Pulsed Dye laserPulsed Dye laser In In DermatologyDermatology

ByByManal SalahManal Salah

Ass.Prof. of dermatologyAss.Prof. of dermatology

NILES Cairo UniversityNILES Cairo University

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)

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

Argon Laser

Gas Laser• Wavelength 488 - 514 nm

• Pulse duration CW - Pulsed • Spot size 1- 2 mm • Chromophore Haemoglobin & Melanin

KTP Laser

Solid state Laser

• Wavelength 532 nm •Pulse duration CW - Pulsed - Q switched •Spot size 1, 2, 4 mm •Chromophore Haemoglobin & Melanin

Nd:YAG Laser

Solid state Laser• Wavelength 1064 nm • Pulse duration CW - Pulsed - Q switched Long pulsed • Spot size variable • Chromophore Non specific

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.

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

*For Vascular Lesions

*Wavelength

*Pulse Duration

*Chromophore

585nm OR 585,590,595,600nm

450 & \ OR 1500 microseconds Up to 40 msec

Oxyhaemoglobin

Dye Lasers

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.

Absorption CurvesAbsorption Curves

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.

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.

Delivery System

Flexible fiberoptic with different size

changeable hand pieces (2, 3, 5, 7,10,

&2x7 or 3x5 mm ).

Pretreatment measures *A written consent *Anesthesia (usually topical)

*Safety measures(precautions)

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.

Treatment Technique

PWS - Energy TestPWS - Energy Test

Treatment Technique

* Determine the MPD.

* Determine the treatment test dose .

* Choose the test site

Treatment Technique

*Pulse delivery. *Evaluation and frequency of revisits.

*Patient should know that treatment may be prolonged from months to years.

spots with overlap of 10% are required to cover effectively

DIRECTION OF TREATMENT

lase

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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.

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).

Pediatric Port Wine Pediatric Port Wine StainStain

Before Treatment

Following Treatment

Photo Courtesy ofMilton Waner, MD

Adult Port Wine StainAdult Port Wine Stain

Before Treatment Following Treatment

Photo Courtesy ofMilton Waner, MD

Facial TelangiectasiaFacial Telangiectasia

Before Treatment Following Treatment

Photo Courtesy ofChris Zachery, MD

Facial TelangiectasiaFacial Telangiectasia

Before Treatment Following Treatment

Photo Courtesy ofDavid McDaniel, MD

RosaceaRosaceaBefore TreatmentBefore Treatment

Following TreatmentFollowing Treatment

Photo Courtesy ofDavid McDaniel, MD

Leg VeinsLeg Veins

Pre TreatmentPre Treatment 33 weeks post treatmentweeks post treatment

Courtesy: Emil Tanghetti. MD