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This review examines the efficacy and safety of fractional CO2 lasers for the treatment of atrophic scarring secondary to acne vulgaris. We reviewed 20 papers published between 2008 and 2013 that conducted clinical studies using fractional CO2 lasers to treat atrophic scarring. We discuss the prevalence and pathogenesis of acne scarring, as well as the laser mechanism. The histologic findings are included to highlight the ability of these lasers to induce the collagen reorganization and formation that improves scar appearance. We considered the number of treatments and different laser settings to determine which methods achieve optimal outcomes. We noted unique treatment regimens that yielded superior results. An overview of adverse effects is included to identify the most common ones. We concluded that more studies need to be done using uniform treatment parameters and reporting in order to establish which fractional CO2 laser treatment approaches allow for the greatest scar improvement. [ABSTRACT FROM AUTHOR]

Background and objectives:Superficial cutaneous vascular lesions (SCVLs) are quite common. Several types of lasers have been used to treat these lesions; however, there are no dedicated treatment guidelines and few studies in the literature addressed their treatment.Aims:In this paper, we aimed to report our clinical experience with potassium titanyl phosphate (KTP) laser treatment on different types of facial SCVLs including telangiectasia, spider angioma, and erythema.Methods:Data were retrospectively collected from 146 patients with SCVLs, who had been treated with the 532-nm wavelength laser at our outpatient dermatology clinic. Treatment responses were graded as four groups: clearance (> 75% improvement compared with the previous session), marked improvement (50–75%), partial improvement (25–50%), and no response (< 25%).Results:The rate of clearance plus marked improvement (favorable outcome) was 66.1% for telangiectasia group, 93.5% for spider angioma group, and 26.7% for erythema group. Mean number of treatments was 2.9 ± 1.4 for telangiectasia group, 1.4 ± 0.8 for spider angioma group, and 2.9 ± 1.7 for facial erythema group. Only minimal adverse effects related to treatment procedure were detected in 5 out of 146 (3.4%) patients.Conclusions:Our results demonstrated that KTP laser might be a safe and effective laser modality for SCVLs, which may be associated with physiological problems due to cosmetic concerns. [ABSTRACT FROM PUBLISHER]

The use and success of high-energy, short-pulse, Q-switched lasers for tattoo removal has been well demonstrated. Three types of lasers are currently commercially available for tattoo removal: the Q-switched ruby laser (694 nm), the Q-switched alexandrite laser (755 nm) and the Q-switched Nd:YAG laser (532 nm and 1064 nm). Multiple parameters such as tattoo type, color, location, and patient skin type dictate which laser is optimal in each patient. Despite the demonstrated efficacy of these modalities, there are few papers that address some of the long-term issues of tattoo removal, such as patient compliance, and how these issues impact on the success rates of optimal tattoo removal treatments. In this retrospective study, 10-year data from a single center are presented. Our data include parameters such as clearance rates, number of treatments, wavelength of the utilized laser, and fluence and spot-size setting. In addition, potential complications such as scarring, hypopigmentation, and pain were analyzed. Finally, we examine the patient compliance that accompanied tattoo removal and the reasons behind the typically low success rates for total tattoo clearance. [ABSTRACT FROM AUTHOR]

Men throughout history have suffered from various degrees of hair loss. Modern techniques for hair transplantation give rise to natural and long-lasting results. In this paper we provide an overview of the procedure, including the harvesting of donor hair in the occipital scalp, and its redistribution along the frontal- and mid-scalp areas. Special consideration must be made to choosing the candidates carefully and to performing their surgery in a manner that looks appropriate for all ages. We describe the role of medications for male pattern hair loss and with hair transplantation. [ABSTRACT FROM AUTHOR]

The lack of uniform and objective techniques to evaluate treatment efficacy in photo-epilation studies leads to contradictory results. Thus, there is an urgent need to explore commonly accepted assessment tools. One of the most common methods uses hair counts via digital photography. However, macrophotography may not be able to depict the vellus-like hair induced by photo-epilation. On the other hand, handheld dermatoscopy is practical, affordable and offers high-quality magnification. Hair counts from a handheld dermatoscope and a digital camera were compared in 73 women who underwent 6 sessions with the Alexandrite 755 nm laser. Significantly more hairs were counted using the dermatoscope than using the digital camera (76.9 ± 41.3 vs. 58.6 ± 31.4, p <.005), independently of hair thickness and hair density. The difference in hair counts between the two instruments was inversely related to hair thickness and directly related to hair density. The handheld dermatoscope may be a more effective tool than the widely used digital camera in evaluating the response to laser hair removal treatment. [ABSTRACT FROM AUTHOR]

Ablative laser technology has been in use for many years now. The large side effect profile however has limited its use. Fractional ablative technology is a newer development which combines a lesser side effect profile along with similar efficacy. In this paper we review fractional ablative laser skin resurfacing. [ABSTRACT FROM AUTHOR]

Ablative Fractional laser (AFL), which has been widely used, but non-ablative and less invasive techniques such as picosecond laser with fewer side effects are available. To objectively determine the degree of scar improvement with picosecond laser compared with ablative fractional carbon dioxide laser in depressed facial scar. This prospective, evaluator-blinded trial enrolled patients with linear depressed atrophic scar. There were 26 patients in the picosecond laser group and 38 patients in the AFL patient group. Standardized images were acquired by the same person using the same device in the same place. Five physicians compared the scar improvement effect using modified Vancouver Scar Scale (mVSS) and Stony Brook Scar Evaluation Scale. No statistically significant demographic differences existed between the two laser groups. On the Stony Brook Scar Rating Scale, the improvement of depression and hatch marks was significantly greater with the picosecond laser group. The picosecond laser resulted in a better score improvement in the overall scar scale on both mVSS and Stony Brook Scar Evaluation Scale. In conclusion, the 755-nm picosecond laser is a safe and effective non-ablative modality for wide and depressed facial scar, with significantly superior scar improvement when compared with the AFL. AFL = ablative fractional laser, CO2= carbon dioxide, LiOB = laser-induced optical breakdown, PIH = postinflammatory hyperpigmentation, mVSS = Modified Vancouver scar scale. [ABSTRACT FROM AUTHOR]

Laser and light-based devices provide scope for long-term "hair-removal" however, there is limited evidence supporting their long-term efficacy. This study aimed to assess the long-term efficacy of laser and light-based "hair-removal" devices, taking into account variations in body site-specific variations in hair growthcycles. A systematic review of randomized controlled trials (RCTs) with follow-up periods greater than or equal to the length of one complete hair growth cycle in the body site targeted was conducted. Only five eligible RCTs were identified as suitable for inclusion, and these comprised a total of 223 patients. The average long-term hair reduction reported for neodymium:yttrium-aluminum-garnet (Nd:YAG) laser ranged from 30 to 73.61%, Alexandrite laser ranged from 35 to 84.25%, and Diode laser ranged from 32.5 to 69.2%. In all three devices, the greatest long-term reduction was observed from trials targeting leg hair (1-year growth cycle) and lowest from targeting facial hair (6-month growth cycle). Intense pulsed light (IPL) produced average long-term hair reduction of 52.7–27%; smallest reduction was observed from targeting the face area and greatest from targeting the axillary area (7-month growth cycle). In conclusion, greater long-term hair reduction was observed on body sites with longer hair growth cycles. Future trials should take into account the variation of hair growth cycles across body sites to provide accurate long-term data on treatment outcomes. [ABSTRACT FROM AUTHOR]

Acne is one of the most common skin diseases whose disfiguring results may cause psychological problems. Despite of the various choices in the treatment of acne, new therapy with fewer complications and lower relapse rate is still in need. In this study, we aim to evaluate the clinical efficacy of a new therapy using selective sebaceous gland electro-thermolysis and non-thermal plasma (NTP) in refractory acne patients. Treatments were given at a monthly interval for three times. The last visit was set at 3 months after the third treatment. Thirty-six moderate to very severe acne patients were enrolled. All the patients got more than 50% clearance after the third treatment. The excellent response rate was 44% at 1 month after the third treatment and 50% at 3 months after the third treatment. Porphyrin and erythema values were significantly reduced after the third treatment. No irreversible complication was reported. Selective sebaceous gland electro-thermolysis combined with NTP can be a safe and effective new option in the treatment of acne. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented in which the editor discusses various reports published within the issue on topics including the use of popular fractional and intense pulsed light (IPL) devices, non-invasive body contouring and cutaneous lasers.

Conventional treatments for excessive hair are tedious and time consuming. Laser hair removal has become the leading therapy option for long–term results. It works on the principle of selective photothermolysis, whereby photons destroy the hair follicle while sparing the surrounding tissue. As demand increases, there has been an increase in the regulation of these treatments. Laser hair removal is not risk-free and side effects are associated with the treatment. Adequate training is vital to minimise adverse side effects. Certain countries have regulatory boards that laser operators need to register with, as well as the completion of mandatory hours. Others require laser operators to register with a Care Quality Commission (CQC) to ensure that minimum training and safety standards are met. Currently, in South Africa, the lack of regulatory boards and mandatory hours poses a risk to the public as anyone with little or no qualification is allowed to perform laser hair removal treatments, placing patients at risk. This review looks at some of the devices used and basic mechanisms of action of laser hair removal, its associated risks, side effects and current regulation. [ABSTRACT FROM AUTHOR]

Laser dermatology is an ever-expanding part of the specialty used extensively for both aesthetic and medical conditions. Advances in laser technology have led to an expansion in the number of devices available, with as a consequence an increase in the total number of complications. Fortunately, the current technology has improved greatly which adds to the safety profile of such devices; nevertheless, thorough knowledge of laser complications and how to avoid them is paramount for any practitioner who uses such technology. [ABSTRACT FROM PUBLISHER]

Background: Verruca Vulgaris (VV) is common benign neoplasm. However, it can present a therapeutic challenge. Previous studies have suggested that the Nd-YAG laser may be beneficial in the management of warts. Objective: To determine the effectiveness and safety of a novel 100 microsecond pulsed 1064 nm Nd:YAG laser for the treatment of VV. Method: A total of 25 adult subjects with a total of 63 hand verrucae were enrolled in the clinical trial to receive treatment with a low-energy (200 mjoule) 1064 nm Nd:YAG laser (PinPointe, NuvoLase, Inc.). Each subject was eligible for 3 treatments administered at monthly intervals. All verrucae were measured before each treatment session and at 6 months after the final treatment. Results: A complete response was seen in 19 subjects and in 41 verrucae. A complete response was defined as complete absence of verruca with the presence of normal skin dermatoglyphics. All other lesions showed at least partial response. A partial response was defined as a 50% or greater reduction in verruca size. No adverse events were noted. Conclusion: Low-energy 1064 nm Nd: YAG laser treatment may be a promising, safe, and effective therapeutic modality for the treatment of VV. However, more treatment sessions may be needed for complete clearance and increased efficacy in some subjects. [ABSTRACT FROM AUTHOR]

Onychomycosis is the most common nail disorder. The causative pathogens are not only dermatophytes in the majority of cases (Trichophyton rubrum and T. mentagrophytes), but also yeasts of the genus Candida and molds. A wide variety of topical antifungal agents are proposed for first-line treatment of superficial onychomycosis, when the matrix is not involved. New treatment options using light were recently introduced, such as thermal lasers, non-thermal lasers, and photodynamic therapy. For thermal lasers, a temperature increase in the nail of around 50°C seems to be a prerequisite for success. For non-thermal lasers, the clinical data are very debatable and their mechanism of action still remains mysterious. For photodynamic therapy, 5-aminolevulinic acid is used. The therapy consists of exciting protoporphyrin IX with red light that penetrates relatively deeply. Further clinical studies of larger series of patients and with longer follow-up are still needed to reach a definitive conclusion on the value of these devices. [ABSTRACT FROM AUTHOR]

Hyperhidrosis is a medical problem defined as perspiration in excess of what is normally needed to cool the body. The excessive production of sweat by the sudoriferous glands is independent of the process of thermoregulation. Techniques have recently appeared that make use of energy sources, in particular microwave devices and light (pulsed flashlamp or laser). The aim is to obtain very long-lasting efficacy without notable side effects. Thermal Nd:YAG lasers used with an interstitial fiber, microwave devices, and photodynamic therapy appear to offer new treatment options for axillary hyperhidrosis. However, insertion of a laser fiber into tissue by means of a cannula may lead to complications if the procedure is not well mastered, as has been shown by numerous studies on laser lipolysis. The only microwave device available on the market is certainly interesting. Photodynamic therapy using eosin gel is an attractive technique. The energy source is a pulsed flashlamp, which many physicians have. Eosin gel is relatively easy to produce and these gels are already marketed in several countries. However, further clinical studies of larger series of patients and with longer follow-up are still needed to reach a definitive conclusion as to the value of this approach. [ABSTRACT FROM AUTHOR]

Background: Despite many studies on the action of yellow light in acne, its efficacy and mechanisms of action are still unclear. Objectives: To determine if IPL can cause a clinical improvement in acne and whether it modifies TLR2 and TNFα expression. Methods: Twenty-one patients with mild to moderate acne involving their backs received 530 nm IPL treatments once every 2 weeks. Assessments at baseline and after the fourth treatment included lesion counts, Leeds grading and SER. Biopsies from the treatment area were taken at three time points. TLR2 expression was determined using immunohistochemistry, and TaqMan® Low Density Arrays were used to measure TNFα, IL-8 and IL-10. Results: Inflamed lesion counts fell significantly by 28.0% ( p = 0.002) but not the Leeds score, SER or non-inflamed lesions. A reduction in TNFα expression of 17.6% ( p = 0.031) weakly correlated with the change in lesion counts. TLR2 expression fell by 2.6% ( p < 0.001) but did not correlate with lesion counts. Neither IL-10 nor IL-8 expression was significantly altered. Conclusions: 530 nm IPL significantly reduces inflammatory lesions, where its efficacy will need optimising to make it a viable treatment option. Its mechanism seems to include a novel anti-TNFα effect, independent of IL-10 up-regulation. [ABSTRACT FROM AUTHOR]

Introduction: The Q-switched 1064-nm laser is associated with rapid vaporization and thermal expansion stresses leading to skin mechanical damage and is typically used for correction of exogenous and endogenous deep pigmentation. Giving the common place of fractional, infrared-domain milliseconds non-ablative lasers in aesthetic dermatology, a novel non-ablative fractional Q-switched 1,064-nm laser was studied for photoaged skin concerns. Materials and methods: Ten healthy female subjects (Age range: 35-53 years, mean: 44.3) and skin types I-IV were diagnosed with mild-to-moderate facial photo-damage, hyper-pigmentation, telangiectasia, laxity, skin roughness, and actinic keratosis. Subjects were treated with a new non-ablative fractional Q-Switched 1,064-nm Nd: YAG laser (Harmony XL, Alma Lasers Ltd.). Treatments consisted of four sessions at 2-4 week intervals. Follow-up (FU) visits were 1 and 3 months following the final treatment. Results: Utilizing the Glogau scale, six Subjects were graded Type II (means wrinkles in motion), and four Subjects were graded Type III (means wrinkles at rest) at Baseline. At the FU2, 3-month post final treatment, 60% of the subjects were graded with at least a one-point improvement in the overall Glogau global assessment. Between baseline and FU2, Investigator assessments showed the following improvements: Hyperpigmentation 70%, Telangiectasias 80%, Laxity 80%, Tactile Roughness 60%, and actinic keratoses 60%. Pain assessment was reported between 0 and 2 in all treatments (scale 0-10). Of expected side effects, erythema was most common, occasionally being reported as high as a 2(scale 0-10). No unexpected adverse effects were reported. Conclusion: The non-ablative fractional Q-Switched 1,064-nm Nd: YAG laser is safe and effective in improving signs of mild-to-moderate photodamage skin irregularities with no downtime, no pain to only minimal pain, and without any adverse side effects. [ABSTRACT FROM AUTHOR]

Background: Asians are prone to develop epidermal pigmentary lesions as a result of photoaging. Solar lentigines, especially those which are light in color, show somewhat limited response to pigment lasers and intense pulsed light sources. Objectives: We sought to compare the early effects as well as side effects of Q-switched Nd:YAG and Er:YAG micropeel in treating light solar lentigines in Asians. Patient and methods: This was a split-face, evaluator-blind, randomized controlled study. A single session of treatment was performed on Asian patients with light facial lentigines. Q-switched Nd:YAG laser was allocated to one half of the face, and Er:YAG micropeel to the other half. The response to therapy was evaluated by two independent dermatologists with standardized photographs taken 2 weeks and 1 month after the laser treatment. Patients' satisfaction and preference in treatment were also assessed. Results: Fifteen patients completed the study and were analyzed. A reduction in pigment was observed with both lasers during the study period. The degree of pigment reduction in the Q-switched Nd:YAG treated side of the face was significantly higher than that of the Er:YAG micropeel treated side at 2-week follow-up ( p < 0.001). The degree of pigment reduction between the Q-switched Nd:YAG-treated side and the Er:YAG micropeel-treated side was similar at 1-month follow-up ( p = 0.110). Conclusion: While there is no perfect therapy for light solar lentigines, a single session of Q-switched Nd:YAG laser and Er:YAG micropeel was shown to reduce pigmentation. The immediate effects (2-week follow-up) were better with the Q-switched Nd:YAG laser but there was no great difference between the two laser types at 1-month follow-up due to the greater degree of post-inflammatory hyperpigmentation following Q-switched Nd:YAG. Both laser types could be applied either singly in turns, or in combination for maximal efficacy in future. [ABSTRACT FROM AUTHOR]

Introduction: The 1210-nm wavelength has absorption-affinity for Lipid-Rich Tissue and has demonstrated to stimulate adipocytes and mesenchymal cells of the subcutaneous tissue, with a new concept: Selective Photothermostimulation (SPS). The application in Liposuction of this wavelength is determined by its preservation of the integrity of adipocytes, making possible the use of these materials for fat grafting in Liposculpture, Breast Reconstruction or as filler in Face Rejuvenation, proven that this technique is less traumatic. Materials and methods: 102 patients diagnosed with lipodystrophy either associated to skin flaccidity or not were applied the 1210-nm diode laser (ORlight®) between June 2010 and August 2011. The protocol was followed and verified through ultrasound imaging. Intraoperative and subcutaneous cellular tissue temperatures were measured. Samples of the aspirated tissue were sent for histological analysis to prove alteration/preservation of adipocytes and connective tissues, including mitochondrial activity. Results: Histological analyses revealed 98% preservation of aspirated adipocytes. The 1210-nm diode laser shows affinity for adipose tissue. In addition, the technique poses a reduced trauma level on tissues, allowing for the performance of associated procedures for the body or face. No major complications were observed; and only minor complications, mainly ecchymosis on 2% of the total body surface area, have been recorded. The recovery period is 24 hours. The Liposuction Diode Laser (LSDL) 1210-nm is ideal for Liposculpture. [ABSTRACT FROM AUTHOR]

Background. Post-inflammatory hyperpigmentation (PIH) after laser treatment of Hori nevus remains problematic. Prevention and treatment of PIH have limited success. Objective. To study the effects on hyperpigmentation using topical antibiotic alone versus combined antibiotic and betamethasone/valerate after 1064 nm Q-switched Nd:YAG laser treatment of Hori nevus. Method. Twenty-five cases of Hori nevus treated with Q-switched Nd:YAG laser randomly applied topical fucidic acid (control group) or fucidic acid plus betamethasone/valerate (study group) on assigned cheek immediately post laser for 2 weeks. Pigmentation was measured using the mexameter as melanin index (MI) and erythema index (EI), at baseline, 2nd and 4th weeks. Photographic evaluation and patient global assessment were done at the 4th week. Results. Twenty-three cases completed the study. No patient developed side effect from either creams. The comparison of M and E-indexes of the control versus the study group revealed no significant difference. However, there was a uniform increase of M index of the control group compared to the study group. Conclusion. Applying topical corticosteroid immediately after laser treatment decreased pigmentation. Although not statistically significant, there was a tendency for lightening. Future studies are needed with more patients, duration of follow-ups and histological studies to assess pigmentary changes. [ABSTRACT FROM AUTHOR]

Background: Intense pulse light (IPL) with square pulse technology is one of the latest hair removal technologies to be marketed in India. However, there is no literature on use of IPL in Indian skin. Objective: A preliminary descriptive study to ascertain the efficacy of an IPL device with square pulse technology for hair removal in Indian patients. Materials and methods: The IFL i200 system (Cyden Ltd, Swansea, UK) was used for hair removal on 12 patients of skin type III, IV and V up to a maximum of six sessions. Hair removal efficacy (HRE) was calculated and photographs taken after each session. Results: Treatment was done for 12 patients. Mean HRE was 69.6%; 83% were satisfied with the procedure; 66% had excellent results; 16% had good results. No permanent adverse effects were seen. Conclusion: With standard precautions, IPL is a safe and effective tool for hair removal in Indian patients. Further studies to compare square pulse technology with traditional IPL systems and lasers are required. [ABSTRACT FROM AUTHOR]

Introduction: Laser hair removal at lower fluences, delivered under certain conditions, may retain the efficacy of high-fluence lasers while improving tolerability. We performed a pilot study comparing the efficacy, safety and tolerability of laser hair removal using traditional settings compared to lower fluences, delivered from a larger handpiece and under vacuum. Material and methods: Fourteen healthy participants underwent 5 axillary hair removal treatments with an 800 nm diode laser at 1-month intervals, with follo-wup 1 and 3 months after the 5th treatment. In all patients, one side was treated with standard parameters using a 9×9 mm chilled tip and gel, while the contralateral side was treated using a 22×35 mm vacuum-assisted handpiece at fluences up to 12 J/cm2. Follow-up assessments were performed after each treatment and at each follow-up visit, and included photography and questionnaires. Results: Eleven participants completed the study and follow-up. All experienced significant hair removal in all treated areas. At the 3-month follow-up visit, the high-fluence and low-fluence treated axillae demonstrated comparable hair reduction. Participants found the lower fluence treatments to be more tolerable. No adverse events were reported. Conclusion: Lower fluence diode laser, delivered under conditions of vacuum and using larger spot sizes, can provide significant hair reduction. [ABSTRACT FROM AUTHOR]

The article introduces the September 2007 edition of the "Journal of Cosmetic and Laser Therapy." The journal looks at a variety of different aspects of laser and light based technologies. Each manuscripts provides a keen insight into useful new approaches in the realm of cosmetic and laser therapy. A multicenter trial that evaluated a new, large spot, constant spectrum emission, IPL device for the removal of unwanted hair is described.

Background and objectives: The ablative fractional CO2 laser has been successfully used in treating photoaged skin in the Caucasian population. However, its application in Asian skin has not been widely reported. The purpose of this study is to observe the efficacy and safety of the protocol 'ActiveFX' for photodamaged facial skin in Chinese patients. Methods: A non-sequential fractional ultrapulsed CO2 laser with specific settings is used in addition to a new computer pattern generator (CPG). Twenty patients received a single-session, single-pass, ablative fractional treatment on a split face. The patients were evaluated at baseline, and 1 and 3 months (M1, M3) after the treatment using a quartile grading scale. They were also asked to assess their overall satisfaction using a 4-point scale. The improvement of the coarse wrinkles was also quantitatively analyzed with a 3D in vivo imaging system. Results: At M1 and M3, the blinded investigator rated global improvement as 2.8 ± 0.95 and 3.00 ± 0.73, which was consistent with the patients' assessment (2.55 ± 0.83 at M1 and 3.15 ± 0.88 at M3). The roughness analysis (Rz) demonstrated a significant decrease in periorbital wrinkles ( p < 0.0001). Minimal and reversible adverse side effects and rapid healing were noted. Conclusions: Non-sequential fractional ultrapulsed CO2 laser resurfacing (ActiveFX) is considered an excellent treatment modality for photodamaged Chinese facial skin. [ABSTRACT FROM AUTHOR]

Background: Data regarding tattoo practices in the Gulf region and response to treatment are almost non-existent in the medical literature. Objective: To study the profile of patients with permanent tattoos in the Arab world, and to evaluate their response to Q-switched ruby laser treatment. Methods: A total of 468 consecutive patients with permanent tattoos consulting us for tattoo removal were recruited in the present study. Before starting the treatment each patient was given a set of questionnaires to answer. The patients were then treated with the Q-switched ruby laser, with a time interval of 8 weeks between each laser session, until complete clearance or up to a maximum of 10 sessions. Results: A total of 292 patients out of 348 patients achieved excellent lightening to complete clearance of tattoo pigment after an average of six sittings (range 2–10 sittings). Female patients with fair complexions and amateur tattoos on the face responded best. Seventy-eight (22.4%) patients developed pigmentary changes. Conclusion: More females than males had tattoos, and at a very young age and mostly on the advice of their parents. The majority of patients wanted to remove the tattoos because of religious reasons. The Q-switched ruby laser seems to be highly effective in removing amateur blue-black tattoos in patients with colored skin. [ABSTRACT FROM AUTHOR]

Background: Various lasers have been developed for epilation of unwanted hair. Effective hair removal in the Turkish population can be difficult, and multiple treatments are usually required for effective treatment. Objective: To evaluate the safety and efficacy profile of a long-pulsed alexandrite laser for hair removal in the Turkish population with Fitzpatrick skin types II-V exclusively and to determine the benefit of multiple treatments. Methods: Retrospective clinical evaluation conducted from September 2005 to May 2008 at a referral private clinic. Pre-laser skin testing was performed starting at 16 J/cm2 and the energy fluence was selected according to response. All subjects were followed for 6 months after their final treatment. Results: A total of 2359 patients are reported (264 men and 2095 women) ranging in age from 14 to 70 years, for a total of 3830 treatment sites. The majority of treatment sites were axillae (24.2%) followed by the bikini line (16.8%). Maximum reductions observed were 95% for axillae, 92% for the bikini line, 86% for breast, respectively. The patients had a mean 80.6% hair reduction. Complications occurred in only 2.2% of cases. Transient hyperpigmentation (0.7%), folliculitis (0.5%), transient hypopigmentation (0.5%), and blistering (0.4%) were commonly seen complications. No subjects had scarring or long-term pigmentary changes. Conclusion: The long-pulsed alexandrite laser is safe for hair removal in darker skin tones. Although Turkish skin can be effectively treated with a cooled, long-pulsed alexandrite laser, complications do occur. [ABSTRACT FROM AUTHOR]

Background: Previous studies suggest that radiofrequency (RF) energy may be effective as a treatment for cellulite. Objective: This bilateral paired blinded comparative study assesses the efficacy and safety of a unipolar RF device for improving the appearance of cellulite using a new quantitative cellulite grading system. Methods: In this randomized, blinded, split-design study, 10 individuals (aged 32-57 years) with a clinically observable excess of subcutaneous fat and cellulite (minimum grade 2 out of 4) on the thighs received up to six unilateral treatments (number of treatments at the investigator's discretion) at 2-week intervals with unipolar RF. The untreated side of the thigh served as an internal control. Treated thighs were randomly assigned by alternate allocation. Results were evaluated using study participant questionnaires and by two blinded evaluators (JSD, KAA) using photographs and the author's (MAA) cellulite grading scale at each treatment visit and at 1-month and 3-month follow-up visits after the final treatment. A novel quantitative four-point cellulite grading system is presented and applied, which separately grades dimple density, dimple distribution, dimple depth, diameter and contour. Results: All participants responded to treatment (mean of 4.22 and range of three to six treatments). The blinded evaluations of photographs using the cellulite grading scale demonstrated the following mean grading scores for the treated leg versus the control leg: dimple density of 2.73 vs 3.18 (11.25% mean improvement), dimple distribution 2.89 vs 3.32 (10.75% mean improvement), dimple depth 1.47 vs 1.54 (2.5% mean improvement), and mean score of 2.36 (SEM 0.45) vs 2.68 (SEM 0.57) (8.00±2.84% mean improvement). The treatment was painless and side effects included minimal to moderate erythema which resolved within 1 to 3 hours. No crusting, scarring or dyspigmentation was observed. Conclusions: This randomized, blinded, split-design, controlled study employing a quantitative four-point grading scale demonstrated that this unipolar RF device is safe for the treatment of cellulite. Clinically visible and quantified improvement which did not achieve statistical significance but showed a trend toward improvement was observed in all patients following a mean of four treatments at 2-week intervals. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic events as well as surgery can cause a large variety of scars, which are often a major psychological concern to patients. Moreover, patients often report itching or burning sensations as well as pain. We investigated the efficacy of purely non-ablative laser therapy in order to improve the appearance and quality of these scars. Methods: A total of 62 patients with problem scars were enrolled in the study. The purely thermal, non-ablative scar mode of an Er:YAG laser (BURANE XL; Wavelight AG, Erlangen, Germany) was used. One to six treatment sessions were performed. The improvement of scar redness, scar flatness, scar quality, itching and burning sensations as well as pain and patient satisfaction were evaluated. Results: The overall scar quality improved in 93% of patients. Similarly, the flatness improved in 89% of scars, itching sensation in 79% and burning sensation in 86% of patients. In 91% of scars a decrease of scar redness was seen and all painful scars showed a pain reduction. Average patient satisfaction was 7.4 on a 10-point scale. Sixty-one patients would recommend the therapy to another person. Side effects were limited to transient erythema and oedema. Conclusion: The high success rate combined with the low side-effects resulted in high patient satisfaction. Post-traumatic or post-surgical scars can safely and effectively be treated by the thermal scar mode of the Er:YAG laser used. [ABSTRACT FROM AUTHOR]

Background: Unlike medical lasers, intense pulsed light (IPL) devices are largely unregulated and unclassified as to degree of safety hazard. With the exception of most of the USA, the United Kingdom and parts of Europe, the Far East and Australia, the sale of IPLs is generally unrestricted, with the majority being sold into the beauty therapy and spa markets. Standards are only imposed on manufacturers for technical performance data and operating tolerances determined by CE-compliance under electrical safety standards or the EU Medical Device Directive. Currently, there is no requirement for measurement of key IPL performance characteristics. Objective: To identify the key IPL parameters, emphasize their importance in terms of safe and effective treatment and provide examples of preliminary measurement methods. These measurements can highlight changes in an IPL device's performance, improving patient safety and treatment efficacy. Methods: Five key parameters were identified as having an important role to play in the way light interacts with the skin, and therefore an important role in patient safety and effective treatment. Simple methods were devised to measure the parameters, which include fluence, pulse duration, pulse profile, spectral output and time-resolved spectral output. Results: The measurement methods permitted consistent and comparable measurements to be made by two of the authors at working clinic locations on 18 popular IPL devices and allowed assessment of output variations. Results showed discrepancies between the measured IPL device outputs and those values displayed on the system or claimed by the manufacturers. The importance of these discrepancies and their impact is discussed. Conclusions: This study, of 18 popular devices in regular daily use in England and Wales, provides example methods for measuring key IPL device parameters and highlights the need for regular measurement of at least those five key parameters measured in this study. These methods can help service technicians to check performance and eliminate device malfunction. [ABSTRACT FROM AUTHOR]

Background and aims: A combined infrared (IR) laser/radio frequency (RF) system has recently been reported to create rejuvenation-related cutaneous effects, but was associated with high levels of pain and some complications. The present study was designed to evaluate the cutaneous effects of the same system with a lower fluence and more treatments. Methods: Twenty patients were randomly assigned into two groups of 10 individuals each: Group A was treated at 50 J/cm2 / 100 J/cm3 (laser/RF), respectively, two passes, three treatment sessions 30 days apart; Group B at 30 J/cm2 / 50 J/cm3, three passes, five treatment sessions 15 days apart. Objective comparisons were made at the same time points with a computer program based on the clinical photography. Results: Group A noted more improvement in wrinkles than Group B at the first assessment, but both groups showed slight and progressive deterioration at the 2- and 6-month assessments. Improved skin appearance was maintained throughout in both groups. The authors recognize that the comparatively small number of subjects possibly limits the statistical power of the study. Conclusions: Lower fluences and more treatment sessions with the combined 900 nm laser/RF system were complication-free, produced improvements in the overall skin condition and less pain during sessions, suggesting that this combination may produce better patient compliance. Further treatment sessions may improve the results with implications in skin rejuvenation. [ABSTRACT FROM AUTHOR]

Objectives. Ablative and nonablative laser treatments have established themselves independently in the rejuvenation of aging skin. This study was designed to determine the effects of sequential nonablative and ablative laser treatments on facial skin. Materials and methods. Twelve patients, ages 32–56 years, with skin phototypes I-IV, received three treatments spaced six weeks apart. Each treatment consisted of one pass with 1319-nm Nd:YAG laser at 16 J/cm 2 , 50 ms pulse duration. This was immediately followed by one pass of 2940-nm Er:YAG laser at 5 J/cm 2 . Photographs and biopsies were taken prior to the first treatment and following the third treatment. Results. Clinical improvements in facial skin tone and texture, acne scarring and dyschromia were noted in all patients. Histologic changes included a more compact epidermal granular layer and lamellar collagen formation with decreased solar elastosis in the dermis. Compared to controls, treated skin had a thicker, more homogeneous papillary dermis. Conclusion. The sequential use of nonablative and superficial ablative laser treatments clinically and histologically improved photodamaged and chronologically aged skin. This occurred with minimal recovery and little morbidity, demonstrating this laser application to be a safe and effective method for facial rejuvenation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Pulsed 532-nm lasers have been widely used in the treatment of vascular and pigmented conditions of aged skin. In addition to lesion clearance, many patients report color and texture improvements to the skin. These improvements are often difficult to appreciate from photographic analysis alone, but are significant to the patient's impression of treatment success. OBJECTIVE: To grade and compare objective and subjective results of treatments with a 532-nm frequency-doubled pulsed Nd:YAG laser using criteria of skin color, skin texture, and wrinkles based on a blinded retrospective analysis of photographs compared with results from patient questionnaires. METHODS: Clinical before and after pictures from 20 patients (skin types l-IV) treated for diffuse vascular and pigmented lesions were selected for evaluation. A blinded grading was performed using criteria of skin color, skin texture, and wrinkles. Patients were asked by questionnaire to also grade improvement using the same criteria. The results of the blinded and patient grading were reported and compared using a chi- squared analysis. RESULTS: Clinical improvements recorded by blinded photographic evaluation and patient evaluation agreed with no statistically significant differences. Both the blinded observers and patients recorded remarkable improvement in the color signs of photoaging, slight to moderate improvement in skin texture and fine wrinkles, and negligible improvement of medium depth and deep wrinkles. CONCLUSION: The 532-nm pulsed laser is a safe and effective device for the treatment of the visible signs of photoaging of skin types I-Ill. In addition to improvements in color defects, objectively and subjectively significant improvements in texture and fine wrinkles can be expected. Little to no improvement in medium to deep wrinkles can be anticipated. [ABSTRACT FROM AUTHOR]

BACKGROUND: Current treatments for acne vulgaris include topical and oral medications that counteract microcomedone formation, sebum production, Propionibacterium acnes, and inflammation. Concerns about the short- and long-term consequences of these medications, along with technological advancements, have to significant progress in the management of acne. These developments include light, laser, and radio frequency, which may offer faster onset of action, equal or greater efficacy, and greater convenience than traditional approaches. CONCLUSION: Research emphasizing long-term follow-up and comparative, randomized trials is necessary to determine whether these emerging technologies will become a viable alternative to standard therapies such as antibiotics. [ABSTRACT FROM AUTHOR]

BACKGROUND : Spider leg veins are common. Their treatment with laser or intensed light therapy shows generally variable success rates and often adverse side effects such as hyper- or hypopigmentation. This study was performed to investigate whether pulsed diode laser (810 nm) treatment is effective and safe. METHODS : Thirty-five female patients with spider leg veins were included in this prospective trial. They were treated twice with a pulsed diode laser (810 nm; spot size 12 mm, frequency 2-4 Hz, pulse width 60 msec, fluence 80-100 Jcm -2 ). Laser therapy was performed on day 0 and day 14. Clinical assessments were carried out before and immediately after the first laser therapy, after 2 weeks, 8 weeks, and one year. Skin biopsies were taken before and immediately after the first laser treatment, and after 10 weeks. Contact-free remittance spectroscopy was performed before laser treatment, immediately after the first treatment, after 2 weeks and 8 weeks. RESULTS : After the first treatment 15 patients showed a complete disappearance (CR) of spider leg veins; in the remaining 20 patients a remarkable improvement (RI) was noted ( n =35). After six months of follow-up CR was seen in 6 patients, RI in 6, a stable situation in 9, and scar formation in 1 patient ( n =21). The effect was almost completely stable during one year of follow-up. The examination of histological specimens before and after laser treatment showed no cellular inflammatory reaction. The mean vascular area was significantly reduced after the first ( p <0.05) and after the second ( p <0.05) laser treatment. Spectral analysis showed a marked decrease of peaks for oxygenized haemoglobin immediately after laser treatment and during the follow-up. Safety profile was excellent without purpuric reaction or pigmentary changes. Mild scarring was observed in two patients at the end of follow-up. CONCLUSIONS : Pulsed diode laser therapy (810 nm) is an effective and safe treatment option for spider leg veins. The effects can be seen immediately. Objective monitoring by non-invasive remission spectroscopy and histology of biopsy specimens demonstrates selectivity of the laser action. [ABSTRACT FROM AUTHOR]

Laser hair removal is the most common procedure which is usually performed on patient's demands. Even though they are usually safe and well tolerated, with the widespread use both expected and unexpected side effects can be seen. Recognizing the source of side effects is an important issue for the laser operator. In recent years, a new laser technology has been introduced to aid in pain and other side effects in laser applications. Diode laser systems are produced for this technology. The major disadvantage with this laser is the gel application during procedure. We herein report a women while on her second session for laser hair-removal procedure with a 808-nm diode laser, complicated with an epidermal burn reaction due to accumulated debris on the guide. [ABSTRACT FROM AUTHOR]

Scrotal cysts are rare cutaneous findings seen in youngsters and young adults. These lesions may eventually lead to scrotal calcification. Standard treatment is surgical removal. A young patient presented with multiple cysts was treated by short-pulsed 910-nm diode laser with rapid and aesthetically excellent improvement. [ABSTRACT FROM AUTHOR]

Familial benign pemphigus (Hailey--Hailey disease) is often resistant to conventional treatments. This report describes a 35-year-old Asian American male with a 12-year history of recalcitrant Hailey--Hailey disease who was treated with a long-pulsed alexandrite laser. Fluences ranged from 12 to 20 J/cm with a 5-ms pulse duration (spot sizes: 10--15 mm). Cold air cooling was used during the sessions. There was 50% improvement noted after the first treatment. Within 10 treatments, there was 95% clearance. Complete resolution was achieved by the thirteenth treatment. The lesions have been clear or nearly clear (greater than 95%) for the past 2 years. Once clearance was achieved, five maintenance laser treatments were initiated at 3-month intervals and eventually discontinued for 12 months without relapse. [ABSTRACT FROM AUTHOR]