Advances in Lasers and Light Sources: What’s the Truth?

On 5 March, at the 2017 American Academy of Dermatology (AAD) Annual Meeting in Orlando, Fla., Dr Jill Waibel M.D., explained in a presentation “Advances in Lasers and Light Sources: What’s the Truth?”, the following:

Dermatology has been at the forefront of the laser and light source development which target many of the most common skin conditions that dermatologists encounter.

The initial indication for the medical use of laser was to treat cutaneous vascular lesions, specifically vascular birthmarks on the skin of children. Several vascular lesions that can be treated are port wine stains (PWS), hemangiomas, venous malformations, facial telangiectasias, rosacea, cherry angiomas and spider angiomas.

Aging skin is prone to develop harmless brown lesions. Lasers and intense pulsed light sources are an excellent choice and frequently used for the cosmetic treatment of pigmented lesions. Superficial pigmented lesions including ephelides, solar lentigines, and flat pigmented seborrheic keratosis, Nevus of Ota, Nevus of Ito, melasma and postinflammatory hyperpigmentation (PIH) can be effectively treated with most of the pigment-specific lasers.

Permanent reduction of unwanted hair by lasers and light sources has been established in the last 20 years as a quick, safe and reliable option overall earlier, temporary hair removal modalities. Excess, unwanted hair affects both genders, and treating it with lasers has been found to improve quality of life.

Tattoo removal is a big and still growing use for lasers. Recent studies have estimated that approximately one in four American adults have tattoos. Furthermore, approximately 40 percent of individuals between the ages of 26 and 40 have a tattoo. Of that subset, approximately one in five will consider removal of their tattoo.

Perhaps the greatest breakthrough with lasers has been to treat wrinkles, texture and scars. The best devices that have been developed for such conditions are the fractional lasers. These lasers can be effective in treating photodamage, fine rhytids, mild dyschromia, melisma, scars, striae, and [much] more. Fractional Ablative lasers continue to evolve with new second generation devices. These fractional devices create fractional grooves and generate a directional injury and cross linear patterns that can be customized.

Photodynamic Therapy (PDT) effectively treats superficial non-melanoma skin cancers, actinic keratosis and acne. The treatment combines use of a photosensitizer, a light source within the absorption spectrum of the photosensitizer and molecular oxygen, which when stimulated will destroy a specific target tissue.

Lasers are leading the way in scar rehabilitation, or the restoration of form and function in scar patients. While there are multiple therapeutic scar rehabilitation approaches, lasers are a scientifically precise and effective treatment modality to rehabilitate and improve scars. The kind of scars that laser can treat are atrophic, acne, surgical, burn and trauma scars,”

Future applications

Emerging technologies, lasers and devices are plasma-induced ablation, vaginal resurfacing, indocyanine green augmented diode laser, free electron laser, smart accessory devices such as the Optimal Coherence Tomography, CelluTome and still others. The military is evaluating plasma-induced ablation as a source of plasma energy for wound healing, infection, skin treatments and aesthetic purposes.

Vaginal laser rejuvenation can tighten and tone sagging, loose or excess tissues in the vaginal and labial area. It also helps with urinary incontinence. These laser techniques are non-invasive, without the need for surgical incisions and sutures.

The indocyanine green augmented laser diode is an IV infusion of the indocyanine green (throughout the process of PDT), which is activated with a laser. European researchers are studying the use of the indocyanine green augmented laser diode port wine stain treatment and other vascular applications. Researchers also are studying the free electron laser. In lasers, electrons go through an accelerator and give up energy in order to be able to control the electromagnetic spectrum. This is how the beam of a laser is simulated and how there are different lasers with different wavelengths to treat different indications.

This new device that is being studied will have one device that will have all of the different wavelengths to be able to treat all of the indications. Smarter devices are on the horizon, such as Optimal Coherence Tomography. This imaging device helps visualize skin structure in in-vivo high definition. It’s non-invasive, rapid and painless for the patient and offers views in less than one second. Dr. Waibel is involved in a clinical trial looking at using novel epidermal harvesting technology for treatment of hypopigmented skin conditions. CelluTome (Acelity) is a scarless, and painless epidermal grafting procedure of fibroblasts and melanocytes by creating micro suction blisters, with a combination of suction and warmth. This device is currently FDA approved as a therapy for diabetic ulcers and allows for epidermal skin grafting in the outpatient setting without donor site morbidities, like scarring.

Dr. Waibel is a speaker, investigator or researcher for Acelity, Alma Lasers, Candela/Syneron, Cutera, Lumenis, Lutronics, Michelson Diagnostics, Kythera, Sebacia and Sciton and assistant professor at the Miller School of Medicine, University of Miami (Voluntary), and chief of dermatology at Baptist Hospital, Miami, Fla.

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