Pulsed Dye Laser Treatment Research Articles

Split‐face randomized treatment of facial telangiectasia comparing pulsed dye laser and an intense pulsed light handpiece

Facial telangiectasia and other vascular lesions have historically been effectively treated with the pulsed dye laser (PDL). This study compares the safety and efficacy of the PDL to an intense pulsed-light (IPL) handpiece with dual-band spectral absorption, shorter pulse widths, and constant output power. Sixteen subjects were enrolled with facial telangiectasia in this single-site study. Subjects were randomized to receive up to two split-face treatments 1 month apart with PDL on one side and IPL on the other. PDL treatments were performed at 595 nm with either a 10 or 7 mm spot at a fluence range of 8.1-14.5 J/cm(2), and either 10 or 40 mseconds pulse width. Zimmer air cooling (setting of 4) and ultrasound gel were used for patient comfort. IPL treatments were performed with a spectral range of 500-670 and 870-1,200 nm, a 10 mm × 15 mm spot, fluence range of 34-70 J/cm(2), either a 10 or 100 mseconds pulse width, and 5°C contact cooling. Safety assessments were conducted by the study investigator immediately, 48-96 hours and 1-2 months post-treatment. Independent, blinded-review assessments were conducted 3 months post-treatment. Efficacy was evaluated using a seven-point Telangiectasia Grading Scale (TGS: -1 to 5). Subject self-assessment data were also collected. The difference in incidence rate and severity of adverse side effects between the two devices were not statistically significant (P ≥ 0.39, Fisher's exact test) at any of the three evaluation periods. Per blinded-review assessment, the mean TGS score for both devices was 3.3 (IPL 95% CI: 2.8-3.7; PDL 95% CI: 2.9-3.8). The difference in blinded-ratings for the two devices were not statistically significant (P = 0.82, ANOVA for repeated measures). The IPL studied here successfully treated facial telangiectasia, resulting in equivalent safety and efficacy outcomes as compared to the PDL.

Pulsed dye laser as an excellent choice of treatment for lupus tumidus: a prospective study

Clinical manifestations of cutaneous lupus erythematosus (CLE) vary widely, and different subtypes of this autoimmune disease exist. Tumidus subtype (LT) has been recently separated from the chronic subtypes and is now considered an independent entity due to its particular clinical and histological features. Different treatments are usually prescribed for CLE. Our group has experience of CLE effectively treated with pulsed dye laser (PDL). It was our impression that better responses were achieved in the LT subtype, but no controlled prospective studies with PDL have been specifically performed. A prospective study was performed on 10 patients with histologically confirmed LT treated with PDL. All patients were treated with 595 nm PDL using the 10 mm spot size at 0.5 ms pulse width and a fluence of 8 J/cm(2). Biopsies were taken before and 4 weeks after treatment and were stained with haematoxylin-eosin. Evaluation after PDL treatment showed clinical improvement in all of them without side-effects and reduction of the dermal lymphocytic infiltrate in 9/10 of the patients. Epidermal changes were absent in all patients. Mucin deposition persisted only in one patient. However, 50% of the patients developed new lesions nearby or distant to the treated zones. PDL therapy is an effective and fast treatment option for acute flares of LT; however, it does not prevent recurrences. A histological improvement has been confirmed in this study. Purpura seems to be necessary to achieve a good response.

Histopathology and Immunohistochemistry of Cutaneous Lupus Erythematosus after Pulsed Dye Laser Treatment

Cutaneous lupus erythematosus (CLE) is a heterogeneous autoimmune disorder with a wide range of skin manifestations. Current treatment options include topical and systemic approaches. Few controlled prospective studies have been performed using the pulsed dye laser (PDL). Based on previous experience that supported the efficacy of PDL treatment of CLE, we decided to study the histological changes induced by PDL. A prospective study was performed on nine patients with histologically confirmed CLE treated with PDL. Biopsies were taken before, immediately after, and 4 weeks after treatment and stained with hematoxylin and eosin and with commercially available antibodies to intercellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1. Evaluation after PDL treatment showed a significant reduction of the dermal lymphocytic infiltrate in six of nine patients (66.7%) and an important reduction of the basal damage in six of seven patients (85.7%). Other epidermal changes improved in four of six patients (66.7%). Mucin deposition persisted in two patients. ICAM and VCAM expression was reduced in seven of seven patients (100%) and five of six patients (83.3%) (p<.05). Clinical improvement was present in eight of nine patients (88.9%), without side effects. PDL therapy is an effective treatment for CLE. Immunohistologic improvement has been confirmed in this study.

Topical niacin cream‐assisted 595‐nm pulsed‐dye laser treatment for facial flushing: retrospective analysis of 25 Korean patients

Flushing is defined clinically as a transient reddening of the face and other areas. Due to the transient nature of flushing, a patient may not show signs of flushing during laser treatment. The aim of this study was to evaluate the efficacy and safety of 595-nm pulsed-dye laser treatment of flushing or erythema after provocation of flushing by topical niacin cream. We retrospectively reviewed a total of 25 Korean patients with facial flushing who were treated with three sessions of 595-nm pulsed-dye laser after the application of topical niacin cream. Follow-up results revealed that 12 of the 25 patients demonstrated marked (51-75%) clinical improvement of baseline facial erythema. Eight patients had moderate (26-50%) improvement and three demonstrated near total (≥ 75%) improvement. Two patients showed minimal to no (0-25%) improvement. We observed that the reactivity to topical niacin cream was markedly reduced in 64% of our patients after 595-nm pulsed-dye laser treatments. Minimal post-therapy facial oedema was noted in most of the patients, which usually resolved spontaneously within 2 days. Pronounced facial swelling was observed in four patients. We suggest that 595-nm pulsed-dye laser treatment after provocation of flushing by topical niacin cream may provide a new treatment algorithm for facial flushing in Asians.

Pulsed dye laser as a novel non‐surgical treatment for basal cell carcinomas: Response and follow up 12–21 months after treatment

We showed previously that pulsed dye laser (PDL) is a potentially effective therapy for BCCs <15 mm on trunk and extremities. To follow-up, we conducted a study based on optimized parameters and expanded the duration of the study to at least 1 year after treatment. Fourteen patients with 20 biopsy-proven BCCs on trunk and extremities, 8-35 mm in diameter, were treated. Each BCC received four consecutive PDL treatments at 3-4 week intervals. A 4 mm margin of clinically normal skin was also treated. Standardized photography was performed prior to each treatment and follow up visit. Patients were asked to consent for standard excision or at least scouting biopsies after treatment completion. Complete clinical response was seen with 19 of 20 treated BCCs, regardless of size and histologic subtype. One did not respond completely to therapy. All remaining 19 BCCs were followed between 12 and 21 months (median = 18 months) after the last PDL treatment. Of these 19 BCCs, only one recurred at 17 months follow up. The remaining 18 BCCs did not show any clinical signs of residual or recurrent tumor at 12-21 months follow-up. Overall, 90% (18/20 tumors) of treated BCCs in this study showed no clinical or histologic evidence of BCC more than 12 months after PDL treatment. Additionally, 18/19 (95%) BCCs less than or equal to 17 mm showed no evidence of residual or recurrent tumor clinically or on histology 12-21 months post-laser treatment. PDL treatment of BCC represents a novel, quick, and relatively non-painful treatment that does not usually produce scar and may represent an alternative treatment for certain types of BCC in the appropriate clinical setting. This study confirms prior findings regarding the efficacy of PDL in the treatment of BCC, with longer follow-up period.

Enhancing effect of pretreatment with topical niacin in the treatment of rosacea-associated erythema by 585-nm pulsed dye laser in Koreans: a randomized, prospective, split-face trial

Rosacea is a chronic dermatosis that is usually confined to the face. A pulsed dye laser (PDL) system has been proven to be effective in treating rosacea-associated erythema and telangiectasias. Niacin is a cutaneous vasodilator that can increase the chromophore through increased blood flow. We hypothesized that increased blood flow by pretreatment with topical niacin could enhance the effect of PDL in the treatment of rosacea. Eighteen Korean patients with rosacea were recruited. Three sessions of 585-nm PDL using a subpurpuragenic dose with and without pretreatment with niacin cream were performed on randomly assigned half-faces at 3-week intervals. Erythema was assessed objectively by a polarization colour imaging system, and evaluations were also made by three blinded dermatologists. Patient satisfaction was evaluated using a 10-point visual analogue scale. Fifteen patients completed this study. All patients showed an improvement in erythema after three sessions of PDL treatment both with and without niacin pretreatment (P = 0·023 and P = 0·009, respectively). There was no significant difference in the improvement of objective erythema between the two sides. However, based on physician assessment the overall clinical improvement on the niacin side was significantly higher (P = 0·005), and patient satisfaction was also higher on the niacin-pretreated side (P = 0·007). There were no remarkable side-effects, with the exception of transient erythema and oedema. Pretreatment with topical niacin safely enhanced the effect of 585-nm PDL treatment of rosacea-associated erythema in Koreans. Application of niacin can be helpful in overcoming the relatively lower effect of subpurpuragenic PDL in dark-skinned Asians.

Does bimatoprost induce choroidal effusion and retinal detachment in patients with port-wine mark, diffuse choroidal hemangioma, and receiving pulsed dye laser treatment?

Purpose: To examine whether bimatoprost induces choroidal effusion and exudative retinal detachment in patients with port wine mark, diffuse choroidal haemangioma and receiving pulsed dye laser treatment.

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.

Treatment of Refractory Keloids with Pulsed Dye Laser Alone and with Rotational Pulsed Dye Laser and Intralesional Corticosteroids:

The limited available effective treatments make the management of keloids challenging. Intralesional triamcinolone and pulsed dye laser have been used for the treatment of keloids. We sought to assess the efficacy of a treatment regime using rotational intralesional triamcinolone and pulsed dye laser in the management of keloids. Materials (Subjects) and Methods: Case notes and photographic records of 99 patients with keloids treated with pulsed dye laser (PDL) alone or rotational PDL and intralesional triamcinolone (ILT) at our centre between 2005 and 2010 were reviewed. Patients with raised, erythematous and/or symptomatic keloids unresponsive to ILT alone (usually 6 treatments) are referred for consideration of PDL. Patients are offered repeated rotational treatments of three PDL (4-15 J/cm(2), 7 mm spot, 1.5 msec pulse duration, 595 nm wavelength, DCD, 30 msec spray: 20 msec delay; spaced at 6-8 weeks intervals) followed by one ILT (10 mg or 40 mg/dl). ILT-treated flat but erythematous and/or symptomatic keloids are treated with PDL alone at 6-8 week intervals. Response after each laser treatment is documented as a percentage improvement from baseline. Based on the improvement in redness, thickness and pruritus the operator classified the response to treatment as mild (0-49%), moderate (50-75%) or excellent (>75%). Patients are reviewed at 6 months following last treatment. A patient satisfaction questionnaire was also sent out to all patients who received treatments between 2005 and 2010 and this was compared with the information gathered from the notes. Of the 99 patients, 58 were women and 41 were men and most were Caucasian (n=84). A total of 755 keloids were treated. The average number of PDL treatments to achieve a moderate-excellent result was 14 in male and 12 in females. Moderate-excellent improvement was seen in 76% patients. The average number of ILT required to achieve a moderate-excellent result was 5 in males and 4 in females. All patients were sent a satisfaction questionnaire and 33 responses were received wherein patients reported an average of 70% improvement in the redness and thickness of the keloids. Localised cutaneous atrophy, self-limiting erythema and injection site discomfort were noted in 3 female patients whilst no side-effects noted in the male cohort. Pulsed dye laser with or without intralesional triamcinolone is a moderately effective treatment of keloid scars with a very good side-effect profile and high patient satisfaction.

Pulsed dye laser treatment of pigmented lesions: a randomized clinical pilot study comparison of 607‐ and 595‐nm wavelength lasers

The 595-nm pulsed dye laser has been used for the treatment of benign epidermal pigmented lesions (EPLs), but there is a risk of inducing undesirable purpura with treatment. To compare a 607-nm laser with a commercially-available 595-nm laser for the treatment of EPLs. Monte-Carlo simulations were performed to characterize laser interaction with skin. Ten patients with EPLs were treated with a 607-nm study prototype laser and the 595-nm pulsed dye laser twice at 2- to 4-week intervals on the left or right side on a randomized basis. Study endpoints included clearance rate of lesions, side effects immediately after treatment and at final follow-up, and patient discomfort/pain. Monte-Carlo simulations show that the 607-nm is absorbed more specifically by melanin than the 595-nm wavelength. Both lasers were effective in treatment of EPLs. The average degree of improvement overall was 41.2% with the 607-nm laser and 40% with the 595-nm laser. Patients reported less discomfort/pain during treatment with the 607-nm laser. Our findings suggest that the 607-nm laser is safe and at least as effective as the 595-nm laser in treatment of EPLs. There was less patient discomfort/pain during treatment using the 607-nm laser.

Effect of a Single Application of Pulsed Dye Laser Treatment of Port-wine Birthmarks on Intraocular Pressure

A new pathophysiologic mechanism has been proposed that indicates that periorbital port-wine birthmarks (PWBs) serve as alternate collateral blood passageways when orbital venous drainage is impaired. The occlusion of such collateral venous channels could, therefore, potentially exacerbate impaired ocular venous flow and trigger the development or worsening of glaucoma in patients with Sturge-Weber syndrome. We investigated to what extent a single application of laser therapy, which occludes only the most superficial portions of a facial PWB, might affect intraocular pressure. Pressures before and after laser treatment were measured to determine pressure difference in 15 patients receiving laser treatment. The greatest pressure differences were observed in patients with a PWB closest to the eye (P = .02). Posttreatment pressures were significantly decreased, relative to pretreatment pressures, only in patients with a PWB on the eyelid compared with patients with a facial PWB not near the eyes (2.33 vs 0.75 mm Hg; P = .004). No correlation was found between change in pressure and patient age, PWB size, or number of previous treatments. A single laser application to a PWB does not appear to show a clinically relevant change in intraocular pressure. Further study is needed longitudinally in a broad range of patients.

Effect of Perioperative Hyperbaric Oxygen on Bruising in Face-lifts

Effect of Perioperative Hyperbaric Oxygen on Bruising in Face-lifts

Pulsed Dye Laser Treatment of Portwine Stain (PWS) and the Other Vascular Lesions, and the Evaluation of the PWS Skin Color Using a Colorimeter

Pulsed Dye Laser Treatment of Portwine Stain (PWS) and the Other Vascular Lesions, and the Evaluation of the PWS Skin Color Using a Colorimeter

New technique using combined pulsed dye laser and fractional resurfacing for treating facial angiofibromas in tuberous sclerosis

Tuberous sclerosis (TS) is a well-described genetic disorder that is classically associated with up to hundreds of facial angiofibromas. Due to the progressive nature of the skin lesions and the early clinical presentation, a safe and effective technique for treating these disfiguring skin lesions is needed. We report a combinatorial technique for treating the angiofibromas of TS. We present a case series of three TS patients treated with this technique combining pinpoint electrosurgery, pulsed-dye laser treatment, and ablative fractional resurfacing (AFR). In all presented cases, improvement in the number and appearance of facial angiofibromas and erythema is noted. No scarring or adverse events were reported. The technique of electrosurgery, pulsed-dye laser treatment, and AFR represents a new and safe therapeutic option for treating facial angiofibromas associated with TS.

Pyogenic Granuloma Arising as a Complication of 595 nm Tunable Pulsed Dye Laser Treatment of Port-Wine Stains: Report of Four Cases

Pyogenic Granuloma Arising as a Complication of 595 nm Tunable Pulsed Dye Laser Treatment of Port-Wine Stains: Report of Four Cases

The pulsed-dye laser as an adjuvant treatment modality in acne vulgaris: a randomized controlled single-blinded trial

Acne vulgaris is the most common skin disease and can pose a substantial therapeutic challenge. Recently, several phototherapeutic modalities, most notably pulsed-dye laser (PDL) treatment, have been introduced, but the published results - albeit promising - are controversial. To assess the efficacy of an adjuvant PDL treatment when combined with a proven topical treatment [fixed-combination clindamycin 1%-benzoyl peroxide 5% hydrating gel (C/BPO)]. Eighty patients (38 males and 42 females, mean +/- SD age 19.7 +/- 5.9 years) were randomized in a 1 : 2 ratio to receive C/BPO alone or in combination with PDL treatment (wavelength 585 nm, energy fluence 3 J cm(-2), pulse duration 0.35 ms, spot size 7 mm). Patients were evaluated at baseline and at 2 and 4 weeks after initial treatment. The primary end points were the Investigator's Static Global Assessment (ISGA) score and lesion count; the secondary end point was the Dermatology Life Quality Index (DLQI). Both groups showed a significant improvement during observation [ISGA 27.1% (C/BPO) and 24.6% (C/BPO + laser), total lesion count 9.2% and 9.0%, inflammatory lesion count 36.3% and 36.9%, DLQI 54.5% and 42.5%], but there was no significant or otherwise appreciable difference between treatment modalities as far as the extent of improvement was concerned. Patients with more severe findings at baseline had a greater benefit from either therapy regimen. Our findings do not support the concept of a substantial benefit of PDL treatment in acne vulgaris.

Treatment of Xanthelasma Palpebrarum Using a Pulsed Dye Laser

Several studies have reported positive results of nonablative laser treatment of xanthelasma palpebrarum, but the published evidence is weak and inconclusive. To systematically evaluate the effect of pulsed dye laser (PDL) treatment of xanthelasmas. Twenty female Caucasian patients with 38 lesions (< or =1 mm above skin level) were enrolled. They received up to five treatment sessions with a PDL (wavelength, 585 nm; energy fluence, 7 J/cm(2); pulse duration, 0.5 ms; spot size, 10 mm; number of passes, 2) at 2- to 3-week intervals. Photographs were taken before each treatment session and 4 weeks after the last treatment. Two independent examiners categorized clearance into four groups (no clearance [<25% xanthelasma area(s) cleared], moderate [25-50%], good [51-75%], and excellent [>75%]). Patient satisfaction was assessed on a verbal rating scale. Approximately two-thirds of the lesions showed clearance greater than 50%, and one-quarter had clearance greater than 75%. Interrater reliability was excellent (contingency coefficient >0.7 at all visits). Treatments were well tolerated and had no major side effects. Patient satisfaction was generally high. PDL is a promising approach for treating xanthelasmas, especially when multiple sessions are performed.

Cellular and molecular effects of pulsed dye laser and local narrow‐band UVB therapy in psoriasis

Pulsed dye laser (PDL) therapy is effective in clearing psoriasis plaques, but the mechanism of action is only partially understood. Local narrow-band ultraviolet B (NB-UVB), which has a better-defined mode of action, is an effective standard treatment for psoriasis. Our aim was to evaluate the cellular and molecular effects of PDL and to compare them with those of local NB-UVB in order to gain further insight into their mechanisms of action in psoriasis. Nineteen patients with stable plaque-type psoriasis were treated either with PDL or NB-UVB. Lesional punch biopsies were obtained from all patients before treatment. Additional biopsies were obtained at 3 and 24 hours after PDL treatment in five of these patients. In 14 patients additional biopsies were taken after 7 and 13 weeks of treatment. Samples were histopathologically examined for the level of dermal T cell infiltrate, and the expression of epidermal beta-defensin 2, immune cell-derived tumor necrosis factor (TNF)-alpha, endothelial E-selectin, vascular endothelial growth factor receptor (VEGFR) 2 and 3, and the expression of interleukin (IL)-23 before and after treatment. The expression of VEGFR2, VEGFR3, and E-selectin was decreased in clinically high responders within 24 hours after PDL treatment. The expression of IL-23, TNF-alpha mRNA, and E-selectin protein were significantly reduced after two PDL treatments, whereas the expression of all epidermal markers and dermal T cell infiltrates had normalized after four treatments. The expression of epidermal activation markers and E-selectin were significantly reduced after 13 weeks of NB-UVB treatment. The expression of epidermal activation markers and the dermal T cell infiltrates were decreased after both treatments. The decreased expression of VEGFR2 and VEGFR3 followed by the down-regulation of TNF-alpha and IL-23p19 may be contributory factors in the efficacy of PDL in stable plaque-type psoriasis.

Photodynamic therapy for acne vulgaris: a randomized, controlled, split‐face clinical trial of topical aminolevulinic acid and pulsed dye laser therapy

There remains the need for more effective therapeutic options to treat acne vulgaris. Interest in light-based acne treatments has increased, but few randomized, controlled clinical trials assessing the value of photodynamic therapy (PDT) for acne have been reported. We sought to examine the efficacy of PDT using 5-aminolevulinic acid (ALA) and pulsed dye laser therapy in the treatment of acne. We conducted a randomized, controlled, split-face, single-blind clinical trial of 44 patients with facial acne. Patients were randomized to receive three pulsed dye laser treatments to one side of the face after a 60-90 min ALA application time, while the contralateral side remained untreated and served as a control. Serial blinded lesion counts and global acne severity ratings were performed. Global acne severity ratings improved bilaterally with the improvement noted to be statistically significantly greater in treated skin than in untreated skin. Erythematous macules (remnants of previously active inflammatory lesions) decreased in number in treated skin when compared with control skin and there was a transient but significant decrease in inflammatory papules in treated skin when compared with untreated skin. There were no other statistically significant differences between treated and untreated sides of the face in terms of counts of any subtype of acne lesion. Thirty percent of patients were deemed responders to this treatment with respect to improvement in their inflammatory lesion counts, while only 7% of patients responded in terms of noninflammatory lesion counts. PDT with the treatment regimen employed here may be beneficial for a subgroup of patients with inflammatory acne.

PULSED DYE LASER TREATMENT FOR RECALCITRANT VIRAL WARTS: AUTO-SIMULTANEOUS LASER TREATMENT

Verruca vulgaris is a benign proliferative lesion of the skin caused by the human papillomavirus (HPV). It is commonly seen in dermatologic and/or plastic surgery clinics. The diagnosis is straightforward, but the treatment of the lesion may be difficult and lengthy. Several treatment methods have been reported but no specific therapy of choice has been developed. It has been suggested that pulsed dye laser treatment is highly effective in the treatment of viral warts which have not responded to other treatments. Pulsed dye laser treatment is a safe method with low side effects and is mostly well-tolerated by patients. Several authors have recently reported the efficiency of pulsed dye laser treatment for warts, but no report has paid attention to the influence of low levels of laser irradiation about the periphery of the treated lesion which may induce immune activation and pain alleviation. We believe these effects are mainly due to the athermal and atraumatic simultaneous Low reactive Level Laser Therapy effect on photobiomodulated cells at the periphery of the treated lesion. We call this coincident duality of thermal damage and athermal stimulation ‘auto-simultaneous laser treatment’. We report herein on pulse dye laser treatment for a recalcitrant huge viral wart and consider the vital response.