Pulsed Dye Laser Treatment Research Articles

Retrospective study of the treatment of port-wine stains with 595-nm pulsed dye laser in 261 Chinese patients.

Pulsed dye laser (PDL) at the wavelength of 595nm is the common choice for the treatment of port-wine stains (PWSs). In this study, the efficacy of 595-nm PDL in treatment of PWSs in Chinese patients was investigated. A follow-up visit was performed on 261 Fitzpatrick skin type II-III Chinese patients with PWS who received more than two treatments with 595-nm PDL. Based on cosmetic improvement, treatment response was graded as follows: complete, if color blanching was > 90%; significant, if color blanching was 60-90%; moderate, if color blanching was 30-60%; and poor, if color blanching was < 30%. The efficacy of laser treatment on patients of different treatment numbers, ages, lesion locations, lesion colors, extents of hypertrophy, and laser pulse durations was evaluated. All patients improved following an average of almost 4 to 5 laser treatments. The earlier the intervention, the better the efficacy was. Lesions on cheek, neck, and forehead were better than that those on oral, eye periorbital, and nose areas. The purple group had a more excellent clearance, i.e., complete and significant clearance rate (53.6%), than the red group (36.1%). Treatment effect became worse as the extent of lesion hypertrophy increased. PWS lesions treated with short pulse durations of 0.45, 1.5, and 3ms had better clearance (complete and significant clearance) rate of 56.5% than those treated with pulse durations of 6ms or longer (34.8%). Pulsed dye laser with 595-nm laser equipped with dynamic cooling device is an effective option for the treatment of PWS in Chinese patients. Younger patients with lateral face position, larger vessel size (deeper color), and lesser hypertrophy received better clinical effect than the others. Treatment with short pulse duration of less than 3ms for 4 to 5 times was recommended to treat PWS.

Dermoscopy predicts outcome in hemoporfin-mediated photodynamic therapy of port-wine stains: A prospective observational study

To the Editor: Port-wine stain (PWS) is defined as ectasia of the vessels in the dermis, affecting the dermal papillae capillary loops, the horizontal plexus at the dermal-subcutaneous junction, or a combination of these.1Anderson R.R. Levins P.C. Grevelink J.M. Lasers in dermatology.in: Fitzpatrick T.B. Eisen A.Z. Wolff K. Freedberg I.M. Austen K.F. Dermatology in General Medicine. 4th ed. McGraw-Hill, New York1971: 1755-1766Google Scholar Recent studies have identified 2 main dermoscopic patterns of PWS. Type 1 is a superficial pattern composed of red globules and dots that correspond to dilated capillary loops in the papillary dermis. Type 2 is a deep pattern that features red ring structures corresponding to dilated ectatic vessels located deep in the horizontal vascular plexus.2Piccolo V. Russo T. Moscarella E. et al.Dermatoscopy of vascular lesions.Dermatol Clin. 2018; 36: 389-395Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar Histopathologic examination is the standard approach to determine the depth of the vascular lesion, but it is invasive. Dermoscopy can preoperatively predict the outcome of treatment and the minimal effective fluence in pulsed dye laser treatment.3Eubanks L.E. McBurney E.I. Videomicroscopy of port-wine stains: correlation of location and depth of lesion.J Am Acad Dermatol. 2001; 44: 948-951Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar,4Shirakawa M. Ozawa T. Wakami S. et al.Utility of dermoscopy before and after laser irradiation in port wine stains.Ann Dermatol. 2012; 24: 7-10Crossref PubMed Scopus (17) Google Scholar PWS in areas that typically respond well to laser treatment were more likely to have a superficial type 1 but those that have a poorer response were more likely to have a deeper type 2. The immediate vessel disappearance after pulsed dye laser treatment observed by dermoscopy can predict the minimal effective fluence and prevent adverse effects. Hemoporfin-mediated photodynamic therapy (HMME-PDT) is considered to be a successful and well-tolerated treatment option for PWS.5Zhao Y. Tu P. Zhou G. et al.Hemoporfin photodynamic therapy for port-wine stain: a randomized controlled trial.PLoS One. 2016; 11: e0156219Crossref PubMed Scopus (38) Google Scholar The response of different depth vessels to HMME-PDT and the relationship between dermoscopic features and the efficacy of HMME-PDT have not been reported to our knowledge. We present a prospective observational study of 16 patients with PWS who received HMME-PDT. The Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (2019S1170) approved this study. All of the detailed methods are in the Supplemental file available on Mendeley at https://doi.org/10.17632/b968gsy7bp.1. Group A consisted of 8 patients with the type 1 pattern, and group B consisted 8 patients with the type 2 pattern (Table I). Dermoscopic images of PWS lesions were taken from each patient using the hand-held dermoscope with 50× polarized light (CH-DSIS-2000 Plus; Guangzhou Chuanghong Medical Technology Co, Ltd, Guangzhou, China). Clinical efficacy was observed after 1 treatment of HMME-PDT.Table IProfile of the patients in the studyPatient No.Age, ySexPWS locationResponse∗No improvement (NI): <20%; some improvement (SI): 20%-59%; great improvement (GI): 60%-89%; nearly completely resolved (CR): 90%.Group A 110FemaleRight cheekCR 231MaleMandible and neckGI 34FemaleMandibleCR 48MaleRight chinGI 56MaleLeft cheekGI 611MaleLeft cheekGI 74FemaleLeft cheek and orbitCR 84FemaleLeft temporalCRGroup B 18MaleRight cheekNI 240FemaleMandible and neckSI 36FemaleRight cheekNI 47MaleRight cheekNI 518MaleLeft cheekNI 69MaleLeft cheekNI 78MaleRight cheekNI 819MaleRight cheekNIPWS, Port wine stain.∗ No improvement (NI): <20%; some improvement (SI): 20%-59%; great improvement (GI): 60%-89%; nearly completely resolved (CR): 90%. Open table in a new tab PWS, Port wine stain. Patients in the 2 groups had markedly different responses after 1 treatment with HMME-PDT. Patients in group A (type 1 pattern) had an excellent response to HMME-PDT, whereas those in group B (type 2 pattern) had a poor response (Fig 1). In HMME-PDT treatment, the 532-nm laser can activate the photosensitizer injected into the blood vessels to produce highly reactive singlet oxygen, which can destroy the endothelial cells.5Zhao Y. Tu P. Zhou G. et al.Hemoporfin photodynamic therapy for port-wine stain: a randomized controlled trial.PLoS One. 2016; 11: e0156219Crossref PubMed Scopus (38) Google Scholar HMME-PDT can more easily destroy or remove deformed vessels that are superficial because of the limited range of wavelength penetration. It is still difficult to penetrate PWS lesions with thicker vessel walls, deeper locations, and larger diameters. Possibility of the need for multiple treatments should be discussed in the initial consultation. Dermoscopy is a simple, noninvasive technique that allows the microvascular patterns in PWS to be assessed and recorded. We have observed that the type 1 pattern is readily treated with HMME-PDT and an excellent response can be expected, whereas the type 2 pattern resists treatment. Further studies will increase the sample size, refine the dermoscopic patterns, and study the relationship between different patterns and HMME-PDT results.

Pulsed dye laser alone versus its combination with topical ivermectin 1% in treatment of Rosacea: a randomized comparative study

Background While the etiology of rosacea is multifactorial, it is not surprising that treatment has been controversial. Pulsed dye laser (PDL) has been successfully used to treat vascular components of rosacea. Ivermectin 1% cream is an emerging treatment of rosacea. Objective To provide a comprehensive clinical and dermatoscopic comparative study between the efficacy and safety of pulsed dye laser alone versus its combination with topical ivermectin 1% in the treatment of rosacea. Materials and methods Thirty Patients were randomly divided into two groups. Group A (n = 15) treated with 585 nm PDL, and group B (n = 15) treated with 585 nm PDL and topical ivermectin 1% cream. All patients received four laser treatments with a 4-week interval. The efficacy of treatment was assessed by photographs and dermoscopic photomicrographs at baseline and 3 months after the final treatment. The patient’s level of satisfaction was also recorded. Results At the 3-month follow-up, group B induced better clinical improvement than group A. However, this difference was not significant. No serious adverse events were observed in either treatment group. Conclusion This study supports the efficacy of PDL treatment for patients with rosacea. PDL could be more effective when combined with ivermectin 1% cream.

Treatment of port wine stain with Tixel-induced rapamycin delivery following pulsed dye laser application.

Although pulsed dye laser (PDL) is considered the gold standard treatment for port wine stains (PWS), post PDL revascularization is one of the main causes of incomplete regression and recurrence. Recently, topical sirolimus have been shown to improve treatment outcome probably through minimizing post-laser revascularization. We sought to evaluate the added value of the Tixel drug delivery system (DDS) to the PDL and topical rapamycin treatment for PWS. This case series includes three teenager patients with previously treated PWS with PDL. Upon enrollment, every stain was divided into A and B halves for treatment assignments to the following regimens: (A) PDL + DDS + rapamycin; (B) PDL + rapamycin. Subjects were instructed to apply rapamycin topically over the PWS twice daily for the entire treatment period. Assessment of the treatment and adverse reactions as well as photographs was performed at baseline and before every PDL treatment. There were clinically significant differences in blanching responses favoring PWS receiving PDL + DDS + rapamycin as compared to PDL + rapamycin alone. Transient hyperpigmentation was noted in one patient. Two patients developed mild transient irritation and dermatitis following the treatment on both halves. The use of drug delivery system combined with topical rapamycin has no remarkable adverse effects, improves the results of PDL treatment for port wine stains, and can reduce the total number of required PDL sessions.

Treatment of Erythematotelangiectatic Rosacea With Pulsed-Dye Laser and Oxymetazoline 1.0% Cream: A Retrospective Study.

Pulsed-dye laser (PDL) and oxymetazoline 1.0% cream are each used for the treatment of erythematotelangiectatic (ET) rosacea. PDL targets oxyhemoglobin and can reduce facial erythema and telangiectasias. Oxymetazoline 1.0% cream is an α adrenergic agonist, which has shown to reduce facial erythema. The aim of this study was to determine the degree of erythema improvement and telangiectasia clearance after combination treatment with PDL plus oxymetazoline 1.0% cream. This retrospective study was conducted at two sites. Pre- and post-treatment cross-polarized images from subjects on combination treatment with PDL and oxymetazoline 1.0% cream were graded by a board-certified dermatologist at each practice. Blinded images were analyzed using the Clinical Erythema Assessment (CEA) Scale (0 = clear and 4 = severe). Unblinded images were analyzed using the five-point Telangiectasia Scale to determine the degree of improvement post-treatment compared with baseline (1 = <5% clearance and 5 = 75-100% clearance). Thirty-one subjects (20 females, 11 males) of age 51 ± 13 years (mean ± standard deviation) were included in the study after an average of 4 months (range: 1-13) of daily oxymetazoline 1.0% cream and two (range: 1-4) PDL treatments. At baseline, 87% of subjects had CEA Grade 2 (mild erythema) or higher. For erythema, 55% of subjects improved by at least one CEA grade and 13% achieved two grades of improvement post-treatment. For telangiectasias, 90% of subjects achieved at least a two-point clearance (5-25%), 62% at least a three-point clearance (25-50%), and 41% at least a four-point clearance (50-75%) post-treatment. Compared with subjects with baseline CEA Grade 1-2 (almost clear to mild erythema), significantly more subjects with baseline CEA Grade 3-4 (moderate to severe erythema) achieved at least one CEA grade of improvement (P = 0.021) and two grades of CEA improvement (P = 0.041). A higher percentage of baseline CEA Grade 3-4 subjects achieved at least a two-point clearance in telangiectasias (P = 0.055). Combination treatment with PDL and daily oxymetazoline 1.0% cream can safely and effectively reduce erythema and telangiectasias. Limitations include the retrospective design of the study, small sample size, and lack of a control group. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Pulsed Dye Laser Treatment and Oxymetazoline Hydrochloride (HCL) 1% Cream for Erythematotelangiectatic Rosacea

Pulsed Dye Laser Treatment and Oxymetazoline Hydrochloride (HCL) 1% Cream for Erythematotelangiectatic Rosacea

Clinical efficacy of 595-nm pulsed-dye laser in treatment of childhood facial spider nevi: a retrospective study of 110 patients.

Background:Spider nevi (SN) are quite common in children. SN are treated via different techniques, and complete removal often requires multiple treatments. However, few studies have evaluated the treatment of SN. The present study aimed to evaluate the therapeutic effect and safety of a 595-nm pulsed-dye laser (PDL) for treating facial SN in children.Methods:A total of 110 children aged 0.2 to 12 years with facial SN were treated with a 595-nm PDL in a single institution from January 2016 to February 2018. In accordance with the treatment method, the patients were retrospectively divided into the small-spot-combined-with-large-spot group (SL-group) and the large-spot group (L-group). Patients with poor therapeutic results were re-treated every 6 weeks until the lesions disappeared. The minimum follow-up period was 1 year. The groups were compared using independent-samples t tests, Mann-Whitney U test, Chi-square test, and Fisher exact probability test.Results:The therapeutic efficacy was significantly higher in the SL-group than in the L-group, with clearance rates of 90.9% and 53.0% after the primary treatment, respectively (χ2 = 17.937, P < 0.001). For skin lesions with a central spider body diameter ≥1 mm, the once-treatment cure rates were 100% in the SL-group and 34.8% in the L-group (χ2 = 20.780, P < 0.001). For skin lesions with a central spider body diameter <1 mm, the once-treatment cure rates were 82.6% in the SL-group and 62.8% in the L-group (χ2 = 3.961, P = 0.138). The rates of adverse reactions and recurrence did not differ between the two groups (P = 0.141 and P = 1.000, respectively).Conclusions:The 595-nm PDL might be a safe and effective treatment option for facial SN in children. The small-spot-combined-with-large-spot method is especially suitable for SN with a central spider body diameter ≥1 mm.

The Efficacy of Pulsed Dye Laser Pretreated With or Without Local Anesthetic on Patients Presenting With Erythema of Face, Neck, Chest, and Extremities.

Erythema is one of the most common cosmetic concerns and usually responds well to pulsed dye laser (PDL) treatment. As this laser can cause significant discomfort, topical anesthesia is sometimes offered. However, it is still uncertain whether topical anesthetics can affect the outcome of the laser therapy. We performed a retrospective single site study to compare the efficacy of PDL for the treatment of erythema in patients with and without pretreatment with topical anesthetic. A chart review was performed and patients who presented with erythema of face, neck, chest, and extremities pretreated with topical anesthesia (23% lidocaine/7% tetracaine ointment or 7% lidocaine/7% tetracaine ointment) undergoing PDL were reviewed and compared with another group without anesthesia. Two blinded dermatologists evaluated the postlaser procedure photographs and gave an assessment compared with baseline. A total of 69 patient charts were reviewed. The erythema resulted from various skin conditions including telangiectasia, cherry angioma, striae, and rosacea. The mean improvement was 2.2581 in the anesthesia group and 2.2632 in the nonanesthesia group. There was no significant difference between both groups as confirmed by a noninferiority test. Topical anesthesia with lidocaine and tetracaine ointment do not interfere with the efficacy of the PDL. Since pain management is essential for any cosmetic procedure, the application of a local anesthetic will enhance patient comfort and satisfaction during treatment with PDL. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Clinical study of pulsed dye laser fine therapy for hypertrophic scar

Objective To compare the efficacy and safety of pulsed dye laser with different parameters in the treatment of hypertrophic scar after burn. Methods From January 2016 to June 2016, 122 patients with hypertrophic scar after burn were treated in our unit. The data were analyzed retrospectively. According to the pulse width and energy of pulsed dye laser treatment, there were 31 cases with 0.45 ms-low energy, 28 cases with 0.45 ms-high energy, 37 cases with 1.5 ms-low energy and 26 cases with 1.5 ms-high energy, which were treated once every 3-4 weeks. The Vancouver Scar Scale (VSS) was used to evaluate the scar condition before and after treatment, and the pain of patients was scored by VAS before and after treatment. The blood flow of scar site was monitored before and 12 months after treatment, and the blood perfusion was recorded. The patients′satisfaction was recorded 3 to 6 months after treatment, and the satisfaction rate was calculated. Results ⑴ The VSS scores of 0.45 ms-low energy, 0.45 ms-high energy, 1.5 ms-low energy and 1.5 ms-high energy groups after treatment were significantly lower than those before treatment in each group (t=11.3, 9.0, 14.1, 12.7, P 0.05), but there was significant difference in the effect of other treatment groups(t=7.29, 4.81, 6.91, 5.11, 4.74, P 0.05). Conclusions The therapeutic effect of pulsed dye laser on hypertrophic scar is very exact, and the treatment parameters of 0.45 ms pulse width and low energy 4-6 J/cm2 are recommended, which provide clinical basis for the prevention and treatment of scar and the application of pulsed dye laser. It is worthy of clinical application. Key words: Cicatrix, hypertrophic; Lasers, dye; Laser therapy

Pulsed Dye Laser Treatment of Port-Wine Stains in Infancy Without the Need for General Anesthesia

Recent concerns regarding repetitive use of general anesthesia in children younger than 3 years have placed greater importance on the controversy surrounding the timing of the initiation of port-wine stain (PWS) laser treatment. To evaluate the use of PWS treatments at the age of 1 year or younger in the office setting without general anesthesia. Retrospective cohort study based on medical record reviews at a single, high-volume laser center for children who started pulsed dye laser treatment at the age of 1 year or younger for their PWS between 2000 and 2017. The data cutoff was at 1 year after the initial treatment to have comparable data points. The primary outcome was improvement of PWSs using before and after photographs, which were reviewed by 4 physicians independently and graded using the following 5-point visual analog scale (VAS): poor (grade 1: 0%-25% improvement), fair (grade 2: 26%-50% improvement), good (grade 3: 51%-75% improvement), excellent (grade 4: 76%-99% improvement), and complete (grade 5: 100% improvement) clearance. Of the 197 patients (73 [37.1%] boys; 124 [62.9%] girls), most (149 [75.6%]) had facial lesions. The mean age at the time of first treatment was 3.38 months (range, 5-355 days) and the mean number of treatments was 9.8 (range, 2-23; median, 10). Per the mean physician VAS grading of 197 patients, 51 patients (25.9%) showed 100% clearance (mean [range] VAS score of 4.78 [4.5 - 5]); 81 patients (41.1%) showed 76 to 99% improvement (mean [range] VAS score of 3.91 [3.5 to <4.5]); 44 patients (22.3%) showed 51% to 75% improvement (mean [range] VAS score of 2.86 [2.5 to <3.5]); 13 patients (6.6%) showed 26% to 50% improvement (mean [range] VAS score of 2.12 [1.5 to <2.5]); and 8 patients (4.1%) showed 0 to 25% improvement (mean [range] VAS score of 0.78 [0 to <1.5]). The presence of a V1 (first branch of the trigeminal nerve [ophthalmic nerve]) lesion was associated with a statistically significantly higher clearance rate by a VAS grade of 0.55 (95% CI, 0.25-0.84; P < .001). The mean (SD) VAS grade for all patients was 3.65 (1.26), corresponding to excellent clearance. None of the patients experienced scarring or permanent pigmentary change. In this study, treatment of PWSs in infancy was both safe and effective. Early intervention allows for treatment without general anesthesia, maximizing the chance to achieve clearance before school age and thereby minimizing the negative outcome of PWSs for both the patient and the family.

Pulsed-dye laser as an adjuvant treatment for papulopustular eruptions from epidermal growth factor receptor inhibitors, a randomized blinded split-faced controlled trial.

To investigate the efficacy of pulsed-dye laser (PDL) as an adjunctive treatment for facial papulopustular eruptions from EGFR inhibitors (EGFRi). Fourteen patients with facial acneiform eruptions were recruited. Half side of the face was randomized to receive PDL treatment while the other side served as a control. The treatments were delivered every 2 weeks for 4 sessions. The patients were seen at baseline, weeks 2, 4, 6, 8, and 10. Erythema index (EI) measured by colorimeter, the papulopustular lesion count and physician global assessment (PGA) were obtained. Patients were allowed to use their standard treatments for their eruptions. Both arms had a significant decrease in EI from baseline at each subsequent visit. In the laser treated side, the mean (95%CI) EI decreased from 23.5 (22.24-24.76) at baseline to 16.3 (15.01-17.59) at week 10, while those of the sham were 23.49 (22.23-24.75) to 20.51 (19.22-21.8), respectively. The mean change was significantly lower in the PDL arm from week 4 onwards. The lesion counts in both groups also decreased significantly, but the mean difference between the arms was not different. PGA scores followed the same pattern as EI. Adjunctive treatment with PDL was a safe and effective treatment. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Clinical efficacy of propranolol and 595 nm pulsed dye laser in treatment of infantile hemangioma

Objective To observe the clinical efficacy of propranolol and 595 nm pulsed dye laser (PDL) in treatment of infantile hemangioma. Methods 26 infants admitted to our hospital from January 2013 to January 2015 with hemangioma underwent oral propranolol 2 mg/(kg·d) treatment after excluding of taboos. The daily doses were divided equally to two parts, taken on the time of 8: 00 and 20: 00, when the electrocardiograph and pulse oxygen were monitored and recorded persistently. The patients were discharged from the hospital when it was stable, with review of blood routine examination, fasting blood glucose, liver and kidney function, and the change of size, character and color of hemangioma were recorded, and taken photos every two weeks after discharge. The 595 nm PDL was used to treat the hemangioma faded incompletely when the propranolol was terminated. Results The tension and color of all hemangioma decreased in varying degrees in taking propranolol for 72 hours, and evaluated the efficacy as recovery completely 19 cases; signifivantly effective in 3 cases and partial efficacy in 4 cases; the latter 7 cases were further treated with 595 nm PDL. Followed-up for 6-12 months showed that efficacy of recovery reached 100%. 10 cases showed heart rate was mild reversibly slow, with no special treatment. 5 cases had diarrhea, and healed with symptomatic treatment. No adverse reactions like liver and kidney dysfunction and so on were found. Conclusions Propranolol and 595 nm PDL can effectively treat infantile hemangioma, and thus it can be used as the recommended treatment of infantile hemangioma. Key words: Hemangioma; Propranolol; Lasers, dye; Infant; Treatment outcome

Clinical effects of sequential laser treatments on early stage hypertrophic burn scars

Objective: To observe the clinical effects of sequential treatments of pulsed dye laser (PDL) and ablative fractional carbon dioxide laser on early stage hypertrophic burn scars. Methods: From January 2016 to December 2017, 221 patients with 228 hypertrophic scars in all parts of body within 6 months post healing, conforming to the study criteria and treated in our department, were included in this prospective study. They were first treated by PDL, repeated at an interval of one month until the vascularity score of scar fell below 2 points, and then treated by ablative fractional carbon dioxide laser, repeated at an interval of 3 months. Their start time and numbers of treatment and follow-up time were recorded. Before the first treatment (hereinafter referred to as before treatment) and at the last follow-up (hereinafter referred to as after treatment), the vascularity, thickness, and pliability of scars were scored by a self-made scar rating scale. The scores of patients with the observation time between 6 to18 months post healing were compared among scars of patients grouped by age, body site of scar, starting time of treatment and numbers of treatment. The laser speckle contrast imaging technique was used to measure the blood flow value of scars. The itching symptom of the scars was evaluated by the Verbal Rating Scale. The satisfaction to the final effects of the doctors and patients was investigated and scored separately by Likert scale after treatment. The therapeutic or adverse reactions were recorded during the treatment. Data were processed with paired t test, Mann-Whitney U test, Wilcoxon signed rank sum test, Kruskal-Wallis H test, and Spearman rank correlation analysis. Results: (1) The patients were treated on (64±36) d post healing, by PDL for (2.5±1.3) times and by ablative fractional carbon dioxide laser for (2.2±1.2) times. The follow-up time was (331±189) d. (2) The vascularity, thickness, pliability scores and total scores of scars were (1.4±0.9), (2.0±0.8), (1.7±0.8), and (5.0±2.1) points respectively after treatment, which were significantly lower than those before treatment [(4.1±0.7), (3.1±0.8), (3.0±0.9), and (10.2±2.0) points respectively, t=43.332, 24.968, 28.063, 46.394, P<0.01]. (3) Among the 123 scars from 120 patients with observation time between 6 to 18 months post healing, there were no statistically significant differences in the vascularity, thickness, pliability scores and total scores of scars among patients with different ages after treatment (χ(2)=4.339, 1.826, 1.375, 2.879, P>0.05). There was only significant difference in the pliability scores of scars among different body sites (χ(2)=13.530, P<0.05). There were statistically significant differences in the vascularity, thickness, pliability scores and total scores of scars with different starting time of treatment (χ(2)=30.725, 25.233, 25.119, 35.798, P<0.01). There were significantly positive correlation between starting time of treatment and the vascularity, thickness, pliability scores and total scores of scars (r=0.492, 0.442, 0.446, 0.532, P<0.01). There were statistically significant differences in the vascularity, pliability scores and total scores of scars with different numbers of treatment (Z=4.883, 4.910, 5.049, P<0.05). There were significantly negative correlation between number of treatment and the vascularity, thickness, pliability scores and total scores of scars (r=-0.176, -0.131, -0.191, -0.201, P<0.05). (4) The blood flow values were determined in 18 scars of 18 patients. The results showed that the blood flow values of scars after treatment were significantly decreased compared with those before treatment (t=7.230, P<0.01). (5) The pruritus scores of scars of patients after treatment were significantly decreased compared with those before treatment (Z=12.818, P<0.01). (6) There were significant differences between the satisfaction scores of doctors and the scores of patients after treatment (t=12.130, P<0.01). (7) After PDL treatment, there were some edema and purpura reactions for all the patients, and 11 (5.0%) patients had blisters. After ablative fractional carbon dioxide laser treatment, 4 (1.8%) patients had blisters, 5 (2.3%) patients suffered inflammatory reaction and erosion, and 9 (4.1%) patients suffered pigmentation. Conclusions: The scores of hypertrophic burn scars can be obviously improved by sequential treatments of PDL and ablative fractional carbon dioxide laser. The effects can be more obvious with the earlier starting time and more numbers of treatment. The laser treatments can also decrease the blood flow values and alleviate the pruritus of scars, with high satisfaction of both patients and doctors.

Pulse dye laser (PDL) treatment of cutaneous larva migrans in a pregnant patient

Pulse dye laser (PDL) treatment of cutaneous larva migrans in a pregnant patient

Less is more: similar efficacy in three sessions and seven sessions of pulsed dye laser treatment in infantile port-wine stain patients.

Port-wine stains (PWS) affect 0.3 to 0.5% of newborns and pulsed dye laser (PDL) remains the treatment of choice. However, no reliable study regarding the benefits of more frequent has been conducted. We designed the present study to evaluate whether more frequent PDL treatments in infantile patients would achieve further lightening of erythema. We prospectively investigated 20 infants with PWS. Two adjacent sites were both treated for a 12-week duration and randomly allocated to be treated for seven sessions at 2-week intervals or three sessions at 6-week intervals. The efficacy outcome 2months after the final treatment was determined by visual and chromameter evaluation. Sixteen patients completed the study with a total of 54 treatment sites. Similar results were observed in the two groups. The average blanching rates were 42.93% (SD = 27.92%) and 43.81% (SD = 32.80%) for PDL treatments with seven and three sessions, respectively (p = 0.374). Partial recovery from the laser treatment was more frequently observed and side effects were significantly higher at 2-week follow-ups (p < 0.001), resulting in a total of 3-13weeks for skin recovery. More frequent PDL treatments do not necessarily increase efficacy in infantile PWS patients. Considering the potential risks and added costs, this practice may not be of benefit. (Clinical trial registration number: ChiCTR-ONC-17010857).

Pulsed-dye laser as an adjuvant treatment for discoid lupus erythematosus: a randomized, controlled trial

Purpose: To evaluate the efficacy and safety of pulsed-dye laser (PDL) for discoid lupus erythematosus (DLE) in a double blinded, randomized, controlled fashion.Method: Forty-eight DLE lesions from nine patients were recruited. The lesions on one side of the body were randomized into the treatment group and the other side served as a control. Treatments with the PDL (595 nm) were delivered every four weeks for four consecutive months. The patients were evaluated at weeks 0, 4, 8, 12, 16 and 24. Erythema index (EI) and Texture index (TI) were obtained by Antera3D®. Modified Cutaneous Lupus Erythematosus Disease Area and Severity Index (mCLASI) and physician global assessment (PGA) scores were assessed in every visit. Lesional skin biopsies before and after the PDL treatment were taken from four patients.Results: The lesions treated with the PDL demonstrated significantly more decreases in EI, TI and improvement in PGA scores compared to the control. Though there was improvement of mCLASI in the laser group, the significance difference was not observed. Interestingly, real-time polymerase chain reaction showed a reduction in CXCL-9, 10, IFN-γ, IL-1β, TNF-α and TGF-β. Additionally, post-treatment DLE lesions demonstrated decreased CD3, CD4, CD8 and CXCR3-positive cells.Conclusions: Improvements of DLE can be achieved with PDL.

Evaluation of the effect of pulsed dye laser on chronic psoriatic plaque

Background: Psoriasis is one of the most prevalent immune mediated skin diseases. Selective vascular destruction by pulsed dye laser is considered one of effective laser treatments. Objective: Evaluation of the therapeutic effect of pulsed dye laser in treatment of chronic psoriatic plaque lesions and changes in human beta defensin-2(HBD-2) expression in the psoriatic patients before and after treatment, with correlation to the clinical improvement.Methods: Twenty patients with psoriatic plaque on right side treated by laser and another plaque on left side similar in size and its severity score served as control receiving no treatment. Each patient received 3–4 sessions of pulsed dye laser 595 nm. Follow up was done for three months.Results: There was statistically significant difference between the two psoriatic plaques (untreated and treated; A and B; p = .004). There was significant decrease in HBD-2 expression after treatment. No recurrence was observed during follow up period.Conclusion: The pulsed dye laser is safe, effective, and tolerable treatment for resistant stable localized plaque psoriasis with minimal side effects and prolonged recurrence period.

Topical Halometasone Reduces Acute Adverse Effects Induced by Pulsed Dye Laser for Treatment of Port Wine Stain Birthmarks.

Introduction: Pulsed dye laser (PDL) for treatment of port wine stain (PWS) usually causes some acute adverse effects, including pain, erythema, scabbing and swelling. This study aimed to determine whether topical halometasone can be used to reduce these acute adverse effects for post-PDL care of patients. Methods: A total of 40 PWS subjects were enrolled in this study and randomly assigned into two regimens: PDL alone and PDL + halometasone. All subjects were given a single treatment of PDL with wavelength of 595 nm, fluence of 8.0~13.5 J/cm2, pulse duration of 0.45~20 ms (We mainly used purpuric pulse duration for PWS) and spot size of 7 mm. Subjects in the PDL + halometasone group received topical application of halometasone daily for 3 days. Subjects were followed-up on days 3, 7 and one month post-PDL to evaluate the reduction of adverse effects. Results: Subjects in the PDL + halometasone group had significantly improved erythema and scab scores and had less erythema duration days as compared to those in the PDL alone group. Topical halometasone also showed a decrease in pain index among subjects, but was statistically insignificant. Topical halometasone did not affect the ultimate efficacy of PDL treatment for PWS. Conclusion: Topical halometasone can significantly reduce acute adverse effects induced by PDL for treatment of PWS birthmarks, thus providing a safe and efficacious solution for post-PDL care of PWS patients.

Efficacy of pulsed dye laser treatment for common warts is not influenced by the causative HPV type: a prospective study.

Verruca vulgaris (VV) is a prevalent skin condition caused by various subtypes of human papilloma virus (HPV). The most common causes of non-genital lesions are HPV types 2 and 4, and to a lesser extent types 1, 3, 26, 29, and 57. Although numerous therapeutic modalities exist, none is universally effective or without adverse events (AE). Pulsed dye laser (PDL) is a favorable option due to its observed efficacy and relatively low AE rate. However, it is not known which verrucae are most likely to respond to PDL, or whether the causative viral subtype influences this response. The objective of this prospective blinded study was to assess whether the HPV subtype was predictive of response to PDL. For that matter, 26 verrucae from 26 immunocompetent patients were biopsied prior to treatment by PDL. HPV coding sequences were isolated and genotyped using PCR analysis. Patients were treated by PDL (595nm wavelength, 5mm spot size, 1.5ms pulse duration, 12J/cm2 fluence) once a month for up to 6months, and clinical response was assessed. Binary logistic regression analysis and linear logistic regression analysis were used in order to evaluate statistical significance. Different types of HPV were identified in 22 of 26 tissue samples. Response to treatment did not correlate with HPV type, age, or gender. As no association between HPV type and response to PDL therapy could be established, it is therefore equally effective for all HPV types and remains a favorable treatment option for all VV.

Ringed telangiectasias: an unusual presentation of telangiectasia macularis eruptiva perstans

Telangiectasia macularis eruptiva perstans (TMEP) is a rare form of cutaneous mastocytosis. While most cutaneous mastocytoses occur in children and are asymptomatic, TMEP occurs predominantly in adults and is associated...