Presidential Greeting - American Society for Laser Medicine and ...

24 American Society for Laser Medicine and Surgery Abstracts
tolerated fluence was determined by treating the test areas with a
series of laser pulses of increasing fluence and assessing the
patient’s pain rating and erythema.
Results: Strong correlation was found between the maximum
tolerated fluence and the MOD. The MOD tended to increase with
the skin type; however, strong variations of the MOD within given
skin type were observed. Effect of the pulsewidth on the maximum
tolerated fluence was also observed, with higher MOD being more
sensitive to changes of the pulsewidth.
Conclusion: MOD measurement can be used to predict
maximum tolerated fluence for visible/near-IR phototreatment
devices. The MOD measurement device can be integrated into the
treatment device, which allows real-time MOD measurement and
automatic adjustment of the treatment fluence.
#75
QUALITY CONTROL AND THE PULSED DYE
LASER: WHEN NOT TO TREAT
Joshua Shofner, Zeina Tannous, Mathew Avram
Massachusetts General Hospital, Boston, MA
Background: The availability of effective laser treatment for
cutaneous vascular lesions has risen dramatically in recent years.
At the same time, there has been a proliferation of laser providers
with varying amounts of training—both medical and non-medical.
Study: We performed a retrospective analysis of four cases from
our clinic, where patients presented for cosmetic evaluation of
vascular lesions and were discovered to have more significant
pathologic disease.
Results: We report four separate cases with images in which
prompt recognition of a pathologic skin finding directed the
healthcare provider to pursue a more aggressive work-up, leading
to the diagnosis of basal cell carcinoma, melanoma, connective
tissue disease, and immune thrombocytopenic purpura.
Conclusion: In presenting these cases, we hope to illuminate a
basic differential diagnosis that exists for cutaneous vascular
lesions and remind healthcare providers that not all cosmetic
consults are benign in origin. There is a differential diagnosis
framework that exists for vascular lesions that is worth reviewing,
and it should be considered in all patients presenting for laser
treatment.
#76
OPTIMAL TATTOO REMOVAL IN ONE
TREATMENT SESSION WITH NANOSECOND-
DOMAIN LASER PULSES
Theodora Kossida, Dimitrios Rigopoulos,
Andreas Katsambas, R. Rox Anderson
A. Syggros Skin Disease Hospital, National and Kapodistrian
University of Athens Medical School, Athens, Greece; Wellman
Center for Photomedicine, Massachusetts General Hospital,
Harvard Medical School, Boston, MA
Background: Presently, Q-switched lasers are the gold standard
for safe and effective tattoo removal. However, multiple and costly
therapeutic sessions are usually required with variable results
which leads to patients’ dissatisfaction and abandonment of the
treatment.
Study: The efficacy of a single laser exposure was compared to
that of multiple laser exposures about 20 minutes apart within a
single treatment session. Each of 18 tattoos on 12 adults was
divided into two symmetrical parts which were then
randomized for treatment with either the administration of a
single Q-switched alexandrite laser exposure (755 nm,
100 nanoseconds pulse duration, 3 mm spot size, 5.5 J/cm 2 ), or four
consecutive exposures separated by 20 minutes. Digital
photographs taken 3 months later were blindly evaluated to
compare tattoo lightening. Biopsies obtained before and
immediately post-treatment from both halves were also compared
in blinded fashion.
Results: Immediate response after the first laser exposure
consisted of typical whitening which faded over the next
20 minutes, while little or no whitening appeared right after
subsequent exposures. Three months later, lightening was much
greater in all sites treated with four exposures delayed by
20 minutes (the ‘‘R20’’ method), compared with sites treated
conventionally with a single laser exposure (P < 0.01). In
addition, a single treatment session using the ‘‘R20’’ method
removed most of the tattoos. There was greater epidermal injury
with the ‘‘R20 method,’’ followed by transient pigmentary
changes. No permanent side effects or scarring occurred.
Histology showed greater and deeper dispersion of tattoo ink with
the ‘‘R20’’ method.
Conclusion: The ‘‘R20’’ method of tattoo removal was safe, well
tolerated and much more effective than conventional Q-switched
laser treatment. This method can potentially reduce the number
of treatment visits and/or increase overall efficacy for tattoo
removal. New laser device technology is not required. Larger
prospective studies are warranted.
#77
COMBINATION OF MULTIPLE Q-SWITCHED
WAVELENGTHS IMPROVES TATTOO
CLEARANCE COMPARED TO SINGLE
WAVELENGTH TREATMENT
Arielle Kauvar
New York Laser & Skin Care, New York, NY
Background: Q-switched lasers can safely lighten tattoos, but
treatment of multicolored tattoos usually requires six or more
treatments, and incomplete pigment removal is common. The
purpose of this study was to determine whether using a
combination of laser wavelengths could improve tattoo clearance
in multicolored tattoos compared to single wavelength treatment.
Study: This was an IRB-approved, prospective, split-lesion
controlled trial of large ( > 6 cm), multicolored tattoos in 13
subjects with phototypes I–III. Each tattoo was bisected
symmetrically. The entire tattoo was treated with one pass of a QS
532 nm laser (50 nanoseconds, 3 mm, 1.5–2.6 J/cm 2 ) to the red,
yellow and orange pigments and one pass of QS 1,064 nm laser
(50 nanoseconds, 3 mm, 3.0–5.0 J/cm 2 ) to the black, blue and
green pigments to an endpoint of tissue whitening. After
20 minutes, a second laser pass was performed over one-half of the
tattoo using a QS 755 nm laser (50 nanoseconds, 3 mm, 5.0–9.0 J/
cm 2 ) for all pigments to an endpoint of tissue whitening. Each
tattoo received a total of four treatments, performed at 4- to 8week
intervals, with follow-up at 1 and 3 months after the last
laser treatment. Subjects were given the option to continue
receiving an additional four laser treatments in the same manner
to their tattoos. Standardized digital photographs and
chromometer measurements were obtained before each treatment
session, and at the follow-up visits. Adverse effects were recorded
at each visit.