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Lasers in Medical Science Mar 2022With the investigation of the efficacy of laser therapy in primary localized amyloidosis(PLCA) only recently starting to materialize, we aimed to review the currently... (Review)
Review
With the investigation of the efficacy of laser therapy in primary localized amyloidosis(PLCA) only recently starting to materialize, we aimed to review the currently available studies of laser therapy in the management of the disease. We searched PubMed, Scopus, Embase, Web of Science, Cochrane, and ProQuest online databases with a specified search strategy, assessed the quality of each study, and then extracted the eligible data. Five RCTs(randomized controlled trials), one non-randomized controlled trial, three case series, and nine case reports(18 in total) were included. Overall, carbon dioxide (CO2), neodymium-doped:yttrium aluminum garnet (Nd:YAG), pulsed dye (PDL), Er (Erbium):YAG, and yttrium/erbium fiber were the studied lasers. One hundred fifty-five cases in total underwent laser therapy, with CO2 being the most frequent laser. Almost all studies demonstrated significantly desirable outcomes, while only mild and transient side effects were noted. Even though the studies' results were significant, we noticed that implementing a consistent methodology and a standardized objective assessment method was missing. Therefore, we recommend that future studies be conducted with less heterogeneous data for a more definite conclusion.
Topics: Humans; Amyloidosis, Familial; Laser Therapy; Lasers, Solid-State; Skin Diseases, Genetic; Randomized Controlled Trials as Topic
PubMed: 34611800
DOI: 10.1007/s10103-021-03429-4 -
Skin Research and Technology : Official... Jan 2023
Meta-Analysis
Topics: Humans; Lasers, Dye; Treatment Outcome
PubMed: 36537074
DOI: 10.1111/srt.13237 -
The Cochrane Database of Systematic... Apr 2018Infantile haemangiomas (previously known as strawberry birthmarks) are soft, raised swellings of the skin that occur in 3% to 10% of infants. These benign vascular... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Infantile haemangiomas (previously known as strawberry birthmarks) are soft, raised swellings of the skin that occur in 3% to 10% of infants. These benign vascular tumours are usually uncomplicated and tend to regress spontaneously. However, when haemangiomas occur in high-risk areas, such as near the eyes, throat, or nose, impairing their function, or when complications develop, intervention may be necessary. This is an update of a Cochrane Review first published in 2011.
OBJECTIVES
To assess the effects of interventions for the management of infantile haemangiomas in children.
SEARCH METHODS
We updated our searches of the following databases to February 2017: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, AMED, LILACS, and CINAHL. We also searched five trials registries and checked the reference lists of included studies for further references to relevant trials.
SELECTION CRITERIA
Randomised controlled trials (RCTs) of all types of interventions, versus placebo, active monitoring, or other interventions, in any child with single or multiple infantile haemangiomas (IHs) located on the skin.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane. The primary outcome measures were clearance, a subjective measure of improvement, and adverse events. Secondary outcomes were other measures of resolution; proportion of parents or children who consider there is still a problem; aesthetic appearance; and requirement for surgical correction. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics.
MAIN RESULTS
We included 28 RCTs, with a total of 1728 participants, assessing 12 different interventions, including lasers, beta blockers (e.g. propranolol, timolol maleate), radiation therapy, and steroids. Comparators included placebo, an active monitoring approach, sham radiation, and interventions given alone or in combination.Studies were conducted in a number of countries, including China, Egypt, France, and Australia. Participant age ranged from 12 weeks to 13.4 years. Most studies (23/28) included a majority of females and different types of IHs. Duration of follow-up ranged from 7 days to 72 months.We considered most of the trials as at low risk of random sequence generation, attrition bias, and selective reporting bias. Domains such as allocation concealment and blinding were not clearly reported in general. We downgraded evidence for issues related to risk of bias and imprecision.We report results for the three most important comparisons, which we chose on the basis of current use. Outcome measurement of these comparisons was at 24 weeks' follow-up.Oral propranolol versus placeboCompared with placebo, oral propranolol 3 mg/kg/day probably improves clinician-assessed clearance (risk ratio (RR) 16.61, 95% confidence interval (CI) 4.22 to 65.34; 1 study; 156 children; moderate-quality evidence) and probably leads to a clinician-assessed reduction in mean haemangioma volume of 45.9% (95% CI 11.60 to 80.20; 1 study; 40 children; moderate-quality evidence). We found no evidence of a difference in terms of short- or long-term serious adverse events (RR 1.05, 95% CI 0.33 to 3.39; 3 studies; 509 children; low-quality evidence), nor in terms of bronchospasm, hypoglycaemia, or serious cardiovascular adverse events. The results relating to clearance and resolution for this comparison were based on one industry-sponsored study.Topical timolol maleate versus placeboThe chance of reduction of redness, as a measure of clinician-assessed resolution, may be improved with topical timolol maleate 0.5% gel applied twice daily when compared with placebo (RR 8.11, 95% CI 1.09 to 60.09; 1 study; 41 children;low-quality evidence). Regarding short- or long-term serious cardiovascular events, we found no instances of bradycardia (slower than normal heart rate) or hypotension in either group (1 study; 41 children; low-quality evidence). No other safety data were assessed, and clearance was not measured.Oral propranolol versus topical timolol maleateWhen topical timolol maleate (0.5% eye drops applied twice daily) was compared with oral propranolol (via a tablet taken once per day, at a 1.0 mg/kg dose), there was no evidence of a difference in haemangioma size (as a measure of resolution) when measured by the proportion of patients with a clinician-assessed reduction of 50% or greater (RR 1.13, 95% CI 0.64 to 1.97; 1 study; 26 participants; low-quality evidence). Although there were more short- or long-term general adverse effects (such as severe diarrhoea, lethargy, and loss of appetite) in the oral propranolol group, there was no evidence of a difference between groups (RR 7.00, 95% CI 0.40 to 123.35; 1 study; 26 participants; very low-quality evidence). This comparison did not measure clearance.None of our key comparisons evaluated, at any follow-up, a subjective measure of improvement assessed by the parent or child; proportion of parents or children who consider there is still a problem; or physician-, child-, or parent-assessed aesthetic appearance.
AUTHORS' CONCLUSIONS
We found there to be a limited evidence base for the treatment of infantile haemangiomas: a large number of interventions and outcomes have not been assessed in RCTs.Our key results indicate that in the management of IH in children, oral propranolol and topical timolol maleate are more beneficial than placebo in terms of clearance or other measures of resolution, or both, without an increase in harms. We found no evidence of a difference between oral propranolol and topical timolol maleate with regard to reducing haemangioma size, but we are uncertain if there is a difference in safety. Oral propranolol is currently the standard treatment for this condition, and our review has not found evidence to challenge this. However, these results are based on moderate- to very low-quality evidence.The included studies were limited by small sample sizes and risk of bias in some domains. Future trials should blind personnel and participants; describe trials thoroughly in publications; and recruit a sufficient number of children to deduce meaningful results. Future trials should assess patient-reported outcomes, as well as objective outcomes of benefit, and should report adverse events comprehensively. Propranolol and timolol maleate require further assessment in RCTs of all types of IH, including those considered problematic, as do other lesser-used interventions and new interventions. All treatments should be compared against propranolol and timolol maleate, as beta blockers are approved as standard care.
Topics: Adrenal Cortex Hormones; Adrenergic beta-Antagonists; Antineoplastic Agents; Bleomycin; Child, Preschool; Hemangioma, Capillary; Humans; Infant; Lasers, Dye; Methylprednisolone; Photochemotherapy; Prednisolone; Propranolol; Radiotherapy; Randomized Controlled Trials as Topic; Remission Induction; Skin Neoplasms; Timolol
PubMed: 29667726
DOI: 10.1002/14651858.CD006545.pub3 -
American Journal of Clinical Dermatology Jan 2021Surgery is the mainstay of treatment for non-melanoma skin cancer. Lasers are an additional option. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Surgery is the mainstay of treatment for non-melanoma skin cancer. Lasers are an additional option.
OBJECTIVE
The objective of this study was to review the literature on the efficacy and safety of lasers for the treatment of non-melanoma skin cancer.
METHODS
A systematic review and meta-analysis of laser treatment for non-melanoma skin cancer was performed. The primary outcome was recurrence rate (RR).
RESULTS
The review included 32 studies (six randomized controlled trials and 26 cohort studies): 27 evaluated basal cell carcinomas (BCCs), three squamous cell carcinomas, and two both, for a total of 4755 BCCs and 214 squamous cell carcinoas. Most BCCs were low risk. The Nd:YAG laser (seven studies, 3286 BCCs) had a 3.1% RR (95% confidence interval [CI] 1.4-6.4%) during a mean follow-up of 7.9 years, with a low rate (< 20%) of scarring and dyspigmentation. The CO laser (ten studies, 904 BCCs) had a 9.4% RR (95% CI 4.1-20) during a mean follow-up of 2.1 years, with a low rate of side effects. The pulsed dye laser (eight studies, 206 BCCs) had a 38% RR (95% CI 24-55). In two studies, the Nd:YAG laser demonstrated a RR of 10% (95% CI 2-31) for Bowen's disease, and in three studies, the CO laser demonstrated a RR of 22% (95% CI 5-61) for squamous cell carcinoma.
CONCLUSIONS
Based on cohort studies, the Nd:YAG laser is a safe and efficacious modality for the treatment of low-risk BCC. Based on settings applied in prior studies in the literature, the CO laser is less efficacious than the Nd:YAG laser, thus it cannot be recommended for BCC treatment. Insufficient data preclude conclusions regarding laser treatment for squamous cell carcinoma.
REGISTRATION
PROSPERO registration number CRD42019129717.
Topics: Biopsy; Bowen's Disease; Carcinoma, Basal Cell; Cicatrix; Cohort Studies; Follow-Up Studies; Humans; Hypopigmentation; Laser Therapy; Lasers, Dye; Lasers, Gas; Lasers, Solid-State; Neoplasm Recurrence, Local; Neoplasm, Residual; Randomized Controlled Trials as Topic; Skin; Skin Neoplasms; Skin Pigmentation; Treatment Outcome
PubMed: 32930983
DOI: 10.1007/s40257-020-00562-8 -
Journal of Plastic, Reconstructive &... Jan 2021Hypertrophic scarring and keloid can cause significant emotional and physical discomfort. Cosmetic appearance, functional limitations, pain and pruritus form a degree of...
BACKGROUND
Hypertrophic scarring and keloid can cause significant emotional and physical discomfort. Cosmetic appearance, functional limitations, pain and pruritus form a degree of impairment. While the etiology is not fully known, there is a wide array of treatment options, which include excision, radiation, cryotherapy, silicone gel sheeting, and intralesional injections. A relatively new modality is laser therapy. While results are promising, the number of different laser systems is substantial. This review evaluates the available evidence regarding outcomes on specific objective characteristics (i.e., erythema, pigmentation, height, and pliability) of the different laser systems.
METHODS
A systematic literature review was performed using MEDLINE, Cochrane Library, and EMBASE. Data on scar characteristics were extracted from scar scales Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS), and from objective measurement tools.
RESULTS
Heterogeneity was seen in a lot of aspects: maturity of scar, origin of scar, follow-up, and number of treatments. The fractional ablative lasers CO 10,600 nm and Er:YAG 2940 nm were found to produce the best results regarding erythema, height, and pliability, while the flash lamp-pumped pulsed dye laser (PDL) 585 nm scored slightly below that.
CONCLUSIONS
Laser systems, and specifically the fractional ablative lasers CO and Er:YAG, improved various characteristics of excessive scarring. An overview of preferred laser modality per scar characteristic is presented. Accounting for the methodological quality and the level of evidence of the data, future research in the form of randomized trials with comparable standardized scar scales is needed to confirm these results.
Topics: Cicatrix, Hypertrophic; Humans; Keloid; Laser Therapy
PubMed: 33645505
DOI: 10.1016/j.bjps.2020.08.108 -
Frontiers in Medicine 2023Port wine stains (PWS) often cause cosmetic effects and psychological distress. Pulsed dye lasers (PDL) and photodynamic therapy (PDT) are the most commonly used...
BACKGROUND
Port wine stains (PWS) often cause cosmetic effects and psychological distress. Pulsed dye lasers (PDL) and photodynamic therapy (PDT) are the most commonly used treatments. PDL is still the "gold standard" of therapy to date. However, its shortcomings have become apparent as clinical applications have increased. PDT has been proven as an alternative to PDL. Patients with PWS still lack enough evidence about PDT to make informed treatment decisions.
OBJECTIVE
The purpose of this systematic review and meta-analysis was to assess the safety and effectiveness of PDT for PWS.
METHODS
The online datasets, comprising PubMed, Embase, Web of Science, and the Cochrane Library, were searched for meta-analysis-relevant publications. Two reviewers separately evaluated the risk of bias in each listed study. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the treatment and safety outcomes.
RESULTS
Our search retrieved 740 hits and only 26 studies were finally included. Among the 26 studies included, 3 were randomized clinical trials, and 23 were prospective or retrospective cohort investigations. Based on a gathered assessment, the percentage of individuals achieving a 60% improvement was estimated to be 51.5% [95% confidence interval (CI): 38.7-64.1; = 83.8%] and a ≥75% improvement was 20.5% (95% CI: 14.5-26.5; = 78.2%) after 1-8.2 treatment sessions (GRADE score: very low). Due to the statistical diversity of the meta-analysis, a subgroup assessment was performed to determine the sources of diversity. The collected findings indicated that the impact of PDT on enhancing the medical effectiveness of PWS was significant in different treatment sessions, different types of ages, different locations of PWS, and different types of PWS. Pain and edema occurred in most patients. Hyperpigmentation was present in 7.9-34.1% of the patients in 17 studies. Photosensitive dermatitis, hypopigmentation, blister, and scar were infrequently reported, with 0-5.8% incidences.
CONCLUSION
Photodynamic therapy is recommended as a safe and effective treatment for PWS based on the current evidence. However, our findings are based on poor-quality evidence. Therefore, comparative investigations of a large scale and high quality are necessary to support this conclusion.
PubMed: 36895715
DOI: 10.3389/fmed.2023.1111234 -
Journal of Voice : Official Journal of... Mar 2013To evaluate the effectiveness and safety of the 532 nm potassium titanyl phosphate (KTP) laser for vocal fold surgery. (Review)
Review
OBJECTIVE
To evaluate the effectiveness and safety of the 532 nm potassium titanyl phosphate (KTP) laser for vocal fold surgery.
STUDY DESIGN
Systematic literature review.
METHODS
Our systematic review was conducted using the meta-analysis of observational studies in epidemiology guidelines. We applied the criteria of the Oxford Centre for Evidence-based Medicine to assess the level of evidence.
RESULTS
We identified seven observational studies of eight case series, which reported a total of 243 KTP procedures carried out for vocal fold lesions: two series each concerning ectasias and varices, early glottic cancer, and recurrent papillomatosis, and one series each for keratosis with dysplasia and various benign laryngeal pathologies. There was also a retrospective review of the use of KTP laser in 387 endoscopic laryngeal surgeries. No studies compared the use of KTP laser with that of other technologies. Thus, according to the Oxford criteria, there is only level 4 evidence of KTP's efficacy and safety. In selected cases, the KTP instrument can be used without general anesthesia in the clinic setting.
CONCLUSIONS
The use of KTP laser for laryngeal surgery is still relatively innovative. Several surgeons have found KTP laser to be the equivalent of, or superior to, the CO2 or pulsed dye lasers, and none have reported inferiority. However, there are currently no published data to support these conclusions. To establish equality/superiority, it is desirable that further evidence of efficacy and safety be obtained, either through randomized controlled trials or at least through well-documented prospective observational studies with reporting of all relevant input and outcome data.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Laryngostenosis; Laser Therapy; Lasers, Solid-State; Male; Middle Aged; Risk Factors; Treatment Outcome; Young Adult
PubMed: 23294705
DOI: 10.1016/j.jvoice.2012.11.006 -
International Journal of Dermatology Feb 2022The current scenario and position of laser and light-based therapies (LLBT) in the therapeutic rosacea scheme are lacking evidence-based recommendations and comparisons... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The current scenario and position of laser and light-based therapies (LLBT) in the therapeutic rosacea scheme are lacking evidence-based recommendations and comparisons on efficacy and tolerability among different devices. This article aimed to systematically compare the efficacy, acceptability, and tolerability of the pulsed dye laser (PDL) versus other devices.
METHOD
A literature search was conducted in March 2020. Four domains were analyzed throughout the following six outcomes: Spectrophotometer erythema index and percentage of reduction for background erythema, telangiectasia grading scale for telangiectasias, visual analog scale for pain, and physician's assessment and patient's satisfaction for treatment success.
RESULTS
Our search yielded 423 potentially relevant studies. After removing the excluded and duplicated records, 12 records were assessed for eligibility in the meta-analysis. Erythema (RR:0.38 95%CI: -0.20-0.95), telangiectasias (RR:0.54 95%CI: -0.87-1.94), and the treatment success throughout the physician's assessment (RR:1.23 95%CI: 0.74-2.04) and the patient's satisfaction (RR:1.15 95%CI: 0.73-1.82) were not significantly different between pulsed dye laser and other LLBT. In the pain domain, PDL was as painful as other LLBT (RR:-0.23 95%CI: -0.96-0.49) but more painful than neodymium: yttrium-aluminum-garnet laser (RR:0.84 95%CI: 0.53-1.14) and less than intense pulsed light (RR:-1.18 95%CI: -1.56-0.80).
CONCLUSION
This work based on previously published literature demonstrates that the quality of evidence to support any recommendation on LLBT in rosacea is low-to-moderate. Among all the available devices, PDL holds the most robust evidence, although in the meta-analysis the effectiveness was comparable to other LLBT, such as neodymium: yttrium-aluminum-garnet laser (Nd-YAG) or IPL.
Topics: Erythema; Humans; Lasers, Dye; Lasers, Solid-State; Low-Level Light Therapy; Rosacea
PubMed: 34089264
DOI: 10.1111/ijd.15680 -
The Cochrane Database of Systematic... May 2011Infantile haemangiomas (also known as strawberry birthmarks) are soft, raised swellings of the skin which are usually uncomplicated and tend to regress spontaneously... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Infantile haemangiomas (also known as strawberry birthmarks) are soft, raised swellings of the skin which are usually uncomplicated and tend to regress spontaneously over time. Some haemangiomas occur in high-risk areas or can develop complications; therefore, intervention may be necessary. Various interventions have been proposed, but it is unclear whether any of these interventions are effective.
OBJECTIVES
To assess the effects of interventions for infantile haemangiomas.
SEARCH STRATEGY
We searched the following databases up to March 2011: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (Clinical Trials) in The Cochrane Library, MEDLINE, EMBASE, PsycINFO, AMED (Allied and Complementary Medicine), LILACS (Latin American and Caribbean Health Science Information database), CINAHL, and reference lists of articles. We also searched online trials registries for ongoing trials and grey literature.
SELECTION CRITERIA
We included children with haemangiomas.
DATA COLLECTION AND ANALYSIS
Two authors independently screened titles, abstracts, and the full text of publications; extracted data; and assessed risk of bias.
MAIN RESULTS
We included 4 studies with a total of 271 participants.One randomised controlled trial (RCT) compared pulsed dye laser (PDL) therapy versus the 'wait and see' approach. At one year PDL was significantly more likely to result in complete clearance. The risk ratio (RR) was 6.10 (95% CI [confidence interval] 1.89 to 19.64); however, there was no difference when clearance was defined as 'complete or minimal residual signs'. Redness was significantly less pronounced in the PDL group, but no differences were seen for height or surface area. Significant increases in atrophy and skin hypopigmentation were seen in the PDL group.One very old RCT assessed radiation versus mock-radiation; there was no significant difference in clearance at six years (RR 1.08, 95% CI 0.63 to 1.87) between the groups, irrespective of the size of the haemangioma and the skin colour.In one small RCT there was a significantly greater reduction in size of the haemangioma with oral prednisolone compared to intravenous methylprednisolone at three months (mean difference [MD] was 58 mm [95% CI 29.24 to 86.76]), and one year. Similar adverse events occurred in both groups.In another small RCT there was a significant reduction in the surface area of the haemangioma with bleomycin compared to the control (RR 21, 95% CI 1.34 to 328.86).
AUTHORS' CONCLUSIONS
This review has found limited evidence from individual RCTs to support some of the existing interventions (corticosteroid and PDL) for infantile haemangiomas. There is a need for further high-quality RCTs to validate the findings from these studies, and RCTs to assess the effect of other treatments, in particular relating to propranolol.
Topics: Adrenal Cortex Hormones; Antineoplastic Agents; Bleomycin; Child, Preschool; Hemangioma, Capillary; Humans; Infant; Lasers, Dye; Methylprednisolone; Photochemotherapy; Prednisolone; Radiotherapy; Randomized Controlled Trials as Topic; Remission Induction; Skin Neoplasms
PubMed: 21563155
DOI: 10.1002/14651858.CD006545.pub2 -
Journal of the American Academy of... Oct 2013The position of the pulsed dye laser (PDL) in the treatment of inflammatory skin diseases is still unclear. Evidence-based recommendations are lacking. (Review)
Review
BACKGROUND
The position of the pulsed dye laser (PDL) in the treatment of inflammatory skin diseases is still unclear. Evidence-based recommendations are lacking.
OBJECTIVES
We sought to systematically review all available literature concerning PDL treatment for inflammatory skin diseases and to propose a recommendation.
METHODS
We searched for publications dated between January 1992 and August 2011 in the database PubMed. All studies reporting on PDL treatment for an inflammatory skin disease were obtained and a level of evidence was determined.
RESULTS
Literature search revealed 52 articles that could be included in this study. The inflammatory skin diseases treated with PDL consisted of: psoriasis, acne vulgaris, lupus erythematodes, granuloma faciale, sarcoidosis, eczematous lesions, papulopustular rosacea, lichen sclerosis, granuloma annulare, Jessner lymphocytic infiltration of the skin, and reticular erythematous mucinosis. The efficacy of PDL laser treatment for these inflammatory skin diseases was described and evaluated.
LIMITATIONS
Most conclusions formulated are not based on randomized controlled trials.
CONCLUSIONS
PDL treatment can be recommended as an effective and safe treatment for localized plaque psoriasis and acne vulgaris (recommendation grade B). For all other described inflammatory skin diseases, PDL seems to be promising, although the level of recommendation did not exceed level C.
Topics: Acne Vulgaris; Dermatitis; Female; Humans; Lasers, Dye; Low-Level Light Therapy; Lupus Erythematosus, Cutaneous; Lupus Erythematosus, Discoid; Male; Prognosis; Psoriasis; Randomized Controlled Trials as Topic; Risk Assessment; Treatment Outcome
PubMed: 23711766
DOI: 10.1016/j.jaad.2013.03.029