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

melanin pigment from the skin with other photocoagulation debris through microscopic treatment zones (MTZs)
created by the laser. Because nevus of Ota is a dermal lesion, specifically localized to the papillary and upper
portion of the reticular dermis, treatment options need to allow adequate dermal penetration. Both of the lasers used
in these patients have settings that, when adjusted accordingly, ensure sufficient depth to target the pigment
characteristic of this lesion. Consequently, this combination therapy approach adds to the currently available
options for successful and safe laser treatment of nevus of Ota in FST IV. Further long-term, prospective studies
with a more expansive study population are indicated to better understand the efficacy of this serial therapy for the
treatment of nevi of Ota and to determine optimal treatment settings.
SUCCESSFUL TREATMENT OF FACIAL MELASMA WITH A COMBINATION OF MICROMDERMABRASION
AND Q-SWITCHED Nd:YAG LASER TREATMENT
Arielle Kauvar, New York Laser & Skin Care, New York, NY
Background: Melasma is a common, disfiguring problem in women that is often refractory to various treatment
modalities, and long term remissions are difficult to achieve. The purpose of this study was to assess the safety and
effectiveness of a procedure combining microdermabrasion and Q-Switched (QS) Nd: YAG laser treatment. Study:
This was an observational study of 27 female subjects, photoypes (II-V), who were referred for treatment of
mixed-type melasma refractory to previous therapies. Treatment consisted of a microdermabrasion, immediately
followed by low fluence QS Nd: YAG laser treatment. Repeat treatment was performed at 4 week intervals.
Beginning 2 days after each laser treatment, the subjects used a topical skin care regimen consisting of
hydroquinone, tretinoin and a broad spectrum sunscreen. Standardized digital photographs were obtained before
each treatment session, and at the follow up visits. Grading was assessed by blinded comparison of standardized
pre- and post-treatment digital images, using a quartile grading system. Adverse effects were recorded at each visit.
Follow up was obtained at 3 to 12 months after the last treatment. Results: The treatment was deemed painless by
all subjects and required no anesthesia. The average number of treatment sessions was 2.6. Of the 27 subjects,
22 (81%) had greater than 75% clearance of melasma, with 11 (40%) of the subjects achieving >95% clearance of
their pigmented patches. The majority of patients showed greater than 50% clearance of their melasma 1 month
after the first treatment session. Only one subject demonstrated less than 25% clearance after one treatment. Side
effects were limited to mild post-treatment erythema, which developed after the microdermabrasion, and lasted
approximately 30-60 minutes. Four subjects noted temporary exacerbation of their melasma after inadvertent sun
exposure, but this resolved within several weeks of resuming the hydroquinone and tretinoin skin care regime.
Conclusion: The combination of a microdermabrasion and low fluence QS:YAG application is a simple,
non-invasive procedure with minimal risk and no recovery time. Subject compliance with skin care was excellent,
probably due to the dramatic improvement they observed within 4 weeks. The combination of a
microdermabrasion and low fluence QS Nd:YAG laser appears to produce consistent improvement in melasma in
all skin phototypes, in just 2-3 treatment sessions, with remissions lasting at least 6 months.
PULSE STACKING WITH A 1450-NM LASER CAN INCREASE DEPTH OF TREATMENT
Arisa Ortiz, William Lewis, R. Rox Anderson, University of California Irvine, Irvine, CA; Wellman Center for
Photomedicine, Boston, MA
Background: Mid-infrared (1320, 1450nm) lasers, absorbed by water, are used to treat a variety of dermal
conditions, but depth of treatment is a limitation. Thermal injury is typically achieved at dermal depths ranging from
150 to 400 microns, while maintaining epidermal preservation with a dynamic cooling device (DCD). In theory, pulse
stacking might be used to increase the depth of treatment depending on the balance between laser-induced skin
heating and cryogen-induced skin cooling. We tested this hypothesis by examining the pattern of thermal injury for
stacked pulses at different DCD cryogen spray durations. Study: Ex vivo porcine skin was irradiated with a 1450nm
laser at a fluence of 14 J/cm 2
, a frequency of 1 Hz, and a 6 mm spot size. A variable number of stacked pulses were
delivered at DCD cryogen spray durations ranging from 0 to 85 milliseconds. Biopsies taken immediately after
irradiation were stained grossly with nitroblue tetrazolium chloride (NBTC). Digital photography was used to
evaluate the depth and pattern of dermal necrosis, and preservation of epidermal viability. Results: The number
of stacked pulses necessary to achieve dermal necrosis increased with increasing cryogen spray duration. Near the
threshold for dermal necrosis, epidermis was preserved. The depth of dermal injury increased with pulse stacking
up to approximately 1 mm. Conclusion: We show the ability to control the depth of dermal treatment by a 1450-nm
laser without epidermal injury by adjusting DCD settings and the number of pulses stacked. Clinical studies are
warranted to explore the possibility of pulse stacking with the 1450-nm laser as a treatment for deep dermal
processes.
Experimental and Translational Medicine Session
CHARACTERIZING VARIABILITY IN RAMAN SPECTRA OF BENIGN LESIONS TOWARDS CANCER
DETECTION IN SKIN
Isaac Pence, Chetan Patil, Elizabeth Vargis, Darrell Ellis, Anita Mahadevan-Jansen, Alex Walsh, Matthew Keller,