Flashlamp-pumped Pulsed Dye Laser Research Articles

Verrucae vulgares. Treatment with 585 nm flashlamp pumped pulsed dye laser

Various approaches have been taken in the management of verrucae vulgares, but a treatment of choice has not been established. Over a period of 12 months, 99 Patients with recalcitrant or untreated verrucae vulgares on their hands or feet (2:1) were treated with a 585 nm flashlamp pumped pulsed dye laser (FPDL) every 2 to 4 weeks. Laser parameters were: energy density 8 J/cm2, spot size 7 mm, pulse duration 450 microseconds. No topical measures were employed during the course of laser treatment. 93 patients finished the study, as 6 were lost to follow-up. Up to 8 laser treatments led to 63% total remission and 22% partial remission, 15% did not respond to this type of management. Relapses were not found in a follow-up period of 2 to 6 months. FPDL is efficient for the removal/reduction of verrucae vulgares and does not requires less patient compliance than other treatment options.

The Treatment of Facial Verrucae With the Pulsed Dye Laser

To evaluate the treatment of facial verrucae with the pulsed dye laser. A prospective, nonrandomized, nonblinded pilot study evaluating the treatment of facial verrucae with the pulsed dye laser. Twelve patients with facial verrucae (four recalcitrant) were identified and followed in the study in the setting of a tertiary referral center. The treatment consisted of the flash-lamp pumped pulsed dye laser (585 mn) with a spot size of 5 mm at fluences between 9.0 and 13 J/cm. Each lesion received one or two pulses with 2 mm of surrounding normal skin included in the treatment. One patient had paring prior to pulse treatment. The patients were examined 3 to 4 weeks after each procedure, and clinical assessment of the lesion was documented. Patient ages ranged from 18 to 47 years. Four patients had refractory lesions, and eight patients had never undergone previous treatment. All 12 patients had full resolution of their facial warts after one to three treatment sessions. No complications such as scarring, alopecia, or recurrence were encountered. Follow-up ranged from 10 to 33 months. Pulsed dye laser therapy is highly effective and safe therapy for facial verrucae. This method appears to selectively destroy warts without damaging surrounding skin.

Correlations between light penetration into skin and the therapeutic outcome following laser therapy of port-wine stains.

For several years the flashlamp-pumped pulsed dye laser (FPDL) has been the favoured method for the treatment of port-wine stains (PWS). The therapeutic outcome of FPDL laser therapy depends on the anatomical location of the PWS and is mainly attributed to morphological parameters such as size and depth of the PWS blood vessels. The aim of this study was to show a correlation between the therapeutic outcome following FPDL therapy and the optical properties of the skin overlying the PWS vessels. For this purpose the therapeutic outcome following FPDL treatment (585 nm; 0.45 ms) of 884 PWS situated on different body sites was evaluated by judging the grade of fading of PWS colour. On the other hand the light penetration into 123 skin samples (thickness 0.10-1.35 mm) was determined between 450 nm and 1030 nm and compared with the PWS laser therapy outcome for equal locations by statistical analysis. PWS on the neck, trunk, arms or legs yielded a higher mean grade of fading as compared to PWS on the head. Within the face, a wide range of fading was evident. The light penetration into skin increased linearly with increasing wavelength and location-dependent differences were found. The attenuation coefficient was 22.8+/-5.3 mm(-1) at 585 nm. No significant or strong correlation was observed between the therapeutic outcome of PWS laser therapy and the light penetration into skin. However, a correlation was obvious by plotting the respective profile plots. Therefore, among other effects, in particular morphological parameters of PWS vessels, the optical properties of the skin contribute to a small extent to the clinical outcome of PWS laser therapy.

Recent advances in laser therapy for the treatment of cutaneous vascular disorders.

The use of lasers for the treatment of cutaneous vascular disorders has expanded rapidly since its inception in the early 1960s. The flashlamp-pumped pulsed tunable dye laser (PDL), which is the best laser system for the treatment of port-wine stains (PWS), is based on the premise of selective photothermolysis. Recent literature demonstrates enhanced selective photothermolysis by modifying the PDL to include a longer pulse width, a longer wavelength and higher energy fluences through the use of dynamic cooling. Multiple pulse laser irradiation, a new innovative method, shows promising preliminary results in eradicating hypertrophic PWS. In the treatment of capillary haemangiomas, previous uncontrolled studies suggest benefit with early PDL therapy but a recent randomised controlled trial does not support this claim. Mixed haemangiomas respond poorly to PDL treatment, uncomplicated tumours are best left to involute spontaneously whilst life/organ-threatening lesions require early active intervention. The efficacy of lasers in the treatment of telangiectatic leg veins (TLV) remains controversial. The literature revealed many conflicting claims. Larger and properly controlled studies are necessary to better define the role of lasers in the treatment of TLV.

Energy density and numbers of treatment affect response of keloidal and hypertrophic sternotomy scars to the 585-nm flashlamp-pumped pulsed-dye laser

Background: The 585-nm flashlamp-pumped pulsed-dye laser (PDL) has proven to be the treatment of choice for certain keloids and hypertrophic scars, but the precise fluence, numbers of treatment, and treatment interval remain anecdotal. Objective: This study was performed to determine whether the therapeutic outcome of the PDL varies with the energy density (fluence) of the laser pulses and numbers of treatment. Method: Ten previously untreated, erythematous, keloidal or hypertrophic median sternotomy scars of 10 patients were divided into 4 segments and were randomly treated with a 585-nm PDL at a fluence of 3, 5, and 7 J/cm2 to 3 of 4 segments every 4 weeks for a total of 6 treatment sessions. One segment of each patient's scars was untreated and served as a control. Clinical improvement including scar height, erythema, and pliability was evaluated before treatment and every 8 weeks for a total period of 32 weeks. Self-assessment was also determined by patients on a 25% increment of improvement scale comparing week 0 and week 32. Results: A significant improvement in scar height, erythema, and pliability was noted in all laser-treated scar areas. There was no significant difference in treatment outcome versus the fluence of the laser (3, 5, and 7 J/cm2), although there was a trend for lower fluences to show more improvement. Objective clinical improvement was seen as early as week 16, after more than two treatments were given. Multiple treatments (>2) appeared to provide a greater percentage of scar resolution. Conclusions: The clinical improvement of scars after PDL treatment demonstrates no statistically significant fluence dependence in this study, but a trend toward better response with lower fluences is seen. In addition, multiple treatment sessions are suggested for achieving greater response. (J Am Acad Dermatol 2001;45:557-65.)

Prediction of portwine stain clearance and required number of flashlamp pumped pulsed dye laser treatments.

Portwine stain (PWS) response to flashlamp pumped pulsed dye laser (FPPDL) treatment is variable and unpredictable. Our aim was to develop a model to predict treatment outcome and the required number of treatments. We hypothesized that PWS clearance decreases exponentially with the number of treatments, as a consequence of the exponential decrease of laser light fluence in human skin. Of 70 patients with a PWS in the head/neck area, the color difference between normal skin and PWS was measured with a chromameter, prior to, and at several stages during FPPDL treatment. Through the obtained values of each of the four color parameters, DeltaL*, Deltaa*, Deltab*, and DeltaE, mono-exponentially decreasing functions were fitted. All four color parameters showed decreasing exponential functions, with decay rates that were not significantly different, and a mean R(2) of 0.6, indicating a reliable fit-quality. Our model suggests that individual prediction of treatment outcome and the required number of treatments is possible in an early stage of FPPDL treatment of PWS, in theory already after one single laser treatment.

Lasers in plastic surgery

The laser is a relatively new tool in many branches of medicine. In particular, in the field of plastic surgery, lasers have found numerous applications. Laser light is produced by the stimulated emission of photons from the lasing medium. Lasers may be classified according to the lasing medium employed, the wavelength of the emitted light and the pulse duration. One of the main uses of lasers is in the treatment of vascular lesions such as port wine stain (PWS). The 585 nm flashlamp pumped pulsed dye laser (FPPDL) is particularly effective in this role. The principle of selective photothermolysis has allowed highly specific targeting of different tissue components. Newer lasers have been developed to treat pigmented lesions as well as primary and metastatic cutaneous malignancies. In cosmetic surgery, lasers have been developed for skin resurfacing and removal of wrinkles, tattoos and unwanted hair. There has been recent interest in the use of lasers to promote wound healing. Laser therapy is not without complications and the safety of both patient and operator must remain paramount. The future is likely to hold greater advances in this rapidly developing field.

Effect of the 585 nm Flashlamp-Pumped Pulsed Dye Laser for the Treatment of Keloids

Effect of the 585 nm Flashlamp-Pumped Pulsed Dye Laser for the Treatment of Keloids

Retrospective clinical comparison of hemangioma treatment by flashlamp‐pumped (585 nm) and frequency‐doubled Nd:YAG (532 nm) lasers

Background and Objective Laser therapy using the flashlamp-pumped pulsed dye laser (FPDL), along with contact cryotherapy, has proven to be an effective method with few side effects in the early treatment of superficial hemangiomas in infancy. The long-pulsed frequency-doubled Nd:YAG laser (VersaPulse®) is a new kind of laser whose efficacy and safety we examined in direct comparison with the FPDL. Study Design/Materials and Methods In a retrospective comparative study, we treated 50 infants with a total of 62 superficial hemangiomas. A total of 29 hemangiomas were treated with the FPDL (wavelength 585 nm, impulse duration 0.3–0.45 msec), 33 with the VersaPulse® (wavelength 532 nm, impulse duration 1–50 msec). Results With an average of 3.0 and 2.6 treatments (FPDL/VersaPulse® respectively), a cessation of growth or regressive tendency could be achieved in 93% and 70% of the hemangiomas, respectively. Complete regression occurred in 41% (FPDL) or 30% (VersaPulse®). Only in 7% (FPDL) or 18% (VersaPulse®) was there progression despite laser therapy. The side effect rates of both laser systems were low. Conclusion The FPDL has proven to be the slightly more effective treatment method in comparison and, therefore, remains the therapy of choice for the initial treatment. If parents wish to pursue further treatment in the regression phase of hemangiomas to optimize the cosmetic appearance, we recommend the VersaPulse® due to its low rates of side effects and painfulness. Lasers Surg. Med. 28:40–43, 2001. © 2001 Wiley-Liss, Inc.

From the Editors

Only seven years after the construction of the first laser by Maiman in 1960, the dermatologist Professor Leon Goldman/USA reported about the first therapeutic laser application in patients with vascular lesions and tattoos in his book Biomedical Aspects of the Laser. In the seventies and early eighties, mainly the argon and carbon dioxide laser were used because of their thermal destructive effects. Most important indications were port-wine stains, telyangiectasias, and the removal of tattoos. A mile stone in laser therapy was the principle of selective photo thermolysis published by Anderson and Parish in Science in 1983. The use of a wave length with high absorption in the target structure and a very short exposure time shorter than thermal relaxation time of the target structure and a sufficiently high energy density allowed the destruction of the target within the skin without damage to the surrounding tissue. Target structures were, for example, ectatic vessels of port-wine stains, tattoo pigment, or melanin-pigmented cells. Nowadays, lasers are an indispensable therapeutic tool in dermatology. They can be used for the treatment of vascular lesions such as port-wine stains, childhood hemangiomas and telyangiectasias, epidermal and organoid nevi, melanin pigmented lesions, tattoos, or benign tumors, inflammatory lesions, virus papillomas, sun-damaged skin, wrinkles, and for epilation. Analogous to the many indications for laser therapy, the number of applied lasers is also very high. Lasers used for selective photo thermolysis are pigmented lesion dye lasers (PLDL,510 nm), flash-lamp pumped pulsed dye lasers (FPDL, 585 nm), long-pulsed tuneable dye lasers (LPDL, 585–600 nm), Q-switched ruby lasers (694 nm), Q-switched Nd:YAG lasers (1064 nm), frequency doubled Q-switched Nd:YAG lasers (532 nm), Alexandrite lasers (755 nm), and diode lasers (800 nm). Apart from these laser units, argon lasers (488 and 514 nm), copper vapour lasers (515 and 578 nm), Krypton lasers (589 nm), and frequency doubled Nd:YAG lasers (532 nm) are also routinely used. Cw-Nd:YAG lasers (1064 nm) are mainly applied if unspecific coagulation of the tissue is warranted. Lasers for vaporisation and ablation include cw-CO2 lasers, pulsed CO2 lasers, CO2 lasers with scanner, and Erbium:YAG lasers. Since not every indication and laser can be covered in one single issue of the journal, topics and authors were selected according to areas of interest. This issue includes articles on ablative therapy with the Erbium:YAG laser, treatment of vascular lesions, analysis of different cooling devices, a study on laser epilation, and the therapy of neurofibromatosis. Two non-dermatological papers on “Indocyanine Green Therapy for Hypopigmented Choroidal Melanoma” and on “Optical Tomography for the Imaging of Rheumatoid Arthritis” describe techniques which are also important in dermatology. In summary, I believe that this issue of Medical Laser Application will be of interest to readers since the articles emphasise laser therapy with regard to the scientific point of view instead of more commercially orientated cosmetic aspects. This issue will help to define the important role of lasers in dermatotherapy.

The treatment of port wine stains with a dye laser: a study of 644 patients.

Between June 1989 and December 1996, the flashlamp pumped pulsed dye laser was used to treat port wine stains (PWS) in 644 patients, age range 3 months-93 years (mean 21). The efficacy of the treatment was assessed after more than one year of follow-up. Each factor that might affect the efficacy was then evaluated statistically. Broad lesions required more laser treatments than narrow lesions and clearing tended to start from the periphery of the lesion, indicating the three-dimensional depth of the broader PWS. Patients who had been given previous treatments such as argon laser required about two more laser treatments than those who had not, but there were no clear differences in the efficacy of dye laser treatment between the two groups.

Recurrence of port-wine stains after treatment with the flashlamp-pumped pulsed dye laser.

To assess the importance of the patient's age at the start of treatment of a port-wine stain (PWS) with the flashlamp-pumped pulsed dye laser (FPDL). FDPL treatment is safe and effective for PWSs, with a low risk of scarring and pigmentary changes. The degree of clearing of the lesion is, however, unpredictable, and the ideal time to start treatment has not yet been agreed. Patients/methods By means of a questionnaire, we investigated the frequency of recurrence in PWS in 147 patients after completion of treatment with the FPDL. In 24 patients (16.3%), partial redarkening of their PWS was observed. The patients who had a recurrence were not different from the group who did not regarding the colour of the PWS, the response to previous treatment or the frequency of side-effects. Children under 10 years of age did not show any PWS recurrence, at least in our group of patients. The age at the beginning of treatment may have an influence on the recurrence rate.

Update on the Clinical Management of Port Wine Stains

. Port wine stains (PWS) are congenital vascular malformations for which lasers are the treatment of choice. This article reviews laser optics in relation to PWS treatment and discusses the major laser and light source systems, including the flashlamp-pumped pulsed dye laser (FLPDL), cryogen spray cooling in combination with the FLPDL, the potassium titanyl phosphate (KTP) laser and the intense pulsed light source, currently utilised for this procedure. Future opportunities for therapeutic improvement are also considered.

Time-sequence histologic imaging of laser-treated cherry angiomas with in vivo confocal microscopy

Objective: To chronicle the pathophysiologic changes that occur subsequent to laser treatment of vascular lesions, we used a confocal scanning laser microscope that yields high-resolution microscopic images of skin in vivo. Methods: Cherry angiomas were treated with the 585-nm flashlamp-pumped pulsed-dye laser (PDL) and the 568-nm continuous-wave krypton laser. Repeated confocal reflectance imaging was performed before and immediately after treatment, as well as after several hours, 1 day, 2 days, 1 week, 2 weeks, 3 weeks, and 4 weeks. Results: Before treatment, confocal images revealed dilated blood vessels ranging from 10 to 50 μm in caliber, closely spaced at 5 to 50 μm apart. After PDL treatment, amorphous cords of refractile material conformed to the shape of the original vessels, followed by dark nonrefractile spaces where the vessels once were. Inflammation and necrosis ensued, with eventual replacement after 3 weeks by normal-appearing skin. After krypton laser treatment, dark nonrefractile spaces appeared immediately, with subsequent inflammation, necrosis, and eventual healing by 4 weeks. Conclusion: Confocal laser microscopic imaging elucidates the dynamic pathophysiologic events that occur after laser treatment of vascular lesions and has added insight into the different mechanisms of vessel damage induced by the PDL and krypton laser. (J Am Acad Dermatol 2000;43:37-41.)

7082 Pancreatoscopic laser lithotripsy (psll) of pancreatic duct stoned.

Introduction: We report the result of pancreatoscopic laser lithotripsy (PSLL) of pancreatic duct stones (PDS). Subjects and Methods: The subjects were 21 patients (18 male, 3 female) with pancreatitis by PDS at our department between 1993 and 1999. The laser used in this study was a flashlamp-pumped pulsed dye laser with a wavelength of 504nm. The laser energy was transmitted via a 320μm flexible quartz fiber. The pancreatoscope was a 1.67mm miniscope with an inner channel 0.55mm in diameter. This miniscope inserted with a 7Fr plastic sheath through a standard duodenoscope was used for transpapillary laser application under direct vision of PDS. The laser energy was transmitted to PDS through the fine laser fiber inserted via the channel. The laser pulses were applied at a repitation rate of 10Hz and an energy output of 30mJ. If the stones fragmented too slowly the energy was increased up to 100mJ provied precise targeting of PDS could be achieved. Extracorporeal shock wave lithotripsy (ESWL) was applied to the cases in which PDS could not be disintegrated completely by PSLL alone. According to therapeutic procedure, all patients were classified into three groups: PSLL group, combination (PSLL and ESWL) group, and ESWL group. We evaluated number and diameter of PDS, treatment period, total number of sessions, relief of pain and clearance of PDS for each group. Conclusion: PSLL is a very useful and effective technique in the treatment of symptomatic PDS.

Nonsurgical delay of cutaneous flaps using the flashlamp pumped pulsed dye laser.

The surgical delay procedure is an effective method for improving skin flap survival. However, it has many disadvantages, such as bleeding, infection, and pain. It also requires an additional operation and a long time for wound management. Nonsurgical delay has a great importance, but pharmacological efforts for delay phenomena have never found clinical application. In this study, the authors attempted to reproduce the delay phenomena via the flashlamp pumped dye laser. Forty Sprague-Dawley rats were studied in four groups of 10 rats each. The experimental and control flaps were on the same rat. Flaps were planned on the ventral skin of the rats, and were symmetrical, three sided, based caudally, and were 2 cm in width, extended to the measured midpoint between the xiphoid and the sternal notch. The laser was applied to the different areas of the experimental flaps 15 days before flap elevation. A week later flap survival was determined by overlaying millimeter-grid acetate paper. Full-surface and perimeter "lased" experimental flaps showed a marked increase in surviving areas when compared with the control flaps. This kind of flap delay has a great potential in clinic application.

Treatment of facial skin using combinations of CO2, Q-switched alexandrite, flashlamp-pumped pulsed dye, and Er:YAG lasers in the same treatment session.

Many patients who seek facial CO2 laser resurfacing for improvement of photodamage are also concerned with "dark circles" under their eyes (periorbital hyperpigmentation) and/or telangiectasia as well as various types of deep scars on their faces. CO2 laser resurfacing alone provides limited improvement for these problems. The purpose of this study was to demonstrate the conjunctive therapeutic effects of the CO2, Q-switched alexandrite, Er:YAG, and/or flashlamp-pumped pulsed dye lasers on facial skin treatments. Thirty patients who underwent CO2 laser resurfacing were treated with additional lasers specific for their cosmetic concerns. Twenty patients with facial telangiectasias were treated with the pulsed dye laser immediately prior to CO2 laser resurfacing. Eleven patients with periorbital hyperpigmentation were treated with the Q-switched alexandrite laser immediately following use of the pulsed CO2 laser. Eight patients having sharply defined acne scars were treated with the Er:YAG laser following use of the CO2 laser. All patients had peripheral feathering performed with the Er:YAG laser. Nine patients were treated with all four lasers. In addition to significant improvement of the wrinkle scores from the CO2 laser resurfacing, patients had 75-100% clearing of the periorbital hyperpigmentation. All patients with facial telangiectasia showed virtually 100% improvement. All deep wrinkles and sharply defined scars responded with combined CO2/Er:YAG laser better than with CO2 laser resurfacing alone. All feathering was more uniform, with a more subtle transition to nontreated skin. There were no complications that could be attributed to the simultaneous use of multiple lasers. For patients who present with multiple cosmetic complaints, combined treatment using appropriate lasers offers excellent therapeutic outcome.

Treatment of Verrucae with Flashlamp-pumped Pulsed Dye Laser

Treatment of Verrucae with Flashlamp-pumped Pulsed Dye Laser

Cutaneous lupus erythematosus-treatment with pulsed dye laser.

Because of its vascular selectivity, the flashlamp-pumped pulsed dye laser (585 nm) is efficacious in the treatment of vascular lesions and is successfully used for the treatment of port-wine stains and haemangiomas in children. Based on the encouraging results with these cutaneous vascular disorders, the cutaneous lesions of patients with lupus erythematosus (LE) have now also been treated with the pulsed dye laser. Cutaneous lesions in lupus erythematosus are often difficult to treat with readily available local therapeutic methods. We report here on a group of 12 patients whose LE lesions were treated with the pulsed dye laser. In 10 patients, the LE was limited to the skin, while two patients had systemic LE (SLE). Even in the two patients with SLE, a significant improvement of skin lesions was achieved. After a mean number of 51 laser sessions, a median clearance rate of 70% was attained for nine patients. In one case, the laser treatment failed to clear the lesions. Two patients did not show any visible improvement of the lesions, but pain and itching were significantly reduced. There were few side-effects. No prolonged laser-induced scarring occurred and in only two patients was hyperpigmentation seen, which had resolved completely after 4 and 5 months, respectively. During a median follow-up of 7 months (range: 3-32 months), only one patient (after a complete clearance of the skin lesions) had a small relapse. In summary, the pulsed dye laser is an effective therapy for the treatment of superficial skin lesions in LE.

The multilayer technique: A new and fast approach for flashlamp-pumped pulsed (FLPP) dye laser treatment of port-wine stains (preliminary reports).

The 585 nm flashlamp-pumped pulsed (FLPP) dye laser is an effective and established treatment for port-wine stains (PWSs) during childhood. Unfortunately, PWSs tend to darken in color and may thicken or develop nodules as the lesions age, thereby making treatment difficult in adult patients since they may require several laser sessions producing unpredictable results. The aim of this article is to present and discuss the results obtained in four adult patients with PWS by use of a new approach in FLPP dye laser treatment. The goal of this technique was to damage, during the same treatment, the lesions at both deep and superficial levels and to reduce the number of laser sessions required to obtain the most effective eradication of hypertrophied PWSs. Four patients (two men and two women aged 54, 57, 49, and 61, respectively) were referred for treatment of congenital hypertrophied PWS of the face. Every dye laser session consisted of two laser passes. During the first pass the wavelength ranged from 590 to 600 nm with a long pulse (1.500 microseconds), while the second pass was performed utilizing the classic short pulse (450 microseconds) and wavelength (585 nm). Successive treatments were performed at 6- to 8-week intervals. All four patients had a complete clearing of their PWS after a number of treatments, ranging from three to five sessions. Three of them (one man and the two women) experienced extremely mild blistering in a limited small area that healed in approximately 10 days without scarring. The laser sessions were well tolerated by all patients. None of the patients developed atrophic or hypertrophied scars or dyschromia. Our results show an excellent response in all patients with just a few treatments (three to five sessions) and, in spite of two passes, only mild side effects that are probably limited due to cooling of the skin. We also observed a flattening and reduction of the nodules.