Hair removal with the long-pulse alexandrite and long-pulse Nd:YAG lasers is safe and well tolerated in children.

BACKGROUND: Children with excessive hair may have severe psychological consequences. Laser hair removal in adults is known to be safe and well tolerated, but this is less well established in children. OBJECTIVE: To describe our experience with laser hair removal in children, and to investigate the safety and tolerability of this procedure in children. METHODS: The case records of 24 children aged < 16 years, who had received a minimum of three treatments for hair removal were analysed retrospectively. For patients with Fitzpatrick skin phototype II-IV, the lasers used were a long-pulse alexandrite (755 nm) with either continuous chilled-air cooling at fluences of 16-27 J/cm(2) or a long-pulse alexandrite with cryogen cooling at fluences of 16-32 J/cm(2). For patients with Fitzpatrick skin phototype IV-VI, lasers used were a long-pulse Nd:YAG (1064 nm) with a chilled contact sapphire tip at fluences of 20-35 J/cm(2) or a long-pulse Nd:YAG with cryogen cooling at fluences of 16-26 J/cm(2). RESULTS: Mean age at first treatment was 12.3 years. Diagnoses were constitutional hirsutism (14 patients), polycystic ovarian syndrome (five), congenital melanocytic naevus (two), generalized hypertrichosis (two) and naevoid hypertrichosis (one). One patient required a general anaesthetic, eight required topical anaesthetic cream, and 15 did not require any form of anaesthesia. Intolerable discomfort requiring adjustment in fluence was the only recorded side-effect, affecting two cases. There were no incidences of blistering, infection, dyspigmentation or scarring. CONCLUSION: When administered appropriately, laser hair removal is safe and well tolerated in children aged < 16 years.

Laser treatment of pigmented lesions in clinical practice: a retrospective case series and patient satisfaction survey.

Lasers are frequently used to treat pigmented skin lesions; however, there is little published data from routine clinical practice. We performed a retrospective review of patients treated between January 2003 and January 2004 to describe the patients, methods used and the clinical outcome. The long-term result was determined by a patient questionnaire. In total, 67 patients with 76 pigmented lesions were treated (22 males and 45 females, mean age 22 years); 27% had Fitzpatrick skin types IV-VI. The Q-switched Nd:YAG, and erbium:YAG lasers were used in 75% and 24% of cases, respectively, with an average of 5.4 treatments/patient. The physician-rated outcome at the end of treatment was 'very positive' in 45% and 'mostly positive' in 30% of cases. The patient-rated outcome at an average of 21 months post-treatment was 'excellent' in 29.5%, 'good' in 25%, and 'fair' in 22.7% of the 44 cases. About 50% of patients with the three most common lesions (congenital naevi, other/unspecified naevi and naevus of Ota) achieved good or excellent long-term results.

Evaluation of the treatment of venous lakes with the 595-nm pulsed-dye laser: a case series.

Venous lakes (VLs) are common benign venous ectasias in the upper dermis. They are treated to improve cosmesis and occasionally to prevent bleeding. Numerous methods have been used, such as cryotherapy, infrared coagulation and various types of lasers. They are variable in their success and all can be complicated by scarring. We report our experiences of using the 595 nm pulsed-dye laser (PDL), which has not been previously described. Eight patients were treated but sufficient resolution was achieved in only three patients. The limited success with this laser could be attributed to insufficient thermal energy being generated to close all the blood vessels permanently. A large prospective study would provide further data regarding the efficacy of the PDL. The use of compression and longer pulse durations may improve the efficacy of the 595 nm PDL to treat VLs.

Er:YAG laser resurfacing for inoperable medium-sized facial congenital melanocytic naevi in children.

Congenital melanocytic naevi (CMN) can cause significant psychosocial morbidity, especially if they are in visually exposed areas. The preferred treatment is surgical excision, though not all lesions are amenable to this because anatomical location may preclude aesthetic and functional reconstruction. Three children with inoperable facial CMN were treated with Er:YAG resurfacing under general anaesthetic. Two children were Fitzpatrick skin type II, and one child was skin type VI. Treatment was performed at 4-9-monthly intervals. The procedure achieved significant lightening and thinning in all three cases, without scarring or dyspigmentation. One child developed herpes simplex infection in the treated area on one occasion, which was managed with oral aciclovir, and did not lead to scarring or preclude further treatment. We conclude that Er:YAG laser resurfacing is effective for CMN, even in darker skin types. The incidence of side-effects is low, although repeated treatment is necessary.

A review of the adverse effects of laser hair removal.

Laser hair removal is ever increasing in popularity. Technology is fast advancing, and there are increasingly excessive commercial claims that laser hair removal in all skin types is free of side effects. The aim of this study is to review the evidence from published literature regarding the incidence of adverse effects after laser and light systems for hair removal. A review of the current published literature on the ill effects reported after laser/light-assisted depilation was conducted. Overall incidence of adverse effects after laser/light hair removal appears to be low, with very uncommon permanent sequelae. The two largest studies to date have shown that acute and transient side effects do occur. Higher incidence of pigmentary alterations is associated with the shorter wavelength lasers (up to 19%), particularly with darker skin types, compared with lower incidence using the neodymium-yttrium-aluminium-garnet laser (2-3%). Both studies did not show any long-term side effects or scarring. Laser/light hair removal, carried out by trained professionals, is a safe procedure with a very low incidence of permanent sequelae. The majority of adverse effects are transient and minor. They are more common in darker skin. Longer wavelength devices reduce the risk in darker skin.

Incidence of acneform reactions after laser hair removal.

There have been several studies published on the side effects of laser hair removal, but none specifically looked at acneform reactions. The aim of this study is to obtain an accurate assessment of the incidence of acneform reactions after laser hair removal in relation to skin type, laser type, site of treatment, polycystic ovarian syndrome history (PCOS), age, and sex of the patient. This is a multi-centre prospective study of patients presenting for laser hair removal. Data were gathered using a questionnaire completed by the staff who performed the treatment. The incidence of acneform reactions was 6%. The following variables showed a statistically significant effect on the percentage of patients with reactions: age, with younger patients more likely to develop lesions; those treated with the Nd:YAG laser type were more likely to develop lesions than those treated with the alexandrite; and the Fitzpatrick skin type V showed the highest incidence of acneform lesions, followed by skin types II and IV. History of PCOS, number of prior treatments, use of aloe vera cooling gel, and the sex of the patient had no apparent effect on the incidence of acneform lesions. Acneform reactions are relatively common after laser hair removal; however, in the majority of cases, the severity of the reaction was mild and lasted for a short duration.

The treatment of port-wine stains with the pulsed-dye laser at 2-week and 6-week intervals: a comparative study.

BACKGROUND: The pulsed-dye laser (PDL) is the treatment of choice for port-wine stains (PWS). Multiple treatments are usually necessary, with standard treatment intervals ranging between 6 and 12 weeks. However, there are no studies on the effect of treating PWS at different time intervals, and the ideal time interval between treatments has not yet been agreed. It is uncertain whether treatment is more effective if administered at shorter time intervals. OBJECTIVES: To establish whether the treatment of PWS with the variable pulse width 595-nm (V-beam) PDL at 2-week intervals achieves better results, with no difference in the complication rate, than treatment given at 6-week intervals. METHODS: We prospectively investigated 15 patients with PWS. Each patient had the whole PWS treated at initial visit. Half of the PWS was randomly allocated to be treated at 2 weeks and the other half at 6 weeks from initial visit. Both halves of the PWS thus were treated twice in total, once at the initial visit and the second treatment either at 2 weeks or 6 weeks from initial visit. At 12 weeks an observer blinded to treatment allocation clinically evaluated the results. The outcome measure was lightening of the PWS as measured with a reflectance spectrophotometer. Complications were recorded throughout the study period. RESULTS: Of the 15 patients, 13 completed the study. Three patients had two PWS each treated separately, giving a total of 16 treated PWS sites. In 11 sites (69%), the 2-week interval treatment resulted in greater reduction in reflectance than the 6-week interval treatment. Using the nonparametric Wilcoxon matched-pair signed rank test, the 2-week treatment interval site resulted in greater reduction in reflectance measurements compared with the 6-week treatment interval site (P < 0.01). This agreed closely with independent observer assessment judging that the 2-week treatment interval resulted in better lightening of the PWS than the 6-week treatment interval (P = 0.003). There were no adverse reactions from the treatments. CONCLUSIONS: Preliminary data suggest that a treatment interval of 2 weeks is well tolerated by patients and resulted in greater lightening of the PWS in the majority, compared with a standard 6-week interval. It also has the potential to reduce the total duration of a course of treatment significantly.

Controlled study of excimer and pulsed dye lasers in the treatment of psoriasis.

BACKGROUND AND OBJECTIVES: The excimer laser delivers high energy monochromatic ultraviolet (UV) B at 308 nm. Advantages over conventional UV sources include targeting of lesional skin, reducing cumulative dose and inducing faster clearance. Studies of the pulsed dye laser (PDL) in psoriasis report between 57% and 82% response rates; remission may extend to 15 months. To our knowledge, this is the first study assessing both excimer and PDL in psoriasis. METHODS: We conducted a within-patient controlled prospective trial of treatment of localized plaque psoriasis. Twenty-two adult patients, mean Psoriasis Area and Severity Index 7.1, were recruited. Fifteen patients completed the full treatment, of which 13 were followed up to 1 year. Two selected plaques were treated with excimer twice weekly and V Beam PDL, pretreated with salicylic acid (SA), every 4 weeks, respectively. Two additional plaques, treated with SA alone or untreated, served as controls. The primary outcome measures were: (i) changes in plaque-modified Psoriasis Activity and Severity Index (PSI) scores from baseline to end of treatment; (ii) clinical response to treatment (CR(T)), assessed by serial photographs; (iii) percentage of plaques clear at the end of treatment; and (iv) percentage of plaques clear at 1-year follow-up. The secondary outcome measures were: (i) number of laser treatments to clearance; (ii) time to relapse; (iii) frequency of side-effects; and (iv) qualitative observations with SIAscope. RESULTS: The mean improvement in PSI was 4.7 (SD 2.1) with excimer and 2.7 (SD 2.4) with PDL. PSI improvement was significantly greater in excimer than PDL (P = 0.003) or both control plaques (P < 0.001). CR(T) indicated 13 patients responded best with excimer, two patients best with PDL, and in seven patients there was no difference between the two lasers. CR(T) was significantly greater for excimer than PDL (P = 0.003) or both controls (P < 0.001). CR(T) was also significantly greater for PDL than SA alone (P = 0.004) or untreated control (P =0.002). Nine (41%) patients cleared with excimer, after mean 8.7, median 10 weeks treatment. Seven of these nine patients were followed up to 1 year; four remained clear, two relapsed at 1 month, and one at 6 months. Six (27%) patients cleared with PDL, after mean 3.3, median four treatments. All six patients were followed up to 1 year; four remained clear, one relapsed at 4 months and one at 9 months. Despite common side-effects including blistering and hyperpigmentation, patient satisfaction was high. Serial images obtained with the SIAscope during treatment indicated different mechanisms of action of the two lasers. CONCLUSIONS: Excimer and V Beam PDL are useful treatments for plaque psoriasis. Although the excimer appears to be on average more efficacious, a subset of patients may respond better to PDL. Long-term remission is achievable with both lasers.

Audit cycle of documentation in laser hair removal.

Lasercare clinics are one of the largest providers of skin laser treatment in the United Kingdom, in both private sector and National Health Service. Laser hair removal is performed by trained nurses following written protocols. Choice of laser and fluence is tailored to Fitzpatrick skin type. We audited and re-audited documentation of six criteria in patients receiving laser hair removal (signed consent, Fitzpatrick skin type, use of appropriate laser, appropriate fluence, patient satisfaction and objective assessment) across 13 clinics at different points in time. Data were obtained on 772 treatments. Overall findings revealed excellent documentation of consent, use of appropriate laser and fluence (median 100%), good documentation of skin type (median 90%) and poor documentation of patient satisfaction and objective assessment (median 67% and 53%, respectively). Comparison between baseline and repeat audit at 6-8 months (nine clinics) showed significant improvement across clinics in these latter two criteria [patient satisfaction: odds ratio (OR) 0.38, 95% confidence interval (CI) 0.15-0.78, P=0.01; objective assessment: OR 0.23, 95% CI 0.07-0.50, P=0.0003 (Mantel-Haenszel weighted odds ratios)]. We conclude that quality of documentation was generally and consistently high in multiple clinics and that re-auditing led to significant improvement in poor scores. This simple measure could easily be implemented more widely across many disciplines.

Granuloma faciale treated with the pulsed-dye laser: a case series.

Granuloma faciale (GF) is a rare cutaneous condition of unknown origin with characteristic clinicopathological features. It predominantly affects the face and in some causes an unacceptable cosmetic appearance. Numerous medical and surgical treatments have been used with varying degrees of success. Several single-patient case reports have demonstrated the successful use of the pulsed dye laser (PDL) in treating GF. This study assesses the results of four patients with facial GF from one dermatological laser centre that were treated with the Candela Vbeam PDL at 595 nm. Resolution of the GF was achieved in only two of the four patients (50%). Nevertheless this study provides further evidence that the PDL can help some patients with GF. Subsequently it is still a valuable treatment option for GF, especially as it is safe, well tolerated and quick.

Recent advances in laser treatment of port-wine stains.

The pulsed dye laser is the treatment of choice for port-wine stains, with proven efficacy and low incidence of side-effects. However, in the majority of cases complete clearance cannot be achieved, and a significant proportion of lesions is resistant to laser treatment. In recent years, increased understanding of the interaction between lasers and port-wine stains has led to modification of the original pulsed dye laser design, producing treatment responses even in those lesions resistant to first-generation pulsed dye lasers. Other lasers and noncoherent light sources also appear to have a potential role in treatment. In this review we discuss these recent developments.

Pulsed dye laser treatment of telangiectasia after radiotherapy for carcinoma of the breast.

BACKGROUND: Chronic radiodermatitis after radiotherapy for carcinoma of the breast is a common sequela of treatment and can be distressing for the patient. The skin is atrophic and shows prominent telangiectasia due to dilatation of a reduced or poorly supported skin vasculature. The pulsed dye laser (PDL) is an established treatment of cutaneous telangiectatic disorders including facial telangiectasia and spider naevi, and is safe and efficacious. OBJECTIVES: To study the efficacy of the PDL in the treatment of postradiation telangiectasia of the breast or chest wall. METHODS: Prospective open study of the treatment of eight females with the Candela SPTL1B PDL. Subjective assessments of vessel clearance, adverse effects and patient questionnaires. RESULTS: All treated patients showed complete clearance of vessels. Two patients developed hypopigmentation. All patients reported a high degree of satisfaction with the treatment. CONCLUSIONS: PDL therapy clears postirradiation telangiectasia of the breast and chest wall successfully with minimal adverse reactions, and can be recommended for patients distressed by this disorder.

Patient satisfaction with laser hair removal.

BACKGROUND: Laser hair removal (LHR) is a widely used treatment for unwanted hair. AIM: To determine patient satisfaction with LHR. METHODS: The clinic offered LHR by long pulse ruby, alexandrite and Nd:YAG. Patients attending the LHR clinic completed a patient satisfaction questionnaire. Satisfaction with LHR treatment was recorded on a linear analogue scale (LAS 0 = laser very much worse than alternative method; 10 = laser very much better than the alternative method). RESULTS: In terms of hair removal, 71% of patients were satisfied with their treatment. Laser treatment compared favourably with electrolysis and waxing. LHR scored 8.6 when compared with electrolysis and 7.7 when compared with waxing. During LHR treatments, 61% of patients used fewer ancillary methods than before. Most patients would recommend LHR to other persons with unwanted hair. CONCLUSIONS: Most patients were satisfied with LHR.

Laser treatment improves quality of life of hirsute females.

Hirsutism has a significant impact on the quality of life of affected patients. We report a prospective study of 45 hirsute females attending a laser clinic. Of these, 15 patients completed a pair of modified dermatology life quality index (DLQI) questionnaires, immediately before and at varying intervals (up to 6 months) after laser treatment. The mean DLQI score before treatment was 12.8 (median = 9.0, SD = 8.5). The mean DLQI score at 1-2 months was 7.0 (median = 2.5, SD = 10.0, P = 0.06), at 2-4 months it was 9.2 (median = 10.0, SD = 10.0, P = 0.48) and at 4-6 months it was 11.5 (median = 10.5, SD = 8.0, P = 0.88). There was a major improvement in DLQI score at 1-2 months but longer-term benefit was not observed. In a separate questionnaire, hirsute females (n = 45) reported a high level of patient satisfaction (71.1%) and willingness to have further treatment (77.8%) despite the fact that 97.1% had unwanted hair back at pretreatment levels at 6 months.

Recent advances in laser therapy for the treatment of cutaneous vascular disorders.

The use of lasers for the treatment of cutaneous vascular disorders has expanded rapidly since its inception in the early 1960s. The flashlamp-pumped pulsed tunable dye laser (PDL), which is the best laser system for the treatment of port-wine stains (PWS), is based on the premise of selective photothermolysis. Recent literature demonstrates enhanced selective photothermolysis by modifying the PDL to include a longer pulse width, a longer wavelength and higher energy fluences through the use of dynamic cooling. Multiple pulse laser irradiation, a new innovative method, shows promising preliminary results in eradicating hypertrophic PWS. In the treatment of capillary haemangiomas, previous uncontrolled studies suggest benefit with early PDL therapy but a recent randomised controlled trial does not support this claim. Mixed haemangiomas respond poorly to PDL treatment, uncomplicated tumours are best left to involute spontaneously whilst life/organ-threatening lesions require early active intervention. The efficacy of lasers in the treatment of telangiectatic leg veins (TLV) remains controversial. The literature revealed many conflicting claims. Larger and properly controlled studies are necessary to better define the role of lasers in the treatment of TLV.

Laser treatment of erythema and telangiectasia associated with rosacea.

The response of rosacea-associated erythema and telangiectasia to treatment with the pulsed tunable dye laser (PDL) was evaluated in 12 patients. Improvements in erythema, telangiectasia, flushing, the physician's and the patient's perception of overall severity, treatment tolerability, and the adverse side effects were examined. With the sole exception of the patient's assessment of overall severity we have found highly significant improvements in all other parameters evaluated, with excellent tolerance of treatment. We therefore conclude that the PDL is a safe and effective treatment for the erythemato-telangiectatic component of rosacea.

Laser treatment of rosacea.

Rosacea is a common condition often resulting in persistent erythema and telangiectasia as well as rhinophyma in a number of patients. Over the last two decades lasers have been increasingly used in the treatment of these permanent changes. The literature is reviewed in terms of the different laser systems, side-effects and comparison with other surgical techniques. Laser studies on rosacea-associated telangiectasia and erythema are limited. Copper-bromide, krypton and KTP lasers have been used with good to excellent results. However, the most commonly applied system is the flash lamp-pumped pulsed dye laser. Rhinophyma can be treated with a variety of different surgical methods, including laser resurfacing. CO(2) lasers are the most widely used lasers, others are the Er:YAG and Nd:YAG lasers. Cosmetic end results are comparable to partial excision with a scalpel or electrosurgery. There does not appear to be an increased risk of infection or scarring, but the conventional surgical methods are quicker to perform and more cost effective.

Management of unwanted hair in females.

The development of lasers as a treatment for unwanted hair has led to an increased interest in this field. Laser hair removal is frequently commercially led and there are few controlled studies to demonstrate efficacy. It is important to be aware of all treatment modalities for hair removal so that patients can be counselled adequately. This review covers all methods of hair removal from physical through hormonal to laser treatment and allows the reader to understand the pros and cons of each form of therapy.