Laser Management and Safety in Dermatology

Laser Treatment in Nail Disorders: A Comprehensive Review

Background

Laser therapy has emerged as an innovative approach for managing various nail conditions, offering precise targeting, minimal invasiveness, and favorable safety profiles. This review analyzes the literature on laser therapy for nail indications, encompassing onychomycosis, nail psoriasis, nail warts, ingrown toenails, onychodystrophy, nail pigmentation disorders, and nail tumors.

Methods

PubMed and Google Scholar databases were searched to identify articles on laser therapy using specific key terms related to nail conditions (e.g., onychomycosis, nail psoriasis). Relevant articles were shortlisted based on laser treatment in nail disorders, its mechanisms of action, research outcomes, and clinical applications.

Results

Nd: YAG or CO2 lasers showed efficacy in onychomycosis by targeting fungal cells. Studies suggest that laser treatments offer comparable results to traditional therapies, often enhancing outcomes when combined with topical agents such as calcipotriol/betamethasone in nail psoriasis. For nail warts, ingrown toenails, onychodystrophy, and nail pigmentation disorders, lasers provide alternative or adjunctive therapies, achieving positive outcomes lesion clearance and symptom improvement. Conclusion: This review underscores the transformative potential of laser therapy in nail disorder management, providing clinicians with innovative treatment alternatives. Nevertheless, further studies are needed to refine protocols, evaluate long-term outcomes and explore its application in specific conditions such as nail tumors.

Standard operating protocol for utilizing energy-based devices in aesthetic practice

BACKGROUND

Lasers and other energy-based devices are increasingly becoming popular in aesthetic practice. Many centers employ doctors or technicians to perform these procedures where treating doctor and operating doctor may be different. Hence the need for standard operative protocols, to be followed while performing these procedures to avoid mistakes, complications and to get optimum results. In the current review article, group of doctors who have worked with these energy-based devices over many years worked together and suggested the protocols to be followed for the most commonly used energy-based procedures.

AIM

To provide Standard operating protocols for the operator and staff to ensure, efficacy, safety, for the patient and for the devices.

METHODS

The following protocols have been drafted based on the best practices followed by the authors in their clinics and reflect their consensus opinion. The objective is to provide operating protocols in a standard format, which can be of use by practicing dermatologists and their staff. The protocols include both general guidelines for the laser room and specific protocols for different machines. The draft follows the following schema: General instructions for all the energy-based devices. Specific protocols for different devices: Laser hair removal, fractional lasers, Q-switched lasers, fractional microneedling radiofrequency and cryolipolysis.

CONCLUSIONS

The protocols proposed help to maintain the uniformity and avoid complications. However, these instructions are generalized and not machine or lesion specific. There may be variations in the protocols depending on the treatment lesion and treating doctor as well as machine.

A Network Meta-analysis to Explore the Effectiveness of the Different Treatment Modalities in Acne Scars

BACKGROUND

Multiple treatments are used to treat acne scars, but comparing the effectiveness of these treatments have not been studied yet. This research aimed to conduct a complete analysis of the effectiveness of commonly used therapies in acne scars.

METHODS

PubMed, Embase, and Cochrane's Library (Cochrane Center Register of Controlled Trials) databases were searched through May 2023. We used patient satisfaction score as the primary outcome and Goodman Baron qualitative scar grading system as the secondary outcome to evaluate the effectiveness of different commonly used therapies for acne scarring, including laser, microneedling (MN), platelet-rich plasma (PRP), autologous fat grafting and combined therapies.

RESULTS

Herein, 495 patients from 13 studies were included. Our results showed that PRP combined with laser was the most effective among therapies in treating acne scars. Ranking of effectiveness by the surface under the cumulative ranking (SUCRA) curve for patient satisfaction score was as following: PRP + laser (96.2%) > laser (71.2%) > MN (45.5%) > MN + PRP (42.0%) > autologous fat grafting (24.5%) > PRP (20.5%). Additionally, ranking of effectiveness by the SUCRA curve for Goodman Baron qualitative scar grading system was as following: PRP + laser (86.3%) > laser (64.2%) > MN + PRP (54.2%) > MN (37.2%) > PRP (8.1%).

CONCLUSION

This network meta-analysis indicated that the combined therapy of PRP and laser might be the most effective. Additionally, more high-quality randomized controlled trials are needed to verify our findings.

LEVEL OF EVIDENCE I

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

Successful Treatment of Minocycline-Induced Facial Hyperpigmentation with a Combination of Chemical Peels and Intense Pulsed Light

Minocycline is a tetracycline derivative antibiotic commonly used to treat acne, rosacea, and other inflammatory skin conditions. Taking minocycline risks inducing skin pigmentation. If minocycline-induced hyperpigmentation is not treated, it may take months to years for the symptoms to subside after discontinuation of the drug, or the hyperpigmentation may never disappear completely, which can lead to cosmetic anxiety and affect people's quality of life. Previous treatment options for hyperpigmentation were mainly q-switched nd: YAG, ruby, and alexandrite lasers. This article reports a case of facial hyperpigmentation caused by minocycline using a combination of chemical peel and intense pulsed light in a patient with eosinophilic cellulitis (Wells syndrome) who was taking oral minocycline. This case suggests combining chemical peel and intense pulsed light is an effective treatment option for minocycline-induced hyperpigmentation.

Assessment of the Effectiveness of Treatment of Vascular Lesions within the Facial Skin with a Laser with a Wavelength of 532 nm Based on Photographic Diagnostics with the Use of Polarized Light

Aesthetic medicine is a dynamically developing field of medicine. It has an impact not only on the improvement of the external appearance, but also on health and quality of life. Currently, vascular changes affect many patients and significantly diminish the condition of the skin. The development of modern laser therapy has contributed to the successful management of multiple skin conditions, among them vascular lesions. The aim of our study was to show the efficacy of repetitive 532 nm laser therapy in reducing vascular skin lesions located on the facial area. Observations were possible due to the implementation of System of Skin Analysis. We retrospectively analyzed the records of 120 patients (100 women and 20 men) using "VISIA" Skin Analysis System after 532 nm laser therapy. Treatment with the use of the 532 nm vascular laser turned out to be effective in reducing vascular changes in both women and men. The skin phototypes did not significantly affect the therapy efficacy. Neither the age of patients nor number of laser sessions affect therapy efficacy. 532 nm laser therapy is effective in reducing vascular skin lesions located in the face area.