Anthony M. Rossi, MD

In the May 2013 issue of the British Journal of Dermatology (2013;168:1040-1046) Gao et al reported on a side-by-side comparison of the use of photodynamic therapy (PDT) versus the pulsed dye laser (PDL) for the treatment of 9 red and 6 purple port-wine stains (PWSs). Fifteen patients (age range, 11–36 years) with PWSs were chosen and 2 adjacent areas of the lesion were randomly assigned to receive either a single PDL treatment or a single PDT session. Eleven lesions were on the neck area, 3 on the upper arm, and 1 on the upper leg. The PDL had a wavelength of 585 nm, and PDT was performed with intravenous hematoporphyrin monomethyl ether and a low-power copper vapor laser (510.6 and 578.2 nm, respectively). The PDT-treated area was done 30 minutes after the PDL-treated area with the other areas being covered. The clinical outcome was measured colorimetrically (blanching rates) and visually.

For the red PWSs the blanching rates at 2 months with the PDL were 11% to 24% and 22% to 55% with PDT (P=.006). For the purple PWSs, blanching rates ranged from 8% to 33% with PDL and 30% to 45% with PDT (P=.0313). Two patients with purple PWSs showed no response to either PDT or PDL. All PDT sites developed localized edema, and all PDL sites developed edema, blistering, purpura, and crusts. Four patients with red PWSs developed hyperpigmentation at the PDL sites.

What’s the issue?
Although there have been studies showing that PDT is an effective treatment of PWSs, this study is a side-by-side quantitative comparison of PDL versus PDT. This study showed that PDT is as effective and as safe as PDL and possibly superior for the treatment of red and purple flat PWSs. This study represents promising steps forward in PDT treatment of dermatologic conditions.

Even though PDL therapy is considered the current standard for treatment of PWSs, this study does show good clearance with PDT. Pulsed dye laser therapy has been more readily available in North America and Europe, though in China, where this study took place, it is not common. The PDT in this study utilized an intravenous photosensitizer, which may not be suitable for all patients. Other limitations of this study include the small sample size and the possibility that treating the lesion halves in close proximity to each other may compound adverse effects. Because each half of the lesion (close proximity to one another) was treated, the effects of each treatment may have been compounded.

Could PDT become an adjuvant treatment in the armamentarium for resistant port-wine stains?

We want to know your views! Tell us what you think.

In the May 2013 issue of the British Journal of Dermatology (2013;168:1040-1046) Gao et al reported on a side-by-side comparison of the use of photodynamic therapy (PDT) versus the pulsed dye laser (PDL) for the treatment of 9 red and 6 purple port-wine stains (PWSs). Fifteen patients (age range, 11–36 years) with PWSs were chosen and 2 adjacent areas of the lesion were randomly assigned to receive either a single PDL treatment or a single PDT session. Eleven lesions were on the neck area, 3 on the upper arm, and 1 on the upper leg. The PDL had a wavelength of 585 nm, and PDT was performed with intravenous hematoporphyrin monomethyl ether and a low-power copper vapor laser (510.6 and 578.2 nm, respectively). The PDT-treated area was done 30 minutes after the PDL-treated area with the other areas being covered. The clinical outcome was measured colorimetrically (blanching rates) and visually.

For the red PWSs the blanching rates at 2 months with the PDL were 11% to 24% and 22% to 55% with PDT (P=.006). For the purple PWSs, blanching rates ranged from 8% to 33% with PDL and 30% to 45% with PDT (P=.0313). Two patients with purple PWSs showed no response to either PDT or PDL. All PDT sites developed localized edema, and all PDL sites developed edema, blistering, purpura, and crusts. Four patients with red PWSs developed hyperpigmentation at the PDL sites.

What’s the issue?
Although there have been studies showing that PDT is an effective treatment of PWSs, this study is a side-by-side quantitative comparison of PDL versus PDT. This study showed that PDT is as effective and as safe as PDL and possibly superior for the treatment of red and purple flat PWSs. This study represents promising steps forward in PDT treatment of dermatologic conditions.

Even though PDL therapy is considered the current standard for treatment of PWSs, this study does show good clearance with PDT. Pulsed dye laser therapy has been more readily available in North America and Europe, though in China, where this study took place, it is not common. The PDT in this study utilized an intravenous photosensitizer, which may not be suitable for all patients. Other limitations of this study include the small sample size and the possibility that treating the lesion halves in close proximity to each other may compound adverse effects. Because each half of the lesion (close proximity to one another) was treated, the effects of each treatment may have been compounded.

Could PDT become an adjuvant treatment in the armamentarium for resistant port-wine stains?

We want to know your views! Tell us what you think.

In the May 2013 issue of the British Journal of Dermatology (2013;168:1040-1046) Gao et al reported on a side-by-side comparison of the use of photodynamic therapy (PDT) versus the pulsed dye laser (PDL) for the treatment of 9 red and 6 purple port-wine stains (PWSs). Fifteen patients (age range, 11–36 years) with PWSs were chosen and 2 adjacent areas of the lesion were randomly assigned to receive either a single PDL treatment or a single PDT session. Eleven lesions were on the neck area, 3 on the upper arm, and 1 on the upper leg. The PDL had a wavelength of 585 nm, and PDT was performed with intravenous hematoporphyrin monomethyl ether and a low-power copper vapor laser (510.6 and 578.2 nm, respectively). The PDT-treated area was done 30 minutes after the PDL-treated area with the other areas being covered. The clinical outcome was measured colorimetrically (blanching rates) and visually.

For the red PWSs the blanching rates at 2 months with the PDL were 11% to 24% and 22% to 55% with PDT (P=.006). For the purple PWSs, blanching rates ranged from 8% to 33% with PDL and 30% to 45% with PDT (P=.0313). Two patients with purple PWSs showed no response to either PDT or PDL. All PDT sites developed localized edema, and all PDL sites developed edema, blistering, purpura, and crusts. Four patients with red PWSs developed hyperpigmentation at the PDL sites.

What’s the issue?
Although there have been studies showing that PDT is an effective treatment of PWSs, this study is a side-by-side quantitative comparison of PDL versus PDT. This study showed that PDT is as effective and as safe as PDL and possibly superior for the treatment of red and purple flat PWSs. This study represents promising steps forward in PDT treatment of dermatologic conditions.

Even though PDL therapy is considered the current standard for treatment of PWSs, this study does show good clearance with PDT. Pulsed dye laser therapy has been more readily available in North America and Europe, though in China, where this study took place, it is not common. The PDT in this study utilized an intravenous photosensitizer, which may not be suitable for all patients. Other limitations of this study include the small sample size and the possibility that treating the lesion halves in close proximity to each other may compound adverse effects. Because each half of the lesion (close proximity to one another) was treated, the effects of each treatment may have been compounded.

Could PDT become an adjuvant treatment in the armamentarium for resistant port-wine stains?

We want to know your views! Tell us what you think.

In the April 2013 issue of the Journal of Drugs in Dermatology (2013;12:428-431), Clark et al retrospectively reviewed 115 laser sessions with the 1550-nm erbium-doped fractional nonablative laser (Fraxel Re:Store SR 1550, Solta Medical) in 45 patients with Fitzpatrick skin types IV to VI to assess the rate of postinflammatory hyperpigmentation and the associated laser parameters. The fluence, treatment level, and number of passes were all reviewed, as well as any posttreatment complications (ie, erythema, blistering, edema, bruising, pain) and long-term (1 month) complications (ie, hypopigmentation, hyperpigmentation). All patients were pretreated with hydroquinone cream 4% 2 weeks before, stopping 7 days before treatment and then continuing 4 weeks thereafter. Also, continuous forced-air cooling was used during treatment as well as posttreatment ice packs. Fifty-eight percent (26/45) of treatments were performed in patients with Fitzpatrick skin type IV, 24% (11/45) with type V, and 18% (8/45) with type VI. Laser parameters ranged from 4 to 70 mJ, treatment level 2 to 9, and 4 to 8 passes. Of 115 sessions, 5 (4%) were associated with postinflammatory hyperpigmentation; 2 of these instances occurred in 1 patient. The occurrence of postinflammatory hyperpigmentation was found to be statistically significant (P=.05), correlating with higher mean energy levels compared to those without hyperpigmentation (60.8 vs 44.7 mJ). Only 1 episode of postinflammatory hyperpigmentation lasted longer than 1 month, and 2 of 5 cases had only transient (<7 days) hyperpigmentation. All 5 cases resolved.

What’s the issue?

The 1550-nm erbium-doped fractional nonablative laser is being used for many skin conditions and has a low incidence of adverse effects when appropriate laser parameters are chosen. When treating darker skin phototypes with this technology, the concern for postinflammatory pigmentary alteration is more concerning. Higher treatment densities used in darker phototypes have been associated with a greater risk for postinflammatory hyperpigmentation. In their review, the authors showed that higher energy levels were associated with their cases of postinflammatory hyperpigmentation, with the caveat that they were careful not to use higher density or treatment levels than they would have used in lighter phototypes. Importantly, all 5 cases of hyperpigmentation did resolve and only 1 lasted longer than 1 month (2 months in total). This analysis reinforces that the 1550-nm erbium-doped fractional nonablative laser is quite safe in Fitzpatrick skin types IV to VI when appropriate parameters are utilized, as well as methodical pretreatment and posttreatment with hydroquinone, concomitant cooling, and strict posttreatment sun protection. With the right parameters, the treatment is quite safe; however, what are the optimal treatment parameters to provide efficacious and lasting results?

We want to know your views! Tell us what you think.

In the April 2013 issue of the Journal of Drugs in Dermatology (2013;12:428-431), Clark et al retrospectively reviewed 115 laser sessions with the 1550-nm erbium-doped fractional nonablative laser (Fraxel Re:Store SR 1550, Solta Medical) in 45 patients with Fitzpatrick skin types IV to VI to assess the rate of postinflammatory hyperpigmentation and the associated laser parameters. The fluence, treatment level, and number of passes were all reviewed, as well as any posttreatment complications (ie, erythema, blistering, edema, bruising, pain) and long-term (1 month) complications (ie, hypopigmentation, hyperpigmentation). All patients were pretreated with hydroquinone cream 4% 2 weeks before, stopping 7 days before treatment and then continuing 4 weeks thereafter. Also, continuous forced-air cooling was used during treatment as well as posttreatment ice packs. Fifty-eight percent (26/45) of treatments were performed in patients with Fitzpatrick skin type IV, 24% (11/45) with type V, and 18% (8/45) with type VI. Laser parameters ranged from 4 to 70 mJ, treatment level 2 to 9, and 4 to 8 passes. Of 115 sessions, 5 (4%) were associated with postinflammatory hyperpigmentation; 2 of these instances occurred in 1 patient. The occurrence of postinflammatory hyperpigmentation was found to be statistically significant (P=.05), correlating with higher mean energy levels compared to those without hyperpigmentation (60.8 vs 44.7 mJ). Only 1 episode of postinflammatory hyperpigmentation lasted longer than 1 month, and 2 of 5 cases had only transient (<7 days) hyperpigmentation. All 5 cases resolved.

What’s the issue?

The 1550-nm erbium-doped fractional nonablative laser is being used for many skin conditions and has a low incidence of adverse effects when appropriate laser parameters are chosen. When treating darker skin phototypes with this technology, the concern for postinflammatory pigmentary alteration is more concerning. Higher treatment densities used in darker phototypes have been associated with a greater risk for postinflammatory hyperpigmentation. In their review, the authors showed that higher energy levels were associated with their cases of postinflammatory hyperpigmentation, with the caveat that they were careful not to use higher density or treatment levels than they would have used in lighter phototypes. Importantly, all 5 cases of hyperpigmentation did resolve and only 1 lasted longer than 1 month (2 months in total). This analysis reinforces that the 1550-nm erbium-doped fractional nonablative laser is quite safe in Fitzpatrick skin types IV to VI when appropriate parameters are utilized, as well as methodical pretreatment and posttreatment with hydroquinone, concomitant cooling, and strict posttreatment sun protection. With the right parameters, the treatment is quite safe; however, what are the optimal treatment parameters to provide efficacious and lasting results?

We want to know your views! Tell us what you think.

In the April 2013 issue of the Journal of Drugs in Dermatology (2013;12:428-431), Clark et al retrospectively reviewed 115 laser sessions with the 1550-nm erbium-doped fractional nonablative laser (Fraxel Re:Store SR 1550, Solta Medical) in 45 patients with Fitzpatrick skin types IV to VI to assess the rate of postinflammatory hyperpigmentation and the associated laser parameters. The fluence, treatment level, and number of passes were all reviewed, as well as any posttreatment complications (ie, erythema, blistering, edema, bruising, pain) and long-term (1 month) complications (ie, hypopigmentation, hyperpigmentation). All patients were pretreated with hydroquinone cream 4% 2 weeks before, stopping 7 days before treatment and then continuing 4 weeks thereafter. Also, continuous forced-air cooling was used during treatment as well as posttreatment ice packs. Fifty-eight percent (26/45) of treatments were performed in patients with Fitzpatrick skin type IV, 24% (11/45) with type V, and 18% (8/45) with type VI. Laser parameters ranged from 4 to 70 mJ, treatment level 2 to 9, and 4 to 8 passes. Of 115 sessions, 5 (4%) were associated with postinflammatory hyperpigmentation; 2 of these instances occurred in 1 patient. The occurrence of postinflammatory hyperpigmentation was found to be statistically significant (P=.05), correlating with higher mean energy levels compared to those without hyperpigmentation (60.8 vs 44.7 mJ). Only 1 episode of postinflammatory hyperpigmentation lasted longer than 1 month, and 2 of 5 cases had only transient (<7 days) hyperpigmentation. All 5 cases resolved.

What’s the issue?

The 1550-nm erbium-doped fractional nonablative laser is being used for many skin conditions and has a low incidence of adverse effects when appropriate laser parameters are chosen. When treating darker skin phototypes with this technology, the concern for postinflammatory pigmentary alteration is more concerning. Higher treatment densities used in darker phototypes have been associated with a greater risk for postinflammatory hyperpigmentation. In their review, the authors showed that higher energy levels were associated with their cases of postinflammatory hyperpigmentation, with the caveat that they were careful not to use higher density or treatment levels than they would have used in lighter phototypes. Importantly, all 5 cases of hyperpigmentation did resolve and only 1 lasted longer than 1 month (2 months in total). This analysis reinforces that the 1550-nm erbium-doped fractional nonablative laser is quite safe in Fitzpatrick skin types IV to VI when appropriate parameters are utilized, as well as methodical pretreatment and posttreatment with hydroquinone, concomitant cooling, and strict posttreatment sun protection. With the right parameters, the treatment is quite safe; however, what are the optimal treatment parameters to provide efficacious and lasting results?

We want to know your views! Tell us what you think.

Dr. Rossi discusses melanoma in the skin of color population including the incidence and presentation of melanoma as well as factors contributing to delayed diagnosis in these patients. He also gives recommendations to physicians to help educate their patients. For more information, read Dr. Rossi's article in the May 2012 issue, "Melanoma in Skin of Color." 

Dr. Rossi discusses melanoma in the skin of color population including the incidence and presentation of melanoma as well as factors contributing to delayed diagnosis in these patients. He also gives recommendations to physicians to help educate their patients. For more information, read Dr. Rossi's article in the May 2012 issue, "Melanoma in Skin of Color." 

Dr. Rossi discusses melanoma in the skin of color population including the incidence and presentation of melanoma as well as factors contributing to delayed diagnosis in these patients. He also gives recommendations to physicians to help educate their patients. For more information, read Dr. Rossi's article in the May 2012 issue, "Melanoma in Skin of Color."