Faculty Bibliography

BACKGROUND. The flashlamp-pumped pulsed dye laser (577,585 nm) with 300 to 450 microseconds pulsewidths has been demonstrated to effectively and safely treat port-wine stains, telangiectases, and superficial hemangiomas in children. OBJECTIVE. The objective of this manuscript is to review the indications of the pulsed dye laser in the treatment of vascular lesions in children. CONCLUSION. Pulsed dye laser treatment of port-wine stains can remove or lighten the lesions with multiple treatment sessions. Spider telangiectases respond with complete resolution, usually within one to two treatment sessions. Superficial hemangiomas respond quite easily and effectively with the pulsed dye laser, while a more variable response is noted in deeper hemangiomas, early proliferative lesions, and ulcerated hemangiomas. This procedure is safe with a low incidence of scarring and pigmentary alteration

Traumatic tattoos can be very difficult to remove. Excision is often not possible because of the extent of the tattoo, and dermabrasion may not be able to reach the area of pigment without significant scarring. Six patients with traumatic (n = 5) or medical (n = 11) tattoos were treated with the Q-switched ruby laser with complete or nearly complete resolution after one to six treatments without cutaneous scarring or permanent pigmentary alteration

Hemangiomas are common vascular lesions in children. The flashlamp-pumped pulsed dye laser has shown excellent results in the treatment of port-wine stains and, more recently, superficial (capillary) hemangiomas. Four patients with clinically evident superficial hemangiomas illustrate the point that early treatment with this laser may not preclude growth of a deeper component of the lesions

We cared for an infant girl with the clinical constellation of supraumbilical midabdominal raphe, sternal atresia, and cutaneous facial and upper trunk hemangioma. This is the first report of this clinical association in the dermatologic literature. The vascular component of the disorder responded to flashlamp-pumped pulsed dye laser therapy and to systemic interferon alfa-2a (Roferon-A)

BACKGROUND AND DESIGN--Anecdotal reports and clinical observations have suggested that the response of port-wine stains to treatment with the pulsed dye laser is variable and dependent on the anatomical location of the lesion. To investigate anatomical variation in response to treatment, a retrospective study of 259 adults and children with port-wine stains of the head and neck treated with the pulsed dye laser was undertaken. Evaluation was performed by comparing simultaneously projected pretreatment and completion-treatment photographs. Anatomical differences in response were evaluated in three ways: (1) by anatomical subdivision of the head and neck into regions, (2) by dermatomal distribution, and (3) by response for midline lesions. The head and neck was subdivided into eight anatomical regions, which were independently evaluated for response. In addition, response for individual dermatomes and for midline lesions was evaluated. Response in all cases was assessed by determining the percentage of lightening from 0% to 100% (where 100% represents complete response) at the completion of treatment. Response grades were also assigned, using grades poor (0% to 25% lightening), fair (26% to 50% lightening), good (51% to 75% lightening), or excellent (76% to 100% lightening). RESULTS--One hundred thirty-seven adults and 122 children were included in the study. Evaluation by subdivision of the head and neck into regions revealed that in adults and children the centrofacial regions (medial aspect of the cheek, upper cutaneous lip, and nose) responded less favorably than the other grouped regions (periorbital, forehead/temple, lateral aspect of the cheek, neck, and chin); the centrofacial regions showed a good response (mean lightening, 70.7%) while the other grouped regions of the head and neck showed an excellent response (mean lightening, 82.3%). Evaluation by dermatomal distribution revealed that dermatome V2 showed a good response (mean lightening of 73.8%), while combined dermatomes V1, V3, and C2/C3 showed an excellent response (mean lightening of 82.4%). Evaluation of midline lesions revealed excellent responses in adults and children (mean lightening, 92.4%). CONCLUSIONS--Port-wine stains of the head and neck in adults and children demonstrate differences in response to treatment with the pulsed dye laser according to their anatomical location. Centrofacial lesions and lesions involving dermatome V2 in adults and children respond less favorably than lesions located elsewhere on the head and neck. Midline lesions respond very favorably in adults and children

BACKGROUND--The Q-switched ruby laser has been demonstrated to provide selective photothermolysis of pigmented tissue at a wavelength of 694 nm and a pulse width of 40 ns with dermal penetration. It was used to treat 15 patients with nevus of Ota involving the face with an age range of 6 to 52 years. Other methods of treatment for the nevus of Ota have either left scarring or were ineffective. The clinical efficacy of this laser treatment was evaluated in a comparative photographic analysis. OBSERVATIONS--Complete clearing was noted in four of the 15 patients and a minimum of 50% lightening of the original color in the remaining 11. Ten of the 15 patients were Asian, two were white, two were Hispanic, and one was Indian. The energy fluence used varied between 6 and 10 J/cm2, and the number of treatments ranged from 1 to 7. Significant lightening or clearing was found at the higher energy ranges of 9 to 10 J/cm2 with significantly less lightening noted at the lower energy range of 6 to 8.5 J/cm2. No scarring was noted in any of the 15 patients, and some isolated hypopigmentation was noted in one of the subjects. Transient postinflammatory hyperpigmentation of 2 months' duration was noted in only one patient. CONCLUSION--Q-switched ruby selective photothermolysis appears to be an effective and safe method of lightening or removing nevus of Ota

The Q-switched ruby laser causes selective damage to pigmented cells in the skin. This laser, which has a wavelength of 694 nm and a pulse duration of 40 nsec, has shown very promising results in the treatment of both amateur and professional tattoos. Less data are available on its ability to treat benign pigmented lesions of the skin. Three patients who had labial lentigos were treated with the Q-switched ruby laser, and dramatic clearing occurred after one or two treatments with a fluence of 10 J/cm2

The past decade has seen a dramatic increase in the use of lasers for the treatment of dermatologic disorders. A variety of laser systems has been found to be useful in the treatment of numerous conditions found in the nail unit. The vascular lesions of the nail unit have been treated with the pulsed dye, tunable dye, copper vapor, argon, and carbon dioxide (CO2) lasers. Pigmented lesions noted in the nail unit have been effectively treated with the Q-switched ruby, copper vapor, argon, and pulsed dye lasers. The CO2 laser has been widely used for the treatment of benign and premalignant neoplasms of the nail unit as well as inflammatory processes. Investigational lasers, such as the gold vapor and excimer lasers, may provide clinical benefits for diseases of the nail unit in the near future. The potential advantages of laser surgery of the nail unit include the selective destruction of vascular and pigmented tissue as well as precise tissue destruction