Long-pulsed Dye Laser Research Articles

Comparison of clinical practice guidelines on radiation dermatitis: a narrative review.

Radiation dermatitis (RD) is a common side effect of radiation therapy (RT). While many different treatment strategies are currently used to address RD, there is a lack of consensus and RD prophylaxis and management guidelines have remained largely unchanged over the last 10years. This review aims to formulate unambiguous supportive care interventions by comparing RD clinical practice guidelines published between 2010 and 2021 by several organizations: Multinational Association for Supportive Care in Cancer (MASCC), British Columbia Cancer Agency (BCCA), Cancer Care Manitoba (CCMB), Oncology Nursing Society (ONS), Society and College of Radiographers (SCoR), and International Society of Nurses in Cancer Care (ISNCC). Areas of agreement and discordance were assessed among the MASCC, BCCA, CCMB, ONS, SCoR, and ISNCC guidelines. Treatment recommendations across guidelines for acute RD and chronic RT-induced skin toxicities have been summarized. The strongest agreement among the guidelines exists for the use of topical corticosteroids, silver sulfadiazine, washing, and deodorant. All guidelines recommend the use of topical corticosteroids, and washing with water and soap is consistently supported. There is minimal consensus on an optimal dressing or barrier film for RD prophylaxis or management. MASCC weakly recommends prophylactic use of silver sulfadiazine to reduce RD, while BCCA, CCMB, and SCoR recommend its use upon signs of infection. MASCC and CCMB recommend the use of a long-pulsed dye laser to manage telangiectasia, a late effect of RT. Given the extent of discordance among guideline recommendations, further research is recommended to establish optimal treatments for RD prophylaxis and management.

Treatments for infantile Hemangioma: A systematic review and network meta-analysis.

BackgroundInfantile hemangioma (IH) is common in children, which may bring about cosmetically disfiguring, functional impairment, and exhibiting complications. There had been various therapies and we aimed to assess the efficacy and adverse effects of different therapies through network meta-analysis.MethodsWe searched PubMed, Embase, Cochrane Library and Web of Science (from database inception to April 11, 2020) for studies assessing the efficacy, success rate and adverse effects. Direct pairwise comparison and a network meta-analysis under random effects were performed. We also assessed the ranking probability.FindingsA total of 30 randomized clinical trials with more than 20 different therapeutic regimens were identified. Treatment combined propranolol orally with laser could improve the curative effect than monotherapy. Laser with topical β blockers showed more efficiency than others whether in children under 6 months or not. The long-pulsed dye laser might be the best laser therapy. A higher dose and a longer treatment duration of propranolol orally achieved a higher success rate and increased side effects. Plus pulse dye laser with propranolol had the lowest incidence of adverse reactions, such as ulcer, color sink and color reduction.InterpretationA combination of β blockers and laser might be the first-line treatment of IHs and a longer pulsed dye laser is preferred.FundingNo funding was received.

Light therapies for acne.

Light therapies for acne.

Effective treatment for infantile hemangioma with long-pulsed dye laser with oral propranolol medication: a preliminary report.

To investigate the efficacy of our treatment of infantile hemangioma (IH)s retrospectively presenting as disfiguring or functionally threatening lesions. 25 infants with IH treated with long-pulsed dye laser or laser with or without propranolol. Tumor fading after treatment was evaluated using both color and size rating scales, before, during and after treatment. 6 infants were treated by laser, 11, oral propranolol and 8 using both treatments. Each treatment was effective for most IH with a median treatment duration of 7.7months for laser, and 13.3months for the latter two. Combination therapy was the most effective in both color-fading and size reduction by the 3rd month. Laser alone was most effective in color-fading with almost complete disappearance of most tumors. Oral propranolol to the three site-specific IHs was effective with disappearance of tumors. There were no apparent side effects related to laser treatment, but one infant suffered from allergy and another from bronchial asthma due to propranolol medication. Most IHs discolored and regressed considerably with these treatments, including complete disappearance of the three functionally threatening lesions. This combined approach is quite useful for accelerating tumor regression.

単純性血管腫に対する色素レーザー治療と問題点

The pulsed-dye laser has been a first choice treatment of a port-wine stain (PWS) since a quarter century ago, and the long-pulsed dye laser with a cold air cooling system is seen as the gold standard treatment for a PWS currently. Selectively the laser irradiation damaged an ectatic blood vessels of PWS without scarring, but the dye laser were limited to a depth and diameter of ectatic blood vessels. We observed significant redarkening of a PWS at long-term follow up after the dye laser therapy. Finally practical problems in dye laser treatment of PWS were discussed.

Efficacy of Early Intervention in Infantile Hemangiomas with Long-Pulsed Dye Laser

Efficacy of Early Intervention in Infantile Hemangiomas with Long-Pulsed Dye Laser

Evidence-based review of photodynamic therapy in the treatment of acne.

Photodynamic therapy (PDT) has been used for acne, however, the efficacy and safety need to be determined. To assess the effects and safety of PDT for acne using an evidence-based approach. Randomized controlled trials (RCTs) on the treatment of acne with PDT were identified by searching PubMed, CNKI and the Cochrane Library. A total of 14 RCTs involving 492 patients were included. Photosensitizers included aminolevulinic acid (ALA), methylaminolevulinate (MAL), and indole-3-acetic acid (IAA). Light sources included red light, pulsed dye laser (PDL), intense pulsed light (IPL), long-pulsed dye laser (LPDL) and green light. The PDT protocols, including ALA + red light, ALA + PDL, ALA + IPL, MAL + red light, and MAL + LPDL, all showed great efficacy on inflammatory lesions. ALA + red light also had effects on non-inflammatory lesions and sebum secretion. ALA + IPL and IAA + green light significantly decreased sebum secretion. Triple treatment protocols showed great improvement on inflammatory and non-inflammatory lesions. Increasing ALA concentration, ALA incubation time, PDT sessions, dose of light source or using occlusion for photosensitizers, or a combination of other treatments with PDT may achieve greater efficacy. The common side effects of PDT were tolerable and transient. Limited evidence indicates that PDT shows good efficacy in the treatment of acne with acceptable side effects. ALA + red light was shown to be the optimal choice. However, more RCTs are needed to determine the types and concentrations of photosensitizers and light sources, and the duration of light activation and incubation.

Solar Lentigines: Evaluating Pulsed Dye Laser (PDL) as an Effective Treatment Option.

Solar lentigines are among commonest cosmetic problems. There are many topical therapies suggested to treat these lesions including cryotherapy, chemical peeling with tri chloro acetic acid (TCA) and laser therapy with q-switched lasers as well as long pulsed lasers. Considering possible treatment side effects (PIH, scar) with cryotherapy and peeling in Iranian patients (darker skin types) it seems necessary to try to find alternative measures. The aim of the present study was to evaluate effect of long pulsed dye laser (LPDL) on lentigines via an objective method (computerized dermoscopy). Patients with pathologically confirmed lentigines were selected if they agreed to participate in the study,were not treated before, hadn't history of psoriasis, vitiligo, scar formation and were not pregnant. Letigines were dermoscopied before and after treatment with PDL (V-beam, 595nm, Candela Corp. Wayland, USA) using fluence of 10 joules,without DCD (dynamic cooling device) via extra compress lens provided with laser system.The resulting figures were compared by two academic unrelated dermatologists as well as by computerized analysis. Post laser side effects were treated with topical antibiotics and mild topical steroids. Patients were followed for six months after the end of the study to determine the rate of recurrence via dermoscopy of sites of previous lesions and also delayed side effects. A total of 21 patients with the same number of lesions, were included in the study.Mean age of patients was 54.2 years (±23.3) ranging from 39 to 71 years. Included patient swere 18 females and three males. From 21 treated lesions, 11 were located on the hands and 10 on the face. Comparing before and after photographs taken through dermoscopy system,revealed that approximately 57% of patients had more than 75% improvement. Mean pigment analysis score (calculated by computerized dermoscope software) was respectively 8 and 2 before and after PDL therapy, showing noticeable decrease in pigment density of lesions.Side effects were mild erythema and local irritation responding to topical mild steroids.No hypo or persistent hyper pigmentation or other delayed side effects was seen after six months follow up. One patient experienced transient hyper pigmentation of treatment site after treatment. During six months follow up, no recurrences were seen. In conclusion, PDL is a safe and effective option to treat lentigines if applied properly using compression method, especially in Iranian patients. However, further studies with larger sample size are required to confirm these results.

Protoporphyrin IX formation and photobleaching in different layers of normal human skin: Methyl‐ and hexylaminolevulinate and different light sources

Topical photodynamic therapy (PDT) is used for various skin disorders, and selective targeting of specific skin structures is desirable. The objective was to assess accumulation of PpIX fluorescence and photobleaching within skin layers using different photosensitizers and light sources. Normal human skin was tape-stripped and incubated with 20% methylaminolevulinate (MAL) or 20% hexylaminolevulinate (HAL) for 3h. Fluorescence microscopy quantified PpIX accumulation in epidermis, superficial, mid and deep dermis, down to 2mm. PpIX photobleaching by light-emitting diode (LED, 632nm, 18 and 37J/cm(2)), intense pulsed light (IPL, 500-650nm, 36 and 72J/cm(2)) and long-pulsed dye laser (LPDL, 595nm, 7.5 and 15J/cm(2)) was measured using fluorescence photography and microscopy. We found higher PpIX fluorescence intensities in epidermis and superficial dermis in HAL-incubated skin than MAL-incubated skin (P<0.001). In mid and deep dermis, fluorescence intensities were higher (37%) in HAL-treated skin than MAL-treated skin, although not significant (P=ns). At skin surface, photobleaching was significantly higher (90-98%) after LED illumination (18 and 37J/cm²) than IPL (29-53%, 36 and 72J/cm²) and LPDL (43-62%, 7 and 15J/cm²) (P<0.001). Within the skin, photobleaching was steady from epidermis to deep dermis by LED illumination (37J/cm², P=ns), but declined from epidermis to mid and deep dermis for IPL-treated skin and LPDL-treated skin (IPL 72J/cm²: 26-15%; LPDL 15J/cm²: 37-23%) (P<0.04). Clinically, erythema correlated linearly with MAL and HAL-induced photobleaching (r²=0.175, P<0.001). In conclusion, selective PpIX accumulation indicates HAL as an alternative to MAL for epidermal-targeted PDT. In clinically relevant doses, PpIX photobleaching throughout the skin was more profound following LED than LPDL and IPL exposure.

A retrospective analysis of the management of freckles and lentigines using four different pigment lasers on Asian skin

Background: The risk of post-inflammatory hyperpigmentation (PIH) is increased during freckles and lentigines treatment in Asians. Objective: To determine the effectiveness and safety of using 595-nm long pulsed dye laser (LPDL), 755-nm LP Alexandrite laser, 532-nm QS Nd:YAG laser and 532-nm LP potassium-titanyl-phosphate (KTP) laser for the treatment of freckles or lentigines in Asian patients. Methods: This is a retrospective study of 40 Chinese patients, who were divided into four groups based on treatment modality using four different pigment lasers. Each patient attended between 1 and 4 treatments (mean of 1.8), at 4–6 weeks intervals, depending on clinical response. Lesional clearance and PIH were assessed by two independent clinicians. Results: Statistically significant improvement of global and focal facial pigmentation was found after treatment with LPDL, QS Nd:YAG and LP KTP lasers. No significant improvement was found after LP Alexandrite laser. PIH risk was 20% after LP Alexandrite treatment, 10% with QS Nd:YAG, and absent after LPDL and LP KTP treatment. Conclusion: A long pulse laser and small spot size appear to reduce the risks of lentigines treatment in darker skin types.

Split‐face comparison of intense pulsed light with short‐ and long‐pulsed dye lasers for the treatment of port‐wine stains

So far, pulsed dye lasers have been regarded as the gold standard in the treatment of port-wine stains (PWS). Recently, intense pulsed light (IPL) has been reported to achieve more pronounced fading in some patients. To evaluate the efficacy and the side effects of IPL treatment of PWS in a direct comparison to the short-pulsed dye laser (SPDL) and the long-pulsed dye laser (LPDL). Test spots (n = 158) were applied with IPL (λ(em) = 555-950 nm, pulse duration: 8-14 milliseconds (single pulse), fluence: 11-17.3 J/cm(2)), the SPDL (λ(em) = 585 nm, pulse duration: 0.45 milliseconds, fluence: 6 J/cm(2)), and the LPDL (λ(em) = 585/590/595/600 nm, pulse duration: 1.5 milliseconds, fluence: 12/14/16/18 J/cm(2)) in a side-by-side modus in untreated (n = 11) and previously treated (n = 14) patients with PWS. Lesion clearance was evaluated by three blinded investigators based on follow-up photographs 6 weeks after treatment. Incidence of side effects was assessed. In previously untreated PWS as well as in pretreated PWS, IPL treatments were rated significantly (P<0.05) better than treatments with the SPDL. In both groups, IPL and LPDL treatments did not differ significantly. Side effects were few in all settings. In PWS resistant to dye laser therapy, IPL showed additional lesion clearance. The use of IPL increases the therapeutic possibilities in PWS.

Long‐pulsed dye laser vs. intense pulsed light for the treatment of facial telangiectasias: a randomized controlled trial

This study aims to compare the efficacy and adverse effects of long-pulsed dye laser (LPDL) and intense pulsed light (IPL) in the treatment of facial telangiectasias. We used intra-individual, randomized, controlled trial with split-face treatments and single-blind outcome evaluations in this study. Forty patients with symmetrically located facial telangiectasias received a series of three LPDL (V-beam, 595 nm, Candela Laser Corp.) and three IPL treatments (Ellipse Flex, PR and VL2 applicators, Danish Dermatologic Development) at 6-week intervals. Patients were evaluated 3 months after the final treatment. Outcome measures were clinical efficacy (five-point ordinal scale), pain (10-point numerical scale), adverse effects, patient satisfaction (10-point numerical scale) and preferred treatment. Thirty-nine of 40 patients completed the study. All but 2 patients obtained a reduction in facial telangiectasias from both IPL and LPDL treatments. Both treatments were effective with good or excellent response in 30 of 39 patients. The LPDL was superior in the overall reduction of telangiectasias by blinded photographic evaluations: Excellent clearance (75% to 100% vessel clearance) was found in 18 patients treated with LPDL (46%) and in 11 patients treated with IPL (28%) (P = 0.01). Patients experienced less pain from LPDL [4 (2-6)] than IPL treatments [7 (3-9)] (P < 0.001). No adverse effects (hypo-/hyperpigmentation or scarring) were seen from any of the treatments. Patients were satisfied with both LPDL [8 (2-10)] and IPL treatments [7 (2-10)] (P = 0.05). Twenty-five patients preferred the LPDL (64%), 8 patients preferred IPL (21%) and 6 patients had no preference (15%) (P < 0.001). This study was based on two specific types of laser and IPL equipment, which effectively clear telangiectasias; however, the most beneficial outcome was from the LPDL.

Hugoniot-Measurement Experiment for the Purpose of Improvement of Pressure Scale

Through shock-compression experiments, pressure-density relation of condensed matter can be directly and precisely determined. We have established the high-time-resolution streak photographic system using a long-pulsed dye laser equipped with both the powder gun and two-stage light gas gun. By using them accuracy of the measurement is much improved. We started the Hugoniot-measurement experiments on pressure-scale materials such as Au and MgO up to >200 GPa for the purpose of improvement of the pressure scales. We are now measuring the Hugoniots of Au and MgO as well as those of some metals (Al, Cu, Ta, W, etc.) to determine the Hugoniot data free from the Los Alamos data. In this article, the backgrounds and problems of the various pressure scales are reviewed, and our approach to establish pressure scales by means of the shock-compression at Kumamoto University is described.

High-Time-Resolution Streak Photographic System Equipped with Propellant Guns for Hugoniot Measurement of Solids

The high-time-resolution streak photographic system equipped with a powder gun and a two-stage light gas gun has been constructed for the Hugoniot measurement of solids at pressures up to >300 GPa. For this system, a compact rotating-mirror-type streak camera and a long-pulsed dye laser with no Q-switch were produced. A time resolution higher than 1 ns was achieved by using a 2-µm-wide slit of the camera formed using the laser. The shock velocity and particle velocity of steady shock waves of the materials with a shock velocity of ∼6 km/s can be measured by the inclined-mirror method with the basic errors of 0.2 and 0.1–0.2%, and 0.2 and 0.35–0.45% for symmetrical and asymmetrical impact, respectively, depending on shock velocity and impact velocity.

Intense pulsed light vs. long-pulsed dye laser treatment of telangiectasia after radiotherapy for breast cancer: a randomized split-lesion trial of two different treatments

Chronic radiodermatitis is a common sequela of treatment for breast cancer and potentially a psychologically distressing factor for the affected women. To evaluate the efficacy and adverse effects of treatments with a long-pulsed dye laser (LPDL) vs. intense pulsed light (IPL) in a randomized split-lesion trial. Thirteen female volunteers with radiodermatitis and Fitzpatrick skin types II-III were included in the study. Subjects received a series of three treatments at 6-week intervals with half-lesion LPDL (V-beam Perfecta, 595 nm) and half-lesion IPL (Ellipse Flex); the interventions were randomly assigned to left/right or upper/lower halves. Primary end-points were reduction in telangiectasia, patient satisfaction and preferred treatment. Secondary end-points were pain and adverse effects. Efficacy was registered by blinded photographic evaluations 3 months after the final treatment. Eleven patients completed the study. Telangiectasia cleared with both treatments but the efficacy of LPDL was superior. Blinded photographic evaluations showed median vessel clearances of 90% (LPDL) and 50% (IPL) (P = 0.01). LPDL treatments were associated with lower pain scores than IPL treatments [median visual analogue scale (VAS) score 4.3 and 6.0, respectively, P < 0.01]. Patients were slightly more satisfied with LPDL (median VAS score 8) than IPL treatments (median VAS score 7; P < 0.05) and more preferred LPDL (n = 9) to IPL (n = 2) (P < 0.01). Two patients withdrew from the study because of hypopigmentation of the IPL treated areas, which slowly repigmented within 1 year. This study was based on two specific laser and IPL devices, and found the LPDL treatment to be advantageous compared with IPL due to superior vessel clearance and less pain.

Long‐pulsed dye laser versus intense pulsed light for photodamaged skin: A randomized split‐face trial with blinded response evaluation

In a randomized controlled split-face trial to evaluate efficacy and adverse effects from rejuvenation with long-pulsed dye laser (LPDL) versus intense pulsed light (IPL). Twenty female volunteers with Fitzpatrick skin types I-III, classes I-II rhytids, and symmetrical split-face photodamage were included in the study. Subjects received a series of three treatments at 3-week intervals with half-face LPDL (V-beam Perfecta, 595 nm, Candela Laser Corporation) and half-face IPL (Ellipse Flex, Danish Dermatologic Development); the interventions being randomly assigned to left and right sides. Primary end-points were telangiectasias, irregular pigmentation and preferred treatment. Secondary end-points were skin texture, rhytids, pain, and adverse effects. Efficacy was evaluated by patient self-assessments and by blinded clinical on-site and photographic evaluations at 1, 3, and 6 months postoperatively. Adverse effects were evaluated by blinded clinical on-site evaluations. Telangiectasia improved from LPDL and IPL treatments with superior vessel clearance from LPDL treatments (postoperative side-to-side evaluations, patient self-assessments, P<or=0.031, 3, 6 months). Irregular pigmentation and skin texture improved from both treatments with no significant side-to-side differences. No reduction was seen of rhytides on LPDL- or IPL-treated sides. Treatment-related pain scores were significantly higher after IPL (medians 7-8) than LPDL (4.75-5.5) treatments (P<0.001). Adverse effects included erythema, oedema, and transient hyperpigmentation. Patients preferred LPDL- to IPL treatments (P<or=0.031). This study was based on two specific laser and IPL equipments, which found LPDL rejuvenation advantageous to IPL rejuvenation due to superior vessel clearance and less pain.

Long-pulsed dye laser versus long-pulsed dye laser-assisted photodynamic therapy for acne vulgaris: A randomized controlled trial

Long-pulsed dye laser (LPDL)-assisted photodynamic therapy has been suggested to be superior to laser alone for acne vulgaris but no evidence is available. To evaluate the efficacy and safety of LPDL alone versus LPDL in photodynamic therapy with methylaminolevulinic acid (MAL-LPDL) for acne vulgaris. Fifteen patients received a series of 3 full-face LPDL treatments and half-face prelaser MAL treatments; the latter being randomly assigned to the left or right side. Inflammatory lesions were reduced more on MAL-LPDL-treated than on LPDL-treated sides (week 4: 70% vs 50%, P = .003; week 12: 80% vs 67%, P = .004). Noninflammatory lesions reduced similarly. Patient satisfaction was slightly greater with MAL-LPDL versus LPDL treatments (scale 0-10: week 4: 7 vs 6, P = .034; week 12: 8 vs 7.5, P = .034). Fluorescence measurements detected photobleaching with MAL-LPDL (35.3%) and LPDL (7.3%) treatments (P < .001). Erythema, edema, and pustular eruptions intensified from MAL incubation. No patients experienced pigment changes or scarring. The sample size was limited. The split-face design in this randomized controlled trial does not allow us to draw conclusions about the efficacy of the LPDL, only about the efficacy of MAL-LPDL compared with LPDL alone. MAL-LPDL is slightly superior to LPDL for the treatment of inflammatory acne.

Long-Pulse Pulsed Dye Laser Delivered with Compression for Treatment of Facial Lentigines

The 595-nm long-pulsed dye laser (LPDL) has been used for the treatment of vascular lesions, and although it is well absorbed by blood, it is also well absorbed by melanin. To utilize this device for the treatment of facial lentigines, we attached a glass window to the tip of the laser's handpiece, allowing compression of the skin during treatment. This prospective study aims to evaluate the efficacy and complications of using a LPDL delivered with compression for the treatment of facial lentigines in Asian persons. Fifty-four Asian patients with facial lentigines were enrolled in this study. The laser settings included fluences between 9 and 13 J/cm(2) and a constant pulse duration of 1.5 ms. Cryogen spray cooling was not used. Thirty-eight patients showed excellent results, 14 patients showed good results, and 2 patients showed fair results. Hyperpigmentation was seen in 1 patient. LPDL delivered with the compression method is effective in the treatment of facial lentigines in Asian patients, and the side effect profile is minimal. The compression technique allows the traditional "vascular" LPDL to be used for treating a variety of pigmented lesions.

An evaluation of post-sclerotherapy laser compression and its efficacy in the treatment of leg telangiectasias

Objective: The use of graduated compression stockings is presently indicated in both surgical and non-surgical treatment of varicose veins. The role that it plays in therapeutic efficacy or the complication profile is yet to be determined. The present study examined the role of compression in the treatment of class I–II venulectasia, utilizing the Pulsed Dye Laser. Methods: Thirteen patients with leg vein size 0.5–1.0 mm in diameter were treated with the Long-Pulse Tuneable Dye Laser (Vbeam®). A surface area of 5 cm2 of vessels on bilaterally symmetric thighs was treated. Class II compression hose was applied immediately following treatment to the left thigh only and were left on during waking hours for a period of 7 days. Post-sclerotherapy results and complication profiles were analysed and graded after one treatment session by two independent blinded observers. Results: There was no significant difference in treatment-clearing parameters or side-effect profiles in the compressed versus non-compressed or control groups ( P≤0.05). Conclusion: Preliminary studies suggest that compression does not alter the therapeutic efficacy or complication profile of Pulsed Dye Laser treatment of class I–II venulectasia. Further studies on a larger patient population are in progress.

Long-Pulsed Dye Laser for the Treatment of Erythromelanosis Follicularis Faciei: Report of Two Clinical Cases

Two Japanese men complained of redness of their jowls and requested treatment of those areas. Examination revealed welldemarcated reddish-brown pigmentation with granular texture on both sides of the cheeks. The redness of the lesion was mainly caused by dilation of superficial vessels and vanished when pressure was applied. Both patients were diagnosed as EFF by the classical triad, which is composed of erythema, hyperpigmentation, and follicular prominence.