Dual-wavelength long-pulsed 755-nm alexandrite/1,064-nm Nd:YAG laser versus Nd:YAG alone for treatment of palmoplantar verruca.

We compared the effectiveness and safety of the long-pulsed neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser alone and combined with a 755-nm alexandrite laser for treating palmoplantar warts. We divided patients into two groups to receive up to four monthly treatments with Nd:YAG alone (single-wavelength) or combined with the alexandrite laser (dual-wavelength). We assessed treatment responses (according to clearance rate), vascular/hyperkeratosis grades, and patient satisfaction and pain ratings. The differences in treatment response (p = .348), patient satisfaction (p = .560), and pain ratings (p = .728) between the groups were not significant. The single- and dual-wavelength treatment options were equally effective in treating recalcitrant palmoplantar warts.

Isotretinoin and timing of procedural interventions: Clinical implications and practical points.

BACKGROUND: For decades, the notion that elective surgeries and cutaneous procedures should be postponed for 6-12 months in patients on, or recently administered with isotretinoin, has been widely accepted. However, some recent studies showed the need for a change in this regard. METHOD: Here, we reviewed the existing data in this regard through searching on PubMed, Google Scholar, and Scopus. All of the relevant papers published in English, until October, 2022, which we could access to their full-texts, were included. RESULTS: We found some recommendations made by plastic surgeons, dermatologists, ENT surgeons, ophthalmologists, orthopedic surgeons, and dentists regarding the correct timing of procedural interventions in patients on, or recently administered with isotretinoin and tried to summarize them to provide a practical guide for clinicians. CONCLUSION: Physicians may discuss with patients regarding the known risk of abnormal wound healing in the setting of systemic isotretinoin treatment and suggest that, when possible, surgical procedures be postponed until the activity of the retinoids has time to subside. It is even more important regarding patients with darker skin phototypes to follow an even more strict guideline.

Radiofrequency and skin rejuvenation: a systematic review.

Increasingly, there is an attempt to minimize expression lines through esthetic procedures, and radiofrequency (RF) is one of the therapeutic modalities. This article aims to systematically review the literature on the different types of RF treatment in clinical trials and in variables related to the aging process. This systematic review included 21 articles that treated 354 people with different physical characteristics. The most used RF was the fractional followed by the non-ablative RF. There was a large discrepancy in relation to the types and parameters. A parameter that did not show so much divergence was the temperature, which was between 38°C and 44°C. The main temporary adverse reactions reported by the authors were as follows: discomfort, pain, erythema, hyperpigmentation, crusting, swelling, edema, and purple and acneic appearance of the skin. Finally, our study concluded that non-ablative and ablative RF was reported to rejuvenate and improve the features of skin in all skin types.

Photobiomodulation in Sciatic Nerve Crush Injuries in Rodents: A Systematic Review of the Literature and Perspectives for Clinical Treatment.

Objective : The aim of the study was to perform a literature review to analyze the effect of photobiomodulation in experimental studies on peripheral nerve regeneration after sciatic nerve crush injury in rodents. Methods: A bibliographic search was performed in the electronic databases, including MEDLINE (PubMed), SCOPUS, and SciELO, from 2008 to 2018. Results: A total of 1912 articles were identified in the search, and only 19 fulfilled all the inclusion criteria. Along with the parameters most found in the manuscripts, the most used wavelengths were 660 nm and 830 nm, power of 30 and 40 mW, and energy density of 4 and 10 J/cm2 . For total energy throughout the intervention period, the lowest energy found with positive effects was 0.70 J, and the highest 1.141 J. Seventeen studies reported positive effects on nerve regeneration. The variables selected to analyze the effect were: Sciatic Functional Index (SFI), Static Sciatic Index (SSI), morphometric, morphological, histological, zymographic, electrophysiological, resistance mechanics and range of motion (ROM). The variety of parameters used in the studies demonstrated that there is yet no pre-determined protocol for treating peripheral nerve regeneration. Only two studies by different authors used the same power, energy density, beam area, and power density. Conclusion: It was concluded that the therapeutic window of the photobiomodulation presents a high variability of parameters with the wavelength (632.8 to 940 nm), power (5 to 170 mW) and energy density (3 to 280 J /cm2 ), promoting nerve regeneration through the expression of cytokines and growth factors that aid in modulating the inflammatory process, improving morphological aspects, restoring the functionality to the animals in a brief period.

Lasers for the prevention and treatment of hypertrophic scars: a review of the literature.

Despite the increasing knowledge about wound healing mechanisms and the advancements made in laser technology, hypertrophic scars remain difficult to manage. This review intends to discuss the laser devices studied in the prevention and treatment of HS, arising from trauma, surgery, and burns, detail their mechanisms of action, and emphasize those devices with the most promising effects. Most of the suggested mechanisms and explanations for the use of lasers in treating hypertrophic scars are based on selective photothermolysis, in which the light energy emitted from a laser is absorbed by its intended target, thereby disrupting existing collagen and altering the cycle of neocollagenesis. Through our literature review, we have determined that combination therapies, utilizing more than one laser target demonstrate enhanced clinical efficacy. Further, early use of laser devices has been shown to enhance the cosmetic result of sutured wounds and may play a role in preventing the development of hypertrophic scars.

A prospective randomized comparative study on 60 Indian patients of melasma, comparing pixel Q-switched NdYAG (1064 nm), super skin rejuvenation (540 nm) and ablative pixel erbium YAG (2940 nm) lasers, with a review of the literature.

Background: Treating melasma is a challenge due to suboptimal efficacy and recurrence encountered with most modalities. There is inadequate literature regarding the use of lasers for melasma in Indian skin. We compared three modalities SSR (Super Skin Rejuvenation 540 nm), PQSNDY (pixel Q-switched Nd: YAG 1064 nm), and ablative pixel-Er: YAG (2940 nm) laser in melasma, amongst Indian patients. Materials/Methods: Sixty patients of recalcitrant melasma were enrolled and randomized into three groups with 20 patients each. These were treated with SSR, low fluence PQSNDY, and pixel-Er: YAG, respectively, for five sessions at 3-week intervals. Results were evaluated using Modified melasma area severity index (mMASI) by blinded comparison of digital photographs at baseline, each visit and 6 months (i.e. 2 months after the last session). Results: All groups showed a highly significant reduction in the mMASI score (p < .001). Pixel-Er: YAG maximally reduced mMASI and homogeneity (p < .001), while the other groups showed a more uniform fading. Epidermal melasma had best results with SSR and PQSNDY (p < .001), while recalcitrant cases of dermal and mixed melasma with pixel-Er: YAG laser (p < .001). There was no persistent or rebound pigmentation observed. Conclusions: All three modalities are effective and safe for melasma in Indian patients. Fractional technology, low fluences, adequate recovery time between sessions and a sound maintenance plan ensure efficacy and safety.

The "in's and outs" of laser hair removal: a mini review.

Conventional treatments for excessive hair are tedious and time consuming. Laser hair removal has become the leading therapy option for long-term results. It works on the principle of selective photothermolysis, whereby photons destroy the hair follicle while sparing the surrounding tissue. As demand increases, there has been an increase in the regulation of these treatments. Laser hair removal is not risk-free and side effects are associated with the treatment. Adequate training is vital to minimise adverse side effects. Certain countries have regulatory boards that laser operators need to register with, as well as the completion of mandatory hours. Others require laser operators to register with a Care Quality Commission (CQC) to ensure that minimum training and safety standards are met. Currently, in South Africa, the lack of regulatory boards and mandatory hours poses a risk to the public as anyone with little or no qualification is allowed to perform laser hair removal treatments, placing patients at risk. This review looks at some of the devices used and basic mechanisms of action of laser hair removal, its associated risks, side effects and current regulation.

A 2017 update: Challenging the cosmetic procedural delay following oral isotretinoin therapy.

For decades it has been widely accepted that elective procedures should be delayed for at least 6-months following completion of isotretinoin therapy. However, numerous 2017 publications demonstrate the need for change in best practice. The evidence has yet to be succinctly summarized in a single article or in a stand-alone quick reference algorithm for physicians. This article's review of all 2017 publications confirms that the 6-month delay is not necessary for all procedures and provides a simple algorithmic approach to summarize the updated recommendations for procedural delay of cosmetic procedures following systemic isotretinoin therapy. This is a useful tool for clinicians and allows patients to receive the most appropriate and timely cosmetic therapy to minimize the psychosocial impact of the skin condition.

Treatment of multiple eccrine hidrocystoma with oral isotretinoin following erbium-yttrium aluminum garnet laser.

Eccrine hidrocystomes (EH) are benign cystic tumors of dermal eccrine ducts. There is still no gold standard treatment option for EH because of the large number of lesions, the risk of cicatrization and the different treatment options offered. We offer combined oral isotretinoin and following erbium-yttrium aluminum garnet laser treatment as an alternative treatment option in difficult patients with EH.

To test or not to test: A study examining the return rates of rosacea patients treated with a pulsed dye laser.

Pulsed dye laser (PDL) is an effective treatment option for erythematotelangiectatic rosacea. The use of a test spot allows patients to experience the procedure on a small area prior to further treatment. The purpose of this study was to elucidate whether the use of a no charge test spot influenced return rates for further PDL treatment. Data were obtained retrospectively using International Classification of Diseases (ICD)-10 codes for rosacea. Sixty charts were identified: 26 patients initially received a PDL test area free of charge, whereas 34 patients initially underwent full PDL treatment. Patients who experienced the test spot laser treatment had a lower return rate compared to those that directly underwent full PDL treatment. However, this difference was not statistically significant (Fisher's exact test p = 0.2883). Future studies evaluating and identifying factors that influence PDL return rates are needed. Abbreviations: ETR: Erythematotelangiectatic rosacea; PDL: pulsed dye laser; ICD: International classification of diseases.

Picosecond alexandrite laser is superior to Q-switched Nd:YAG laser in treatment of minocycline-induced hyperpigmentation: A case study and review of the literature.

BACKGROUND: Minocycline is a commonly prescribed tetracycline antibiotic used for the treatment of a number of dermatological conditions including acne and rosacea. Long-term adverse effects of minocycline include cutaneous hyperpigmentation. Various treatment options have been suggested for the treatment of minocycline pigmentation. We report a case of a patient on long-term low-dose minocycline for the treatment of rosacea with type III minocycline hyperpigmentation. A comparison was made between Q-Switch Nd:YAG and picosecond laser over a nine 9-period with treatments spaced 1 month apart, with a clearance in the patient pigmentation after four treatments with picosecond laser.

Treatment of post-pulsed dye laser purpura with pulsed dye laser.

The pulsed dye laser (PDL) is used for the treatment of a variety of vascular and nonvascular disorders, and its therapeutic efficacy often depends on purpura as an endpoint. However, post-PDL purpura is an undesirable side effect of treatment as it may increase patient dissatisfaction and downtime. Recent studies have suggested that repeat treatment with PDL may speed the resolution of post-procedural purpura; however, there is paucity of data on using repeat PDL treatment specifically for post-PDL purpura. We report three cases of 585 nm PDL-induced purpura treated with 595 nm PDL with clinically significant improvement. We suggest that treatment with PDL, which targets hemoglobin and its breakdown products, after initial PDL treatment may reduce post-PDL purpura.

Treatment of gingival melanin hyperpigmentation with Er,Cr:YSGG laser: Short-term follow-up of patient.

The increasing melanin hyperpigmentation of dark skinned individuals is related to the high activity of melanocytes. A healthy 36-year-old female patient complained about unaesthetic gingiva and she had been smoking for over 17 years and also smoking reactive the melanocytes. Gingival depigmentation is a periodontal plastic procedure which has been carried out by various techniques. Hyperpigmentation of gingiva was observed on the labial surface of both maxilla and mandibula. Erbium, chromium-doped yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser was used for depigmentation with wavelength of 2780 nm, frequency of 20 Hz, and pulse energy between 0 and 300 mJ. Topical anesthetic spray was applied and there was mild bleeding and pain in the operation area. The ablated regions were healed almost in 1 week. After 3-month and 6-month follow-up there were no repigmented areas. It may be concluded that the application of Er,Cr:YSGG laser appears to be a safe and an effective alternative procedure for the treatment of gingival melanin hyperpigmentation.

Fractional carbon dioxide laser for facial rejuvenation: A prospective study to evaluate the efficacy and the safety.

BACKGROUND: The aim of this study was to evaluate the efficacy and safety of the fractional ablative carbon dioxide laser for facial rejuvenation. MATERIALS AND METHODS: Twenty-nine female who have the complaint of facial aging were recruited for the study. Participants received a maximum of three laser treatment sessions with one-month intervals and were scored using a 5-point scale on seven categories for facial aging before and after the treatment by the physicians. Self-assessments by participants were done at the last month of follow-up period and 3 years after the last session. RESULTS: Mean facial aging score before the treatment was 11,24 ± 4,30 and after the treatment was 10,51 ± 3,86 (p = 0.003). The decrease in the score was mild in 18 (62,1%) participants, whereas it was moderate in only 1 (3,4%) participant. None of the participants had significant or perfect improvement. When the seven categories were analyzed seperately, the only statistically significant alteration in the score was found in the skin tone category (p = 0.0001). CONCLUSION: Results show that rejuvenation with the fractional ablative carbon dioxide laser decreases mildly the symptoms of facial aging in more than half of the patients.

Laser-assisted hair removal for facial hirsutism in women: A review of evidence.

Poly cystic ovarian syndrome (PCOS) has been described as the common diagnosis for hirsutism in women. Facial hirsutism is by far the most distressing symptom of hyperandrogenism in women with PCOS. A statistically significant improvement in psychological well-being has been reported in patients with PCOS allocated for laser-assisted hair removal. The theory of selective photothermolysis has revolutionized laser hair removal in that it is effective and safe, when operated by sufficiently trained and experienced professionals. Long-pulsed ruby (694 nm), long-pulsed alexandrite (755 nm), diode (800-980 nm), and long-pulsed Nd:YAG (1064 nm) are commercially available laser devices for hair removal most widely studied. This article will introduce the fundamentals and mechanism of action of lasers in hair removal, in a contemporary literature review looking at medium to long term efficacy and safety profiles of various laser hair removal modalities most widely commercially available to date.

Photobiomodulation therapy for androgenetic alopecia: A clinician's guide to home-use devices cleared by the Federal Drug Administration.

The market for home-use photobiomodulation devices to treat androgenetic alopecia has rapidly expanded, and the Food and Drug Administration (FDA) has recently cleared many devices for this purpose. Patients increasingly seek the advice of dermatologists regarding the safety and efficacy of these hair loss treatments. The purpose of this guide was threefold: (1) to identify all home-use photobiomodulation therapy devices with FDA-clearance for treatment of androgenetic alopecia; (2) to review device design, features and existing clinical evidence; and (3) to discuss practical considerations of photobiomodulation therapy, including patient suitability, treatment goals, safety, and device selection. A search of the FDA 510(k) Premarket Notification database was conducted using product code "OAP" to identify all home-use devices that are FDA-cleared to treat androgenetic alopecia. Thirteen commercially available devices were identified and compared. Devices varied in shape, wavelength, light sources, technical features, price, and level of clinical evidence. To date, there are no head-to-head studies comparing the efficacy of these devices. Photobiomodulation therapy devices have an excellent safety profile and mounting evidence supporting their efficacy. However, long-term, high quality studies comparing these devices in diverse populations are lacking. As these devices become increasingly popular, dermatologists should be familiar with this treatment modality to add to their therapeutic armamentarium. ABBREVIATIONS: AGA, androgenetic alopecia; FDA, Food and Drug Administration; IEC, International Electrotechnical Commission; LED, light-emitting diode; PBMT, photobiomodulation therapy.

Successful treatment of Becker's Nevus with long-pulsed 1064-nm Nd:YAG and 755-nm alexandrite laser and review of the literature.

BACKGROUND: Becker's Nevus is an aesthetically troublesome condition secondary to hyperpigmentation and hypertrichosis. Although several lasers have been employed with varying degrees of success, the exact devices and treatment parameters have yet to be elucidated. OBJECTIVE: To assess the combination Nd:YAG and alexandrite laser as a safe and efficacious treatment for Becker's Nevus. METHODS: In a 20-year-old Fitzpatrick Skin Type IV male, a Becker's Nevus was treated with six sessions of long-pulsed 1064 nm Nd:YAG laser at six-week intervals followed by five sessions of long-pulsed 755 nm alexandrite laser at three-month intervals. RESULTS: This patient experienced a significant reduction in both hyperpigmentation and hypertrichosis after these treatment sessions. No serious adverse events were reported. CONCLUSION: This case supports the use of combination long-pulsed 1064 nm laser and 755 nm laser as a safe and efficacious treatment for Becker's Nevus.

Influence of low-level laser on pain and inflammation in type 2 diabetes mellitus with diabetic dermopathy - A case report.

Numerous skin lesions have been commonly observed in individuals with diabetes mellitus. The common skin manifestations of diabetes mellitus are erythrasma, xanthomatosis, xanthelasma, phycomycetes and cutaneous infections like furuncolosis, candidiasis, carbuncle, dermatophytosis, etc. Diabetic dermopathy is the most common skin lesion found in patients with diabetes. It is typically seen in men aged above 50 years. In low-level laser therapy (LLLT), the entire lower limb was illuminated with the frequency of 20 Hz and wavelength of 830 nm for 9 min, and the treatment was divided into four parts. With the continued sessions of LLLT, the skin manifestations and neuropathy conditions improved drastically. On the 21st day, the skin colour was found to be normal. Also, there were significant changes in clinical findings for diabetic peripheral neuropathy. LLLT with specific exercises can promote healing of skin manifestations in individuals with type 2 diabetes mellitus. It can be used as an effective treatment modality for treating diabetic dermopathy.

Treatment of vascular lesions located in the lip and in the oral cavity with Nd:YAG laser.

Vascular lesions such as hemangiomas can be found in the oral cavity. Some therapeutic modalities can be used in the treatment of these lesions and Nd:YAG 1064 nm long pulse laser shows good results with easy application, fewer complications and satisfactory results. This study describes the technique and outcome of a case of hemangioma located on the tongue treated with Nd:YAG laser.

Erbium:yttrium aluminum garnet laser versus Q-switched neodymium:yttrium aluminum garnet laser for the treatment of xanthelasma palpebrarum.

BACKGROUND: Several lasers have been used for the treatment of xanthelasma palpebrarum (XP), such as Q-switched neodymium:yttrium aluminum garnet (QSNd:YAG) and erbium:yttrium aluminum garnet (Er:YAG) laser. Up to now, a comparative study among these laser options in the treatment of XP has not been reported. OBJECTIVE: The aim of this study was to compare the clinical efficacy and response rates of QSNd:YAG and Er:YAG in the treatment of XP. METHODS: Sixty patients with a total of 102 XP lesions were randomly and equally divided into two groups. The first group was treated with QSNd:YAG at a fluence of 10 joule/cm2, 10 Hz and 2 mm spot size, and the second group was treated with Er:YAG at 200-300 millijoule, 4 Hz and 2 mm spot size. RESULTS: In the Er:YAG group, the percentage of patients who required 3 or 4 sessions and wound healing time were higher compared to those of the QSNd:YAG group. Furthermore, the percentage of patients who had an improvement score of 4 was higher in the Er:YAG than that in the QSNd:YAG group. CONCLUSION: Er:YAG is an efficient, successful and minimally invasive method without long-lasting adverse effects.