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Pulsed dye laser in dermatology


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Pulsed dye laser in dermatology

  1. 1. Pulsed Dye laserPulsed Dye laser InIn DermatologyDermatology ByBy Manal SalahManal Salah Ass.Prof. of dermatologyAss.Prof. of dermatology NILES Cairo UniversityNILES Cairo University
  2. 2. Vascular LasersVascular Lasers  Argon(488-514nm)Argon(488-514nm)  KTP(532nm)KTP(532nm)  Dye(585,590,595,600nm)Dye(585,590,595,600nm)  Nd-YAG(1064nm)Nd-YAG(1064nm)
  3. 3. Indications Of VascularIndications Of Vascular LasersLasers  Vascular NeviVascular Nevi  Vascular malformationsVascular malformations  Pyogenic granulomaPyogenic granuloma  Venous lakesVenous lakes  AngiokeratomaAngiokeratoma  TelangiectasiaTelangiectasia  AngiofibromaAngiofibroma  RosaceaRosacea  Keloids & ScarsKeloids & Scars (existing&prophylactic)(existing&prophylactic)  WartsWarts  Striae distensaeStriae distensae  PostAcne scarsPostAcne scars  PsoriasisPsoriasis  XanthelasmaXanthelasma
  4. 4. Argon Laser Gas Laser • Wavelength 488 - 514 nm • Pulse duration CW - Pulsed • Spot size 1- 2 mm • Chromophore Haemoglobin & Melanin
  5. 5. KTP Laser Solid state Laser • Wavelength 532 nm •Pulse duration CW - Pulsed - Q switched •Spot size 1, 2, 4 mm •Chromophore Haemoglobin & Melanin
  6. 6. Nd:YAG Laser Solid state Laser • Wavelength 1064 nm • Pulse duration CW - Pulsed - Q switched Long pulsed • Spot size variable • Chromophore Non specific
  7. 7. Dye Lasers Lasers containing fluorescent dyes dissolved in a common solvent e.g. alcohol or water,that absorbs light at one wavelength and emits light at another wavelength.
  8. 8. Dye lasers work based on the theory of SelectivePhotoThermolysis(SPTL) which means : - Site specific -Thermally mediated injury of -Microscopic tissue targets -By selectively absorbed pulses of radiation. Dye Lasers
  9. 9. *For Vascular Lesions *Wavelength *Pulse Duration *Chromophore 585nm OR 585,590,595,600nm 450 & OR 1500 microseconds Up to 40 msec Oxyhaemoglobin Dye Lasers
  10. 10. Why 585 nm? Oxyhaemoglobin has 3 peaks for light absorption: * 418nm (The strongest) * 542nm * 577nm (The deepest & least absorbed by melanin) 585nm was found to be deeper than 577nm& less absorbed by melanin.
  11. 11. Absorption CurvesAbsorption Curves
  12. 12. Thermal RelaxationThermal Relaxation TimeTime The time necessary for the targetThe time necessary for the target chromophore to cool down 50%,chromophore to cool down 50%, through the transfer of its heat tothrough the transfer of its heat to surrounding tissue via thermalsurrounding tissue via thermal diffusion.diffusion.
  13. 13. In order to get OPTIMUM results: * The wavelength must be well absorbed by oxyhaemoglobin, less by melanin & of deep penetration. * The pulse duration must be shorter than or equal to the TRT of the target. This makes the majority of the absorbed energy to be retained by the target structure & minimizes non-specific thermal damage.
  14. 14. Delivery System  Flexible fiberoptic with different size changeable hand pieces (2, 3, 5, 7,10, &2x7 or 3x5 mm ).
  15. 15. Pretreatment measures  *A written consent  *Anesthesia (usually topical)  *Safety measures(precautions)
  16. 16. Safety measures(precautions)  Protect eyes ……….. eye glasses & shields.  Laser off or standby when not in use.  Plume or steam ……….smoke evacuator.  Avoid reflecting objects. * Labeling the theatre.
  17. 17. Treatment Technique
  18. 18. PWS - Energy TestPWS - Energy Test
  19. 19. Treatment Technique * Determine the MPD. * Determine the treatment test dose . * Choose the test site
  20. 20. Treatment Technique *Pulse delivery. *Evaluation and frequency of revisits. *Patient should know that treatment may be prolonged from months to years.
  21. 21. spots with overlap of 10% are required to cover effectively DIRECTION OF TREATMENT laser
  22. 22. Post treatment measures *Sun screen for at least 6 months after the end of last session. *Topical antibiotic ointment once/day until disappearance of purpura.
  23. 23. Complications Of Laser treatment *Generally it is very safe with very low incidence of side effects, and can be used at any age. -Scarring(<1%). -Hyperpigmentation ( 10 - 15% , transient, resolves in 2-3 months). -Hypopigmentation (5%, transient,resolves within 2 months).
  24. 24. Pediatric Port Wine StainPediatric Port Wine Stain Before Treatment Following Treatment Photo Courtesy of Milton Waner, MD
  25. 25. Adult Port Wine StainAdult Port Wine Stain Before Treatment Following Treatment Photo Courtesy of Milton Waner, MD
  26. 26. Facial TelangiectasiaFacial Telangiectasia Before Treatment Following Treatment Photo Courtesy of Chris Zachery, MD
  27. 27. Facial TelangiectasiaFacial Telangiectasia Before Treatment Following Treatment Photo Courtesy of David McDaniel, MD
  28. 28. RosaceaRosacea Before TreatmentBefore Treatment Following TreatmentFollowing Treatment Photo Courtesy of David McDaniel, MD
  29. 29. Leg VeinsLeg Veins Pre TreatmentPre Treatment 33weeks post treatmentweeks post treatment Courtesy: Emil Tanghetti. MD