Efficacy and Safety of Long Pulsed Nd:YAG Laser in the Management of Hypertrophic Scars and Keloids

@#Keloid scars have always been a therapeutic challenge. Lasers due to their versatile action are being tried in the management of hypertrophic scars and keloid. Use of Nd:YAG laser especially in dark skin types is justifiable but sufficient data is not available.

Long-pulsed 1064 nm Nd: YAG laser combined with terbinafine against chromoblastomycosis caused by and the effect of laser therapy in a Wistar rat model / 南方医科大学学报

We report a case of chromoblastomycosis caused by , which was successfully treated by long-pulsed 1064 nm Nd: YAG laser combined with terbinafine. A 60-year-old man was admitted for the presence of a 30 mm×40 mm erythematous plaque on the dorsum of his right hand for about 10 months without any subjective symptoms. Both microscopic examination and tissue biopsy of the lesion showed characteristic sclerotic bodies of chromoblastomycosis. Lesion tissue culture on SDA at 26 ℃ for 2 weeks resulted in a black colony, and slide culture identified the isolate as Fonsecaea species. ITS sequence analysis of the isolate showed a 99% homology with strain KX078407. The susceptibility of the isolate to 9 antifungal agents was determined using the microdilution method according to the guidelines of CLSI M38-A2 protocol, and terbinafine showed the lowest MIC (0.125 μg/ml). We subsequently established a Wistar rat model of chromoblastomycosis using the clinical isolate and treated the rats with long-pulsed 1064 nm Nd: YAG laser (pulse width of 3.0 ms, fluence of 24 J/cm, spot size of 3 mm, frequency of 4 Hz, repeated 3 times at an interval of 30 s) twice a week for a total of 8 sessions. Although the laser treatment alone was not able to eliminate the fungi, histopathological examination showed the aggregation of numerous lymphocytes in the local affected tissue, indicating an immune response that consequently facilitate the regression of the lesion. The patient was successfully treated by long-pulsed 1064 nm Nd: YAG laser once a week combined with terbinafine (0.25 /bid) for 8 weeks, and follow-up for 20 months did not reveal any signs of recurrence.

Efficacy of 1064nm Q-switched laser with small light spot in treatment of melasma / 中华医学美学美容杂志

Objective To evaluate the efficacy and experience of Q-switched laser with small light spot in the treatment of melasma.Methods Forty-six patients with melasma were emolled in study.Subjects received total of forty-six patients treatment with 1064 nm Q switched laser at one month intervals.Light spot of 3-4 nm were used.Results Forty-six patients completed the trial.The physician evaluation showed that 50％ of patients achieved 90％ to 100％ clearance,and 89.1％ patients achieved 60％ to 90％ clearance.Side effects was minimal and all the patients tolerated the treatment well.Conclusions Small light-spot and low-energy 1064 nm Q Switched laser is substantially effective and highly safe for the treatment of melasma.

Study on 1064 nm Q-switched Laser Combined with Drug Therapy in Treatment of Mild to Moderate Rosacea / 中山大学学报(医学科学版)

[Objective]To determine the efficacy and safety of 1064nm Q-switched laser combined with drug therapy in the treatment of mild to moderate rosacea.[Methods]73 patients with mild to moderate rosacea were divided into two groups randomly.The treatment group including 37 patients were treated with Q-switched laser combined with drug thera-py,the control group including 36 patients were treated with drug therapy only.Efficacies and safety were evaluated 6 and 9 weeks after the treatments.[Results]A mean reduction in lesion count was observed,statistically significance differenc-es in effectiveness were found among each group(P<0.05),the effective ratio was 83.8% in treated group,of which was 61.1% in control group,it showed significant difference between these two groups(P<0.05). There was no side effect.[Conclusion]1 064 nm Q-switched laser combined with drug therapy has a marked effect on mild to moderate rosacea,it is safe and effective,better than simple drug treatment.

Clinical effect of large speckle modulated Q1064nm laser combined with Xiaoyao pills in treatment of chloasma / 中华医学美学美容杂志

Objective To investigate the clinical efficacy of large spot modulated Q 1064 nm laser combined with Xiaoyao pills in the treatment of chloasma.Methods 90 patients with chloasma were treated in the hospital.The patients were randomly divided into 3 groups:treatment group were treated with Q 1064 nm laser combined with large spot Xiao Yao pill;the control group 1 was treated with large spot Q 1064 nm laser only,and control group 2 was treated with Xiaoyao Pill only.Results After 8 weeks of treatment,the effective rate was higher in the treatment group than the control group 2 (P＜0.05);after 16 weeks of treatment,the efficacy was better in the treatment group than the control group 1 and control group 2 (P＜0.05).The combination of the two methods can improve the curative effect and inhibit the recurrence.Conclusions The treatment of chloasma with large speckle modulated Q 1064 nm laser combined with Xiaoyao pills is effective and worthy of clinical promotion.

Clinical Efficacy of Long-pulsed 1064 nm Laser Combined with Amorolfine Hydrochloride in the Treatment of Patients with Onychomycosis / 中国药师

Objective:To investigate the clinical efficacy of long-pulsed 1064nm laser combined with amorolfine hydrochloride in the treatment of patients with onychomycosis. Methods:Totally 106 cases of patients with onychomycosis were randomly divided into the observation group (n=53) and the control group(n=53) according to the random number table. The control group was given 5%amorolfine hydrochloride liniment, while the observation group was treated with long-pulsed 1064nm laser additionally. The course of treatment was 6 months. The clinical efficacy, length of deck in ward areas, length of deck in health zone, clearance of mycology and adverse reactions were compared between the groups. Results:The total effective rate of the observation group(90. 57%) was signifi-cantly higher than that of the control group(75. 47%, P<0. 05). After the treatment, the length of deck in ward areas in both groups were significantly decreased, while the length of deck in health zone were significantly increased (P<0. 05). The length of deck in ward areas in the observation group was significantly lower than that in the control group, while the length of deck in health zone was significantly higher than that in the control group(P<0. 05). The clearance rate of mycology in the observation group (86. 79%) was significantly higher than that in the control group (67. 92%, P<0. 05). There were no serious adverse reactions during the treatment course. Conclusion:Long-pulsed 1064nm laser combined with 5% amorolfine hydrochloride liniment in the treatment of patients with onychomycosis has remarkable, safe and reliable clinical effects, which shows important study value.

Hypopigmentation Induced by Frequent Low-Fluence, Large-Spot-Size QS Nd:YAG Laser Treatments

The Q-switched 1064-nm neodymium-doped yttrium aluminum garnet (QS 1064-nm Nd:YAG) laser is increasingly used for nonablative skin rejuvenation or "laser toning" for melasma. Multiple and frequent low-fluence, large-spot-size treatments are used to achieve laser toning, and these treatments are associated with the development of macular hypopigmentation as a complication. We present a case series of three patients who developed guttate hypomelanotic macules on the face after receiving laser toning treatment with QS 1064-nm Nd:YAG.

Comparison of Wound Repair after Irradiation of Rat Skin with 1064 nm Nd:YAG, CO2, and Er:YAG Lasers / 대한피부과학회지

BACKGROUND: Laser therapy for various skin conditions is one of the most common procedures in dermatology. Recently, several articles described the use of 1064 nm Q-switched Nd:YAG lasers for the treatment of benign skin lesions. Such treatment is known to trigger its therapeutic effect through a photoacoustic effect and selective photothermolysis effect. However, only a limited number of articles have dealt with the theoretical base of the photoacoustic effect of the 1064 nm Q-switched Nd:YAG laser. OBJECTIVE: To compare the wound repair process and nonselective tissue heat damage induced by three different laser modalities: the CO2 laser, Er:YAG laser, and 1064 nm Q-switched Nd:YAG laser. METHODS: We irradiated the skin of an albino rat (Sprague Dawley(R), 200~250 g) with CO2, Er:YAG, and 1064 nm Q-switched Nd:YAG lasers. Skin biopsy specimens of the irradiated areas were collected on the first, fifth, and tenth day after laser exposure. For histologic analysis, the specimens were stained with the H&E, Verhoff-Van Gieson, and Masson's trichrome protocols. RESULTS: Compared with other laser modalities, rat skin irradiated by the 1064 nm Q-switched Nd:YAG laser showed the least amount of heat damage and the quickest tissue repair response to the damage. CONCLUSION: A 1064 nm Q-switched Nd:YAG laser with a photoacoustic effect capable of ablating the epidermis and dermis can be a proper treatment modality for the removal of benign skin lesions. The 1064 nm Q-switched Nd:YAG laser may be considered as an alternative treatment option for the treatment of benign skin lesions.

Treatment of facial telangiectasia with long-pulse 1 064 nm laser plus AFT540 nm photons / 中华医学美学美容杂志

Objective To treat facial telangiectasia with long-pulse 1 064 nm laser combined with AFT 540 nm photons and to observe the effect.Methods The disease was treated with composite vascular therapeutic apparatus of Alma laser.According to skin type and treatment response,the different energy density and pulse width were chosen in the treatment.Results After 4-6 times of treatment,the totally effective rate in 60 cases was as high as 100%without scar formation and pigmentation.Conclusion Treatment of facial telangiectasia with long-pulse 1 064 nm laser plus AFT540nm photons is safe and effective.

Treatment of naevus of Ota with Q-switched 1064nm Nd:YAG laser

Background Naevus of Ota was first described in 1939 by Ota M. It is characterized by a bluish-gray mottled hyperpigmentation in the distribution of the trigeminal nerve. It affects between 0.014 - 0.6% of the Asian population. It is not only physically disfiguring but may be associated with tremendous psychosocial impact on the patient. The aim of the study is to determine the demographic data of local patients with naevus of Ota, their response to treatment with Q-switched 1064nm Nd:YAG laser, complications and recurrence. Materials and Methods A retrospective analysis of all patients with naevus of Ota treated with Q-switched 1064nm Nd:YAG laser between January 1998 to December 2007 was conducted at the dermatology clinic, Kuala Lumpur Hospital. Patients’ demographic data, clinical characteristics, response to Q-switched 1064nm Nd:YAG laser and the complications were reviewed. Results A total of 50 patients with naevus of Ota were treated with Q-switched 1064nm Nd:YAG laser. There were 42 female and 8 male patients with a F : M ratio of about 5:1. The mean age of presentation was 31 years old (11-60 years). More than half were Chinese patients (56%) followed by Malays (38%), Indian (2%) and others (4%). Seventy four percent of the patients had Fiztpatrick skin-type IV and the rest skin type V. Ninety two percent of the patients had unilateral trigeminal dermatomal involvement while 8% had bilateral trigeminal dermatomal involvement. Of the 15 patients who were referred to the ophthalmologist, 10 were found to have scleral involvement and none had glaucoma. Patients who had 2 treatments (13 patients) did not have any significant lightening of their lesions. In the remaining 37 patients who had 3 sessions (mean = 5.7, range 3 -15 sessions), 9 patients (24.3%) reported the response as good (51-75% lightening); 17 patients (45.3%) as excellent (>75% lightening) and 8 patients (22%) had near complete lightening (>90%). None reported any complications or recurrence. Conclusion Q-switched 1064nm Nd:YAG laser is an effective and safe treatment modality for patients with naevus of Ota.

The Effect of 1320 nm Nd: YAG Laser and Long-pulsed 1064 nm Nd: YAG Laser Irradiation on Hairless Mouse Skin / 대한피부과학회지

BACKGROUND: The treatment of facial rhytides has traditionally centered around methods that involve removal of the epidermis and superficial dermis, encouraging the production of a new epidermis with collagenesis and remodelling. But all of the resurfacing techniques lead to postoperative complications such as oozing, bleeding, infections, "downtime" as the skin begins to reepithelialize, and the occasional incidence of posttreatment, postinflammatory pigmentary changes. 1320nm and 1064nm wavelengths are nonspecifically absorbed in the human dermis and are unique for its significant horizontal scattering. These wavelengths, when used for localized facial areas, have been shown to produce new collagen formation and improvement in the quality of treated skin. OBJECTIVE: The purpose of this study was to examine the effect of 1320nm Nd: YAG laser and long-pulsed 1064nm Nd: YAG laser irradiation on hairless mouse skin and rat skin. METHODS: In this study, the effect of 1320nm Nd: YAG laser and long-pulsed 1064nm Nd: YAG laser irradiation were examined by Hematoxylin and eosin (H&E) stain, Masson's trichrome stain, immunohistochemical stain for type I collagen and dot-blot hybridization for alpha1(I) procollagen mRNA. RESULTS: In the H&E stain, Masson's trichrome stain, and immunohistochemical stain of the hairless mouse skin, the number of collagen fibers with a greater density of fibers increased, compared to the non-irradiated controls on both the 1320nm Nd: YAG laser and the long-pulsed 1064nm Nd: YAG laser. In the dot-blot hybridization in the hairless mouse, levels of alpha1(I) procollagen mRNA were increased 3.0-fold, 4.8-fold and 5.2-fold at each 1 week, 4 weeks and 12 weeks after irradiation in 1320nm Nd: YAG laser and 1.8-fold and 2.1-fold at each 4 weeks and 12 weeks after irradiation in long-pulsed 1064nm Nd: YAG laser, compared to the non-irradiated controls. But in the 1320nm Nd: YAG laser irradiation on the rat, there is no significant change in the number and density of collagen fibers, compared to the non- irradiated controls. CONCLUSION: These results indicate that the 1320nm Nd: YAG laser and the long-pulsed 1064nm Nd: YAG laser may be a powerful up-regulator of collagen synthesis through significant dermal damage and the 1320nm Nd: YAG laser is better than the long-pulsed 1064nm Nd: YAG laser for collagen synthesis. Therefore, the 1320nm Nd: YAG laser can be more effective clinically than the long-pulsed 1064nm Nd: YAG laser for the treatment of photodamaged skin.