Rufus R. Noble Laser therapy delivers intense UVB to a small area of skin. This can provide a more rapid response to treatment while avoiding side effects from ultraviolet light exposure on unaffected skin. The pulsed dye lasers emit high-intensity yellow lights (wavelength 585 nm), which destroy the targeted tissue.
The pulsed dye laser (PDL), which delivers energy with a wavelength that is optimized for the selective treatment of vascular lesions, has been developed. It is used to treat warts and other vascular lesions, such as hemangiomas, port wine stains, or hypertrophic scars. Pulsed dye lasers are used in place of carbon dioxide lasers or surgical excision. Some examples of pulsed dye include the C-beam Laser Pulsed Dye System, PhotoGenica Star, and PhotoGenica Lasers.
The FDA has approved the PDL to treat warts and other skin conditions such as port-wine stains and hypertrophic scars. PDL is effective for treating glomangiomas on the neck and face, where surgical excision might not be possible. The PDL has been shown to be an effective treatment for pyogenic Granulomas on the front and neck, which are cosmetically sensitive.
Rosacea is an inflammatory chronic disorder that affects the nose, cheeks, forehead, and nose skin. It is characterized by congestion, flushing (abnormal dilation or superficial blood vessels), and nodular swelling. Goldberg (2005) said that pharmacological treatments remain the primary treatment for rosacea. Monochromatic (i.e., laser) and multichromatic light-based therapy are becoming more popular for treating certain symptoms of rosacea. The author stated that, despite the increased use of light-based therapy and lasers for rosacea treatment, there have only been a few controlled studies. A Cochrane Review on Interventions for Rosacea (van Zuuren, 2005) concluded that the studies that evaluated rosacea treatment were generally of poor quality. Van Zuuren and colleagues (2005) concluded that topical metronidazole and azelaic acids are effective. The assessment found evidence to support the effectiveness of oral metronidazole, tetracycline, and azelaic acid. The evaluation concluded that the evidence for other treatments is not sufficient. The review concluded that there is an urgent need for good randomized controlled studies that examine these treatments.
Maw (2004) reported that there are a number of options for treating genital warts, but only a few have been evaluated in large-scale randomized placebo-controlled studies. The most popular treatments are non-surgical and surgical treatments applied by providers. Surgery, such as cryotherapy and electrotherapy or laser surgery, is generally the same in terms of clearing warts, but it is associated with a high rate of recurrence. Trichloroacetic Acid is a non-surgical treatment that is widely used, but its effectiveness is unknown, and it has unpleasant side effects. Patients and doctors alike are now more accepting of the newer therapies, imiquimod or podophyllotoxin, which patients apply. These two treatments have similar wart-clearing rates, but imiquimod has a lower rate of recurrence. Patient-applied home treatment is an appealing option to treat genital warts, especially in light of the increasing pressure on genitourinary services.
O’Mahony (2005) reported that electrocautery, lasers, and trichloroacetic acids are all commonly used methods of physical treatment for genital warts. Many patients, however, respond very well to home treatments using podophyllotoxin and imiquimod. Most patients prefer home treatment because of its comfort and dignity. In most cases, routine screening for sexually transmitted diseases is recommended. In order to reduce the psychological distress caused by this genital condition, it is important to provide a detailed explanation and offer reassurance.
Komericki et al. (2006) state that flashlamp-pumped PDL is one of the many options available for treating viral warts. Researchers evaluated the effectiveness of FPDL in treating genital warts in 22 patients. After 1.59 (1-5) laser sessions, all patients had complete remission. No scarring was seen. The authors concluded that FPDL was a safe and simple alternative treatment for genital warts that could save time and money. It should be included in genital genital warts treatment guides. Ockenfels and Hammes (2008) stated that FPDL was superior to carbon dioxide laser because it is a nonablative treatment for genital warts with fewer side effects.
Scheinfeld and Lehman (2006) state that genital HPV infection is the most prevalent sexually transmitted Disease. Every year, 1 million new cases are diagnosed of genital Warts. 2/3 are women. In the United States, 15 percent of people are estimated to have genital warts. Human papillomavirus is a virus that infects the keratinocytes. This infection can present clinically as warts. There are many effective and well-established treatment options for genital squamous cell carcinoma. Topical treatments include imiquimod (podophyllin), trichloroacetic acids, and podophyllotoxin. Carbon dioxide lasers, surgical excisions, loop excisions, cryotherapy, and electrodessication are destructive or surgical therapies. To treat genital Warts, interferon can either be administered systemically or locally. Randomized blind-controlled studies, prospective studies, and retrospective cohorts provide evidence of effectiveness in treating genital warts.
The evidence of efficacy is good. However, more studies need to be conducted to compare combination therapies with monotherapy and to conduct head-to-head comparisons. The number, size, and location of the lesions will determine which treatment is best. Although costs may differ, there is no certainty about which approach is better. Cryotherapy is the most destructive first-line treatment, but electro-desiccation and surgery are more effective. The first-line topical treatment appears to be podophyllotoxin or imiquimod. Interferon costs too much, and trichloroacetic is inconsistent to recommend as a primary treatment. Combinations of therapies may be more effective than monotherapy, but it is not clear. The side effect profile determines the choice of treatment, cost, and effectiveness, as well as convenience (ability to visit a physician’s office or undertake a protracted home-based therapy).
Granuloma faciale is a rare benign chronic vasculitis with distinctive clinicopathological characteristics. It usually affects the facial skin. Many medical and surgical procedures have been tried with varying degrees of success. Several case reports of single patients have shown the success of using the pulsed dye in treating GF. Chatrath (2002) used a long-pulsed tunable laser to treat GF. This was done in order to minimize scarring and target the vessels. The diagnosis was confirmed by a punch biopsy of the lesion, followed by three treatments at six-week intervals with the long-pulsed dye laser. After two treatments, the lesions were significantly flattened and cleared completely after the third. In the nine months of follow-up, no scarring could be detected, and there were no recurrences. The authors concluded that GF can be treated successfully with the long-pulsed tunable laser with minimal scarring risk. This is especially true in cosmetically sensitive regions.
Cheung and Lanigan (2005) evaluated the results of four patients with facial GF treated by the Candela PDL 595 nm at a dermatological laser center. In 2 out of 4 patients (50%), the GF was resolved. This study showed that PDL could help some GF patients. It is a good treatment for GF because it is quick, safe, and well-tolerated. Wiederkehr and Schwartz (2008) also stated that PDL was the preferred treatment option for GF.
Cooper and Burge (2003: p. 3) noted that Darier’s Disease, also known as Darier White disease or keratosis folliculicularis, is a rare skin disease with autosomal dominance inheritance. The seborrheic area and the flexures are affected by greasy papules or plaques. Nearly all patients also have abnormal nails. Acantholysis, dyskeratosis, and dyskeratosis is the most common histological finding. The underlying defect results from mutations of the ATP2A2 on chromosomes 12q23-24, which encodes a sarco/endoplasmic reticulum Calcium ATPase. Acantholysis may be caused by desmosome breakage. Darier’s Disease is an example of a dominantly inherited disease that results from haplo-insufficiency. Oral retinoids provide the best treatment, but they can have adverse side effects. Although there are many advocates for topical retinoids and topical corticosteroids, as well as surgery, laser surgery, and surgery with topical steroids, the evidence is not strong.
Schmitt (2009) reported that Darier’s Disease is frequently associated with pruritus, an unpleasant smell, and medical problems. Laser therapy is effective at alleviating these symptoms. This approach can cause permanent hypopigmentation, and scarring is a possibility. The investigators described two cases in which nonablative treatment with pulsed dye lasers was a safe and efficient way to treat intertriginous lesions. The mechanism of action remains unclear, but the results from this small series of case studies indicate that PDL treatment is an option for Darier disease. The authors concluded that a larger number of patients must be treated this way, ideally through multi-center studies.
Mortensen et al. (2008) conducted a preliminary evaluation of the PDL for the treatment of vocal fold scars. The study was approved by the Institutional Review Board and involved 11 patients. Scarring was caused by phonosurgery (7 patients), radiation (2 patients), and partial laryngectomy (2 patients). Pre- and post-procedure, the subjects were assessed using voice handicap index, laryngeal stroboscopy, voice recordings, acoustic analysis aer, dynamic analysis, and self-evaluation. Three treatments were performed in an office setting using the fiberoptic system. Each treatment ended with a blanching at the treatment site. Three women and eight men were in the study group. Ten out of eleven patients improved subjectively by self-rating. VHI decreased from 48.44 at pre-treatment to 36.55 six months after treatment (p 0.05). At six months, the jitter enhanced from 2.2% to 1.7% (p = Ns), and the shimmer improved from 3.7% to 3.23% (p = Ns). Noise to harmonic ratio increased from 0.143 (p = NS) to 0.132. The mean phonotory flux went from 0.177 L/S to 0.254 (p 0.05). In a forced-choice comparison, three raters blinded by treatment sequence rated post-treatment findings of stroboscopy as better than the pre-treatment. Kappa’s score was 0.903. The authors concluded that PDL was a safe, potentially promising treatment of vocal fold scars. Subjectively, 10 out of 11 patients said that their voice had improved. The VHI, the acoustic measurements of shimmer and noise, and the stroboscopy results were all enhanced. They noted that further research using this method in a larger group of patients seems warranted.
Bernstein and colleagues (2011) stated that the 595-nm PDL is the device of choice to treat cutaneous vascular lesions due to its hemoglobin-selective spectrum. It is less effective at removing dyschromia, which, along with hyper-vascularity, is a key sign of photodamage to the skin. As a first step, a novel 607-nm laser dye was developed to create a dual-wavelength PDL. Twenty-two of the 25 patients with dyschromia due to chronic photodamage on the chest completed the open-label trial to investigate the safety and effectiveness of the 607-nm PDL. Two treatments, one month apart, were given to the chest using fluences between 3 and 6 J/cm2 with a spot of 10 mm in diameter and pulse durations of 1.5 msec. Physicians unthinkingly rated the improvement of cross-polarized digital photos taken before and after the final treatment. The progress was graded on a five-point scale. No subject was given a poor rating (less than 25% clearance), three subjects (13.6%) showed fair improvement (26-50%), seven issues (311.8%) were rated good (51-75%), 12 (54.5%) were rated excellent (76-95% improvement), and none of the subjects received a score higher than 95%. The authors concluded that the study was the first to show that the 607-nm PDL is safe and effective in treating dyschromia due to chronic photodamage on the chest.
