Flashlamp-pumped Dye Laser Research Articles

The effectiveness of flashlamp-pumped pulsed dye laser in conjunction with topical imiquimod treatment for rosacea

Rosacea is a chronic dermatosis with no cure. Our goal was to evaluate if the combination of flashlamp-pumped Pulsed Dye Laser (PDL) treatment with topical imiquimod could improve therapeutic outcomes. Fourty patients diagnosed with rosacea and aged between 16 and 53 years were assigned for three different types of treatment: i) PDL-only, ii) imiquimod-only, and iii) PDL + imiquimod. The PDL test sites received a single treatment with the VBeam laser (λ = 595 nm; spot size = 7 mm; tp = 1500 msec) at a dosage of 10 J/cm2 with cryogen spurt duration (30 msec) and the delay time (20 msec). For the test sites of PDL + imiquimod and imiquimod-only, the patients applied imiquimod topically to the test sites once a day for 1 month. Patients were followed-up at 1, 3, and 6 months. The primary efficacy was measured with a DermoSpectrometer. Patients were also monitored for adverse effects. Pair-wise analysis showed statistically significant differences between the blanching responses for the PDL + imiquimod and PDL-only and imiquimod-only treatments (p<0.005). Transient hyperpigmentation was noted in 5% (n=2) and 20% (n=8) of patients in the PDL + imiquimod and PDL-only treatment, respectively. Hyperpigmentation resolved spontaneously within 6 months. Permanent hypopigmentation or scarring was not observed. Superior blanching responses were obtained when using PDL + imiquimod than PDL-only or imiquimod-only treatment for rosacea. A larger number of patients are required to support the results of this study.

EXPERIMENTAL STUDIES OF CHARACTERISTICS OF A LIDAR EMITTER BASED ON A LAMP-PUMPED DYE LASER

The results of experimental studies of a flashlamp-pumped organic dye laser with a dispersion resonator are represented. Intracavity interferometers were used for narrowing the spectrum and the radiation frequency tuning. The results of the studies indicate that there is an optimal value for the length of the active element, at which the maximum values of the spectral brightness of the radiation, is realized.

Treatment of Telangiectasia Macularis Eruptiva Perstans with an Intense Pulsed Light Device

Telangiectasia macularis eruptiva perstans (TMEP) is a rare adult mastocytosis with prominent cutaneous manifestations including red to brown telangiectatic macules typically on the chest or limbs. TMEP can be a cause of morbidity with associated cutaneous findings (e.g. flushing, pruritus, ulcers) and extracutaneous symptoms (e.g. dyspnea, reflux, diarrhea, hypotension). Previous attempts to treat the cutaneous manifestations of TMEP include PUVA, topical steroids, electron beam radiation, and 585-nm flashlamp-pumped dye laser. We report the first case of successful treatment of the cutaneous findings of TMEP with intense pulsed light (IPL). The patient underwent 2 treatments with IPL spaced 3 months apart, and remained entirely clear at 14 months follow-up.

Factors Associatedwith with the Development of Striae Gravidarum

Abstract Background and aim: Striae Gravidarum is one of the common skin changes during pregnancy. There are several risk factors for striae development. The aim of this study was to survey of associated factors with the development of striae gravidarum. Materials and methods: A convenience sample of 325 primiparous women were assessed during the immediate postpartum period for evidence of SG. Data were collected by a questionnaire and physical examination. The presence and and severity of striae was evaluated by Davey’s score. To determine the possible risk factors for the development of SG, characteristics of women with and without striae were compared using chi square test, independent t test and logistic Regression. Findings: In 182 (81.3%) of participants striae gravidarum was developed. Development of SG in 174 of 182 women (95.6%) was on the abdomen, 110 of 182 (60.4%) was on the thighs and in 74 of 182 (40.6%) SG was developed on the breasts during their pregnancy. Mean and SD of Davey score in breast, abdomen and thighs were (1.08 ± 1.55), (4.31 ± 2.21) and (1.76 ± 2.02) respectively. Family history of SG in mother, weight gain and body mass index during pregnancy and newborn weight, were signi fi cantly associated with the development of SG. Conclusions: This study showed that genetic factors (family history of striae gravidarum) and physical factors (weight gain and body mass index during pregnancy) may have a significant role in development of striae gravidarum. Therefore, conducting studies in the future to identify how these factors can cause striae gravidarum seem to be helpful. Keywords: Striae Gravidarum, Striae, Prevalenceو Risk Factors. REFERENCES Atwal GS ML, Griffiths CE, Polson DW (2006) Striae Gravidarum in Primipae. British Journal of Dermatology . 155(5) 965-9. Chang AL Agredano YZ Kimball AB (2004) Risk Factors Associated with Striae Gravidarum. Journal of the American Academy of Dermatology , 51(6) 881-5. Cunningham FG, Bloom SL, Leveno KJ (2010) Williams Obstetrics 23rd Ed. New York: McGraw-Hill. Davey CM(1972) Factors Associated with the Occurrence of Striae Gravidarum. An International of Journal Obstetrics and Gynecology . 79(12) 1113-4. Durmazlar SPK, Eskioglu F(2009) Striae Gravidarum: Associated Factors in Turkish Primiparae. Journal of the Turkish Academy Dermatology , 3(4) 93401a. Fitzpatrick TB(1988) The Validity and Practicality of Sun-Reactive Skin Types I Through VI. Archives of Dermatology . 124(6) 869. Gabbe S.G. NJR, Simpson J.L (2002) Obstetrics: Normal and Problem Pregnancies . 4th Ed. New York (NY): Churchill Livingstone. Ghasemi A, Gorouhi F, Rashighi Firoozabadi M, Jafarian S, Firooz A (2007) Striae Gravidarum: Associated Factors. Journal of the European Academy of Dermatology and Venereology . 21(6) 743-6. Lerdpienpitayakul R, Manusirivithaya S, Wiriyasirivaj B, Lorwatthanasirikul J(2009) Prevalence and Risk Factors of Striae Gravidarum in Primiparae. Thai Journal of Obstetrics and Gynaecology . 17(2) 70-9 Liu D(1974) Letter:Striae gravidarum. Lancet. 1(7858) 625. McDaniel DH, Ash K, Zukowski M(1996) Treatment of Stretch Marks with the 585-nm Flashlamp-Pumped Pulsed Dye Laser. Dermatologic Surgery . 22(4) 332-8. Osman H, Rubeiz N, Tamim H, Nassar AH (2007) Risk Factors for the Development of Striae Gravidarum. American Journal of Obstetrics and Gynecology . 196(1) 62 e1-5. Ratree JO, Titapant V, Chuenwattana P, Tontisirin P (2008) Prevalence and Associate Factors for Striae Gravidarum. Journal of the Medical Association of Thailand = Chotmaihet Thangphaet . 91(4) 445-51. Salter SA, Batra RS, Rohrer TE, Kohli N, Kimball AB (2006) Striae and Pelvic Relaxation: Two Disorders of Connective Tissue with a Strong Association. Journal of Investigative Dermatology . 126(8) 1745-8. Shuster S. 1979. The Cause of Striae Distensae. Acta Dermato-Venereologica Supplementum , 59(85) 161. Thomas R, Liston W(2004) Clinical Associations of Striae Gravidarum. Journal of Obstetrics & Gynecology . 24(3) 270-1. Wade TR, Wade SL, Jones HE (1978) Skin Changes and Diseases Associated with Pregnancy. Obstetrics & Gynecology .52(2) 233-42. Watson R, Parry E, Humphries J, Jones C, Polson D, Kielty C, et al (1998) Fibrillin Microfibrils Are Reduced in Skin Exhibiting Striae Distensae. British Journal of Dermatology . 138(6) 931-7. Wong RC, Ellis CN. 1984. Physiologic Skin Changes in Pregnancy. Journal of the American Academy of Dermatology , 10(6) 929-40.

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.

Möglichkeiten und Grenzen der Farbstofflasertherapie bei kapillären Malformationen

Capillary malformations (port-wine stains) are observed in less than 1 % of neonates and may occur coincidentally with other vascular and nonvascular malformations. Two thirds of lesions occur in the head and neck area and may have important cosmetic and psychological implications for the patients. Treatment with flashlamp-pumped pulsed dye lasers is still the therapy of choice for capillary malformations and can be applied to infants. If the laser device is used appropriately, the rate of persistent side effects is low. Although laser treatment achieves good clearance in the majority of patients with capillary malformations, complete clearance is rare. New therapeutic options are thus urgently required.

A Randomized Controlled Trial to Optimize Indocyanine Green‐Augmented Diode Laser Therapy of Capillary Malformations

Indocyanine green (ICG)-augmented diode laser therapy (ICG + DL) represents a new treatment modality for capillary malformations (CM). However, an increase of the ICG-concentration or the use of an intense pulsed light (IPL) device as light source may further optimize treatment outcomes in CM. This proof-of-concept trial including 15 patients (skin type II to III) with CM evaluated the efficacy and safety of ICG-augmented diode laser therapy (808 nm) at a total dose of 4 mg/kg body weight (b.w.). Additionally, five patients with extensive CM received IPL therapy before and after ICG-administration (ICG + IPL). ICG was intravenously administered to 15 patients with CM at a total dose of 4 mg/kg b.w. Immediately after ICG injection, diode laser pulses with different radiant exposures (20-110 J/cm(2) ) were applied as one single treatment. Five patients with extensive CM additionally received IPL (555-950 nm) therapy. Safety and efficacy were assessed both 1 and 3 months after the single treatment by a blinded investigator and the patient. Furthermore, color of the CM was objectively measured by means of a color meter (colorStriker™, Eduard Mathai GmbH, Hannover, Germany). Treatment with the flashlamp-pumped pulsed dye laser (FPDL) and the IPL alone (five patients) served as reference treatment. According to the assessment by the patients and the blinded investigator, the clearance rate was slightly better after ICG + DL therapy than after FPDL treatment (P = 0.1, P = 0.8). In one out of five patients, IPL with and without ICG injection induced poor to moderate clearance of CM and persisting erythema in another patient. The correlation between the visual assessment by the blinded investigator and the colorimetric measurements was poor. A minority of patients with CM may benefit from ICG + DL therapy, but efficacy cannot be improved by higher ICG doses.

Indocyanine green-augmented diode laser treatment of port-wine stains: clinical and histological evidence for a new treatment option from a randomized controlled trial

Complete clearance of port-wine stains (PWS) is difficult to achieve, mainly because of the resistance of small blood vessels to laser irradiation. Indocyanine green (ICG)-augmented diode laser treatment (ICG+DL) may overcome this problem. To evaluate the feasibility of ICG+DL therapy of PWS and to compare the safety and efficacy of ICG+DL with the standard treatment, flashlamp-pumped pulsed dye laser (FPDL). In a prospective randomized controlled clinical study, 31 patients with PWS were treated with FPDL (λ(em)=585 nm, 6 J cm(-2) , 0.45 ms pulse duration) and ICG+DL (λ(em)=810 nm, 20-50 J cm(-2) , 10-25 ms pulse duration, ICG-concentration: 2 mg kg(-1) body weight) in a split-face modus in one single treatment setting that included histological examination (haematoxylin and eosin, CD34). Two blinded investigators and the patients assessed clearance rate, cosmetic appearance and side-effects up to 3 months after treatment. ICG+DL therapy induced photocoagulation of medium and large blood vessels (>20 μm diameter) but not of small blood vessels. According to the investigators' assessment, clearance rates and cosmetic appearance were better after ICG+DL therapy than after FPDL treatment (P=0.114, P=0.291, respectively), although not up to a statistically significant level, whereas patients considered these parameters superior (P=0.003, P=0.006, respectively). On a 10-point scale indicating pain during treatment, patients rated ICG+DL to be more painful (5.81 ± 2.12) than FPDL treatment (1.61 ± 1.84). ICG+DL represents a new and promising treatment modality for PWS, but laser parameters and ICG concentration need to be further optimized.

Flashlamp-pumped pulsed dye laser (595 nm) for the treatment of port-wine stains: a clinical review of 1560 patients

Objective To evaluate the efficacy and safety of a 595-nm flashlamp-pumped pulsed dye laser in the treatment of patients at different ages with port-wine stains (PWS).Methods A retrospective review was performed in 1560 patients with PWS who had been treated with a 595-nm flashlamp-pumped pulsed dye laser.Treatment parameters were selected according to the age of and types of lesions in patients.Results The total response rate was 76.73％ (1197/1560) in all of the patients.Clinical efficacy of the flashlamppumped pulsed dye laser was closely correlated with patients'age (x2 =83.47,P ＜ 0.01) and types of lesions (x2 =46.30,P ＜ 0.01 ).There was a low incidence of adverse reactions which were well tolerable.Conclusion The 595-nm flashlamp-pumped pulsed dye laser is safe and effective for the treatment of PWS.

An overview of clinical and experimental treatment modalities for port wine stains

Port wine stains (PWS) are the most common vascular malformation of the skin, occurring in 0.3% to 0.5% of the population. Noninvasive laser irradiation with flashlamp-pumped pulsed dye lasers (selective photothermolysis) currently comprises the gold standard treatment of PWS; however, the majority of PWS fail to clear completely after selective photothermolysis. In this review, the clinically used PWS treatment modalities (pulsed dye lasers, alexandrite lasers, neodymium:yttrium-aluminum-garnet lasers, and intense pulsed light) and techniques (combination approaches, multiple passes, and epidermal cooling) are discussed. Retrospective analysis of clinical studies published between 1990 and 2011 was performed to determine therapeutic efficacies for each clinically used modality/technique. In addition, factors that have resulted in the high degree of therapeutic recalcitrance are identified, and emerging experimental treatment strategies are addressed, including the use of photodynamic therapy, immunomodulators, angiogenesis inhibitors, hypobaric pressure, and site-specific pharmaco-laser therapy.

In vitro investigations of repulsion during laser lithotripsy using a pendulum set-up

Ureteroscopic laser lithotripsy is a commonly used technique to treat ureteral calculi.The type of energy source used is one of the main influences of retrograd calculi propulsion. Using a momentum pendulum under-water set-up the induced momentum and the initial velocity were investigated. Pulsed laser light from three different clinically available laser systems, including a Ho:YAG laser, a frequency-doubled double-pulse (second harmonic generation, SHG) Nd:YAG laser and a flash-lamp pumped dye (FLPD) laser, were transmitted via flexible fibres of different core diameter to the front of the pendulum sinker. Single pulses at variable pulse energy, according to the clinical laser parameter settings, were applied to the target sinker, thus causing a repulsion-induced deflection which was documented by video recording. The maximum deflection was determined. Solving the differential equation of a pendulum gives the initial velocity, the laser-induced momentum and the efficiency of momentum transfer. The induced deflection as well as the starting velocity of the two short-duration pulsed laser systems (SHG Nd:YAG, FLPD) were similar (s (max) = 2-3.6cm and v (0) = 150-200mm/s, respectively), whereas both values were lower using the Ho:YAG laser with a long pulse duration (s (max) = 0.9--1.6cm and v (0) = 60-105mm/s, respectively). The momentum I induced by the Ho:YAG laser was only 50% and its transfer efficacy η (Repuls) was reduced to less than 5% of the values of the two short-pulsed laser systems. This investigation clearly showed the variable parts and amounts of repulsion using different pulsed lasers in an objective and reproducible manner. The momentum transfer efficiency could be determined without any physical friction problems. Further investigations are needed to compare stone fragmentation techniques with respect to laser repulsion and its clinical impact.

Update on Flashlamp Pumped Pulsed Dye Laser Treatment for Port Wine Stains (Capillary Malformation) Patients

Currently, the method of choice for the treatment of port-wine stains is laser photocoagulation. Because of evolving treatment options, it is no longer enough for port-wine stains merely to be lightened through laser treatment. The best course of management consists of the most appropriate laser that will produce the most complete clearing of a lesion in the fewest treatment sessions with the least morbidity. The goal is generally accomplished with the use of yellow-light lasers. Materials (Subjects) and Methods: Absorption of laser energy by melanin causes localized heating in the epidermis, which may, if not controlled, produce permanent complications such as hypertrophic scarring or dyspigmentation. Refinements of the results can be achieved by using the flashlamp-pumped pulsed dye laser (FLPDL) in conjunction with the cryogen spray cooling (CSC) system. In our related studies, the infrared thermal image instrument is used for doctors in determining the optimum laser light dosage and preventing the side effects caused by FLPDL. Topic application of angiogenesis inhibitor (Imiquimod) in conjunction with pulsed dye laser treatment for the PWS patients has been assessed for improvement of FLPDL treatment. We present the clinical effect of FLPDL, and the efficacy and safety of cooled laser treatment of PWS birthmarks. Our clinical outcome in the laser treatment of patients with PWS has been achieved to maximize thermal impact on targeted vessels, while minimizing adverse complications. CSC in conjunction with FLPDL can improve the treatment of PWS. The infrared image instrument is helpful for doctors in determining the optimum laser light dosage. Topic application of angiogenesis inhibitor (Imiquimod) in conjunction with laser treatment for the PWS patients is promising in the near future.

Effect of pulsed dye laser on intercellular adhesion molecule-1 (ICAM-1) expression after treatment of psoriasis

Intercellular adhesion molecule-1 (ICAM-1) is a member of the immunoglobulin super family of adhesion molecules that plays a role in transendothelial migration and adhesion processes involved in the pathogenesis of psoriasis. Previous studies have demonstrated partial and total clearance of psoriasis by selective photothermolysis of dermal vessels with the pulsed dye laser. The aim of this study is to assess the efficacy of the pulsed dye laser (PDL) in treatment of chronic psoriatic plaque lesions by measuring changes in ICAM-1 expression in the epidermis and dermis of psoriatic patients before, during and after treatment, with correlation to the clinical improvement. Sixty patients with chronic plaque psoriasis were treated with flashlamp-pumped pulsed dye laser (FPDL) with 585 nm wavelength, 450 μs pulse duration, 7–8.5 J/cm2 fluence, and 7 mm spot size. Sessions were performed every 2 weeks with each patient receiving a total of 3 sessions. Clinical, histological, and immunohistochemical assessments were carried out. A correlation between plaque severity score (sum score) and changes in the mean of ICAM-1 expression was assessed throughout and after treatment. Reduction of ICAM-1 expression mean in psoriatic lesion was 1.83 ± 0.29 at week 2, 1.60 ± 0.19 at week 4, and 1.53 ± 0.18 at week 6 from the start of the laser treatment, compared to the baseline which was 2.90 ± 0.40. In the control group, ICAM-1 expression was 0.60 ± 0.07. A significant correlation between clinical improvement and reduction in ICAM-1 expression at weeks 4 and 6 of laser treatment was proven (p < 0.05). ICAM-1 expression is reduced significantly after treatment of psoriasis with pulsed dye laser, which can be used as an indicator for its efficacy. Das Adhäsionsmolekül ICAM-1 gehört der Immunglobulinsuperfamilie an und spielt eine wichtige Rolle in der Pathogenese der Schuppenflechte (Psoriasis). Frühere Studien haben gezeigt, dass eine partielle oder vollständige Beschwerdefreiheit („clearance“) durch Photothermolyse dermaler Gefäße mittels Farbstofflaser erzielt werden kann. Ziel der vorgelegten Studie war es, die Effektivität des Farbstofflasers in der Behandlung der Psoriasis zu evaluieren, indem Änderungen der ICAM-1-Expression vor, während und nach der Laserbehandlung in Korrelation zur klinischen Verbesserung des Hautbildes gemessen wurden. Es wurden 60 Patienten mit chronischer Schuppenflechte mit einem Blitzlampen-gepumpten Farbstofflaser (Wellenlänge: 585 nm, Pulslänge: 450 μs, Bestrahlung: 7–8.5 J/cm2, Spotgröße: 7 mm) behandelt. Jeder Patient erhielt insgesamt 3 Laserbestrahlungen im Abstand von jeweils 2 Wochen. Vor und nach Laserbehandlung wurden der jeweilige klinische, histologische und immunhistologische Status erfasst. Es wurde ein Summen-Index zur Ermittlung des Schweregrades der Psoriasis-Erkrankung bestimmt und mit den ermittelten Werten für die ICAM-1-Expression korreliert. Es konnte eine Reduktion der ICAM-1-Werte beobachtet werden ausgehend von 1.83 ± 0.29 nach 2 Wochen, auf 1.60 ± 0.19 nach 4 Wochen und 1.53 ± 0.18 nach 6 Wochen nach Beginn der Laserbehandlung verglichen mit einem Anfangswert von durchschnittlich 2.90 ± 0.40 vor der Behandlung. In einer gesunden Vergleichsgruppe betrug die ICAM-1-Expression 0.60 ± 0.07. Es bestand ein signifikanter Zusammenhang zwischen der klinischen Verbesserung des Beschwerdegrades und der ICAM-1-Reduktion 4 bzw. 6 Wochen nach Beginn der Lasertherapie (p < 0.05). Die ICAM-1-Expression war nach Laserbehandlung mit einem gepulsten Farbstofflaser signifikant reduziert und kann daher als Indikator für eine effektive Behandlung der Psoriasis genutzt werden.

Comparison of two dye lasers in the treatment of port-wine stains

Port-wine stains (PWS) are congenital capillary malformations that persist throughout life. Laser therapy is a common treatment for PWS, and pulsed-dye laser is the current treatment of choice. To compare the clinical results on untreated PWS of two dye lasers with different wavelengths and pulse duration: a flashlamp-pumped dye laser (FPDL) and a long-pulse-duration dye laser (LPDL). In total, 24 patients were treated on 4-6 test areas with both laser types using high-energy and low-energy fluences. An FPDL with 0.45 ms pulse duration tuned to 585 nm was compared with an LPDL with 1.5 or 3.0 ms pulse duration tuned to 595 nm. Twelve weeks later the degree of lightening was evaluated by a blinded assessor. Pain was assessed directly after treatment with both lasers, using a visual analogue scale. There was no significant difference overall between the two systems in lightening of the lesion or in patient-reported pain. Both laser systems are equivalent in terms of efficacy and pain.

Lasertherapie infantiler Hämangiome und anderer kongenitaler vaskulärer Tumore des Säuglings- und Kleinkindalters

As a high rate of spontaneous regression exists for infantile haemangioma, the indication for an active therapy is rare. On the other hand excessive growth can cause permanent defects. Thus, an early differential diagnosis and indication for therapy are necessary. Besides the phase, the localisation and the behaviour are the keys for complications and therefore crucial for the indication. The most important investigation for correct diagnosis as well as for exact determination of the phase and expansion is colour-coded duplex sonography (CCDS). This is an essential prerequisite for an adjusted haemangioma therapy. For the congenital haemangioendothelioma the type and therefore the behaviour determine the indication for therapy. In Kaposiform haemangioendotheliomas, the Kasabach-Merritt phenomenon with disseminated intravasal coagulopathia is the major complication. By means of an early laser therapy these complication can be avoided or reduced. Important is the correct selection of the laser type and laser proce-dure. For superficial strong intracutaneous early stages of infantile haemangioma with less than 3 mm thickness, the flashlamp pumped dye laser (FLPDL) is a good option and superior to cryotherapy because with the FLPDL even larger flat haemangiomas can be treated without epithelial damage. For thicker and primary subcutaneous haemangiomas this laser is not suitable. This is an indication for the cw Nd:YAG-laser applied transcutaneously with ice-cube cooling or mucously in the impression technique. These haemangiomas with a thickness of up to 30 mm are treatable without any epithelial damage. More voluminous or primary deep subcutaneous haemangiomas are interstitially treated with the CCDS-controlled puncture technique. Especially subglottic or tracheal haemangiomas can be treated endoscopically so early that a tracheostomy can be avoided. However, in these haemangiomas and even in periorbital haemangiomas an adjuvant prednisolone therapy is obligatory. Also in Kaposiform haemangioendotheliomas with Kasabach-Merritt phenomenon an adjuvant prednisolone therapy is necessary. The intercurrent laser therapy, preferably transcutaneous Nd:YAG laser with ice-cube cooling, induces the regression and prevents the rebound effect after finishing the prednisolone therapy, so even here a short-term prednisolone therapy is sufficient.

Successful Treatment of Cutaneous Sarcoidosis Lesions with the Flashlamp Pumped Pulsed Dye Laser

We report on the successful treatment of nodular cutaneous sarcoidosis lesions using a flashlamp pumped pulsed dye laser (FPDL). After a test treatment session with FPDL, we were able to achieve complete remission of the treated skin lesions. The nontreated areas increased in size and served as a control. The patient has since undergone further treatments of the remaining areas, with complete clearance of all lesions after a follow-up of 28 months.

Lasertherapie infantiler Hämangiome und anderer kongenitaler vaskulärer Tumore des Säuglings- und Kleinkindalters

Da die infantilen Hämangiome eine hohe Rate der Spontanregression zeigen, muss einerseits die Indikation zu einer Therapie streng gestellt werden, andererseits kann exzessives Wachstum zu bleibenden Schäden führen, so dass eine frühzeitige Differentialdiagnose und damit Indikationsstellung erforderlich ist. Neben dem Stadium sind die Lokalisation und das Wachstumsverhalten für Komplikationen und damit für die Indikation zur Therapie entscheidend. Die wichtigste Untersuchungsmethode, mit der sowohl eine Artdiagnose, exakte Bestimmung des Stadiums und der Ausdehnung möglich ist, ist die Farbkodierte Duplexsonografie (FKDS). Sie ist somit die Säule einer adjustierten Hämangiomtherapie. Bei den kongenitalen Hämangioendotheliomen bestimmt der Typ und somit die Verlaufsform die Therapieindikation. Bei den kaposiformen Hämangioendotheliomen stellt die Kasabach-Merritt-Symptomatik mit disseminierter Koagulopathie die Hauptkomplikation dar. Durch eine frühzeitige Lasertherapie können diese Komplikationen verhindert, zumindest in ihrer Schwere vermindert werden. Entscheidend ist die korrekte Auswahl der Lasertypen und der Laserverfahren. Für oberflächliche rein intrakutane Frühstadien der infantilen Hämangiome mit einer Dicke von weniger 3 mm ist der Farbstofflaser eine wichtige Behandlungsoption und der Kryotherapie überlegen, damit dem FLPDL auch großflächige infantile Hämangiome behandelt werden können und mit geeigneten Kühlverfahren eine Epithelverletzung vermieden werden kann. Er versagt aber bei allen dickeren und vor allem den subkutanen Hämangiomen. Diese werden mit dem cw-Nd:YAG Laser entweder transkutan mit Eiswürfelkühlung oder mukosal in Impressionstechnik behandelt. Damit sind Hämangiomdicken von bis zu 30 mm sicher ohne Oberflächenverbrennung zu behandeln. Voluminösere oder primär tief subkutan gelegene Hämangiome werden nach Farbduplexsonografie gesteuerter Punktion interstitiell behandelt. Insbesondere subglottische und tracheale Hämangiome können endoskopisch so rechtzeitig behandelt werden, dass eine Tracheotomie verhindert werden kann. Jedoch ist bei diesen Hämangiomen, genauso wie bei ausgedehnten periorbitalen Hämangiomen immer eine adjuvante kurzzeitige Hochdosis-Prednisolon-Therapie erforderlich. Auch bei kaposiformen Hämangioendotheliomen mit Zeichen einer Kasabach-Merritt-Symptomatik ist eine adjuvante Prednisolon-Therapie notwendig. Die intercurrente Lasertherapie, vorzugsweise transkutane Nd:YAG-Laser mit Eiswürfelkühlung leitet die Regression ein und verhindert so den Rebound-Effekt nach Absetzen des Prednisolon, so dass auch hier eine kurzzeitige Therapie ausreichend ist.

Vascular based non conventional dye laser treatment for basal cell carcinoma

Basal cell carcinoma is the most common skin tumor in humans which can be removed in a variety of ways (depending on the type of the lesion, the affected area, and depth of the lesion). Laser therapy offers another option to the traditional methods of treatment; thus, the purpose of this work is to valuate the efficacy of dye laser in a selected group of patients affected by superficial basal cell carcinoma. We suggest that the success of pulse dye laser treatment lies in the fact that as all tumors, basal cell carcinomas contain an increased number of dilated blood vessels. Twenty patients (eight males and 12 females) with superficial basal cell carcinoma were given five treatments with a flashlamp-pumped pulse dye laser every 20 days. The clinical follow up was 12-24 months after the fifth treatment. A complete response was obtained in 16 patients out of 20. Three recurrences and one no response was observed during the study. Pulse dye laser is effective and safe in the treatment of superficial basal cell carcinoma.

New data on the variation of laser induced retinal-damage threshold with retinal image size

In earlier studies, we examined the dependence of the laser induced retinal damage threshold on retinal image size for extended-source ocular exposures. We reported the spot-size dependence of the retinal threshold (based on ophthalmic observations at 24 h postexposure) for two pulsewidth regimes: nanosecond-duration (Q-switched) pulses from a doubled Nd:yttrium–aluminum–garnet laser and microsecond-duration pulses from a flashlamp-pumped dye laser at 590 nm. In either case, the retinal threshold was shown to vary with the area (i.e., diameter squared) for image diameters &amp;gt;5 mrad. More recently, we have collected additional data for the intermediate spot-size range (1.5–10 mrad) and have compared both the absolute values and the spot-size trend of retinal thresholds determined via ophthalmoscopic observation at 1 h postexposure to the analogous threshold data collected with observations at 24 h postexposure. These additional data and analyses reinforce our earlier conclusions regarding the threshold vs. spot-size trend and are compared to and reconciled with results from previously published extended-source ocular damage studies. The experimental spot-size trends are also contrasted to the existing laser safety standard treatments of maximum permissible exposure levels for extended-source ocular exposures.

Laser treatment of scars and keloids – How we do it

The existence of scars may present considerable problems for patients. As well as being sometimes disfiguring and having an influence on a person's perception of him or herself, hypertrophic scars and keloids can often also cause pruritus, dysesthesia and pain, and can form strictures. Since the first attempts to influence hypertrophic scars and keloids with lasers, many refinements in the technology and improved laser treatment techniques have taken place. Flashlamp-pumped dye lasers and near infrared (NIR) lasers are the most frequently used lasers for hypertrophic scar treatment, whereas CO2 and Er:YAG lasers are preferred to diminish atrophic scars. Non-ablative skin remodeling may be used for minor changes. Lasers and other intensive light sources can also play a role in prevention of scars, and new strategies for acne treatment are on the horizon. Narben können Patienten erhebliche Probleme bereiten. Neben der manchmal entstellenden Wirkung können sie zu Juckreiz, Dysaesthesien und Schmerzen führen oder durch Kontrakturen die Bewegung einschränken. Seit den ersten Laserbehandlungen sind durch technologische Verbesserungen sowie eine verbesserte Technik der Anwendung deutliche Fortschritte erreicht worden. Blitzlampen-gepumpte Farbstofflaser und Nahinfrarot (NIR)-Laser sind heute in der Behandlung hypertropher Narben und Keloiden am weitesten verbreitet. CO2- und Erbium:YAG-Laser werden zur Behandlung von atrophen Narben genutzt. Nicht ablative Verfahren können bei weniger ausgeprägten Veränderungen genutzt werden. Laser und andere intensive Lichtquellen spielen heute auch eine Rolle in der Vorbeugung von Narben und als therapeutische Option in der Behandlung der floriden Akne.