimod was continued for a further 3 weeks after the PDL session with a minimal increase in irritation. The tumor cleared and there has been no recurrence for 12 months. The literature search revealed a total of 7 small studies that included 120 tumors, the majority treated with a 595-nm device (104/120). Overall 81/120 (67.5%) treated tumors have been assessed as complete responders. No differences were recorded in relapse rates in association with the localization of the tumor, the histology (superficial vs. non-superficial), the wavelength of the device employed (595 vs. 585 nm), or the application of dynamic cooling. From the treatment parameters, only the use of multiple vs. single PDL sessions affected the outcome favorably (Conclusion:The combination of PDL with imiquimod could be a promising approach for the treatment of BCC and should be further evaluated in future studies.

A Comparative Study on the Efficacy of Treatment with 585 nm Pulsed Dye Laser and Ultraviolet B-TL01 in Plaque Type Psoriasis

Narrow-band ultraviolet-B and pulsed dye laser (PDL) affect psoriasis but via different pathways. To compare the results of PDL with ultraviolet-B light therapy (UVB) and to look for synergism of both therapies in patients with plaque type psoriasis. In each eligible individual, four similar target plaques were selected, and halves of these plaques were treated using PDL, UVB, or a combination of PDL and UVB or were not treated. Results were recorded single-blind using the Physician's Global Assessment score at study enrolment and Week 13. Nonparametric, paired statistical tests were used to test for differences within and between therapies.The results were also analyzed after dichotomization of the changes in the Physician's Global Assessment score into responsive and nonresponsive to treatment. A significant improvement of the psoriasis lesions was noted at Week 13 (P<.001) with each therapy. No significant differences were noted between the therapies. Synergism of PDL and UVB was not observed. PDL is safe for treating plaque type psoriasis, but its efficacy is limited to a subgroup of patients. Combining PDL with UVB has no additional benefit.

Pulsed‐Dye Laser Treatment of Leg Telangiectasia: With and Without Simultaneous Sclerotherapy

Thirty consecutive female patients with red leg telangiectasia less than 0.2 mm in diameter were treated with a Candela SPTL-1 Pulsed Dye Laser (PDL) tuned to 585 nm with a pulse duration of 450 microseconds at energies ranging from 6.0 to 8.5 J/cm2 delivered through a 5-mm spot size to the entire length of the telangiectasia. Seven patients with 25 patches of telangiectatic matting after previous sclerotherapy were also treated. Twenty-seven patients with symmetrical telangiectatic patches or a large "starburst" telangiectatic flair that could be divided into two separate treatment sites were treated at one site with PDL alone, and at the other site with a combination of PDL followed immediately by sclerotherapy (SCL) with Polidocanol 0.1-0.25 ml per injection site at a concentration of either 0.25%, 0.5%, or 0.75%. PDL treatment is efficacious for both essential telangiectasia and vessels that arise through the phenomena of telangiectatic matting. Sixty-five percent of vessels are completely faded with treatment. PDL alone has a remarkably low incidence of adverse sequelae. Treatment is most efficacious if all vessels larger than 0.2 mm in diameter, especially varicose and reticular feeding veins, are treated first. Treatment results are not affected by vessel location. And post-treatment compression of this type of vessel appears unnecessary. Combination PDL/SCL treatment appears to offer no advantage to sclerotherapy treatment alone and has a significant degree of complications when treatment is limited to red telangiectasia less than 0.2 mm in diameter with the laser parameters utilized.