Faculty Bibliography

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

Sixty-seven patients with periorbital port-wine stains were treated with the flashlamp-pumped pulsed dye laser at a wavelength of 577 or 585 nm and a pulse-width of 450 microseconds. A retrospective analysis of the efficacy of this treatment was performed by qualitative and quantitative comparison of simultaneously projected pretreatment and post-treatment photographs and by comparison of photographs with a visual analog scale. These periorbital port-wine stains were treated with good-to-excellent results in 95% of the patients. As a result of treatment, macular (ie, nonhypertrophic) lesions, were lightened by an average of 80%. Neither scarring nor permanent pigmentary alteration was noted. Children of all ages were treated without adverse consequences, and the results were comparable to those of adults. The flashlamp-pumped pulsed dye laser treatment of periorbital port-wine stains is effective and safe in patients of all ages and should be considered the treatment of choice for flat and mildly hypertrophic lesions

A black man presenting with a port-wine stain was spot-treated with a flashlamp-pumped pulsed dye laser. The 1 cm2 area was treated with the flashlamp-pumped pulsed dye laser using rhodamine in methanol as the dye, a wavelength of 585 nm, a pulse duration of 450 microseconds, and a circular spot size of 5 mm. Energy density was 7.75 J/cm2. Superficial sloughing of the skin was noted immediately posttreatment. Persistent hyperpigmentation, textural changes to the skin, and no improvement in the port-wine stain were noted at follow-ups 2-, 4-, and 8-months posttreatment