210: Nonablative Laser and Light-Based Therapy: Cosmetic and Medical Indications Flashcards
What is the principle behind selective photothermolysis in nonablative laser therapy?
Selective photothermolysis involves using a wavelength of light that is preferentially absorbed by a cutaneous target, applied over an appropriate pulse duration, allowing for selective destruction of a skin structure if adequate energy is delivered.
What are the characteristics of nonablative procedures?
Nonablative procedures are characterized by:
- Producing biological changes without creating a clinically relevant wound.
- Necessitating minimal postprocedure wound care.
- Having a highly favorable risk profile.
- Being the clear treatment of choice for various aesthetic and medical conditions.
- Allowing for serial procedures that may yield results comparable to more invasive methods.
What are the risks and potential complications associated with nonablative laser therapy?
The risks and potential complications include:
- Very low risk of complications.
- Infection, scarring, and temporary or permanent skin discoloration.
- Crusting requiring topical therapy such as emollients.
- Ocular injuries, which can be prevented with appropriate eyewear.
- Localized tissue reactions such as edema and erythema.
What safety measures should be taken during nonablative laser procedures?
Safety measures include:
- Wavelength-specific eye protection.
- Posting device-specific warning signs in the treatment room.
- Covering all windows appropriately.
- Using smoke evacuators for laser plume.
- Covering reflective surfaces to avoid electrical fire risks.
- Ensuring device-specific in-service training for laser support personnel.
What types of devices are commonly used in nonablative laser therapy?
Common types of devices include:
| Device Type | Wavelength | Applications |
|————-|————|————–|
| Flashlamp-pumped pulsed dye laser | 595 nm | Port-wine stains, benign vascular conditions |
| KTP laser | 532 nm | Discrete telangiectases, facial hypervascularity |
| Nd:YAG laser | 1064 nm | Facial vessels, spider veins, hair removal |
| Diode lasers | 810 nm | Hair removal |
| Alexandrite laser | 755 nm | Vascular lesions, hair removal |
| Ruby laser | 694 nm | Dermatologic applications |
| CO2 and Er:YAG lasers | 10,600 nm and 2940 nm | Resurfacing applications |
What types of anesthesia may be used during nonablative laser procedures?
Types of anesthesia that may be used include:
1. Topical anesthetic creams
2. Ice applications
3. Forced chilled air
4. Local anesthesia
5. Oral or injectable analgesics
6. Regional nerve blocks
There is great variability in patient tolerance to these methods.
What are the perioperative care considerations for patients undergoing nonablative laser therapy?
Perioperative care considerations include:
- No specific topical regimen required for most patients
- Use of hydroquinone for darker Fitzpatrick skin types to minimize postinflammatory dyspigmentation
- Application of petrolatum to facilitate healing
- Antibacterial antibiotics usually not required
- Prophylactic antiviral treatment for patients with a history of herpes simplex.
What patient selection criteria should be considered for nonablative laser therapy?
Patient selection criteria include:
- Willingness to handle brief social downtime
- Ability to accept potentially subtle results
- Favorable risk profile for the procedure
- Consideration of age and skin type, particularly for darker skin tones due to risk of postinflammatory dyspigmentation.
How does the treatment of vascular lesions differ from that of pigmented lesions in nonablative laser therapy?
The treatment of vascular lesions typically results in more dramatic and rapid outcomes, while the treatment of pigmented lesions may require serial procedures and results may develop gradually.
What are the applications of nonablative laser systems in dermatology?
Nonablative laser systems are used for:
1. Nonablative dermal remodeling
2. Treatment of vascular lesions
3. Management of pigmented lesions
4. Skin rejuvenation.
What cooling techniques are used during laser treatments to protect the epidermis?
Cooling techniques used during laser treatments include:
1. Dynamic cryogen spray
2. Direct contact cooling
3. Bulk cooling.
What is the gold standard treatment for Port-Wine Stains (PWSs) and why?
The gold standard treatment for Port-Wine Stains (PWSs) is the pulsed dye laser (PDL) because it provides increased tissue penetration and effective treatment with relatively short pulse durations.
What factors influence the treatment response of Port-Wine Stains to laser therapy?
Factors influencing treatment response of Port-Wine Stains include:
- Anatomic location
- Size of the lesion
- Age of the patient.
What are the common characteristics and treatment options for hemangiomas?
Hemangiomas are characterized by benign vascular tumors appearing in the first month of life. Treatment options include observation, topical or systemic medications, and laser therapy.
What is the role of selective targeting of hemoglobin in the treatment of vascular lesions?
Selective targeting of hemoglobin in vascular lesions results in thermal damage to blood vessels within treated lesions.
What are the potential complications associated with laser treatments for vascular lesions?
Potential complications of laser treatments for vascular lesions include blistering, crusting, scarring, and dyspigmentation.
What is the significance of using longer wavelengths in laser therapy for vascular lesions?
Using longer wavelengths in laser therapy for vascular lesions allows for deeper tissue penetration, enhancing treatment efficacy and reducing the risk of damage to the epidermis.
What are the treatment options for telangiectasias and how do they differ?
Treatment options for telangiectasias include KTP and Nd:YAG lasers, and pulsed dye laser. These options differ in their effectiveness, side effects, and specific applications.
What might be required for effective treatment of port-wine stains?
Multiple sessions with progressively higher fluences may be required. Dynamic cryogen spray cooling can protect the epidermis and enhance results.
What laser is the gold standard for treating port-wine stains?
The flashlamp-pumped pulsed dye laser (PDL) at 595 nm is the gold standard for port-wine stains.
Significant improvement with lightening of at least 50% or better is expected in most cases.
What laser can be used to treat vitiligo?
The excimer laser (308 nm) can be used to treat vitiligo by targeting depigmented areas.
What should be considered for patients with a history of keloid formation seeking laser treatment for acne scars?
Patients with a history of keloid formation should be treated cautiously, as laser therapy may exacerbate scarring. Fractionated nonablative devices may be safer options.
What is the expected outcome of using a 1550-nm erbium-doped fiber laser for acne scars?
The 1550-nm erbium-doped fiber laser is effective for nonablative dermal remodeling, leading to gradual improvement in acne scarring with minimal downtime.
What laser might be used for treating psoriasis?
The excimer laser (308 nm) is sometimes used to treat psoriasis by targeting affected areas with ultraviolet light.
What are the advantages of using Q-switched lasers for pigmented lesions?
Q-switched (QS) lasers can lighten the color of pigmented lesions, aiding in the diagnosis of malignancies, and provide a more predictable outcome compared to other methods like cryotherapy.
What are key considerations for laser hair removal?
Key considerations include hair color, hair thickness, skin type, pre-treatment care, and post-treatment care.
What complications are associated with laser hair removal?
Complications can include erythema, perifollicular edema, paradoxical new hair growth, and dyspigmentation.
How do Q-switched lasers differ in effectiveness for treating lentigines and seborrheic keratoses?
Q-switched lasers are effective for lentigines and thin seborrheic keratoses, with varying healing times.
What are traditional and modern methods for tattoo removal?
Traditional methods include excision and dermabrasion. Modern methods include Q-switched lasers that target specific ink colors.
What is the role of Q-switched lasers in treating pigmented lesions?
Q-switched lasers lighten the color of pigmented lesions without significantly increasing the risk of malignant degeneration.
Why are longer-wavelength devices preferred for hair removal in darker skin tones?
Longer-wavelength devices like the 1064-nm Nd:YAG laser reduce the risk of complications while effectively targeting deeper pigment-containing structures.
What is the significance of using a cooling system during laser hair removal?
A cooling system minimizes epidermal damage and reduces the potential for complications during the procedure.
What are the mainstays of treatment for melasma?
Mainstays include topical therapies, avoidance of exacerbating factors, and new protocols using low-fluence QS 1064-nm Nd:YAG lasers.
What are the differences in treatment outcomes between Q-switched lasers and IPL for lentigines?
Q-switched lasers provide more immediate results, while IPL treatment results are more gradual and typically require multiple sessions.
What is the role of laser therapy in managing Becker nevi?
Laser therapy can treat Becker nevi, although the response may be inconsistent, and laser hair removal can reduce hair density.
How do Q-switched lasers work in tattoo removal?
They use photoacoustic and photomechanical effects to target ink colors, breaking down ink particles for clearance.
What precautions should be taken before laser hair removal treatments?
Patients should avoid alternative hair removal methods and follow strict perioperative sun precautions.
What are the indications for nonablative laser therapy for vascular lesions?
Indicated for treating angiomas and venous lakes, effective results are typically achieved after only 1 or 2 treatment sessions.
Which laser is recommended for Fitzpatrick type IV skin seeking hair removal?
The 1064-nm Nd:YAG laser is recommended due to its reduced risk of dyspigmentation.
What alternative approach could be considered for a patient with melasma resistant to QS laser and IPL treatments?
Nonablative fractionated laser therapy with conservative energy levels can be used, along with new protocols using low-fluence QS 1064-nm Nd:YAG lasers.
What lasers are effective for treating nevus of Ota?
QS ruby, alexandrite, and Nd:YAG lasers are effective, with multiple treatments usually required for maximal correction.
What laser is effective for pseudofolliculitis barbae?
The 1064-nm Nd:YAG laser is effective, especially in patients with darker skin tones.
What lasers can be used for treating café-au-lait macules?
QS lasers with various wavelengths can be used, but recurrence is possible even after clinical resolution.
What device is recommended for treating rosacea-related facial redness?
IPL systems are commonly used and effective for treating facial redness associated with rosacea.
What treatment is effective for hypervascular poikiloderma of Civatte?
Pulsed dye laser (PDL) treatments are effective for this condition.
What pre-treatment advice should be given to patients seeking laser hair removal?
Patients should avoid waxing, threading, and plucking before treatment, while shaving is acceptable.
What might cause paradoxical hair growth after laser treatment in Fitzpatrick skin type III?
Paradoxical new hair growth can occur, especially at the margins of treated skin.
What immediate effect might occur after treating lentigines with lasers?
A white frosting of the epidermis may appear immediately after treatment, representing intraepidermal water vapor.
What challenges might be faced when treating Becker nevus?
Becker nevi respond less consistently to QS laser therapy, and recurrence is possible.
What laser is effective for unwanted leg veins?
The long-pulsed Nd:YAG (1064-nm) laser is effective for smaller prominent leg veins.
What is the principle of selective photothermolysis in tattoo removal?
It involves using nanosecond-range pulse durations of QS lasers that match the size of subcellular ink particles.
Which laser types are effective for removing black and dark blue inks?
Effective laser types include QS Nd:YAG (1064-nm), QS Alexandrite (755-nm), and QS Ruby (694-nm).
What challenges are associated with removing yellow ink tattoos?
They can be difficult to eliminate, often requiring multiple sessions and sometimes local anesthetics due to pain.
What are common side effects of laser tattoo removal?
Common side effects include edema, blistering, crusting, and pinpoint bleeding.
What is the R20 treatment method in tattoo removal?
The R20 treatment method involves multiple treatment passes on the same day, which may decrease the time to tattoo clearance.
What is the significance of using picosecond lasers in tattoo removal?
Picosecond lasers may achieve tattoo clearance in fewer treatments for some ink colors.
What potential allergic reactions can occur with tattoo inks during laser treatment?
Reactions can include pruritus, induration, and erythema, requiring counseling for excision or treatment.
How do ablative and nonablative resurfacing devices work in skin treatment?
They target water as the chromophore, inducing dermal remodeling and neocollagenesis.
What is the role of pulsed dye lasers in treating scars?
Pulsed dye lasers target telangiectatic vessels within scar tissue, effective for treating conditions like erythematous striae.
What is the principle of selective photothermolysis and its relation to tattoo removal?
It involves using nanosecond-range pulse durations of QS lasers that match the size of subcellular ink particles.
What factors influence the response of tattoos to laser treatment?
Factors include ink color, tattoo age, and ink composition.
What are the treatment options for erythematous striae and hypervascular scars?
Options include vascular-specific lasers and pulsed dye lasers, often requiring serial treatments.
What is the role of ablative and nonablative resurfacing devices in skin treatment?
They are used to improve the quality and texture of the skin.
What are treatment options for erythematous striae and hypervascular scars?
Treatment options include vascular-specific lasers, pulsed dye lasers, and serial treatments combined with intralesional injections of corticosteroids or 5-fluorouracil.
What is the role of ablative and nonablative resurfacing devices in skin treatment?
They improve skin quality and texture by targeting water as the chromophore, inducing dermal remodeling and neocollagenesis.
What precautions should be taken when treating tattoos with QS lasers?
Precautions include conducting small test areas, monitoring for allergic responses to the ink, and avoiding treatment in patients with localized chrysiasis due to systemic gold therapy.
What challenges might you face when removing a tattoo with yellow ink?
Yellow ink is particularly resistant to removal. The QS 532-nm laser is typically used, but complete elimination may be difficult, requiring multiple sessions and patient counseling.
What complication should you be cautious of when treating a patient with a history of systemic gold therapy?
Localized chrysiasis, characterized by blue-gray discoloration of the skin, can occur due to structural alterations in dermal gold deposits.
What should you counsel a patient with a large, multicolored tattoo about the treatment process?
Large, newer, multicolored tattoos are the most difficult to eliminate, requiring numerous treatment sessions, with some colors being particularly resistant.
What is your recommendation for a patient with a history of allergic reactions to tattoo ink seeking QS laser treatment?
QS laser treatment should generally be avoided, and signs of an allergic response should be addressed by excising or otherwise treating the offending ink.
What laser would you use for treating a patient with erythematous striae?
Vascular-specific lasers, such as pulsed dye lasers, are effective for treating erythematous striae by targeting telangiectatic vessels.
What laser would you use for removing embedded particles in a patient with a history of gravel injuries?
QS lasers of various wavelengths are effective for removing embedded particles such as gravel.
What combination therapy would you consider for a patient with a hypertrophic scar?
Laser therapy may be combined with intralesional injections of corticosteroids or 5-fluorouracil.
What complication might occur with titanium dioxide-containing tattoo ink during removal?
Inks containing titanium dioxide may undergo an oxidization reaction when laser energy is applied, causing an immediate darkening effect.
What laser would you use for a patient with a history of striae rubra?
Pulsed dye lasers are effective for striae rubra as they target telangiectatic vessels within the stretch marks.
What lasers would you use for different colors in multicolored tattoos?
Black and dark blue inks: QS Nd:YAG (1064-nm), QS alexandrite (755-nm), QS ruby (694-nm). Red ink: Frequency-doubled QS Nd:YAG (532 nm). Blue and green inks: QS alexandrite, QS ruby, or picosecond-based lasers.
What should you tell a patient about expected results from fractional laser treatment for scars?
Fractional laser treatment induces dermal remodeling and neocollagenesis, leading to improvements in skin quality and texture, with serial treatments often required for optimal results.
