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Aggarwal I, Rossi M, Puyana C, Tsoukas M. Review of Fractional Nonablative Lasers for the Treatment of Dermatologic Conditions in Darker Skin Phototypes. Dermatol Surg 2024; 50:459-466. [PMID: 38335306 DOI: 10.1097/dss.0000000000004111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
BACKGROUND Fractional nonablative lasers (NAFLs) have demonstrated efficacy and safety for treating dermatologic conditions in patients with darker skin phototypes. Nonablative lasers are preferred in darker skin tones due to lower risk of postinflammatory hyperpigmentation. OBJECTIVE This review aims to identify the ideal laser options and parameters for treating common dermatologic conditions in patients with skin types IV-VI. MATERIALS AND METHODS A comprehensive literature search was conducted on PubMed in May 2023. Of 1,065 articles were identified, and 40 articles met the inclusion criteria. The studies were classified based on design, dermatologic condition, and skin phototype of patients, and assigned levels of evidence according to the Modified Criteria of the Oxford Center of Evidence Based Medicine. RESULTS Strong level 1 evidence supports the treatment of melasma and atrophic scars using NAFL. Moderate level 2 evidence was found for using NAFL in acne vulgaris, striae, and skin rejuvenation; 45% of the studies examined skin types III-IV, 20% III-V, 7.5% II-IV, 5% II-V, 5% IV alone, and 2.5% I-IV. CONCLUSION Further research is needed to determine the optimal treatment modalities and parameters for skin types V and VI. Appropriate device selection and conservative treatment settings are crucial for optimizing outcomes and minimizing adverse events.
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Affiliation(s)
- Ishita Aggarwal
- All authors are affiliated with the Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois
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Kim KE, Jeong JY, Jo JY, Ryu HJ, Kim IH. Efficacy of skin rejuvenation with a fractional 1927-nm thulium laser alone or combined with a chemical peel: a controlled histopathological preliminary study in a mouse model. Lasers Med Sci 2023; 38:262. [PMID: 37947906 DOI: 10.1007/s10103-023-03928-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
Many patients demand minimally invasive treatments for skin rejuvenation, such as nonablative laser and superficial chemical peels. Combination therapy yet has not been studied histopathologically. The purpose of this study is to assess the histopathological efficacy of a 1927-nm thulium laser-assisted salicylic acid (SA) peel in skin rejuvenation. A six-segment table was drawn on the shaved back of C57BL/6 mouse. All segments were irradiated with the thulium laser-different tips and passes were used for specific segments. A 30% SA peel was then applied to the right-hand segments. After treatment, the skin samples were collected from each segment and examined for dermal thickness, collagen density, and melanin content. Greater thickness was seen in the combination therapy group compared with the laser alone group and in those segments receiving more passes with larger beam-sized tip. Collagen density increased in all treated skin segments, irrespective of the group. No adverse events were noted in the treated areas. The sample size was small and mouse skin has histological differences with human skin. The combination of a thulium laser and 30% SA peel has a synergistic effect on dermal thickness, so that can be suggested as a novel skin rejuvenation technique.
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Affiliation(s)
- Ko Eun Kim
- Department of Dermatology, Korea University Ansan Hospital, Ansan, Republic of Korea
- Department of Dermatology, College of Medicine, Korea University, Jeokgeum-Ro 123, Danwon-Gu, Ansan-Si, Gyeonggi-Do, Republic of Korea
| | - Jae Yeong Jeong
- Department of Dermatology, Korea University Ansan Hospital, Ansan, Republic of Korea
- Department of Dermatology, College of Medicine, Korea University, Jeokgeum-Ro 123, Danwon-Gu, Ansan-Si, Gyeonggi-Do, Republic of Korea
| | - Ju Young Jo
- Department of Dermatology, Korea University Ansan Hospital, Ansan, Republic of Korea
- Department of Dermatology, College of Medicine, Korea University, Jeokgeum-Ro 123, Danwon-Gu, Ansan-Si, Gyeonggi-Do, Republic of Korea
| | - Hwa Jung Ryu
- Department of Dermatology, Korea University Ansan Hospital, Ansan, Republic of Korea
- Department of Dermatology, College of Medicine, Korea University, Jeokgeum-Ro 123, Danwon-Gu, Ansan-Si, Gyeonggi-Do, Republic of Korea
| | - Il-Hwan Kim
- Department of Dermatology, Korea University Ansan Hospital, Ansan, Republic of Korea.
- Department of Dermatology, College of Medicine, Korea University, Jeokgeum-Ro 123, Danwon-Gu, Ansan-Si, Gyeonggi-Do, Republic of Korea.
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Nguyen L, Schneider SW, Herberger K. [Picosecond lasers in dermatology]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00105-023-05144-3. [PMID: 37099130 DOI: 10.1007/s00105-023-05144-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND The picosecond laser is one of the latest laser systems in dermatology and was originally developed to optimize tattoo removal. Advances in this technology has expanded the use of the picosecond laser to numerous other indications. OBJECTIVES This article provides an overview of the technical background as well as the indications of the picosecond laser in dermatological laser medicine and elucidates the possibilities and limits of this laser system. MATERIALS AND METHODS The article is based on a review of the current literature as well as experience from clinical practice in a university laser department. RESULTS The picosecond laser enables a particularly gentle and effective treatment due to ultra-short pulses and the principle of laser-induced optical breakdown. Compared to Q‑switched lasers, the picosecond laser has fewer side effects and is associated with lower pain intensity and shorter downtime. In addition to the removal of tattoos and pigmentary disorders, it is also used in the treatment of scars and rejuvenation. CONCLUSIONS The picosecond laser has a wide range of indications in dermatological laser medicine. The current data indicate that the laser is an effective method with few side effects. Further prospective studies have to be conducted to assess the efficacy, tolerability and patient satisfaction in an evidence-based manner.
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Affiliation(s)
- Lynhda Nguyen
- Laserabteilung, Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Stefan W Schneider
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Katharina Herberger
- Laserabteilung, Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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Ertam Sagduyu I, Marakli O, Oraloglu G, Bulut Okut E, Unal I. Comparison of 1064 nm Q-switched Nd:YAG laser and Jessner peeling in melasma treatment. Dermatol Ther 2022; 35:e15970. [PMID: 36346028 DOI: 10.1111/dth.15970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/20/2022] [Indexed: 11/10/2022]
Abstract
Melasma is an acquired hyperpigmentation disease characterized by hyperpigmented patches in sun-exposed areas that significantly impairs life quality. Topical treatments such as hydroquinone, retinoic acid, azelaic acid, chemical peels and laser treatments are among the main treatment options. In our study, we aimed to compare the effectiveness of Jessner peeling and 1064 nm Q-switched Nd:YAG laser in melasma treatment. For this purpose, Jessner peeling was applied to 20 patients and 1064 nm Q-switched Nd: YAG laser was applied to 19 patients of 39 melasma patients who applied to the cosmetology unit of Ege University department of dermatology and venereal diseases between November 2018-March 2020. Thirty seven patients completed the study. Changes in MASI, pigment and erythema scores measured by mexameter before and after treatment were compared for two groups. A statistically significant decrease in MASI scores, pigment and erythema scores was observed in both groups with no significant difference between two groups. In conclusion, in our study, it has been shown that Jessner peeling and 1064 nm Q-switched Nd:YAG laser are equally effective in treatment of melasma.
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Affiliation(s)
| | - Onur Marakli
- Siverek State Hospital, Dermatology Clinics, Sanliurfa, Turkey
| | - Gokturk Oraloglu
- Siirt Education and Research Hospital, Dermatology Clinics, Siirt, Turkey
| | - Ecem Bulut Okut
- Tinaztepe Galen University Hospital, Dermatology Clinics, Izmir, Turkey
| | - Idil Unal
- Dermatology and Venerology Department, Ege University, Izmir, Turkey
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Friedman PM, Dover JS, Chapas A, Rahman Z, Ross EV, Kilmer SL, Roberts WE, Sodha P, Stimmel JB, Moncrief MBC, Waibel JS. 1,550 nm Erbium-Doped and 1,927 nm Thulium Nonablative Fractional Laser System: Best Practices and Treatment Setting Recommendations. Dermatol Surg 2022; 48:195-200. [PMID: 35050945 PMCID: PMC8806037 DOI: 10.1097/dss.0000000000003321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The Fraxel Dual laser system (Solta Medical, Inc., Bothell, WA) contains a 1,550 and 1,927 nm wavelength single handpiece with different indications for each wavelength. OBJECTIVE To discuss treatment setting recommendations and best practices for select on-label and investigational applications of the 1,550 and 1,927 nm dual laser system. MATERIALS AND METHODS Eight board-certified dermatologists with 10 or more years of experience with the 1,550 and 1,927 nm laser system completed an online survey about their clinical experience with the system and then participated in a roundtable to share clinical perspectives and best practices for using the laser system. RESULTS For all Fitzpatrick skin types, treatment recommendations were described for selected approved indications for the 1,550 and 1,927 nm laser system, including both lasers in combination. Treatment recommendations were also reached for investigational applications with the 1,550 nm laser and 1,927 nm laser. Best practices for using the lasers during the treatment session to achieve optimal outcomes and decrease the post-treatment recovery time were compiled. CONCLUSION The 1,550 and 1,927 nm dual laser system is effective for a wide range of aesthetic and therapeutic applications, on and off the face and across all Fitzpatrick skin types.
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Affiliation(s)
| | | | - Anne Chapas
- Union Square Laser Dermatology, New York, New York
| | - Zakia Rahman
- Stanford Department of Dermatology, Redwood City, California
| | | | | | - Wendy E. Roberts
- Generational and Cosmetic Dermatology, Rancho Mirage, California
| | - Pooja Sodha
- Department of Dermatology, George Washington University, Washington, District of Columbia
| | - Julie B. Stimmel
- Synchrony Medical Communications, LLC, West Chester, Pennsylvania
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Kim SM, Hwang S, Almurayshid A, Park MY, Oh SH. Non-Ablative 1927 nm Fractional Thulium Fiber Laser: New, Promising Treatment Modality for Riehl's Melanosis. Lasers Surg Med 2020; 53:640-646. [PMID: 33259661 DOI: 10.1002/lsm.23341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 09/27/2020] [Accepted: 10/12/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The treatment of Riehl's melanosis, also known as pigmented contact dermatitis, is highly challenging. Intense pulsed light (IPL) and 1064 nm Q-switched Nd:Yag (QS-Nd:YAG) laser are reported to have some efficacy. However, no single effective treatment has yet been identified. In this study, we demonstrated the efficacy and safety of the non-ablative 1927 nm fractional thulium fiber laser (TFL, LASEMD™; Lutronic Corp., Goyang, Korea) for patients with Riehl's melanosis. STUDY DESIGN/MATERIALS AND METHODS A retrospective chart and photographic review of nine patients with Riehl's melanosis, who had received at least three sessions of TFL treatment, was performed. Before the start of TFL treatment, combination treatment with a topical cream containing hydroquinone, low-fluence QS-Nd:YAG laser, pulsed dye laser, and IPL was used with variable and discouraging effects. Seven patients were treated on the face and two patients on the neck with three to seven sessions at 1-month intervals. Clinical improvement was assessed using clinical photos taken before and after every treatment session according to dermal pigmentation area and severity index (DPASI) and a quartile grading scale by two blinded dermatologists. RESULTS Patients underwent three to seven sessions of TFL treatment depending on severity of pigmentation. Of nine patients, six demonstrated a clinical improvement of 51%-75%, one demonstrated an improvement of 76%-100%, and two showed an improvement of 26%-50% after treatment. The DPASI was significantly decreased from 9.55 to 5.25 on average. Melanin index was decreased after treatment in two patients whose melanin index were measured at initial visits. Treatment-related adverse events, such as scarring or postinflammatory hyperpigmentation (PIH), were not observed in all patients except for transient erythema and swelling. CONCLUSIONS This report suggests that TFL could be an alternative and/or additive treatment option for hyperpigmentation in intractable Riehl's melanosis and might be a promising treatment for PIH caused by any reason including Riehl's melanosis. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Su Min Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Shinwon Hwang
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Abdurrahman Almurayshid
- Department of Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Saudi Arabia
| | - Min-Young Park
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Ho Oh
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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