Laser-induced tissue reactions and dermatology.

Knowledge of laser tissue reactions and tissue properties allows the practitioner to tailor a treatment to an individual patient's need and goals. A laser's power, spot size and pulse duration may be manipulated to yield different tissue reactions. Five tissue reactions, each the result of varying laser pulse durations and energy densities, may be achieved. They are photochemical, photothermal, photoablation, plasma-induced ablation and photomechanical. Of these, photothermal reactions are most utilized in dermatology. When higher powered pulses are applied, tissue often undergoes multiple reactions simultaneously. An understanding of these reactions allows their effects to be predicted. In this chapter, the various reactions are reviewed, and the reactions caused by many of the most commonly used lasers in dermatology are discussed.

A split-face comparison of two ablative fractional carbon dioxide lasers for the treatment of photodamaged facial skin.

OBJECTIVE: To compare the safety and efficacy of two fractional carbon dioxide (CO(2)) laser devices for the treatment of photodamaged facial skin. METHODS: Eight healthy subjects underwent full-face resurfacing for photodamaged skin with two fractionated CO(2) laser devices using manufacturer-recommended settings for facial rejuvenation. For each subject, one device with a rolling handpiece was used on one side and a second device with a stamping handpiece was used on the other. Patients were evaluated 3 months postoperatively and photographed. A blinded physician investigator assessed the photographs and rated each side for improvement in four categories (wrinkles, pigmentation, skin laxity, and overall appearance). Patient ratings for overall improvement for each side were also recorded. RESULTS: All patients had improved on the basis of photographic and clinical assessments at 3 months. No significant differences in patient ratings of overall improvement and physician-measured parameters of clinical improvement were found, although intraoperative times and pain ratings were greater with the laser with the stamping handpiece. No complications were experienced with either device. CONCLUSIONS: Both fractionated CO(2) resurfacing devices used in the study were safe and effective for the treatment of photodamaged facial skin, but the modality using a stamping handpiece was associated with longer operative times and greater intraoperative pain. The authors have indicated no significant interest with commercial supporters.

Linear cutaneous lupus erythematosus in the lines of Blaschko.

Eleven patients with linear cutaneous lupus erythematosus following the lines of Blaschko have been previously reported in the literature. We describe a child with this entity following Blaschko lines on the trunk. The patient responded to oral hydroxychloroquine therapy combined with topical flurandrenolide tape resulting in resolution with atrophic scarring. The clinical and histological features of linear cutaneous lupus erythematosus are discussed and a review of the literature is presented.

Dermal fillers: complications and informed consent.

Dermal fillers are increasingly used for in-office cosmetic treatments. Although complications are rare, they can occur with any dermal filler. Such complications can lead to adverse medical, legal and economic difficulties. This article reviews the various complications most commonly seen with dermal fillers. In addition the appropriate consent prior to filler use and the legal implications of a lack of consent will be described.