PMID- 17558762
OWN - NLM
STAT- MEDLINE
DCOM- 20070810
LR  - 20151119
IS  - 1476-4172 (Print)
IS  - 1476-4172 (Linking)
VI  - 9
IP  - 2
DP  - 2007 Jun
TI  - Vascular lasers and IPLS: guidelines for care from the European Society for Laser 
      Dermatology (ESLD).
PG  - 113-24
AB  - Dermatology and dermatologic surgery have rapidly evolved during the last two 
      decades thanks to the numerous technological and scientific acquisitions focused 
      on improved precision in the diagnosis and treatment of skin alterations. Given 
      the proliferation of new devices for the treatment of vascular lesions, we have 
      considerably changed our treatment approach. Lasers and non-coherent intense 
      pulse light sources (IPLS) are based on the principle of selective 
      photothermolysis and can be used for the treatment of many vascular skin lesions. 
      A variety of lasers has recently been developed for the treatment of congenital 
      and acquired vascular lesions which incorporate these concepts into their design. 
      The list is a long one and includes pulsed dye (FPDL, APDL) lasers (577 nm, 585 
      nm and 595 nm), KTP lasers (532 nm), long pulsed alexandrite lasers (755 nm), 
      pulsed diode lasers (in the range of 800 to 900 nm), long pulsed 1064 Nd:YAG 
      lasers and intense pulsed light sources (IPLS, also called flash-lights or pulsed 
      light sources). Several vascular lasers (such as argon, tunable dye, copper 
      vapour, krypton lasers) which were used in the past are no longer useful as they 
      pose a higher risk of complications such as dyschromia (hypopigmentation or 
      hyperpigmentation) and scarring. By properly selecting the wavelength which is 
      maximally absorbed by the target--also called the chromophore (haemoglobin in the 
      red blood cells within the vessels)--and a corresponding pulse duration which is 
      shorter than the thermal relaxation time of that target, the target can be 
      preferentially injured without transferring significant amounts of energy to 
      surrounding tissues (epidermis and surrounding dermal tissue). Larger structures 
      require more time for sufficient heat absorption. Therefore, a longer laser-pulse 
      duration has to be used. In addition, more deeply situated vessels require the 
      use of longer laser wavelengths (in the infrared range) which can penetrate 
      deeper into the skin. Although laser and light sources are very popular due to 
      their non-invading nature, caution should be considered by practitioners and 
      patients to avoid permanent side effects. These guidelines focus on patient 
      selection and treatment protocol in order to provide safe and effective 
      treatment. Physicians should always make the indication for the treatment and are 
      responsible for setting the machine for each individual patient and each 
      individual treatment. The type of laser or IPLS and their specific parameters 
      must be adapted to the indication (such as the vessel's characteristics, e.g. 
      diameter, colour and depth, the Fitzpatrick skin type). Treatments should start 
      on a test patch and a treatment grid can improve accuracy. Cooling as well as a 
      reduction of the fluence will prevent adverse effects such as pigment alteration 
      and scar formation. A different number of repeated treatments should be done to 
      achieve complete results of different vascular conditions. Sunscreen use before 
      and after treatment will produce and maintain untanned skin. Individuals with 
      dark skin, and especially tanned patients, are at higher risk for pigmentary 
      changes and scars after the laser or IPLS treatment.
FAU - Adamic, Metka
AU  - Adamic M
AD  - Dermatology Centre Parmova, Ljubljana, Slovenia. metka.adamic@dcp.si
FAU - Troilius, Agneta
AU  - Troilius A
FAU - Adatto, Maurice
AU  - Adatto M
FAU - Drosner, Michael
AU  - Drosner M
FAU - Dahmane, Raja
AU  - Dahmane R
LA  - eng
PT  - Journal Article
PT  - Review
PL  - England
TA  - J Cosmet Laser Ther
JT  - Journal of cosmetic and laser therapy : official publication of the European 
      Society for Laser Dermatology
JID - 101136419
SB  - IM
MH  - Humans
MH  - Informed Consent
MH  - Low-Level Light Therapy/*methods/*standards
MH  - Patient Selection
MH  - Phototherapy/*methods/*standards
MH  - *Practice Guidelines as Topic
MH  - Vascular Diseases/*therapy
RF  - 54
EDAT- 2007/06/15 09:00
MHDA- 2007/08/11 09:00
CRDT- 2007/06/15 09:00
PHST- 2007/06/15 09:00 [pubmed]
PHST- 2007/08/11 09:00 [medline]
PHST- 2007/06/15 09:00 [entrez]
AID - 779335403 [pii]
AID - 10.1080/14764170701280693 [doi]
PST - ppublish
SO  - J Cosmet Laser Ther. 2007 Jun;9(2):113-24. doi: 10.1080/14764170701280693.