Advances in laser technology necessitate educated choices

In an effort to help alleviate the confusion, Ronald G. Wheeland, M.D., presented a seminar, "Lasers for the Non-Surgeon," at the American Academy of Dermatology (AAD) Academy '04 here recently. Dr. Wheeland is professor and chief of dermatology at the University of Arizona's College of Medicine, as well as a Dermatology Times and Cosmetic Surgery Times editorial adviser.

'LASER' an acronym After explaining that the word "laser" is actually an acronym (for light amplification by stimulated emission of radiation), Dr. Wheeland notes that in the past 20 years, the number of laser and other light-source treatment types has grown from three - CO₂ argon and ruby - to at least a dozen. They include pulsed dye laser (PDL), diode, Nd:YAG, krypton, alexandrite and also several non-laser sources of light, such as intense pulsed light (IPL), radio frequency (RF), light-emitting diode (LED) and others.

For example, vascular lesions - such as port wine stains, facial telangiectasia and rosacea - are very effectively treated with the pulsed dye laser (PDL), which has seen several refinements over recent years that make it perhaps the most effective laser technique for many vascular lesions, Dr. Wheeland says.

"Larger vessels have longer thermal relaxation times (TRT) and require longer pulses, while small targets, like melanosomes, have short TRT and require shorter pulses to be selectively targeted," he explains. "Because of advances in terms of PDL now having the ability to deliver multiple wavelengths, longer pulse widths and higher fluences, it's a highly effective tool for treating more vascular lesions."

In fact, he adds, PDL was first developed specifically to treat port wine stains in infants. Now, in addition to being used for treating a variety of vascular lesions, it's also used for treating burns and scars, warts, striae, leg veins, psoriasis and even acne.

"The PDL is a very versatile device, and has been used with the greatest enthusiasm for these conditions," says Dr. Wheeland. "But other laser devices and light sources are very effective, too, and some even more so for certain treatments."

Pigmented targets containing melanin (lentigo, café au lait macule) and traumatic tattoos (skin injuries of the type suffered in auto crashes), for example, once were poorly treated, but are treated most effectively today with the Q-switched Nd-YAG and alexandrite laser types (Q-switched meaning billionth-of-a-second-long pulses), and with Q-switched ruby, one of the old "standby" laser types, now enhanced.