Faculty Bibliography

Background and Objective Pulsed KTP lasers effectively treat facial telangiectasia without purpura production. Transient side effects following treatment include erythema, edema, and vesiculation leading to crust formation. The aim of this study was to investigate the utility of an aqueous gel in reducing side effects associated with pulsed KTP laser treatment of facial telangiectasia. Study Design/Materials and Methods Nineteen patients with extensive facial telangiectasias were treated with a pulsed KTP laser (Versapulse, Coherent, Palo Alto, CA). The laser was used with the water cooled handpiece chilled to 4C, a 4 mm spot size, a 10-millisecond pulse duration and a fluence of 9.5 J/cm(2). One side of the face was treated with the laser using the cooling handpiece alone. The other side was treated using the cooling handpiece applied to a 2-mm film of aqueous gel spread over the treatment area. RESULTS: Treatment side effects, including pain, erythema, edema, vesiculation, and crusting were scored following treatment with and without the aqueous gel. Use of the aqueous gel in conjunction with the cooling handpiece decreased the incidence and severity of pain, erythema, edema, and crusting following pulsed KTP laser treatment of facial telangiectasia. Most patients demonstrated 50--75% clearance of their telangiectasias 1 month after one treatment session, and use of the gel did not alter the treatment efficacy. CONCLUSIONS: The application of an aqueous gel during pulsed KTP laser treatment of facial telangiectasia improves treatment associated side effects without affecting vessel clearance

OBJECTIVE: To examine the safety and efficacy of a pulsed alexandrite laser for treatment of leg telangiectasia and reticular veins. DESIGN: Observational study. SETTING: Laser and Skin Surgery Center of New York, New York, NY. SUBJECTS: Twenty women with skin phototypes I to III and with 54 patches of leg veins measuring 0.3 to 2.0 mm in diameter. INTERVENTIONS: Each patch was treated once using 1 to 3 passes of a 755-mm, 3-millisecond alexandrite laser. An 8-mm spot and fluences of 60 to 80 J/cm(2) were used, with dynamic epidermal cooling. MAIN OUTCOME MEASURES: Subjects underwent evaluation at 4 and 12 weeks for degree of clearance, based on a quartile grading system, and incidence of adverse effects. RESULTS: At the 4-week follow-up, 17 (35%) of 48 treatment sites showed greater than 75% clearance and an additional 16 (33%) showed greater than 50% clearance. By 12 weeks, 33 (65%) of 51 treatment sites showed greater than 75% clearance, and there was greater than 50% clearance in an additional 11 (22%). Hyperpigmentation was observed in 18 (35%) of 51 treatment sites. CONCLUSION: A single treatment with a 755-nm, 3-millisecond alexandrite laser at high fluence in conjunction with cryogen skin cooling produced excellent clearance of telangiectasia and reticular veins of the leg with minimal adverse effects

BACKGROUND: Pseudofolliculitis barbae is a common disorder in individuals with thick, curly hairs, and treatment options are limited. OBJECTIVE: To evaluate the effectiveness of a diode laser in the treatment of pseudofolliculitis barbae. DESIGN: Observational study. SETTING: Laser and Skin Surgery Center of New York, New York, NY. PATIENTS: Ten consecutive patients with long-standing pseudofolliculitis barbae and skin phototypes I to IV. INTERVENTIONS: Treatment was performed using an 810-nm diode laser (20- to 30-millisecond pulse duration) at fluences of 30 to 40 J/cm(2). Three treatments were performed at 6- to 8-week intervals, and subjects underwent evaluation for improvement in the pseudofolliculitis and the degree of hair reduction. MAIN OUTCOME MEASURES: Patients were assessed at 6- to 8-week intervals for the degree of hair-count reduction, improvements in papule and pustule formation, and adverse effects. RESULTS: Complete hair-growth delays of 3 to 8 weeks' duration were produced, and a decrease in hair density of greater than 50% was noted in all subjects 6 to 8 weeks after the last laser treatment. All patients exhibited greater than 50% improvement in the signs of pseudofolliculitis. Preexisting pigmentary changes improved with therapy. CONCLUSION: Diode laser treatment is a safe and effective method for improving pseudofolliculitis barbae in patients with skin phototypes I to IV

New developments in laser technology have enabled improved therapy of small and large leg telangiectasia. While sclerotherapy remains the gold standard of treatment, laser therapy should be considered a first line approach for isolated, superficial, fine-caliber, nonarborizing telangiectasia and postsclerotherapy telangiectatic matting. Laser therapy is an excellent option for patients who are fearful of needles or have demonstrated a poor response to sclerotherapy injections. Recent studies have demonstrated good clearance of leg telangiectasia and reticular veins using a variety of laser systems with deeper penetrating, near-infrared wavelengths and higher fluences in conjunction with various epidermal cooling methods. As with sclerotherapy, optimal results are achieved with lasers when larger feeding vessels are treated first using appropriate modalities