Source: American Academy of Dermatology (AAD)

Released: Thu 24-Oct-2002, 00:00 ET  Embargo expired: Wed 23-Oct-2002, 12:00 ET  Printer-friendly Version

New Laser/Light Therapies Hit the Mark in Treating Some Hard-To-Treat Skin Conditions

EMBARGOED UNTIL OCTOBER 23, 2002

Psoriasis, eczema, seborrheic dermatitis, vitiligo and hypopigmentation are common skin disorders that affect millions of Americans. While treatment of these conditions often requires topical and systemic medications such as corticosteroids and antibiotics, results vary from person to person and often these medications can cause side effects. But now, help may be only a light beam away for these patients thanks to newly developed laser and light-based technology that offers non-invasive, non-systemic and medication-free treatment alternatives.

Speaking today at the American Academy of Dermatology's Derm Update 2002, dermatologist Arielle N.B. Kauvar, MD, Clinical Associate Professor of Dermatology, New York University School of Medicine, New York, discussed how lasers and light sources show promising results as a viable alternative in treating several common skin conditions.

Psoriasis

Psoriasis is an inherited skin disorder affecting an estimated 7 million Americans, with approximately 200,000 new cases diagnosed each year. The disease appears as red, scaly lesions or plaques, and is commonly found on the knees, elbows, trunk and buttocks. Traditional treatments range from topical creams or ointments to oral medications -- which must be monitored for systemic side effects -- to ultraviolet B (UVB) light box phototherapy -- which is time consuming and associated with an increased risk of photoaging and skin cancer.

Light-based technology that has been shown to clear psoriatic skin lesions include the yellow light pulsed dye laser at 585 nm, and the excimer laser -- emitting UVB light at 308 nm. Laser and light-based technologies provide non-invasive treatments without systemic side effects. Compared to conventional phototherapy, the psoriatic lesions can be precisely treated with significantly higher doses of light. This results in fewer treatment sessions for disease clearance and eliminates exposure of healthy skin.

With the pulsed dye laser, the abnormal mass of small blood vessels that grow in psoriasis lesions is destroyed. The pulsed dye laser clears psoriatic lesions by selectively destroying the blood vessels responsible for skin inflammation from the inside out, without damaging the surrounding skin. In general, two to six treatment sessions are performed at intervals of two to four weeks. Bruising and occasional crusting develops over the treated lesions, lasting approximately one week. Studies have shown that 40 percent to 60 percent of subjects experienced a good to excellent result, and 40 percent of patients were cleared of their lesions in two to five treatment sessions on average. Complete remissions have lasted as long as 48 months.

Another laser that was studied in a multi-center trial for the treatment of mild to moderate plaque-type psoriasis was the 308 nm excimer laser. Treatments were performed twice weekly for a total of 10 treatments. Fifty percent of patients achieved 90 percent or better clearing in 10 or fewer treatment sessions. Eighty-four percent of patients reached improvement of
75 percent or better after 10 or fewer treatment sessions.

"One of the major advantages of using laser therapy for psoriasis is that the treatment takes only minutes and fewer sessions are needed than conventional phototherapy to achieve similar clearing," said Dr. Kauvar. "Patients can incorporate treatment sessions into their daily lives such as during their lunch hour and return to work with no obvious signs of their treatment."

Eczema and Seborrheic Dermatitis

Eczema is a skin disorder that appears as patches of dry, red skin, sometimes with a scale and crust. Oftentimes intense itchiness is present with this condition, which leads to scratching and skin infections. Patients with eczema usually require frequent use of topical, and occasionally, systemic medications. In the United States alone, eczema affects more than 15 million people of all ages.

Seborrheic dermatitis, affecting approximately 3 percent to 5 percent of the adult population, is a chronic inflammatory condition of the skin that arises in areas with a high concentration of active sebaceous glands -- particularly the face and scalp. It is considered a severe form of dandruff and appears as red, inflamed skin with waxy scales.

For both of these conditions, an intense pulsed UVB light can be delivered to the skin at higher doses than conventional UVB phototherapy. Only the affected skin areas are treated, sparing the surrounding normal skin. Results using the intense pulsed UVB light can be seen in fewer treatment sessions than with the UVB phototherapy.

Vitiligo and Hypopigmentation

In recent studies, the excimer laser and intense pulsed UVB light source have also been demonstrated to repigment vitiligo and hypopigmented or white scars. Vitiligo is a skin condition of sharply bordered, white patches resulting from the loss of melanocytes, the skin pigment cells. Vitiligo affects 1 percent to 2 percent of the population, and approximately 50 percent of patients develop skin lesions before age 10. Vitiligo commonly affects the skin around the mouth and eyes and can be cosmetically disfiguring, particularly in dark-skinned individuals.

Until recently, available treatments including phototherapy, and topical or injected corticosteroids have been used with little success. Conventional phototherapy often requires treatment several times a week for up to a year to see visible improvement in coloration.

In a study of the 308 nm excimer laser, 29 patches of vitiligo were treated three times a week up to a maximum of 12 treatment sessions. Twenty-three patches of vitiligo received at least six treatments, resulting in some repigmentation in 57 percent of the patches. Of the 11 vitiligo patches that received all 12 laser treatments, 82 percent showed some repigmentation.

"The degree of repigmentation observed after two to four weeks of this therapy is significantly better than that achieved with conventional vitiligo therapy," said Dr. Kauvar.

In other studies, the 308 nm excimer laser, as well as the intense pulsed UVB light source, were shown to partially repigment white scars that developed following surgical procedures as well as laser resurfacing. Prior to the use of these methods, there was no known treatment to repigment skin. Treatment usually requires two sessions a week for five to ten weeks, and in some individuals, maintenance therapy may be necessary.

"The improvements seen in patients with these common skin disorders using new laser therapies are really remarkable," added Dr. Kauvar. "Ongoing clinical investigation should help to further optimize these novel techniques and apply them to the treatment of other skin conditions in the future."

Patients need to be aware that many states do not distinguish who can and cannot perform procedures with laser/light sources. "Since skin treatments using lasers can carry potential side effects, they should be performed by a qualified physician or under direct physician supervision. I encourage patients to ask their physician questions about who will be performing laser surgery, including their qualifications," cautioned Dr. Kauvar.

The American Academy of Dermatology, founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of over 14,000 dermatologists worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical, and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; supporting and enhancing patient care for a lifetime of healthier skin. For more information, contact the AAD at 1-888-462-DERM or www.aad.org.

The American Society for Dermatologic Surgery (ASDS) was founded in 1970 to promote excellence in the field of dermatologic surgery and to foster the highest standards of patient care. For more information or referrals to dermatalogic surgeons in specific geographic areas, please contact the ASDS Consumer Hotline, 1-800-441-ASDS (2737), during weekday business hours or log on at http://www.aboutskinsurgery.com.