Effects of pulse dye laser on cosmetic suturing scar / 中华医学美学美容杂志

Objective To evaluate the effects of the pulsed-dye laser (PDL) at a wave length of 595 nm in treatment of scar after cosmetic suturing.Methods Twenty patients after cosmetic suturing were randomly assigned to the treatment group and control group.Each group had ten patients.The scar of patient was evaluated with the Vancouver scar scale (VSS).The treatment group was treated with 595 nm PDL for three times,and the control group did not receive any treatment.Follow-up was arranged at one mouth after the last treatment.Acquired score was compared with paired T-test transversely and longitudinally.Results Pre-operation VSS was 3.80± 1.48 and post-operation VSS was 5.20±2.66 in control group,which had no statistic difference (P ＜ 0.05).Pre-operation VSS was 4.10 ± 1.20 and post-operation VSS was 2.80±1.23 in treatment group,which showed statistic difference (P＞0.05);scars were much normal in treatment group,including less vasculature,more flatter and softer.VSS in the control group postoperatively had no statistic difference as compared with the treatment group (4.10±1.20 vs.3.80±1.48,P＞0.05).VSS in the treatment group showed significant statistic difference between pre-operation and post-operation (2.80 ± 1.23 vs.5.20 ± 2.66,P ＜ 0.05).Conclusions 595nm PDL is a safe and effective treatment in improving the appearance of scars after cosmetic suturing.

The Utilization of Cutaneous Laser Therapy at the Department of Dermatology, Hospital Kuala Lumpur: A 5-year review

Introduction:The Department of Dermatology, Hospital Kuala Lumpur has been providing cutaneous laser therapyservices for over 20 years. We aim to describe the utilization of cutaneous laser therapy at the Departmentof Dermatology, Hospital Kuala Lumpur and the post treatment complications.Methods:We reviewed all patients who received cutaneous laser therapy at the Department of Dermatology, HospitalKuala Lumpur from January 2012 till December 2016. Complications were defined as dyspigmentation,infection, scarring, blisters, ulcerations, skin textural changes or contact dermatitis secondary to post/ pre-lasertopical therapy.Results:A total of 1190 patients with a male to female ratio of 1:2.21 and a mean age of 35.8 years received single,repeated or combination cutaneous laser therapy from 2012 till 2016 for 48 different skin conditions. Annually,an average of 1314 laser sessions were performed. Indications included seborrhoeic keratosis (249, 20.9%),port wine stain (162, 13.6%), solar lentigines (144, 12.1%), syringoma (105, 8.8%), viral warts (88, 7.4%),and Naevus of Ota (82, 6.9%) among others. Majority underwent Q-switched Nd:YAG laser (36.5%) followedby pulsed dye laser (33.6%), ablative conventional carbon dioxide laser (29.2%) and fractional carbon dioxidelaser (0.7%). Over the past 5 years, 3 patients developed severe complication post laser therapy which wasblisters. Pain was tolerable with application of topical 5% EMLA? (lidocaine 2.5% and prilocaine 2.5%) creampre-laser treatment.Conclusion:Q-switched Nd:YAG laser therapy was the most frequently employed laser in the Department ofDermatology, Hospital Kuala Lumpur. Our centre has a high volume of cases with a low rate of posttreatment complication.

Lasers for vascular lesions: Standard guidelines of care.

Introduction: Lasers are a good therapeutic tool for congenital and acquired vascular lesions. Technological advances in lasers have reduced the adverse effects and increased the efficacy. Machines: Among the various lasers used for treating vascular lesions, pulsed dye laser (PDL) has the best efficacy and safety data. The other machines that are widely available are Nd:YAG laser and intense pulse light (IPL). Rationale and scope of guideline: Much variation exists in different machines and techniques, and therefore, establishing standard guidelines has limitations. The guidelines recommended here indicate minimum standards of care for lasers on vascular lesions based on current evidence. Physician Qualification: Laser may be administered by a dermatologist, who has received adequate background training in lasers during post-graduation or later at a center that provides education and training in lasers, or in focused workshops, which provide such trainings. He/she should have adequate knowledge of the lesions being treated, machines, parameters, cooling systems, and aftercare. Facility: The procedure may be performed in the physician's minor procedure room with adequate laser safety measures. Indications: PWS, hemangioma, facial telangiectasia, rosacea, spider angioma, pyogenic granuloma, venous lakes, leg veins. Contraindications: Absolute: Active local infection, photo-aggravated skin diseases, and medical conditions. Relative: Unstable vitiligo, psoriasis, keloid and keloidal tendencies, patient on isotretinoin, patient who is not cooperative or has unrealistic expectation. Patient Selection: Patient selection should be done after detailed counseling with respect to the course of lesions, different treatment options, possible results, cost, need for multiple treatments, and possible postoperative complications. Treatment Sessions: The number of treatments per lesion varies from 2 to 12 or more at 6-8 week intervals. All lesions may not clear completely even after multiple sessions in many cases. Hence, a realistic expectation and proper counseling is very important. Laser parameters: Laser parameters vary with area, type of lesion, skin color, depth of the lesion, and machine used. A test spot may be performed to determine individual specifications. Complications: Pain, edema, purpura, bleeding, scarring, postinflammatory hyperpigmentation/hypopigmentation, and atrophy changes.

Demographic and clinical characteristics for infantile haemangioma in a tertiary centre in Malaysia

Introduction: Infantile haemangioma is the most common tumor in infancy. They are extremely heterogenous clinically. Established risk factors for infantile haemangioma include female sex, white ethnicity, prematurity, low birth weight and multiple gestation. There is a lack of demographic studies in the Asian population especially in the Malay ethnic group. Objective: To describe the demographics and clinical characteristics of infantile haemangioma in a tertiary centre in Malaysia. To describe associated complications and the need for therapeutic intervention. To determine whether there is any difference in demographics and clinical characteristics of infantile hemangiomas in a Malaysian population comprising predominantly Malay ethnic group with published reports of Western population. Design Retrospective review of patients with infantile haemangioma referred to the Paediatric Dermatology unit, Kuala Lumpur Hospital between January 2009 and May 2011. Main Outcome Measures: Demographic and clinical characteristics were summarized and compared with data from previous studies. The study included 50 patients (38 females and 12 males) with a mean age of 6.23 months (range 0.1 to 16 months) at presentation. 11(22%) patients were premature. The mean age of onset was 20 days (range 0 to 5 months). 18(37%) patients had a premonitory mark at birth. Of 62 hemangiomas in 50 patients, 45(72.5%) were localized, 5(8.1%) were segmental, 11(17.7%) indeterminate and 1(1.6%) multifocal. The most frequent location of the haemangiomas was in the face with 29(46.8%) lesions, followed by 10(16.1%) lesions in the head and neck, 10(16.1%) lesions in the extremities, 8(12.9%) lesions in the trunk and 5(8.1%) in the perineum. Complications that occurred included ulceration in 8(16%) patients, threat to vision in 7(14%), infection in 2 (4%) and bleeding in 6(12%) patients. Of the 50 patients, 24(48%) patients required interventions. These interventions included propranolol only in 12(24%) patients, prednisolone only in 4(8%), both propranolol and prednisolone in 5(10%), wound care in 2(4%) and pulse dye laser in 1(2%). Conclusion: The demographics and clinical characteristics of infantile haemangiomas in Malaysia are similar to published reports.

Treatment of Infantile Haemangiomas with 585nm pulsed dye laser

Haemangiomas usually develop within the first few weeks of life, most regressing spontaneously before the age of 7 to 10 years. Some may ulcerate or compromise a vital function, in which case systemic corticosteroids, surgery or radiotherapy may be helpful. All of these treatment modalities are associated with significant morbidity. Treatment with 585nm flashlamp pulsed dye laser is safe and effective in the management of ulcerated and superficial proliferating haemangiomas. We report a retrospective review of 33 children under the age 12 months, who were treated at our centre with 585nm pulsed dye laser over a period of 4 years. Forty eight percent of these children presented with rapidly proliferating haemangiomas causing functional impairment, 40% with ulcerated haemangiomas and others for re-growth after stopping oral treatment. Patients were treated with the 585nm pulsed dye laser (fluence: 5.5-7J/cm2; spot size: 7mm and duration: 0.45s). Patients received treatment until the lesion was almost clear or until lesion failed to respond. All lesions ulcerated haemangiomas healed after an average 3 treatment. Both the physician and parental perception of improvement were analysed based on three parameters, which include reduction in redness, thickness and size. All the haemangiomas showed significant reduction in size, thickness and colour. Less than 1% of patients had atrophic scaring. We conclude that the flashlamp-pulsed dye laser may successfully prevent enlargement and promote involution of superficial haemangiomas with minimal adverse effect. Therapy is most appropriate for patients with ulcerated haemangiomas and haemangiomas at sites of potential functional impairment.