Pulsed Dye Laser Therapy Research Articles

Cochrane Review: Interventions for infantile haemangiomas (strawberry birthmarks) of the skin

Cochrane Review: Interventions for infantile haemangiomas (strawberry birthmarks) of the skin

Preclinical in vivo evaluation of Npe6‐mediated photodynamic therapy on normal vasculature

Current treatments of port-wine stain birthmarks typically involve use of a pulsed dye laser (PDL) combined with cooling of the skin. Currently, PDL therapy protocols result in varied success, as some patients experience complete blanching, while others do not. Over the past decade, we have studied the use of photodynamic therapy (PDT) as either a replacement or adjuvant treatment option to photocoagulate both small and large vasculature. The objective of the current study was to evaluate a PDT protocol that involves use of an alternate intravascular photosensitizer mono-L-aspartylchlorin-e6 (NPe6) activated by an array of low-cost light emitting diodes. To monitor the microvasculature, a dorsal window chamber model was installed on 22 adult male mice. The light source consisted of a custom-built LED array that emitted 10 W at a center wavelength of 664 nm (FWHM = 20 nm). The light source was positioned at a fixed distance from the window chamber to achieve a fixed irradiance of 127 mW/cm(2). A retroorbital injection of NPe6 (5 mg/kg) was performed to deliver the drug into the bloodstream. Laser irradiation was initiated immediately after injection. To monitor blood-flow dynamics in response to PDT, we used laser speckle imaging. We employed a dose-response experimental design to evaluate the efficacy of NPe6-mediated PDT. We observed three general hemodynamic responses to PDT: (1) At low radiant exposures, we did not observe any persistent vascular shutdown; (2) at intermediate radiant exposures, we observed an acute decrease in blood flow followed by gradual restoration of blood flow over the 7-day monitoring period; and (3) at high radiant exposures, we observed acute vascular shutdown that persisted during the entire 7-day monitoring period. Dose-response analysis enabled identification of 85 J/cm(2) as a characteristic radiant exposure required to achieve persistent vascular shutdown at Day 7 following PDT. The experimental data suggest that NPe6-mediated PDT can achieve persistent vascular shutdown of normal microvasculature.

Treatment of Basal Cell Carcinomas with Pulsed Dye Laser: A Case Series

Background. Basal cell carcinoma (BCC) is the most prevalent skin cancer. Because of its highly vascular characteristic, it is amendable to treatment with pulse dye laser (PDL). The goal of this study is to determine the safety and efficacy of PDL therapy for mostly facial BCCs. Materials and Methods. Sixteen men and thirteen women (29 total) with 39 biopsy-proven BCCs were treated with 1–4 PDL (595 nm) therapies at 2–4-week intervals. The treatment parameters included pulse energy of 15 J/cm 2, pulse length of 3 millisecond, with no dynamic cooling, and 7 mm spot size. The age of the patients was 30–90 years (mean 73 years). Response rates were evaluated by the clinical assessments with mean followup of 11 months. Results. Twenty-four patients with thirty-two tumors reached at least three months followup: 24/32 (75%) tumors with complete resolution (mean 3 treatment sessions); 5/32 (16%) tumors recurred; 3/32 (9%) tumors with incomplete responses after four treatments. Minimal side effects and discomfort were experienced by the patients with PDL therapy. Conclusion. PDL is a safe, tolerable, and moderately effective method of treating various BCCs. The ideal niche and standardized settings for PDL treatment of BCCs are yet to be determined.

White Gel Pen Easily Marks a Port-Wine Stain Margin During Pulsed Dye Laser Therapy

White Gel Pen Easily Marks a Port-Wine Stain Margin During Pulsed Dye Laser Therapy

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.

Interventions for infantile haemangiomas (strawberry birthmarks) of the skin

Infantile haemangiomas (also known as strawberry birthmarks) are soft, raised swellings of the skin which are usually uncomplicated and tend to regress spontaneously over time. Some haemangiomas occur in high-risk areas or can develop complications; therefore, intervention may be necessary. Various interventions have been proposed, but it is unclear whether any of these interventions are effective. To assess the effects of interventions for infantile haemangiomas. We searched the following databases up to March 2011: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (Clinical Trials) in The Cochrane Library, MEDLINE, EMBASE, PsycINFO, AMED (Allied and Complementary Medicine), LILACS (Latin American and Caribbean Health Science Information database), CINAHL, and reference lists of articles. We also searched online trials registries for ongoing trials and grey literature. We included children with haemangiomas. Two authors independently screened titles, abstracts, and the full text of publications; extracted data; and assessed risk of bias. We included 4 studies with a total of 271 participants.One randomised controlled trial (RCT) compared pulsed dye laser (PDL) therapy versus the 'wait and see' approach. At one year PDL was significantly more likely to result in complete clearance. The risk ratio (RR) was 6.10 (95% CI [confidence interval] 1.89 to 19.64); however, there was no difference when clearance was defined as 'complete or minimal residual signs'. Redness was significantly less pronounced in the PDL group, but no differences were seen for height or surface area. Significant increases in atrophy and skin hypopigmentation were seen in the PDL group.One very old RCT assessed radiation versus mock-radiation; there was no significant difference in clearance at six years (RR 1.08, 95% CI 0.63 to 1.87) between the groups, irrespective of the size of the haemangioma and the skin colour.In one small RCT there was a significantly greater reduction in size of the haemangioma with oral prednisolone compared to intravenous methylprednisolone at three months (mean difference [MD] was 58 mm [95% CI 29.24 to 86.76]), and one year. Similar adverse events occurred in both groups.In another small RCT there was a significant reduction in the surface area of the haemangioma with bleomycin compared to the control (RR 21, 95% CI 1.34 to 328.86). This review has found limited evidence from individual RCTs to support some of the existing interventions (corticosteroid and PDL) for infantile haemangiomas. There is a need for further high-quality RCTs to validate the findings from these studies, and RCTs to assess the effect of other treatments, in particular relating to propranolol.

Successful treatment of upper and lower extremity port wine stains using high-fluence pulsed dye laser therapy initiated in infancy

Successful treatment of upper and lower extremity port wine stains using high-fluence pulsed dye laser therapy initiated in infancy

Treatment of Dermatosis Papulosa Nigra in 10 Patients: A Comparison Trial of Electrodesiccation, Pulsed Dye Laser, and Curettage

Dermatosis papulosa nigra (DPN) is a common variant of seborrheic keratoses in darkly pigmented individuals. Treatment options include cryosurgery, curettage, electrosurgery, and shave removal. To compare the efficacy and complications of pulsed dye laser (PDL) therapy for the treatment of DPN with those of curettage and electrodesiccation. Randomized, controlled, single-center, evaluator-blinded trial of 10 patients with at least four clinically diagnosed lesions. All 10 patients completed the study. Mean lesion clearance was 96% for curettage, 92.5% for electrodesiccation, and 88% for laser. There was no significant difference between the three treatment modalities. All three techniques had an overall cosmetic outcome of good for most patients. Five of the 10 patients preferred electrodesiccation. Patients rated the laser as the most painful treatment method. The most common adverse outcome was hyperpigmentation. There were no significant differences between the treatment groups for any of the measured outcomes. The efficacy of PDL in the treatment of DPN is not significantly different from the already established treatment modalities of electrodesiccation and curettage. The authors have indicated no significant interest with commercial supporters.

The Cyrano Nose: Refinements in Surgical Technique and Treatment Approach to Hemangiomas of the Nasal Tip

Nasal tip hemangiomas cause significant parental distress and can negatively affect the psychological development of a child. Treatment is controversial, with numerous modalities available for reconstruction. The authors outline their combined medical and surgical approach to treating nasal tip hemangiomas and describe their preferred surgical technique. A retrospective review was performed of all nasal tip hemangiomas presenting to the Multidisciplinary Vascular Anomalies Clinics at the Children's Hospital of Wisconsin and Children's Hospital of Michigan from 1999 to 2007. Parameters for review included onset age, symptoms, medical therapies (laser with or without steroid) used, age and status of lesion at time of surgery, outcomes, and complications. Twenty-five patients met inclusion criteria, with a mean onset age of 1.43 months. Most received steroids and pulsed dye laser therapy (mean no. of laser treatments, 3.5) during the proliferative and plateau phases of the tumor's natural history. Surgical resection after involution has been performed using an open rhinoplasty technique on 15 patients thus far. Eleven of them had surgical correction in the postinvolutional phase, and at parental request, four had early surgical correction during the proliferative-plateau phases. In the early treatment cohort, one child developed a hematoma postoperatively; the same patient required a revision rhinoplasty for alar rim asymmetry. Acceptable aesthetic results were obtained in both groups. A combined medical and surgical approach offers the best method to treat the Cyrano nose. The authors' treatment algorithm uses early medical management to accelerate involution of the lesion, providing optimal conditions for excision. Early surgical treatment also allows satisfactory results but may require secondary correction. An open rhinoplasty approach with skin resection is the authors' preferred technique.

Stem cell marker upregulation in normal cutaneous vessels following pulsed‐dye laser exposure and its abrogation by concurrent rapamycin administration: implications for treatment of port‐wine stain birthmarks

Port-wine stains (PWS) represent a group of vascular malformations that are usually accompanied by psychological distress for affected patients, often reflected in high treatment demand. Although the pulsed-dye laser (PDL) was established as standard therapy for PWS more than a decade ago, therapeutic outcome may be unsatisfactory. One of the main drawbacks to successful PDL therapy is PWS revascularization shortly after laser exposure. Therefore, inhibition of revascularization should improve therapeutic outcome of PDL therapy. In this study, we first evaluated the effects of various light energies on normal cutaneous vessels over a period of 14 days, particularly the proliferation and stem cell marker expression of dermal endothelial cells, which were found to be highest 8 days following laser exposure. We found that PDL exposure induced dose-dependent damage of dermal vessels up to energy densities of 6 J/cm(2), above which no increase in PDL-induced effects were observed with the energies employed in this study. In dermal endothelial cells of PDL-exposed skin, we found strong expression of the proliferation marker Ki-67 as well as the stem cell marker nestin but not other stem cell markers such as CD133 and CD166. The influence of rapamycin (RPM), used as an adjuvant to PDL exposure, was also investigated. RPM administration reduced Ki-67 and nestin expression in dermal endothelial cells and increased PDL-induced destruction of dermal vessels, indicating that the use of RPM after PDL exposure may be an interesting new approach for prolonging and improving PWS laser therapeutic outcome.

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.

Botulinum toxin type-A (BT-A) for the treatment of multiple eccrine hydrocystomas

Background: The treatment of multiple eccrine hydrocystomas is challenging. Surgical excision is impractical. The outcomes of CO2 and pulsed-dye laser therapy are not well studied. Botulinum toxin-A (BT-A) can block the secretions of the sweat glands and prevent dilatation of the cysts. Objective: To study the efficacy of BT-A on eccrine hydrocystoma. Methods: Eighteen patients with multiple facial eccrine hydrocystomas were treated by BT-A. The 500 IU vial of BT-A (Dysport; Ipsen Ltd, UK) was dissolved in 7.5 cc of normal saline to prepare a solution, 0.1 cc of which contains 6 IU of BT-A. Then, 0.1–0.2 ml of diluted BT-A was injected intradermally around the lesions using an insulin syringe with a 30-gauge needle. A second BT-A injection session was carried out 3–4 weeks later for four partially responsive patients. Results: Thirteen patients showed significant flattening of the lesions after the first session. The remaining partially responsive four patients showed considerable flattening after the second boosting session, performed 3–4 weeks later. The side effects were temporary and minimal. The duration of effect for the BT-A injection was 5–7 months. Conclusion: Intradermal BT-A injection can be considered as a relatively safe and cost-effective treatment for multiple eccrine hydrocystomas.

Comparing Pulsed-dye Laser with Cryotherapy in the Treatment of Common Warts

Introduction: No modality has been identified as the treatment of chice for treating common warts. Cryothearpy and pulsed-dye laser (PDL) are among common modalities for treating these lesions. The aim of this study was to compare pulsed dye laser with cryotherapy in terms of efficacy and complications. Matherial & Methods: Of a total of 46 patients enrolled in this study, 7 patients withdrew the study, 20 patients underwent cryotherapy and 19 patients underwent PDL. Patients underwent a maximum of 4 therapeutic sessions at 3-week intervals in both groups. They were assessed for the remission rate (complete and partial), side effects and recurrence rate in each session and 1 month after termination of the treatments. Results: At the end of the study complete remission was achieved in 37.8% of patients in cryotherapy group and in 52.3% of patients in PDL group. This difference wasn’t statistically significant (P=0.229), though after first and second sessions of treatment complete and excellent partial remission occurred more in PDL group with significant difference (P=0.007 and P=0.021). Pain and bulla formation occurred statistically higher in cryotherapy group (P=0.002 and P=0.001). Other complications were rare in both groups. Conclusion: In terms of efficacy, we couldn’t demonstrate the superiority of pulseddye laser therapy to cryotherapy in treating common warts. Both methods were safe for long-term complications but PDL was much safer for short-term complications.

Pyogenic granuloma–treatment by shave-excision and/or pulsed-dye laser

We present the results of our evolving treatment strategy for pyogenic granuloma (PG) affecting cosmetically sensitive areas, from 1996 to 2007. Fifty-one lesions in 49 patients aged six weeks to 87 years (mean, 23.5 years) affecting the head and neck skin (39%) and lip vermillion (14%), limbs (31%) and trunk (16%) were treated. Fifteen lesions (29%) had failed previous treatments elsewhere. Forty-two lesions (in 40 patients) underwent pulsed-dye laser (PDL) therapy alone, using fluences of 5.3-9.4 J/cm(2) (Photogenica V) or 15 J/cm(2) (V-Beam) without dynamic cooling, at 7 mm spot-size. An average of 1.8 (range, 1-5) treatment sessions were required for lesions <5 mm, while an average of 2.7 (range 1-6) sessions were needed for lesions 5-10 mm in size. Five patients (with five lesions) measuring 4-6 mm elected for surgical excision following 1-3 (mean, 1.7) PDL treatments. Since 2001, nine PG (in nine patients) measuring 5-20 (mean, 11) mm underwent shave-excision and immediate PDL and repeat PDL as necessary. One patient elected for surgical excision following two PDL sessions. The remaining eight patients required an average of 1.1 (range, 0-5) additional PDL sessions for eradication of their PG. PDL alone for PG <5 mm, and shave-excision and immediate PDL to the base for larger lesions are effective treatments for lesions affecting cosmetically sensitive areas.

Combined 595-nm and 1,064-nm Laser Irradiation of Recalcitrant and Hypertrophic Port-Wine Stains in Children and Adults

Although pulsed dye laser (PDL) treatment of port-wine stain (PWS) has long been proven safe and effective, incomplete clearance of these vascular malformations can be problematic. In addition, advanced PWS with deeper coloration and tissue hypertrophy can be particularly difficult to treat because of the superficial dermal penetration of 585- to 595-nm light. The purpose of this study was to evaluate the safety and efficacy of a novel device that delivers sequential pulses of 595- and 1,064-nm wavelengths in the treatment of recalcitrant and hypertrophic PWS. Twenty-five children and adults (skin phototypes I-III) with recalcitrant or hypertrophic PWS showing incomplete clearance after 10 prior PDL treatments were included in the study. Successive treatments using a 595-nm PDL and a 1,064-nm neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser were delivered at 6- to 8-week intervals. Two masked assessors determined clinical improvement of treatment areas using independent evaluation of comparative photographs at baseline and 3 months after treatment using a standard quartile grading scale. The use of dual 595-/1,064-nm wavelengths provided continued improvement of PWS that were previously recalcitrant to ongoing PDL therapy. Side effects were limited to transient erythema, edema, and mild purpura. Rare vesicle formation was observed, with no subsequent scarring or undesirable pigmentary changes. The novel dual 595-nm PDL and 1,064-nm Nd:YAG laser is an effective treatment for PWS that are recalcitrant to PDL therapy alone.

Evaluation of the clinical and immunohistological efficacy of the 585‐nm pulsed dye laser in the treatment of psoriasis

The 585-nm pulsed dye laser (PDL) therapy is useful for the patients with psoriasis. PDL treatment is based on selective photothermolysis of the dermal vasculature. The objectives of this study were to evaluate the clinical and immunohistological effects of PDL on psoriasis and to examine the association between psoriatic dermal vasculature and the clinical effects. Eleven patients with recalcitrant psoriasis were treated with 585-nm PDL. Biopsy specimens obtained before and after treatment were stained with CD31. All microvessels to the depth of 400 microm from the rete ridge were counted and the internal diameters were measured. The mean percent reduction of plaque severity score was 42. The mean microvessel count decreased significantly from 63 to 35.6 ( P < 0.001). There was a strong positive correlation between the plaque severity score and microvessel number ( P < 0.001) and a strong negative correlation between the microvessel count of an untreated area and degree of the change in the microvessel count after treatment (P = 0.005). The findings of this study suggest that PDL treatment improves psoriasis. Moreover, PDL treatment decreased the number of dermal papillary microvessels. Dermal papillary microvessels are important pathogenetic targets of psoriasis, and PDL therapy, which selectively targets superficial vessels, is therefore a valid therapeutic approach.

Role of the 585-nm pulsed dye laser in the treatment of acne in comparison with other topical therapeutic modalities

Background: Acne vulgaris is a disease of the pilosebaceous unit characterized by the development of inflammatory and/or non-inflammatory lesions that may progress to scars. The increase of bacterial resistance and adverse effects, the teratogenicity of retinoids and lack of response to usual therapies has led to the investigation of new therapeutic alternatives. Objective: To evaluate the role of the pulsed dye laser in the treatment of acne in comparison with other topical therapeutic modalities. Methods: We studied 45 patients with mild to moderate acne. Patients were randomly divided into three groups: group A received treatment with pulsed dye laser therapy every 2 weeks, group B received topical preparations and group C was subjected to chemical peeling using trichloroacetic acid 25%. Results: At 12 weeks of treatment, there was a significant improvement of the lesions within each group with the best results seen in group A; however, no significant difference was detected between the three treatment protocols after the treatment period. Remission in the follow-up period was significantly higher in the first group. Conclusions: Pulse dye laser therapy mainly improves the inflammatory lesions of acne with few adverse effects.

Botulinum toxin type-A (BT-A) for the treatment of multiple eccrine hydrocystomas

The treatment of multiple eccrine hydrocystomas is challenging. Surgical excision is impractical. The outcomes of CO(2) and pulsed-dye laser therapy are not well studied. Botulinum toxin-A (BT-A) can block the secretions of the sweat glands and prevent dilatation of the cysts. To study the efficacy of BT-A on eccrine hydrocystoma. Eighteen patients with multiple facial eccrine hydrocystomas were treated by BT-A. The 500 IU vial of BT-A (Dysport; Ipsen Ltd, UK) was dissolved in 7.5 cc of normal saline to prepare a solution, 0.1 cc of which contains 6 IU of BT-A. Then, 0.1-0.2 ml of diluted BT-A was injected intradermally around the lesions using an insulin syringe with a 30-gauge needle. A second BT-A injection session was carried out 3-4 weeks later for four partially responsive patients. Thirteen patients showed significant flattening of the lesions after the first session. The remaining partially responsive four patients showed considerable flattening after the second boosting session, performed 3-4 weeks later. The side effects were temporary and minimal. The duration of effect for the BT-A injection was 5-7 months. Intradermal BT-A injection can be considered as a relatively safe and cost-effective treatment for multiple eccrine hydrocystomas.

Pulsed-dye laser treatment of angioma serpiginosum

Angioma serpiginosum (AS) is a rare, benign, vascular disorder comprising nonblanchable punctate red to purple lesions in a gyrate or serpiginous configuration. Tunable pulsed-dye laser (PDL) therapy has been successfully used in the treatment of AS. We report our results of treatment of 12 AS sites in eight patients who were treated with PDL. After an average of 3.75 treatments, complete resolution of AS was seen in five lesions, an excellent response in four and a good response in three. Self-limiting hyperpigmentation at the test sites was noted in two patients. This study provides further evidence of the efficacy of PDL for treatment of AS.