Faculty Bibliography

BACKGROUND: The flashlamp-pumped pulsed dye laser has been used in the treatment of cutaneous vascular disorders since 1986. Although this laser is now widely used for the treatment of port-wine stains, telangiectases, and hemangiomas, the incidence of adverse reactions has not been clearly defined in a large series of patients. OBJECTIVE: We assessed the incidence of adverse effects associated with the use of the pulsed dye laser in the treatment of vascular lesions. METHODS: We studied 500 patients undergoing pulsed dye laser treatments for port-wine stains, telangiectases, and hemangiomas. All patients were examined during the course of their treatment to assess the incidence of adverse effects associated with the use of the pulsed dye laser. RESULTS: There were no cases of hypertrophic scarring. The incidence of atrophic scarring was less than 0.1%. A spongiotic dermatitis was seen in 11 of 297 patients (0.04%) after multiple treatments of port-wine stains. Hyperpigmentation was seen in five of 500 patients (1%), whereas transient hypopigmentation was seen in 13 (2.6%). CONCLUSION: These findings demonstrate that the flashlamp-pumped pulsed dye laser is safe for the treatment of port-wine stains, telangiectases, and hemangiomas in children and adults

BACKGROUND: Despite good results in the treatment of most port-wine stains (PWS) with continuous-wave visible-light lasers, light PWS and those in certain locations respond less favorably and have a higher risk of scarring. Robotized scanning devices such as the Hexascan device have been developed for continuous-wave laser sources to produce greater target specificity, to increase reproducibility of results, and to decrease the incidence of adverse effects. OBJECTIVE: The purpose of this study was to compare the effects of the same wavelength of light (585 nm) on test sites within PWS with the flashlamp-pumped pulsed dye laser and a continuous-wave tunable dye laser scanned through a Hexascan robotized scanning device. METHODS: Two adjacent, noncontiguous sites within PWS were treated in 29 patients, one site with the flashlamp-pumped pulsed dye laser and the other with an argon-pumped continuous-wave tunable dye laser affixed to a Hexascan device. RESULTS: Twenty-eight patients completed the study. The pulsed dye laser was found to be superior to the continuous-wave dye laser with the Hexascan device in 45% of patients, whereas the continuous-wave tunable dye laser with the Hexascan device was considered superior in 15%. There was no difference in the remaining 40%. Undesirable side effects were infrequent with both treatments. There was no significant difference in hypopigmentation or atrophic and hypertrophic scarring, but hyperpigmentation was more frequent with the continuous-wave dye laser with the Hexascan device. CONCLUSION: Both the pulsed dye laser and continuous tunable-wave dye laser with the Hexascan device produce slight lightening after one treatment. The pulsed dye laser produces slightly greater lightening than the continuous-wave tunable dye laser with the Hexascan device 6 weeks after treatment of test areas within PWS in 40% of those treated. It also produced slightly less hypopigmentation and hyperpigmentation

BACKGROUND: High-energy, short-pulse lasers, eg, Q-switched lasers, emitting visible and near-infrared light have recently been developed for removing tattoos, with little risk of scarring. The mechanisms of action, and possible adverse effects other than scarring and hypopigmentation, are not fully understood. OBSERVATIONS: We describe five cases of pulsed-laser-induced, immediate, irreversible darkening of cosmetic, white, flesh (skin-color), and pink-red colored tattoos. Irreversible ink darkening can be an insidious complication, because immediate whitening of the skin temporarily obscures the subsequently impressive color change. Among these cases, irreversible ink darkening occurred with Q-switched ruby (694 nm), Q-switched neodymium (Nd):YAG (1064 nm/532 nm), and pulsed green dye (510 nm) lasers. Attempts to remove the darkened ink with further laser treatment failed in two cases, and surgical excision was necessary. In the other three cases, subsequent laser treatments successfully removed the darkened ink. The red cosmetic tattoo ink used in one of the cases was placed in agar in vitro and was converted to a black compound immediately on Q-switched ruby laser exposure. Ferric oxide, a brown-red ingredient commonly used in cosmetic tattoos, was similarly tested and blackened in vitro by Q-switched ruby laser exposures. CONCLUSIONS: Although most tattoos are not darkened by laser treatment, short-pulsed lasers over a wide spectrum can cause immediate darkening of some tattoo inks. Patients should be warned of the potential for irreversible cosmetic tattoo darkening, and test-site exposures should be performed prior to treatment. In some cases, subsequent laser treatments may remove the blackened ink. The mechanism probably involves, at least for some tattoos, reduction of ferric oxide (Fe2O3, 'rust') to ferrous oxide (FeO, jet black), but the chemical reaction that is involved remains unknown

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)