Missy Gough (847) 240-1734 [email protected]
Karen Klickmann (847) 240-1735 [email protected]
Nadine Tosk (504) 483-6957 [email protected]
EMBARGOED UNTIL JULY 31, 1999
LASERS PROVIDE EFFECTIVE TREATMENT OPTIONS FOR DISFIGURING SKIN CONDITIONS
NNEW YORK (July 31, 1999) - Vascular lesions, pigmented lesions, warts, scars, and stretch marks are common skin disorders which are seen in patients of all ages. While treatment options for these disfiguring skin conditions were either unavailable, unsuccessful, or unacceptable in the past, effective and safe treatments are now available as a result of recent advances in laser technology which have revolutionized the field of dermatology.
Speaking today at Academy '99, the American Academy of Dermatology's summer scientific meeting, dermatologists Kenneth Arndt, MD, Professor of Dermatology, Harvard Medical School, Boston; Jeffrey Dover, MD, Associate Professor of Dermatology, Harvard Medical School, Boston; and George Hruza, MD, Associate Professor of Dermatology, Washington University, St. Louis, discussed the latest in the laser treatment of vascular lesions, pigmented lesions, warts, scars, and stretch marks.
VASCULAR LESIONS
Hemangiomas are relatively common vascular lesions that enlarge by rapid cell growth and appear within the first few weeks of life. "Although most hemangiomas spontaneously resolve in childhood, early treatment minimizes the enlargement of the tumor, prevents complications such as bleeding and ulceration, and produces more cosmetically-acceptable long-term results," stated Dr. Arndt.
Superficial ("capillary") hemangiomas respond best to pulsed dye laser (PDL) therapy. Because superficial hemangiomas are usually small in diameter, treatment results are generally quick (within two to four treatment sessions) and simple, with anesthesia seldom required. "Deep hemangiomas, which appear thick and bluish, usually do not benefit from laser therapy," explained Dr. Arndt. "In combined superficial and deep hemangiomas, the superficial component often responds, but the deep component continues to grow following treatment."
Port wine stains (PWS) are congenital vascular malformations which occur primarily on the face and the neck. "PDL treatments of port wine stains can produce remarkable lightening with a low risk of side effects," stated Dr. Arndt. "Although it has been thought that younger patients respond better to treatment, recent studies have demonstrated that similar results are obtained whether the PWS is treated in early childhood or at a later age." While multiple laser treatments are needed for significant lightening, clearing also depends on the anatomic location. Facial PWS respond best, neck lesions slightly less well, and PWS on the trunk and extremities respond the least favorably to laser therapy.
Dilated blood vessels on the face are vascular lesions which also respond favorably to laser treatment. Dilated blood vessels located in the lower portion of the side of the nose and in the groove between the nose and the lip are more resistant to treatment and are associated with an increased risk of scarring.
"Although there is great demand for laser treatment of dilated blood vessels on the legs, in general, response to any of the available laser therapies is poor," explained Dr. Arndt. Leg veins are more resistant to laser treatment than facial veins because they are usually deeper, larger in diameter, and have different flow characteristics. "Sclerotherapy is still the mainstay of therapy for leg veins," continued Dr. Arndt. "Lasers are most effective for superficial, fine vessels and when used in conjunction with sclerotherapy. They also offer an alternative for patients who cannot tolerate injections or have been unresponsive to other treatment modalities."
PIGMENTED LESIONS
Age spots are very responsive to pigment laser therapy. Occasionally, a second or third treatment is necessary to achieve an ideal result. "In general, the farther away the age spot is from the face, the less effective the laser treatment," stated Dr. Dover. Freckles are also responsive to laser therapy.
Cafe-au-lait spots do not respond as well to laser treatment as age spots. "In general, these light brown patches of skin require repeated laser treatments over a period of months to achieve maximal lightening," explained Dr. Dover. "As treatment progresses, uniform cafe-au-lait spots break up into a speckled pattern that eventually clears." While a patient's skin may darken during the treatment, it eventually fades.
Results of laser treatment of melasma, an abnormal darkening of the skin, and postinflammatory hyperpigmentation, darkening of the skin as a result of injury, are generally disappointing. "Although superficial melasma is responsive to laser therapy, it is also effectively treated with topical bleaching agents, limiting the need for laser treatment," stated Dr. Dover. "While deep melasma or mixed superficial and deep melasma may lighten with treatment, invariably pigmentation recurs with sun exposure." Postinflammatory hyperpigmentation has shown temporary improvement and, in the occasional case, total lightening is observed. However, in many cases, the darkening of the skin is actually worsened by treatment.
Currently, there are several lasers that can effectively remove tattoos with a very low risk of scarring. Laser treatment of tattoos depends on the type of tattoo and its pigment content. "Since black tattoo pigment absorbs all laser wavelengths, it is the easiest to remove," remarked Dr. Dover. "Colored tattoos selectively absorb laser light and can thus effectively be treated by only some lasers."
Since a tattoo may consist of more than one color, and because there is no single laser that can treat all colors, multicolored tattoos usually require the use of more than one laser for complete removal. "Amateur tattoos require fewer laser treatments because they usually consist of a single pigment," explained Dr. Dover. "Professional tattoos may contain multiple pigments, which are less easily disrupted, requiring more treatments to clear. "
WARTS, SCARS, AND STRETCH MARKS
Lasers effectively flatten and reduce the redness of thick scars. "Relatively recent thick scars, especially those that are still red, respond best to pulsed dye laser (PDL) therapy, while old, white, hard scars are less responsive," stated Dr. Hruza. Multiple laser treatments are usually necessary and patients may experience temporary darkening of the skin after laser treatment. The addition of wound dressings such as silicone gel sheeting and/or intralesional steroids may enhance a scar's response to laser therapy.
The PDL is also effective in improving the appearance of stretch marks.
"Because of the reduction of redness, red stretch marks respond to laser treatment better than white stretch marks," stated Dr Hruza. "In addition, childbirth related stretch marks respond better than adolescence related ones." While the response rate is very gradual, PDL therapy ultimately improves skin texture and increases elastin.
Lasers are also used to treat warts and keloids. "While both the PDL and the CO2 laser are moderately effective in the treatment of warts, these treatments can be painful and expensive," explained Dr. Hruza. "To date, no laser has proven effective in the treatment of keloids."
The American Academy of Dermatology, founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership over 12,000 dermatologists worldwide, the Academy is committed to: advancing the science and art of medicine and surgery related to the skin; advocating high standards in clinical practice, education, and research in dermatology; supporting and enhancing patient care; and promoting a lifetime of healthier skin, hair, and nails. For more information, contact the AAD at 1-888-462-DERM (3376) 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 on cosmetic surgery and referrals to doctors in specific geographic areas, please contact the ASDS Consumer Hotline, 1-800-441-ASDS (2737), during weekday business hours or visit our Web site at www.asds-net.org.
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