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Pulsed Dye Laser for the Treatment of Macular Amyloidosis: A Case Report
Macular amyloidosis causes an eruption of brown pigment in the skin when keratin is altered. The resulting hyperpigmentation, which often leads to...
An article in Dermatologic Surgery, “Comparative Study on Bruise Reduction Treatments After Bruise Induction Using the Pulsed Dye Laser,” (2013;39:1459-1464) compared the of effectiveness different modalities in reducing time for bruise resolution. The investigators compared cold compresses; hydrogen peroxide; over-the-counter bruise serum containing primrose oil, vitamin E oil, and glycerin; and pulsed dye laser (PDL). Seventeen patients (Fitzpatrick skin types I–IV) were enrolled and had bruise induction with a PDL to produce five 2×2-cm zones of bruising on the lower abdomen. Excluding the control, bruises were randomly treated using a cold compress, bruise serum, 3% hydrogen peroxide–soaked gauze, or PDL. Subjects and 2 blinded physician evaluators graded the bruise severity using a visual scale on days 0, 3, and 7. The investigators found that treatment did not result in statistically significantly shorter bruise resolution time than in controls. They reported that PDL-treated bruises took a longer time to resolve than controls.
What’s the issue?
Although this study found that the PDL-treated bruises took a longer time to resolve, there have been other studies that have shown PDL to hasten time to bruise resolution, which could be due to the fact that the initial bruises in this particular study were actually induced by PDL. In another study, DeFatta et al (Arch Facial Plast Surg. 2009;11:99-103) found maximal efficacy when PDL was performed on or after postoperative day 5. It was reasoned that treatment before then was less effective because of the depth of red blood cell extravasation and overlying inflammation and edema. Karen and Hale (Dermatol Surg. 2010;36:1328-1331) reported that the optimal time for PDL treatment was between 48 and 72 hours, suggesting that hemoglobin predominates during this period instead of the bilirubin predominance seen in the later stages of ecchymosis. Their parameters were 7.5 J/cm2, 10-mm spot, 6-millisecond pulse duration, and cryogen 30 milliseconds with a 20-millisecond delay for a single pass. What do you use for posttreatment bruising?
