Recent developments in lasers and the treatment of birthmarks - skin resurfacing at home

Despite rapid progress over the past 20 years, there are still unanswered questions. The treatment of Spore line staining has become the standard for the treatment of pornographic stains.
Over the past 20 years, these devices have witnessed
The form of selective treatment of highly precise lasers capable of selective thermal cracking.
Nevertheless, there is still a big gap in the outcome of treatment.
Although the vast majority of portwine stains were significantly reduced after treatment, only 15-20% was completely removed.
In addition, a recent disturbing report reveals what many of us suspect over a period of time: portwine stains may recur after treatment.
The impact in this regard has not yet been determined.
These findings lead to several important questions: why can't we remove more lesions and is there any progress recently to improve our results? oas_tag.
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The two most important considerations are the depth and diameter of the vessel.
For some time now, we already know that there is a significant change in the depth of the vessel in pornographic stains.
Given the limited depth of yellow light penetration (1-2mm at 585 nm), it seems inevitable that we cannot effectively treat the full thickness of some lesions.
Recent work has shown that there is indeed a correlation between vascular depth and response to laser therapy.
2 In lesions with an average vascular depth greater than 1030 μm, the response was poor, while those with more superficial vessels (with an average vascular depth less than 830 μm) responded well
In another study, the response to treatment also depends on the depth of the blood vessels.
There are two ways to increase the penetration depth of light.
The first and most obvious is to increase the wavelength of the light from the standard 585 nm to 595 nm or even 600 nm.
The second is to increase the spot size from 5mm to 7.
5mm or even 10mm.
Based on Monte Carlo simulation, the larger the spot size (up to 1 cm), the greater the degree of scattering, and the deeper the effective treatment depth.
Vessel diameter the diameter of the vessel also seems to play a key role in whether the lesion responds to treatment.
Dierickx et al show that the pulse width in the millisecond domain is more appropriate than the standard 500 μs pulse width available on most pulse dye lasers.
This is based on the computational thermal relaxation time of the vessels that make up these lesions.
Therefore, in order to improve our ability to handle larger blood vessels, the pulse width needs to be increased from 500 μs to the millisecond range.
The next advance of surface cooling occurs in the form of surface cooling.
Nelson et al show that cooling the skin surface with refrigerant spray before laser pulse emission will achieve two main advantages.
First of all, the possibility of skin damage is reduced;
Secondly, the pain of treatment is relieved.
The third advantage in the form of greater efficacy soon emerged.
Skin cooling allows us to increase the amount of injection without the risk of skin damage.
Increased injection means more effective treatment and, most importantly, a greater impact on deeper blood vessels.
This important progress has led to surface cooling as a standard feature of a pulsed dye laser.
There were several other cooling methods soon.
These methods include contact methods, where the cooled surface is placed on the skin during treatment, and where
In the process of treatment, the contact method of cold air flow to the surface.
6, 7 at this point, no clinical data of these methods were compared.
Anecdotal reports suggest that all of these are valid and there doesn't seem to be any significant difference in efficacy.
Among them, the pulse dye laser is the most widely used.
Many changes have been made since the introduction in late 1980;
The latest features included in these lasers include the following: longer wavelength (585-600 nm ).
Most doctors are treated within the range of 585-595 nm.
Anecdotal comments suggest that 600 nm seems to be too long and inefficient.
8 Larger spot sizes.
Most lasers will offer 7mm and 10mm options.
A longer pulse width.
Currently, there is no clinical data to support longer pulse widths, but anecdotal reports support exposure times of 1500 μs.
The clinical experience of pulsewidths beyond this time did not lead to improved results.
Surface cooling.
Several cooling technologies are currently being used.
These include refrigerant spray, cold air, a cold window and a cooled Sapphire tip.
All of these methods seem to have advantages and disadvantages, but they don't seem to translate into any difference in efficacy.
However, it is most important that we use a cooling method.
Although good clinical data have not yet been published at this point, the above features do seem to improve our results.
These developments are recent, however, and clinical data are expected to be released soon.
The latest generation of pulse dye lasers with all of the above features, as well as the pulse width (up to 50 MS) in the millisecond domain, are available.
There are obvious theoretical advantages for the pulse width of longer milliseconds, but whether these will be converted into better clinical efficacy remains to be seen.
Other devices are also useful.
Including KTP laser and Nd: YAG laser;
Recently, a non
The application of coherent intense pulse light has achieved certain success.
The KTP laser emission wavelength is 532 nm (green light) and is absorbed by oxygen hemoglobin at 585 nm, but unfortunately, melanin absorption is greater and skin scattering is more.
This will limit the depth of penetration.
On the other hand, these devices have a millisecond exposure time and can be delivered through surface cooling.
Therefore, it is hoped that they will treat Grade IV (c. f. ) lesions.
In fact, they have been successfully used to treat portwine staining for all grades, but their use is not as extensive as a pulse dye laser, and no published data to date have demonstrated their effectiveness.
The use of Nd: YAG lasers is very limited and unsafe in the hands of people without experience.
They can only be used to treat pebbles.
10 strong pulse light sources with proper filtration and surface cooling are also useful for handling portwine stains of all grades, but again, they are not used as widely as pulse dye lasers.
In the hands of skilled people, these devices are beneficial.
The pathogenesis and classification evidence suggest that portwine staining is the result of the festival, absolute or relative deficiency of the posterior autonomic nerve
Capillaries in the dermal nipples.
12-14 this causes the small veins of the lesion to gradually expand throughout the patient's life.
The absolute deficiency of autonomic nerve domination will lead to faster progress in the formation of early fat and pebbles.
Relatively insufficient lead to slow progress of lesions.
Since vessel diameter is such an important factor, it seems logical to classify according to vessel size.
This classification exists, with both clinical and pathological basis.
It helps to choose the treatment.
Grade I lesions: the vessel diameter is within the range of 80 μm.
These lesions are light pink spots.
Grade II lesions: 120 μm can be measured in vessel diameter.
These lesions are dark pink spots.
Grade III lesions: 150 μm can be measured in vessel diameter.
These lesions are red spots.
Grade IV lesions: vessel diameter greater than 150 μm.
These lesions are purple and may turn into pimples.
Since laser treatment can destroy the blood vessels caused by autonomic nerve defects, laser treatment will only affect the effect and will not affect the cause of portwine staining.
So it makes sense that many people, if not all, will have a recurrence, because autonomic nerve defects seem to be segmented and may affect all blood vessels, large or small in the affected areas
Pulse dye laser is the most widely used laser in this field.
Their efficacy for grade IV lesions and pebble-formed lesions is poor, probably because the vessel diameter that constitutes these lesions takes milliseconds of exposure.
While increasing surface cooling and higher flux is likely to change this, KTP lasers and strong pulse light sources are useful for grade IV lesions at this point.
Nd: YAG laser is useful in cases where pebbles are formed, but if pebbles have been present for several years, surgical resection may be required.
Surgical treatment of soft tissue enlargement can occasionally help, especially on the lips and eyelids.
However, surgical resection and full-thickness skin grafting are no longer necessary and should be strongly opposed given the success of laser treatment.
Vascular newborn staining laser is essential for the treatment of the surface components of hemangioma in the developmental proliferation stage and the degradation stage.
During the proliferation phase, it is thought that repeated treatment with 3-4 intervals per week may reduce the final size of the lesion and, in some cases, even completely resolve the lesion.
For ulcer disease, pulse dye laser treatment is also advocated.
While this is appropriate in most cases, in a very small number of patients, ulcers may deteriorate after treatment, especially in segmented lesions.
Re-surface skin with CO2 laser and Er: YAG laser is useful for the treatment of atrophy scars, which usually remain after the ulcer lesion has subsided.
In addition to this, the new "combined" laser combines more accurate ablation with Er: the collagen shrinkage effect produced by laser and CO2 laser or long pulse Er: YAG laser is at least better in theory.
A new generation of Q-spots
Switching lasers can selectively destroy the melanin body, so it is very useful for the treatment of benign lesions such as cafes, lentils and OTA moles.
Unfortunately, reports of early success have been influenced by the fact that many treatments have eventually recurred.
In a recent study, lesions with irregular edges have the most favorable response to treatment.
19 cases of OtaSeveral mole reported confirmed with Q-
Ruby laser and Q switch
21 lasers.
Recurrence has not been reported.
Results of treatment of congenital neviThe Q
Switching the ruby laser was disappointing.
All this seems to happen again eventually.
Despite rapid progress over the past 20 years, there are still some outstanding issues.
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