Lasers in dermatology

San Francisco

- All the attention garnered by medical lasers’ aesthetic indications has overshadowed the fact that lasers’ utility for treating medical conditions continues to grow, an expert says.

Among U.S. medical applications, photodynamic therapy (PDT) ranks as probably the most important underused laser technology, says Jill Waibel, M.D., a dermatologist in private practice at Palm Beach Esthetic Dermatology & Laser Center, West Palm Beach, Fla., and a volunteer faculty member with the University of Miami Department of Dermatology.

"In Europe, physicians are starting to use PDT not only for skin cancer, but also for ovarian cancer and other cancers. We know that PDT prevents skin cancer and treats pre-cancers of the skin," yet the U.S. healthcare system spends billions of dollars annually to freeze actinic keratoses (AKs) or to excise skin cancers only after they’ve developed, Dr. Waibel says.

Also in the area of skin cancer, she says her colleagues are doing preliminary research with laser-assisted imaging systems that would allow a dermatologist to view skin cancer down to the microscopic level while it’s still on the body.

Additional applications for PDT include treating actinic chelitis, basal cell carcinoma nevus syndrome and disseminated porokeratosis, she says. Dr. Waibel says she’s also achieved very good results with PDT in treating acne keloidalis nuchae, pseudofolliculitis barbae and hidradenitis suppurativa.

Furthermore, she says European researchers have begun exploring the possibility of spraying on the photosensitizing agent aminolevulinic acid (ALA).

New photosensitizers being studied for treating acne vulgaris include indole-3-acetic acid and methyl aminolevulinate, she says.

Additionally, Dr. Waibel says that work is being done to decrease pain while using the 1,450 nanometer diode laser for acne.

Another promising possibility that she says could yield fruit in the future is nano suturing - utilizing light generated by medical lasers in conjunction with light-activated dyes such as Rose Bengal to close surgical wounds without stitches.

In this area, Dr. Waibel says researchers at Massachusetts General Hospital’s Wellman Center for Photomedicine are leading the way.

For burn patients experiencing functional and cosmetic problems due to scarring, Dr. Waibel says she recently completed a study using the Fraxel (Solta) device.

In the study, she says, "Patients experienced great results on all counts, including functionality, cosmetic concerns and self-esteem issues."

Perhaps within the next five years, she adds, this laser device may be used in the medical arena as a drug delivery system.

Regarding the treatment of port wine stains with vascular lasers, she says recent research reinforces that patients fare best if physicians begin treating these problems early (Chapas AM, Eckhorst K, Geronemus RG.Lasers Surg Med. 2007 Aug;39(7):563-568).

"One can treat an infant with port wine stain as early as 2 weeks of age and every two weeks thereafter," Dr. Waibel says. For port wine stains that had failed treatment with the PDL, a study has shown the alexandrite can produce excellent results (Izikson L, Anderson RR. J Cosmet Laser Ther. 2008 Nov 13:1-4)." DT