pulsed dye laser in dermatology
TRANSCRIPT
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Pulsed Dye laserPulsed Dye laser In In DermatologyDermatology
ByByManal SalahManal Salah
Ass.Prof. of dermatologyAss.Prof. of dermatology
NILES Cairo UniversityNILES Cairo University
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Vascular LasersVascular Lasers
Argon(488-514nm)Argon(488-514nm) KTP(532nm)KTP(532nm) Dye(585,590,595,600nm)Dye(585,590,595,600nm) Nd-YAG(1064nm)Nd-YAG(1064nm)
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Indications Of Indications Of Vascular LasersVascular Lasers
Vascular NeviVascular Nevi Vascular malformationsVascular malformations
Pyogenic granulomaPyogenic granuloma Venous lakesVenous lakes AngiokeratomaAngiokeratoma TelangiectasiaTelangiectasia AngiofibromaAngiofibroma
RosaceaRosacea Keloids & Scars Keloids & Scars
(existing&prophylactic)(existing&prophylactic) WartsWarts Striae distensaeStriae distensae PostAcne scarsPostAcne scars PsoriasisPsoriasis XanthelasmaXanthelasma
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Argon Laser
Gas Laser• Wavelength 488 - 514 nm
• Pulse duration CW - Pulsed • Spot size 1- 2 mm • Chromophore Haemoglobin & Melanin
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KTP Laser
Solid state Laser
• Wavelength 532 nm •Pulse duration CW - Pulsed - Q switched •Spot size 1, 2, 4 mm •Chromophore Haemoglobin & Melanin
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Nd:YAG Laser
Solid state Laser• Wavelength 1064 nm • Pulse duration CW - Pulsed - Q switched Long pulsed • Spot size variable • Chromophore Non specific
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Dye Lasers
Lasers containing fluorescent dyes dissolved in a common solvent e.g. alcohol or water,that absorbs light at one wavelength and emits light at another wavelength.
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Dye lasers work based on the theory of SelectivePhotoThermolysis(SPTL)which means :- Site specific-Thermally mediated injury of-Microscopic tissue targets-By selectively absorbed pulses of radiation.
Dye Lasers
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*For Vascular Lesions
*Wavelength
*Pulse Duration
*Chromophore
585nm OR 585,590,595,600nm
450 & \ OR 1500 microseconds Up to 40 msec
Oxyhaemoglobin
Dye Lasers
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Why 585 nm?Oxyhaemoglobin has 3 peaks for light
absorption: * 418nm (The strongest) * 542nm * 577nm (The deepest & least
absorbed by melanin)
585nm was found to be deeper than 577nm& less absorbed by melanin.
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Absorption CurvesAbsorption Curves
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Thermal Thermal Relaxation TimeRelaxation TimeThe time necessary for the The time necessary for the
target chromophore to cool target chromophore to cool down 50%, through the down 50%, through the transfer of its heat to transfer of its heat to surrounding tissue via surrounding tissue via thermal diffusion.thermal diffusion.
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In order to get OPTIMUM results:* The wavelength must be well absorbed by
oxyhaemoglobin, less by melanin & of deep penetration.* The pulse duration must be shorter than or equal to the TRT of the target.
This makes the majority of the absorbed energy to be retained by the target structure & minimizes non-specific thermal damage.
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Delivery System
Flexible fiberoptic with different size
changeable hand pieces (2, 3, 5, 7,10,
&2x7 or 3x5 mm ).
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Pretreatment measures *A written consent *Anesthesia (usually topical)
*Safety measures(precautions)
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Safety measures(precautions) Protect eyes ……….. eye glasses &
shields.
Laser off or standby when not in use.
Plume or steam ……….smoke evacuator. Avoid reflecting objects. * Labeling the theatre.
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Treatment Technique
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PWS - Energy TestPWS - Energy Test
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Treatment Technique
* Determine the MPD.
* Determine the treatment test dose .
* Choose the test site
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Treatment Technique
*Pulse delivery. *Evaluation and frequency of revisits.
*Patient should know that treatment may be prolonged from months to years.
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spots with overlap of 10% are required to cover effectively
DIRECTION OF TREATMENT
lase
r
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Post treatment measures
*Sun screen for at least 6 months after the end of last session. *Topical antibiotic ointment once/day until disappearance of purpura.
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Complications Of Laser treatment
*Generally it is very safe with very low incidence of side effects, and can be used at any age. -Scarring(<1%). -Hyperpigmentation ( 10 - 15% , transient, resolves in 2-3 months). -Hypopigmentation (5%, transient,resolves within 2 months).
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Pediatric Port Wine Pediatric Port Wine StainStain
Before Treatment
Following Treatment
Photo Courtesy ofMilton Waner, MD
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Adult Port Wine StainAdult Port Wine Stain
Before Treatment Following Treatment
Photo Courtesy ofMilton Waner, MD
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Facial TelangiectasiaFacial Telangiectasia
Before Treatment Following Treatment
Photo Courtesy ofChris Zachery, MD
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Facial TelangiectasiaFacial Telangiectasia
Before Treatment Following Treatment
Photo Courtesy ofDavid McDaniel, MD
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RosaceaRosaceaBefore TreatmentBefore Treatment
Following TreatmentFollowing Treatment
Photo Courtesy ofDavid McDaniel, MD
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Leg VeinsLeg Veins
Pre TreatmentPre Treatment 33 weeks post treatmentweeks post treatment
Courtesy: Emil Tanghetti. MD
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