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

and randomized to receive up to four treatments approximately one month apart with OPL (MaxG Optimized Light
Handpiece, Palomar, Burlington, MA). OPL was used with a spectral range of 500-670 and 870-1200nm, pulse
duration of 3, 5 or 10msec, and fluence range of 20-40 J/cm 2
. One small area of the PWS was treated with PDL
(VBeam, Candela, Wayland, MA) at 595nm, 1.5-3ms, and 6.0-8.5 J/cm 2
for comparison. Clinical photographs were
taken before and after each treatment, and improvement of the PWS was assessed clinically. A reflectance-based
device was used to objectively measure hemoglobin and melanin levels to track PWS clearance in comparison to
adjacent normal skin. Results: Five patients with PWS on the trunk or extremity were enrolled in the study. Most
patients underwent four treatment sessions. One patient only received two treatment sessions due to relocation.
Majority of the patients had fair (26-50%) improvement of PWS after one treatment. Good (51-75%) to excellent
(76%-99%) improvement of PWS vascularity was achieved in patients four treatments with various pulse durations
(3, 5, and 10msec). Areas treated with the lower pulse duration (3 msec) showed the greatest improvement based
on reflectometer readings. However, in two cases, post-inflammatory hyperpigmentation compromised the clinical
vascular clearance. Pain associated with OPL treatment was mild to moderate, and only one patient required
numbing cream prior to the treatment. Erythema and edema were commonly observed post OPL treatment
regardless of settings. However, purpura, blanching, and hyperpigmentation were observed with the short pulse
duration (3 msec) and high fluence settings. Conclusion: A new optimized light handpiece is effective in the
treatment of PWS. Lightening of PWS with OPL is comparable to PDL. Shorter pulses achieved slightly better
clearance, but with greater risk of post-inflammatory hyperpigmentation.
1064NM QS Nd:YAG LASER AND 1550NM ERBIUM-DOPED FRACTIONATED FIBER LASER FOR THE
TREATMENT OF NEVUS OF OTA IN FITZPATRICK SKIN TYPE IV
Irene Vergilis-Kalner, Paul Friedman, Jennifer Landau, Megan Moody, Leonard Goldberg, Denise Marquez, Derm
Surgery Associates, Houston, TX
Background: Nevus of Ota, or oculodermal melanocytosis, typically presents as a blue-black, brown, or gray
macule on the face along the distribution of the ophthalmic or maxillary branches of the trigeminal nerve. It is a
congenital lesion that is present at birth in the majority of cases; otherwise, it tends to appear in the teen
years. Treatment options for these nevi include the use of bleaching creams, cryotherapy, surgery, and lasers, with
varying degrees of success being reported. Lasers have recently been designated the most effective treatment
modality for this condition. Most commonly, Q-switched (QS) lasers have been used, including the Q-switched
ruby (QSRL), Q-switched neodymium-doped yttrium aluminum garnet (QS Nd:YAG), and Q-switched alexandrite
(QSAL) lasers. The Q-switched mechanism is advantageous over other options in that it allows for the laser to be
used at higher energies over a shorter pulse duration, which limits nonspecific thermal damage and
scarring. More recently, a fractionated 1550-nm erbium-doped fiber laser was reported to effectively treat one
patient with nevus of Ota. We report the successful treatment of a nevus of Ota in two patients with Fitzpatrick Skin
Type IV utilizing serial therapy with a 1064-nm QS Nd:YAG and a 1550-nm fractionated Erbium-doped fiber laser.
Study: In case 1, patient received over the period of 2 years a total of 9 treatments with the 1064-nm QS
Nd:YAG (Medlite®, HOYA ConBio®, Fremont CA). Response to treatment was observed to plateau 6 months
after the final QS Nd:YAG session. Consequently, it was decided to utilize nonablative fractional technology. The
patient subsequently underwent 4 treatments with the 1550-nm fractionated erbium-doped fiber laser (Fraxel
re:store, Solta Medical, Haywood, CA) conducted at an average treatment interval of 2 months. In case 2,
patient underwent 2 treatments with the 1064-nm QS Nd:YAG laser (Medlite®, HOYA ConBio®, Fremont CA).
Due to the minimal response to treatment, it was decided to utilize a sequential approach with the 1064-nm QS
Nd:YAG laser followed immediately on the same day by a treatment session with the 1550-nm fractionated erbium
doped fiber laser (Fraxel re:store, Solta Medical, Haywood, CA). A total of ten treatment sessions were
conducted at an average treatment interval of 2 months. Results: In case 1, 85% improvement was noted after
the series of treatments with the1064-nm QS Nd:YAG, and >95% improvement was achieved after additional
treatment sessions with the 1550-nm fractionated Erbium-doped fiber laser. At the12-month follow-up after the
final laser treatment session, greater than 95% improvement in the nevus of Ota was seen without any visible
evidence of recurrence. In case 2, significant improvement was noted after 6 sequential treatment sessions with
the1064-nm QS Nd:YAG followed immediately by treatment with the 1550-nm fractionated Erbium-doped fiber
laser; complete clearance was noted after a total of 10 sessions. At an 11-month follow-up after the final laser
treatment session, we noted that complete clearance in the Nevus of Ota was maintained without any visible
evidence of recurrence. Conclusion: These cases exemplify the utilization of a serial therapy treatment approach
to accomplish clearance of the nevi of Ota using both the 1064-nm QS Nd:YAG laser and the1550-nm fractionated
erbium-doped fiber laser in patients with FST IV. In the first case, after observing no further response 6 months
after the final treatment with 1064-nm QS Nd:YAG, we decided to see if fractionated laser technology would yield
further improvement in our patient’s condition. And in the second case, we treated the patient sequentially with both
lasers on the same day. In both cases, the combination turned out to be an ideal treatment regimen considering that
it targets pigment by two different, yet seemingly synergistic mechanisms. The 1064-nm QS Nd:YAG laser functions
by selective photothermolysis of melanin, which results in injury to epidermal and dermal melanosomes. Fractional
photothermolysis is believed to function by a “melanin shuttle” mechanism, which results in the elimination of