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The Journal of Dermatological Treatment Jun 2022
Meta-Analysis
Topics: Erythema; Humans; Lasers, Dye; Low-Level Light Therapy; Rosacea; Treatment Outcome
PubMed: 34291712
DOI: 10.1080/09546634.2021.1959507 -
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 -
Journal of Drugs in Dermatology : JDD Apr 2021Dermatosis papulosa nigra (DPN) is a benign skin condition that is primarily reported in skin of color patients. While prevalent, treatment options are limited and the...
Dermatosis papulosa nigra (DPN) is a benign skin condition that is primarily reported in skin of color patients. While prevalent, treatment options are limited and the benign course of DPNs may cause them to be overlooked by clinicians. However, large and multiple lesions in cosmetically sensitive areas may be emotionally and socially distressful to patients. There are few literature reviews examining treatment options for this condition. A literature search was performed using PubMed, Medline, Embase, and Web of Science databases. 67 articles were identified and 15 studies met the inclusion criteria. Our findings demonstrate that laser therapy is becoming increasingly utilized as a safe and efficacious treatment for DPNs in skin of color patients. J Drugs Dermatol. 20(4):467-472. doi:10.36849/JDD.2021.5555.
Topics: Curettage; Dose Fractionation, Radiation; Electrosurgery; Humans; Lasers, Dye; Lasers, Gas; Lasers, Semiconductor; Lasers, Solid-State; Low-Level Light Therapy; Quality of Life; Skin; Skin Diseases, Papulosquamous; Skin Pigmentation; Treatment Outcome
PubMed: 33852246
DOI: 10.36849/JDD.2021.5555 -
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 -
Lasers in Medical Science Dec 2021The pulsed dye laser (PDL) is the standard treatment for port-wine stains (PWS). Maximal improvement occurs after multiple treatment sessions; however, the optimal... (Meta-Analysis)
Meta-Analysis
The pulsed dye laser (PDL) is the standard treatment for port-wine stains (PWS). Maximal improvement occurs after multiple treatment sessions; however, the optimal treatment interval has yet to be determined. The aim of this study was to review whether there is an association between PDL treatment interval and outcome of PWS. Six databases were searched by three reviewers for publications investigating treatment of PWS with PDL. The 75% improvement rates (75IR) were extracted for quantitative analysis. Meta-regression was used to investigate the association between treatment intervals and 75IR. The systematic review included 1 RCT and 33 cohort studies (7 prospective cohorts and 26 retrospective cohorts), with a total of 3777 patients. The pooled 75IR was 37% (95% CI 29-45%; I = 95%). Light Fitzpatrick skin type (p = 0.04), facial anatomic location (p = 0.01), and young age (p = 0.008) were associated with 75IR. In an unadjusted (p = 0.42) and multivariable adjusted (p = 0.98) meta-regression, no association was found between time interval between treatments and 75IR. These results persisted in a sensitivity analysis of studies with a mean patient age of ≤ 1. The majority of included studies were heterogeneous and retrospective. Based on cohort studies of low-to-moderate quality, time intervals between PDL treatments are not associated with PWS outcome.
Topics: Humans; Lasers, Dye; Port-Wine Stain; Prospective Studies; Retrospective Studies; Treatment Outcome
PubMed: 33580846
DOI: 10.1007/s10103-021-03264-7 -
Journal of Lasers in Medical Sciences 2020Darier disease (DD) is a chronic disease with high morbidity and limited treatment options. Laser efficacy in the treatment of DD remains understudied. A literature... (Review)
Review
Darier disease (DD) is a chronic disease with high morbidity and limited treatment options. Laser efficacy in the treatment of DD remains understudied. A literature search conducted between 07/21/2017 and 05/05/2018 identified all original cases of DD treated with laser therapy. Outcomes from 24 patients were reviewed, 22 patients were identified in the literature and 2 cases are included from our institution. Five types of lasers were identified [CO laser, Er:YAG laser, pulse dye laser [PDL], diode laser, erbium-doped fiber laser], with CO (46%) and PDL (42%) being the most common. Seventy-nine percent of patients were treated with more than one procedure (average, 3 procedures). The estimated body surface treated with each session ranged from 5%-50%. The most common adverse events came from CO and Er:YAG lasers and included dyspigmentation, pain, and post-laser erythema and edema. The time to response (mode, 1 month) was only reported in half of the studies. Laser treatments appear to be a promising alternative to standardized therapies in DD.
PubMed: 33425289
DOI: 10.34172/jlms.2020.63 -
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 -
Dermatologic Surgery : Official... Nov 2020Keratosis pilaris (KP) is a common hereditary keratinization disorder. Keratosis pilaris rubra and KP atrophicans faciei are less frequent variants of the disease....
BACKGROUND
Keratosis pilaris (KP) is a common hereditary keratinization disorder. Keratosis pilaris rubra and KP atrophicans faciei are less frequent variants of the disease. Topical treatments often yield ineffective and temporary results.
OBJECTIVE
The objective of this article is to review and assess all the studies that used light and laser devices to treat KP and its variants.
MATERIAL AND METHODS
On January 15, 2017, an online search of the MEDLINE, Embase, and Cochrane databases was performed using the following combination of keywords: "keratosis pilaris" and "treatment."
RESULTS
Seventeen studies related to light and laser treatments were retained for analysis. The total number of treated patients was 175. Of which, 22 patients had KP atrophicans faciei, 17 patients had KP rubra, and 136 patients had KP.
CONCLUSION
Light and laser devices have been emerging as promising therapeutic options for a disfiguring disease that still lacks, until today, an effective long-term treatment.
Topics: Abnormalities, Multiple; Clinical Trials as Topic; Darier Disease; Eyebrows; Humans; Intense Pulsed Light Therapy; Lasers, Dye; Lasers, Gas; Lasers, Semiconductor; Lasers, Solid-State; Low-Level Light Therapy; Severity of Illness Index; Treatment Outcome
PubMed: 32804891
DOI: 10.1097/DSS.0000000000002441 -
The Journal of Dermatological Treatment May 2019Striae distensae are caused by rapid stretching of the skin. They are often secondary to obesity or pregnancy and can lead to significant cosmetic disfigurement.
BACKGROUND
Striae distensae are caused by rapid stretching of the skin. They are often secondary to obesity or pregnancy and can lead to significant cosmetic disfigurement.
AIM
To determine the efficacy, indications, and side effects of commonly used energy devices in the treatment of striae.
METHODS
A comprehensive literature search was performed using the PubMed and Medline databases.
RESULTS
A total of 41 relevant articles were identified. Radiofrequency (RF) was the commonest employed modality (11 studies), followed by the CO, and pulsed dye lasers (10 and 5 studies, respectively). The best results against striae alba were seen with a combination of RF, platelet-rich plasma and ultrasound (either excellent or very good results in 71.9%), followed by intense pulsed light in isolation (very good results in 40%). The response of SR was assessed by fewer studies. The best outcomes were seen after treatment with either the Nd:YAG (excellent results in 40% and good in 40%) or Er:Glass lasers (excellent results in 10% and good in 20%).
CONCLUSIONS
The therapeutic measures for striae are multiple and no current treatment offers consistent and complete resolution. However, energy devices are a safe and potentially effective modality in the treatment of striae.
Topics: Combined Modality Therapy; Female; Humans; Laser Therapy; Platelet-Rich Plasma; Radiofrequency Therapy; Skin; Striae Distensae; Ultrasonic Therapy
PubMed: 30049244
DOI: 10.1080/09546634.2018.1506078 -
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