Treatment of Pain in Keloids Using Only a Long-Pulsed 1064 nm Nd:YAG Laser.

BACKGROUND AND OBJECTIVE: Keloids are benign lesions arising from overproduction of the extracellular matrix and abnormal collagen deposition by dermal fibroblasts. This altered wound healing typically occurs in response to dermal trauma. Keloid treatment poses a challenge due to the variable nature of treatment response, which can be affected by the size, appearance, and associated symptoms of erythema, pruritus, and pain. Recently, successful treatment of keloids has been reported using the Nd:YAG laser in conjunction with 5-fluorouracil and intralesional corticosteroids. We present a series of patients with symptomatic keloids, who we treated with only a 1064 nm Nd:YAG laser. STUDY DESIGN/MATERIALS AND METHODS: Eight patients of Fitzpatrick skin types I-VI presented for treatment of keloids with associated symptoms of pain. The keloids were most commonly located on the trunk, and seven patients had intralesional steroid injections prior to presentation with persistence of symptoms. Patient treatment consisted of two passes under a long-pulsed 1064 nm Nd:YAG laser with a 10 mm spot size, a fluence of 18-19 J/cm2 , and 60 ms pulse duration every 3-8 weeks. Patient-reported pain scores were collected before and after treatment. RESULTS: Following treatment, transient erythema and mild edema were noted at the treatment site. All patients reported improvement in the symptoms of pain, with an average of a 5-point reduction using a 10-point scale (R: 2-10). Five out of eight patients had total resolution of their pain. An average of 3.25 treatments (R:1-5) were needed for patients to first notice an improvement in the pain. A Wilcoxon signed-rank test showed that treatment with a 1064 nm laser elicited a statistically significant improvement in pain in individuals with keloids (Z = 2.46, P = 0.01). No patients in our study suffered any scarring or pigment changes as a result of these treatments. CONCLUSION: Keloids are a common condition with variable rates of treatment satisfaction. Lasers have been used in an attempt to improve clinical appearance and associated symptoms. We report a significant reduction in pain for patients treated exclusively with a 1064 nm Nd:YAG laser. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Sustained Benefit After Treatment of Acne Vulgaris Using Only a Novel Combination of Long-Pulsed and Q-Switched 1064-nm Nd: YAG Lasers.

BACKGROUND: Acne vulgaris remains a challenging disease to treat in many patients. Traditional therapies may have limited successes with potential side effects. Laser and light energy devices may offer a desirable alternative. OBJECTIVE: To evaluate the effectiveness and safety in using a combination laser approach with both long-pulsed (LP) and Q-switched (QS) Nd:YAG lasers in the treatment of active acne. METHODS: Twenty patients with moderate to severe inflammatory acne were treated with LP YAG laser followed immediately with QS YAG laser. Patients received at least 8 treatments. Follow-up evaluation occurred at a minimum of 12 months. Pre- and post-treatment photographs were graded by blinded physicians. All topical acne medications and oral antibiotics were discontinued throughout the therapy and follow-up period. RESULTS: There was a 81% reduction in acne lesions, with 60% of patients having 90% or greater reduction. Overall appearance was graded at 84% improvement at follow-up. Follow-up occurred at a mean of 22.7 months after completion of therapy. Aside from transient erythema, there were no other adverse effects. CONCLUSION: Active acne can be treated successfully with a combination of LP and QS YAG lasers with patients remaining off acne medications throughout laser therapy and the follow-up period.

Photodamage therapy using an electro-optic Q-switched Nd:YAG laser.

BACKGROUND AND OBJECTIVE: Q-Switched Nd:YAG lasers produce photoacoustic effects in addition to photothermal effects which may allow for greater tissue collagen production. The objective of the study is to determine the effectiveness and tolerability of an Electro-Optic (EO) Q-switched Nd:YAG laser with Single Pulse and novel Double Pulse (DP) options in the treatment of photodamaged skin. MATERIALS AND METHODS: Sixteen subjects with photoaging were enrolled in this prospective, randomized, split-faced study. Subjects received 6 bi-weekly laser treatments. One half of the face was treated with a Single Pulse while the other half was treated with energies divided into a DP. Blinded investigators and subjects assessed improvement after the sixth treatment for wrinkles, coarseness, pigmentation, redness, laxity, comedones, pore size, and overall skin condition. Subjects also rated the tolerability of the treatments. RESULTS: For the Single Pulse side of the face, the investigators rated 33% of the patients as having a good to excellent (51% or greater) improvement in the overall condition of the skin while 47% of the subjects reported these levels. On the DP side, the overall improvement was good to excellent at a 27% rate by the investigators and 54% by the subjects. Distributions of improved ratings among investigators and subjects were similar for both sides of the treatment area. The majority of stinging/burning sensations during treatment were reported as mild on the DP side (62.8%) and moderate (63.8%) on the Single Pulse side. The chance of reporting none or only mild stinging/burning sensation during treatment was four times greater on the side of the face treated with the DP (P < 0.0001). CONCLUSIONS: Results have shown that treatment with the EO QS Nd:YAG laser provides a safe and effective method of skin rejuvenation with the additional benefit of significantly lower patient discomfort during use of the DP mode.

Long-term fine caliber hair removal with an electro-optic Q-switched Nd:YAG Laser.

BACKGROUND: In spite of major advances in hair removal therapy, fine caliber hair remains a significant challenge for laser- and light-based devices. OBJECTIVE: Evaluate a novel Electro-Optic (EO) Q-switched Nd:YAG laser for pigmented fine caliber hair removal in the Standard Single and a double pulse (DP) mode. METHODS: Eleven patients underwent four laser treatments at monthly intervals. Bilateral anatomical regions received to one side the standard single pulse (SSP) while the other side the DP option. Blinded investigators conducted hair counts at 6 months post-treatment and after 24 months. Patients assessed hair loss and discomfort. Six patients rated their satisfaction at 6 months. RESULTS: At 6 months, investigators found a reduction of 50% in hair counts with the DP and 46% with standard pulse. Ninety percent in DP and 50% in SSP reported none to mild discomfort. Transient erythema and edema was observed with a lower severity rating with the DP. There were no other untoward effects. 83.3% of patients who completed the study at 6 months expressed satisfaction with the results. At 24 months hair loss was maintained at the same rate. CONCLUSION: The EO Q-switched Nd:YAG laser is an effective option for the permanent treatment of unwanted fine hair and has a high-patient satisfaction rate. There is less therapeutic discomfort in the DP mode.

Cutaneous compression for the laser treatment of epidermal pigmented lesions with the 595-nm pulsed dye laser.

BACKGROUND: The 595-nm pulsed dye laser has been the standard of care for many vascular lesions and has rarely been used in the treatment of epidermal pigmented lesions. OBJECTIVE: The objective was to investigate the effectiveness and safety of a compression technique for the treatment of epidermal pigmented lesion using a modified 595-nm pulsed dye laser with no epidermal cooling. METHODS: Twelve subjects (mean age 58 years) underwent treatments using a modified 595-nm dye laser with a compression handpiece and no epidermal cooling. Treatments were performed with radiant exposures of 7 to 12 J/cm(2), 7-mm spot size, and 1.5-ms pulse duration. Each subject received one to four treatments, 4 to 6 weeks apart. Follow-up evaluations were held before each treatment and 4 months after last treatment. RESULTS: Clearance of 75% to 100% was obtained in 43, 59, 76, and 79% of the lesions treated after one, two, three, and four treatments respectively. The fourth treatment was evaluated 4 months posttreatment. Side effects included immediate erythema and edema and rare cases of transient hyperpigmentation and atrophy. No purpura and long-lasting side effects were observed. CONCLUSION: The compression technique with a modified 595-nm pulsed dye laser system is effective and safe for the treatment of epidermal pigmented lesions.

Complications of laser dermatologic surgery.

BACKGROUND AND OBJECTIVE: Innovations in lasers, light and radiofrequency devices have allowed for improved therapeutic efficacy and safety and the ability to treat patients with an ever-increasing number of medical and aesthetic indications. Safety remains a primary concern and the timely communication of complications and their management is vital to insure that treatments be as safe as possible. The purpose of this report on the Proceedings of the First International Laser Surgery Morbidity Meeting is to provide laser experts the opportunity to present and discuss complications that their patients have experienced and how they were successfully managed. METHODS: Laser experts were invited to present complications of laser, light, and radiofrequency treatments that their patients have experienced and to discuss the potential mechanisms leading to the complications their management and final outcomes. RESULTS: Nineteen unique cases are presented and the clinical management of each case discussed. Eighteen sets of pre- and post-operative photos are presented. CONCLUSION: This report shows that even experts, with extensive experience using light-based therapies, can and do have patients who develop complications. Sound clinical judgment, and knowing how to avoid complications and their timely post-operative management, is essential to insure optimal therapeutic outcome.

Comparison of a 1,064 nm laser and a 1,320 nm laser for the nonablative treatment of acne scars.

BACKGROUND: There have been many reports of the use of nonablative lasers for the treatment of acne scars. OBJECTIVE: To evaluate the ability of the 1,064 nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser to treat acne scars and compare it with that of the 1,320 nm Nd:YAG laser. METHODS: Twelve patients with Fitzpatrick skin types I to III were randomly selected to have half of the face or back treated with the Lyra 1,064 nm Nd:YAG laser (Laserscope Corporation, San Jose, CA, USA) and the other half with the CoolTouch II 1,320 nm Nd:YAG laser (ICN Pharmaceuticals, Inc., Costa Mesa, CA, USA). Three treatments at 4-week intervals were performed. Patients were evaluated by photographic and profilometric methods before and 6 months after the last treatment. RESULTS: Immediate changes included mild erythema with the 1,064 nm Nd:YAG laser and mild edema and erythema with the 1,320 nm Nd:YAG laser. No long-term adverse changes were seen with either laser system. Using the 1,320 nm system, 42% of the patients had 30 to 40% clinical improvement, 42% had 11 to 29%, and 16% had 10% or less. With the 1,064 nm system, 58% had 30 to 40% clinical improvement and 42% had 11 to 29%. Average improvement in acne scars evaluated by three independent observers was 22% with the 1,320 nm laser compared with 28% with the 1,064 nm laser. The subjects' own grading was 39% with the 1,320 nm laser compared with 37% for the 1,064 nm laser. Prolifometric studies demonstrated comparable improvement, with no statistical difference using either laser. CONCLUSION: These data indicate that both the 1,064 nm laser and the 1,320 nm Nd:YAG laser are safe and effective systems for the nonablative treatment of acne scars, achieving similar improvement. There appears to be a greater response with the 1,064 nm laser system as assessed by the clinical investigators.

Viral disease transmitted by laser-generated plume (aerosol).

OBJECTIVE: To evaluate the possibility of disease transmission through liberated plume from virally infected tissue that is exposed to the carbon dioxide laser. DESIGN: Bovine papillomavirus-induced cutaneous fibropapillomas were exposed to the carbon dioxide laser. Laser settings were within the range of clinically used settings. The laser plume (aerosol) was suctioned and collected and then reinoculated onto the skin of calves. SETTING: University laboratory research center. MAIN OUTCOME MEASURES: Laser plume viral content and postinoculation tumor growth were analyzed and documented. RESULTS: Collected laser plume contained papillomavirus DNA in all tested laser settings. The viral DNA was most likely encapsulated. Tumors developed at laser plume-inoculated sites for all laser parameter settings. Histological and biochemical analyses revealed that these tumors were infected with the same virus type as present in the laser plume. CONCLUSIONS: Laser plume has been shown, for the first time to our knowledge, to actually transmit disease. Strict care must be maintained by the laser practitioner to minimize potential health risks, especially when treating viral-induced lesions or patients with viral disease.