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Lasers in Surgery and Medicine Jan 2024The current gold standard treatment for port-wine stains (PWS) is pulsed dye laser (PDL). However, multiple treatment sessions may be necessary and complete resolution...
OBJECTIVES
The current gold standard treatment for port-wine stains (PWS) is pulsed dye laser (PDL). However, multiple treatment sessions may be necessary and complete resolution is often not achieved. Neoangiogenesis can occur soon after treatment and is thought to be a major factor contributing to treatment failure. Adjuvant antiangiogenic topical therapies may therefore improve the efficacy of pulsed dye laser treatment of port-wine stains.
MATERIAL AND METHODS
Following PRISMA guidelines, we searched PubMed, Embase, Web of Science, and clinicaltrials.gov using "port-wine stain," "nevus flammeus," "capillary malformation," "sturge weber," and "pulsed dye laser" as keywords and medical subject heading (MeSH) terms. Articles were included if they (1) were a randomized controlled trial (RCT); (2) studied patients with PWS; and (3) investigated topical adjuvant therapies with PDL. Bias was assessed using the Critical Appraisal Skills Programme (CASP) Randomized Controlled Trial Standard Checklist.
RESULTS
1835 studies were identified, with six studies meeting inclusion criteria. The total number of patients studied was 103 (range: 9-23), with 8-36 week follow-up. The average age ranged from 11 to 33.5 years old. Three studies examined adjuvant topical sirolimus (n = 52), two examined timolol (n = 29), and one studied imiquimod (n = 22). Two of three RCTs reported no improvement through colorimetric analysis with topical sirolimus; however, one of these studies did show a significant improvement through Investigator Global Assessment (IGA) score. The last sirolimus study showed significant improvement through digital photographic image scoring (DPIA). Studies examining topical timolol reported no change in PWS appearance compared to placebo. The addition of 5% adjuvant imiquimod cream did lead to significant improvement. A variety of outcome measures were used. Imiquimod and sirolimus led to mild cutaneous adverse events, while timolol caused no side effects. None of the adverse events led to treatment discontinuation. Study quality was moderate in three, high in two, and low in one.
CONCLUSION
The efficacy of adjuvant topical therapy was unclear. Limitations included variation in concentration and duration of adjuvant therapies, differences in follow-up time, and inconsistent outcome measure reporting. Given their potential clinical promise, larger prospective studies examining topical adjuvant therapies should be considered.
Topics: Humans; Child; Adolescent; Young Adult; Adult; Port-Wine Stain; Imiquimod; Timolol; Lasers, Dye; Sirolimus; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 37431532
DOI: 10.1002/lsm.23706 -
Journal of Personalized Medicine Sep 2023The objective of this manuscript was to review the indications, efficacy, and safety of a 585 nm pulsed dye laser (PDL) in non-malignant laryngeal lesions. Following the... (Review)
Review
The objective of this manuscript was to review the indications, efficacy, and safety of a 585 nm pulsed dye laser (PDL) in non-malignant laryngeal lesions. Following the PRISMA statement recommendations, three independent authors searched for articles published in PubMed/MEDLINE, the Cochrane Library, Google Scholar, Scielo, and Web of Science. A bias analysis was performed following NICE guidance tools. From the 506 identified publications, 19 observational studies met the inclusion criteria. The PDL improves vocal quality objectively and subjectively in vascular lesions ( < 0.005) and improves vocal quality in patients with dysplasia/leukoplasia without changing the natural history of the disease compared to other treatments. Reinke's edema and granulomas require an average of 1.5 PDL sessions for resolution. Treatment of recurrent respiratory papillomatosis requires multiple sessions, with complete remission achieved in 50-70% of patients. Regardless of the lesion, the tolerance of the procedure under local anesthesia is exceptional (84-97%), and the results in terms of regression and vocal quality are promising. The complication rate is minimal, and the procedure does not interfere with other treatment alternatives. There is no consensus on laser settings. The lack of consistent use in evaluating vocal outcomes, whether objective or subjective, prevents the comparability between studies. The 585 nm pulsed dye laser appears to be an effective and safe therapeutic option in patients with non-malignant laryngeal pathology. Future controlled studies are needed to compare the 585 nm pulsed dye laser with other lasers or cold instrument procedures.
PubMed: 37763142
DOI: 10.3390/jpm13091374 -
Lasers in Medical Science Jun 2024Previous clinical studies have shown that pulsed dye laser (PDL) and intense pulsed light (IPL) are effective for treating erythematotelangiectatic rosacea(ETR). This... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
Previous clinical studies have shown that pulsed dye laser (PDL) and intense pulsed light (IPL) are effective for treating erythematotelangiectatic rosacea(ETR). This article aims to compare the efficacy and safety of PDL and IPL at three different wavelength bands (broad-band, single-narrow-band, and dual-narrow-band) in treating ETR. Sixty subjects with ETR were randomly categorized into four groups and received one of the following laser treatments: PDL (595 nm), IPL with Delicate Pulse Light (DPL, 500-600 nm), IPL with M22 590 (590-1200 nm), or IPL with M22 vascular filter (530-650 nm and 900-1200 nm). Four treatment sessions were administered at 4-week intervals, with one follow-up session 4 weeks after the final treatment. The efficacy of the four lasers was evaluated by comparing the clinical symptom score, total effective rate, VISIA red area absolute score, and RosaQoL score before and after treatment. The safety was evaluated by comparing adverse reactions such as pain, purpura, erythematous edema, and blister. All 60 subjects completed the study. Within-group effects showed that the clinical symptom score, VISIA red area absolute score, and RosaQoL score of all four groups were significantly reduced compared to before treatment (p < 0.001). Between-group effects showed no statistically significant difference among the four laser groups. Safety analysis showed that all four lasers were safe, but the incidence of blister was higher in the M22 vascular group. Nonpurpurogenic PDL, DPL, M22 590, and M22 vascular were equally effective in treating ETR and were well-tolerated. ClinicalTrial.gov Identifier: NCT05360251.
Topics: Humans; Lasers, Dye; Female; Rosacea; Adult; Male; Middle Aged; Intense Pulsed Light Therapy; Treatment Outcome; Low-Level Light Therapy
PubMed: 38822948
DOI: 10.1007/s10103-024-04098-9 -
Current Opinion in Pediatrics Aug 2023The use of lasers in pediatric dermatology is well established, but recent literature has expanded the evidence for specific timelines of treatment. Additionally, new... (Review)
Review
PURPOSE OF REVIEW
The use of lasers in pediatric dermatology is well established, but recent literature has expanded the evidence for specific timelines of treatment. Additionally, new devices and combinations with medical therapy have improved outcomes and treatment options for various conditions.
RECENT FINDINGS
Pulsed dye laser remains the first-line laser for vascular lesions. Recent guidelines support early initiation of laser treatment in port-wine birthmarks to optimize outcomes. For hemangiomas, laser treatment can offer a meaningful addition to oral propranolol therapy. Lasers with shorter wavelengths offer improved outcomes with decreased downtime for pigmented lesions. General anesthesia in the pediatric population continues to be a controversial topic, and the decision to perform laser under general versus topical anesthesia requires discussion with family of risks and benefits.
SUMMARY
Primary care providers can benefit their patients by prompt referral to dermatology for discussion of laser treatment. Port-wine birthmarks require referral in the first weeks of life so that laser treatment can be initiated if appropriate. Although many dermatologic conditions cannot be completely cleared or cured with laser, treatment can offer meaningful outcomes and benefit for patients and families.
Topics: Child; Humans; Dermatology; Laser Therapy; Port-Wine Stain; Lasers, Dye; Primary Health Care
PubMed: 37335276
DOI: 10.1097/MOP.0000000000001269 -
Skin Research and Technology : Official... Nov 2023An excessive proliferation of fibroblasts and collagen synthesis after an injury may lead to a benign fibrous tumor, known as keloid, which does not regress...
INTRODUCTION
An excessive proliferation of fibroblasts and collagen synthesis after an injury may lead to a benign fibrous tumor, known as keloid, which does not regress spontaneously. Earlobes are a very frequent site of onset, since after a trauma (i.e., piercing) keloids may develop either on the helix and on the anterior or posterior lobe, from a few months up to several years after the injury.
OBJECTIVES
To report the effectiveness of a combined protocol of CO2 laser + Dye laser + a portable Blue LED Light medical device for Photobiomodulation Therapy (EmoLED®).
METHODS
Fifty-two patients with a total of 56 ear keloids have been treated in the same session with a single CO2 laser procedure + a pulsed Dye laser procedure with an adjunctive EmoLED® procedure for 3 up to 6 min. A monthly follow-up has been performed with an adjunctive EmoLED® session in case of signs of inflammation.
RESULTS
Among 56 treated keloids, 89.3% of them (50/56) did not recur during a follow-up period (from 6 up to 24 months, mean 16.3 months) while six keloids recurred (6/56, 10.7%) with mild thickening of the scar, thus requiring further treatments.
CONCLUSIONS
Even if an excellent outcome obtained by the synergistic effect of combined laser treatments has already been described (i.e., CO2 laser + Dye Laser), the present study showed the adjuvant procedure with EmoLED® can reduce significantly the risk of keloids recurrences.
Topics: Humans; Keloid; Inflammation; Lasers, Gas; Recurrence; Light; Treatment Outcome
PubMed: 38009040
DOI: 10.1111/srt.13506 -
Optics Letters Mar 2024Random lasers are highly configurable light sources that are promising for imaging and photonic integration. In this study, random lasing action was generated by...
Random lasers are highly configurable light sources that are promising for imaging and photonic integration. In this study, random lasing action was generated by optically pumping N-(4-methoxybenzylidene)-4-butylaniline (MBBA) liquid crystals infiltrated with gold nanoparticles and a laser dye (pyrromethene 597 (PM597)). By varying the pump energy near a lasing threshold, we show that it is possible to control intensity correlations between random lasing modes. The correlations in the system were phenomenologically characterized using the Levy statistics of the emission spectrum survival function. We also find that correlations and persistence of lasing action are correlated. These results demonstrate the possibility to dynamically control a key physical feature of random lasers, which may find applications in biomedical settings and network communications.
PubMed: 38427000
DOI: 10.1364/OL.516290 -
Indian Dermatology Online Journal 2023The role of lasers in the treatment of standard therapy-resistant inflammatory dermatoses and connective tissue disorders has been controversial and evidence supporting...
INTRODUCTION
The role of lasers in the treatment of standard therapy-resistant inflammatory dermatoses and connective tissue disorders has been controversial and evidence supporting the role of lasers in this setting is scarce.
OBJECTIVE
To assess the efficacy of lasers in the management of inflammatory dermatoses and connective tissue disorders (CTD).
MATERIALS AND METHODS
A retrospective case review of all inflammatory dermatoses/connective tissue diseases treated in a tertiary laser clinic between March 2010 and 2020 was undertaken.
RESULTS
A total of 60 cases (48 = female) were included and the average age was 51 years (range 21 to 74). The following conditions were treated: scleroderma = 22 (37%), granuloma faciale = 10 (17%), sarcoidosis = 8 (13%), discoid lupus erythematosus = 7 (12%), and systemic lupus erythematosus = 2 (3%). Other diagnoses included necrobiosis lipoidica, pyoderma vegetans, hypertrophic lichen planus, and dermatomyositis. The most common type of laser used was pulsed dye laser (PDL) in = 41 (68%) cases. Eight (13%) patients received treatment with the carbon dioxide (CO) laser. The most common site treated was the face. A good response with a marked reduction of signs was seen in 62% of patients while 10% of the patients did not respond to laser treatment. Self-limiting complications included purpura and hyperpigmentation.
LIMITATIONS
Lack of objective assessment and outcome measures.
CONCLUSIONS
This is the largest cohort of patients to have undergone laser treatment for inflammatory dermatoses/connective tissue disease. Based on this retrospective review, we conclude that lasers can be a useful adjunct in the management of otherwise difficult-to-treat selected inflammatory and connective tissue diseases.
PubMed: 37727556
DOI: 10.4103/idoj.idoj_439_22 -
Transfusion Medicine and Hemotherapy :... Apr 2024Before being implemented in daily clinical routine, new production strategies for platelet concentrates (PCs) must be validated for their efficacy. Besides in vitro...
INTRODUCTION
Before being implemented in daily clinical routine, new production strategies for platelet concentrates (PCs) must be validated for their efficacy. Besides in vitro testing, the establishment of new methods requires the labeling of platelets for in vivo studies of platelets' survival and recovery. Indocyanine green (ICG) is a Food and Drug Administration-approved near-infrared (NIR) fluorescent dye for diagnostic use in vivo, suitable for non-radioactive direct cell labeling of platelets.
METHODS
Platelets from PCs in storage solutions with different plasma concentrations were labeled with ICG up to concentrations of 200 μm. Whole blood (WB) was used as an ex vivo matrix to monitor the labeling stability of ICG-labeled platelets. The impact of labeling processes was assessed by the quantification of CD62P expression and PAC-1 binding as platelet function markers. Platelet aggregation was analyzed by light transmission aggregometry. ICG-labeling efficiency and stability of platelets were determined by flow cytometry.
RESULTS
Platelets from PCs could be successfully labeled with 10 μm ICG after 1 and 4 days of storage. The best labeling efficiency of 99.8% ± 0.1% (immediately after labeling) and 81% ± 6.2% (after 24 h incubation with WB) was achieved by plasma replacement by 100% platelet additive solution for the labeling process. Since the washing process slightly impaired platelet function, ICG labeling itself did not affect platelets. Immediately after the ICG-labeling process, plasma was re-added, resulting in a recovered platelet function.
CONCLUSION
We developed a Good Manufacturing Practice compatible protocol for ICG fluorescent platelet labeling suitable for survival and recovery studies in vivo as a non-radioactive labeling alternative.
PubMed: 38584698
DOI: 10.1159/000533623 -
Acta Dermato-venereologica Jan 2024Utilization of lasers and energy-based devices for surgical scar minimization has been substantially evaluated in placebo-controlled trials. The aim of this study was to... (Meta-Analysis)
Meta-Analysis
Utilization of lasers and energy-based devices for surgical scar minimization has been substantially evaluated in placebo-controlled trials. The aim of this study was to compare reported measures of efficacy of lasers and energy-based devices in clinical trials in preventing surgical scar formation in a systematic review and network meta-analyses. Five electronic databases, PubMed, Scopus, Embase, ClinicalTrials.gov, and the Cochrane Library, were searched to retrieve relevant articles. The search was limited to randomized controlled trials that reported on clinical outcomes of surgical scars with treatment initiation no later than 6 months after surgery and a follow-up period of at least 3 months. A total of 18 randomized controlled trials involving 482 participants and 671 postsurgical wounds were included in the network meta-analyses. The results showed that the most efficacious treatments were achieved using low-level laser therapy) (weighted mean difference -3.78; 95% confidence interval (95% CI) -6.32, -1.24) and pulsed dye laser (weighted mean difference -2.46; 95% CI -4.53, -0.38). Nevertheless, low-level laser therapy and pulsed dye laser demonstrated comparable outcomes in surgical scar minimization (weighted mean difference -1.32, 95% CI -3.53, 0.89). The findings of this network meta-analyses suggest that low-level laser therapy and pulsed dye laser are both effective treatments for minimization of scar formation following primary closure of surgical wounds with comparable treatment outcomes.
Topics: Humans; Network Meta-Analysis; Cicatrix; Lasers, Dye; Databases, Factual; Low-Level Light Therapy
PubMed: 38189223
DOI: 10.2340/actadv.v104.18477 -
Dermatologic Surgery : Official... May 2024While mammalian target of rapamycin inhibitors have revolutionized the management of angiofibroma in tuberous sclerosis complex (TS), physical modalities such as laser...
BACKGROUND
While mammalian target of rapamycin inhibitors have revolutionized the management of angiofibroma in tuberous sclerosis complex (TS), physical modalities such as laser are still indicated for recalcitrant lesions.
OBJECTIVE
The authors performed a systematic review of the efficacy and safety of laser treatment for TS-related facial angiofibroma.
METHODS
The electronic databases such as MEDLINE, Embase, PubMed, Cochrane Central Register of Controlled Trials, and Web of Science were searched from inception to October 10, 2023, for eligible records.
RESULTS
Forty-seven articles met the inclusion criteria, representing a total of 217 patients with TS-related facial angiofibroma who received laser treatment. Several lasers have been trialed in patients including carbon dioxide (n = 95, 43.7%), pulsed dye (n = 21, 9.7%), argon (n = 16, 7.4%), neodymium-doped: yttrium aluminum garnet (n = 12, 5.5%), copper vapor (n = 9, 4.1%), potassium titanyl phosphate (n = 7, 3.2%), erbium: yttrium aluminum garnet (n = 2, 0.9%), lasers and various combination therapies (n = 55, 25.3%).
CONCLUSION
Potassium titanyl phosphate, pulsed dye, and neodymium-dopsed:yttrium aluminum garnet lasers are better suited to manage the vascular components of angiofibroma while ablative lasers such as erbium: yttrium aluminum garnet and carbon dioxide lasers may present better options for lesions with a prominent fibrous component. While several lasers have been trialed with broadly favorable results, the low level of evidence precludes definitive conclusions, and no single laser appears superior.
PubMed: 38728593
DOI: 10.1097/DSS.0000000000004222