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Previous clinical studies have shown that pulsed dye laser (PDL) and intense pulsed light (IPL) are effective for treating erythematotelangiectatic rosacea(ETR). This article aims to compare the efficacy and safety of PDL and IPL at three different wavelength bands (broad-band, single-narrow-band, and dual-narrow-band) in treating ETR. Sixty subjects with ETR were randomly categorized into four groups and received one of the following laser treatments: PDL (595 nm), IPL with Delicate Pulse Light (DPL, 500–600 nm), IPL with M22 590 (590–1200 nm), or IPL with M22 vascular filter (530–650 nm and 900–1200 nm). Four treatment sessions were administered at 4-week intervals, with one follow-up session 4 weeks after the final treatment. The efficacy of the four lasers was evaluated by comparing the clinical symptom score, total effective rate, VISIA red area absolute score, and RosaQoL score before and after treatment. The safety was evaluated by comparing adverse reactions such as pain, purpura, erythematous edema, and blister. All 60 subjects completed the study. Within-group effects showed that the clinical symptom score, VISIA red area absolute score, and RosaQoL score of all four groups were significantly reduced compared to before treatment (p < 0.001). Between-group effects showed no statistically significant difference among the four laser groups. Safety analysis showed that all four lasers were safe, but the incidence of blister was higher in the M22 vascular group. Nonpurpurogenic PDL, DPL, M22 590, and M22 vascular were equally effective in treating ETR and were well-tolerated. ClinicalTrial.gov Identifier: NCT05360251.

To evaluate the efficacy and safety of pulsed dye laser (PDL) alone, the combination of PDL and botulinum toxin type A (BTA) injection, and the combination of PDL and triamcinolone injection in the treatment of hypertrophic scars and keloids. In this three-arm, single-blind randomized controlled clinical trial, 10 patients over 18 years old with hypertrophic scars or keloids were enrolled. Each patient had at least 3 lesions, each measuring at least 10 × 10 square centimeters or 10 centimeters long. In the first treatment session, each of the 3 lesions was randomly assigned to one of three interventions: PDL (control), PDL with BTA injection (at a concentration of 2 units/cm 2 ), or PDL with triamcinolone injection (20 mg/cc). All the interventions carried out in the groups have been repeated in three sessions. One follow-up visit took place one month after the last session, without any intervention. Clinical images of the lesions were collected during the treatment sessions. A blinded dermatologist assessed the effectiveness of the treatment using a physician global assessment score and the Vancouver Scar Scale (VSS). Patient satisfaction and any side effects were recorded during follow-up visits. The average age of the cases under consideration was 36.00 ± 13.23 years. In terms of gender, 4 out of the cases (40.00%) were females. During the initial session, the mean VSS scores in the PDL, PDL–BTA, and PDL–Triamcinolone groups were 7.90 ± 1.52, 7.10 ± 0.56, and 7.30 ± 0.24, subsequently. These scores decreased to 7.30 ± 1.34, 4.90 ± 1.37, and 4.30 ± 0.95 in the PDL, PDL–BTA, and PDL–Triamcinolone groups, respectively ( P  = 0.001). The group that received both PDL and BTA showed the most significant enhancement in pliability ( P  = 0.001) and regarding scar vascularity and height the most improvement was related to PDL-triamcinolone group ( P  = 0.01 and 0.001, respectively). In addition, the level of physician’s satisfaction in the PDL–BTA and PDL–Triamcinolone groups were significantly higher than in the PDL group ( P  = 0.004). However, no significant difference was seen between the combined treatments. Finally, no significant side effects were observed in the studied methods during various treatment sessions. The findings of the study revealed that utilizing a combination of two modalities yielded better outcomes compared to a single treatment approach. Specifically, the combination of PDL and BTA demonstrated greater improvement in scar pliability. On the other hand, when considering scar vascularity and height, the combination of PDL with triamcinolone exhibited more significant enhancement. What’s already known about this topic? • Hypertrophic and keloid scars are often characterized by unsightly appearances and impose numerous restrictions on patients. Various treatments have been suggested for these skin lesions, each associated with different levels of effectiveness in promoting recovery. • The pulsed dye laser is an effective treatment option for vascular lesions, hypertrophic scars, and keloids. It is associated with improvements in color, reduction in height, and increased flexibility. What does this study add? • The combined treatment of PDL and BTA (at a dose of 2 units per square centimeters) is an effective option for treating hypertrophic scars and keloids. This combination is more effective than using pulsed dye laser alone and can serve as a novel treatment approach for these conditions. • The combined treatment of PDL and triamcinolone injection (at a concentration of 20 mg per 1 ml, with 1 ml injected for each lesion) is an effective option for managing hypertrophic and keloid scars. This approach is more effective than using PDL alone and can significantly improve hypertrophic and keloid scars. • The combination of PDL and triamcinolone injection, when compared to the combination of PDL and BTA injection, results in a more significant improvement in VSS reduction, especially regarding scar vascularity and height. • The greatest improvement in pliability was observed in the group that received PDL and BTA, followed by the group that received PDL and triamcinolone, while the group receiving PDL only showed the least improvement.

IntroductionKeloids, benign fibroproliferative tumours characterised by excessive fibroblast proliferation and over-deposition of extracellular matrix, pose a therapeutic challenge with high recurrence rates. Betamethasone (diprospan) injection (BI) is one of the most common non-invasive therapies for keloids. Pulsed dye laser (PDL) has the function of closing microvessels, which may become one of the auxiliary treatment methods of BI and may enhance its curative effect. Some studies suggest that the combination of a dual-wavelength dye laser (DWL) and BI may offer superior efficacy. This randomised controlled trial aims to evaluate whether the combined therapy of DWL+BI outperforms BI alone in treating keloids.Methods and analysisThis single-centre, parallel positive control, randomised trial evaluates the efficacy and safety of DWL (585 nm PDL+1064 nm neodymium-doped yttrium aluminium garnet) combined with BI for keloid treatment. Enrolling 66 adult patients, participants are randomised into DWL+BI or BI groups in a 1:1 ratio. Over 12 weeks, each group undergoes four treatment sessions, ensuring blinding for outcome assessors. Data collection occurs at multiple time points (4, 12, 24 and 52 weeks), with primary outcomes assessing the Vancouver Scar Scale (VSS) improvement rate 24 weeks after the last intervention. Secondary outcomes include VSS improvement rates, changes in keloid volume, changes in relative perfusion index measured by laser speckle contrast imaging, Patient and Observer Scar Assessment Scale results and patient satisfaction. Safety assessments include vital signs, laboratory tests, pregnancy tests and self-reports of adverse reactions.Ethics and disseminationThe results will be presented in peer-reviewed journals and at international conferences. This study is approved by the Ethics Committee of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences.Trial registration numberChinese Clinical Trial Register (ChiCTR2400080148).

Background Comedone extraction provides greater satisfaction for acne treatment than conventional treatment alone; however, post‐comedone extraction erythema (PCEE) remains a concern for patients. Objectives To evaluate the efficacy of pulsed‐dye laser (PDL) in PCEE and comedone reduction. Methods Mild‐to‐moderate acne patients were randomly allocated in split‐face fashion. Three comedones were extracted on each facial side. On the PDL‐treated side, 595‐nm PDL was delivered to the entire side with an additional shot on three comedone‐extracted sites. Erythema index (EI) and total acne lesion counts (TALC) were evaluated at baseline, week 2 and 4. The comprehensive acne severity scale (CASS) was assessed by three blinded independent pediatric dermatologists. Participant satisfaction surveys were completed at the end of the study. Results Thirty‐five participants (age 12.9–24.2 years) showed no differences in the EI and TALC at baseline on both sides. At weeks 2 and 4, the EI on the PDL‐treated side was significantly lower (p < 0.001) with a greater EI reduction (p < 0.001) when compared to the control side regardless of gender and menstruation. There was significantly lower TALC on the PDL‐treated side at week 2 (p < 0.001) and week 4 (p = 0.02). No complications were noted with high participant satisfaction reported (median 8; IQR 7–9). PDL remained significantly associated with EI improvements after controlling for gender, menstruation cycle, and examination stress. Conclusion PDL can be an adjunctive intervention for the treatment of PCEE and comedone reduction due to its effectiveness and high participant satisfaction.

Background Top surgery masculinizes the chest appearance for transgender men (TM); however, some individuals may experience hypertrophic scars (HTS) or keloids following the surgery. Objectives This study aimed to evaluate the efficacy of combined 595‐nm pulsed dye laser (PDL) and intralesional triamcinolone acetonide injection (IL TAC) compared to IL TAC monotherapy for treating HTS and keloids. Methods Twenty‐five TM with 35 pairs of bilateral symmetric postmastectomy HTS or keloids were randomly allocated to receive the combined PDL and IL TAC on the scar(s) on one side of the chest and IL TAC monotherapy on the contralateral scar(s) in four monthly treatment sessions. Clinical improvement was evaluated using the Vancouver Scar Scale (VSS). Melanin index, hemoglobin index, and scar roughness were determined before each treatment session and at 1, 3, and 6 months after the last treatment. Participant‐rated satisfaction and adverse events were documented. Results After two treatment sessions, scars treated with combined PDL and IL TAC demonstrated significantly greater improvements in the VSS (p = 0.012) and melanin index (p = 0.004) compared to those treated with IL TAC alone. The superior outcomes of the combined therapy persisted for 3 and 6 months after the end of treatment sessions for the VSS (p = 0.001) and melanin index (p = 0.048), respectively. Participants reported higher satisfaction for combined PDL and IL TAC than IL TAC monotherapy (p = 0.005). No serious or permanent adverse event was reported. Conclusion The addition of 595‐nm PDL to IL TAC may provide more favorable outcomes for treating postmastectomy HTS and keloids among TM.

EMLA cream was developed to reduce pain during pulsed-dye laser (PDL) treatment; however, no standard assessment for the therapeutic outcomes of PDL with EMLA creams thus far available. This comparative, prospective clinical trial evaluates laser efficacy and pain reduction during PDL treatment with EMLA cream for local topical anesthesia. Nineteen patients with untreated port-wine stain (PWS) were treated using PDL and examined in this study. Treatment specifications included Vbeam® PDL (Candela Corp.), 595-nm wavelength, 9 J/cm2 radiant exposure, 0.45 ms pulse duration, 10 mm spot size, and cryogen spray cooling (40 ms cooling plus a 20 ms delay). A topical anesthetic (EMLA cream: 2.5% lidocaine and 2.5% prilocaine) and a placebo were applied to two respective testing areas on all patients prior to treatment. The visual analog scale (VAS) was used for pain assessment. Clinical therapeutic outcomes were evaluated by visual evaluation and with the use of a chromameter 2 months after 3PDL treatments. The average VAS scores were 3.15 ± 0.95 and 8 ± 0.57 for the EMLA cream site and the placebo site, respectively, at a significance level p < 0.001. The EMLA cream site and the placebo site had clearance or fading rates of 45.08 and 44.12%, respectively (p < 0.05). No serious side effects were reported. Patients reported a consistent decrease in pain during PDL treatment when the topical anesthetic EMLA cream was administered. Treatment of PWS by PDL with EMLA cream does not lead to a decrease in efficacy or an increase in side effects; instead, it significantly reduces pain during treatment. EMLA cream is a safe and effective local topical anesthetic for PWS treatment by PDL.

The aim of this study was to compare the efficacy and adverse effects of a 595-nm pulsed dye laser therapy alone (PDL alone) with a 5-aminolevulinic (5-ALA) local application followed by a 595-nm PDL (5-ALA PDL) in the treatment of superficial hemangioma (SH). A prospectively randomized study in 181 patients with SH was carried out over a period of 24 months. One hundred and ninety-three patients were seen. One hundred and eighty-one patients with SH were enrolled, of which 165 completed final follow-up. One hundred and nineteen patients received PDL alone and 46 received 5-ALA PDL. The patients were assessed clinically and the patient’s parents were given a satisfaction questionnaire. Baseline patient data (gender, lesion size, lesion site, treatment times, cure rate, and adverse reactions) were recorded and the results of the treatment of the two groups were analyzed and compared. Complete clearing of the lesion (recovery grade 4) was achieved in 44/119 (37.0%) of the PDL alone group and 31/46 (67.4%) of the 5-ALA PDL group ( X 2  = 10.30, p  < 0.001). Atrophic scars, hyper- and hypopigmentation occurred in both groups ( X 2  = 3.32, p  = 0.564). The patients’ parents’ satisfaction was greater in the 5-ALA PDL group. The clinical outcome of 5-ALA PDL was superior to that of PDL alone in the treatment of SH and only minor adverse events occurred in each group.

Background: Basal cell carcinoma is the most common form of skin cancer worldwide. It has a specialized microvasculature system that can be targeted by the pulsed dye laser using the theory of selective photothermolysis. Objective: To evaluate the efficacy and safety of single session versus two sessions of pulsed dye laser in the treatment of basal cell carcinoma. Methods: A total of 22 patients with basal cell carcinoma were collected in this randomized controlled trial. The patients were divided into two groups: Group I - 11 patients were treated by one session of pulsed dye laser, and Group II - 11 patients received two sessions of pulsed dye laser 2 weeks apart. The patients were assessed clinically and histopathologically after end of the treatment. Results: There was a significant improvement of basal cell carcinoma clinically and histopathologically. Maximal histological clearance rate was achieved in superficial basal cell carcinoma type, small-sized basal cell carcinoma < 0.7 cm and in cases with strong inflammatory response after laser treatment. Treatment of basal cell carcinoma with two sessions of pulsed dye laser was more effective than one session treatment. Limitations: The small sample size of patients and the limited location of the lesions on the head compared with trunk and extremities. Also, the lack of adequate study power may prevent generalization of results. Conclusion: Pulsed dye laser proved to be a safe, effective and noninvasive modality for the treatment of basal cell carcinoma that can be used as a monotherapy in small-sized lesions. Also, it can be used to debulk large-sized lesions before surgery.

More than 70 million surgical procedures are performed annually in the USA with the majority involving a skin lesion and almost all individuals in their lifetime will have one or more surgical procedures resulting in scars. Patients and physicians alike are thereby motivated to improve the cosmetic outcome of scars. Prior studies have shown that the pulsed dye laser (PDL) is effective in improving the quality and appearance of the scar when using the 585-nm PDL immediately after the removal of sutures. Most published studies used a pulse duration of 450 µs, which along with the other study parameters, has led to an overall improvement of the scars. However, a pulse duration of 1.5 ms is also available when using the pulsed dye laser and it should theoretically cause fewer side-effects. To our knowledge, there are no other studies comparing the effectiveness of different pulse durations in the treatment of surgical scars starting on the day of suture removal. The purpose of this study is to compare the effect of different pulse durations (450 µs vs. 1.5 ms) in the treatments of postsurgical linear scars immediately after suture removal when using the 585-nm pulsed dye laser (PDL). Twenty non-hospitalized male and female patients (older than 18 years of age) with skin types I–IV and with postoperative linear scars measuring at least 2.1 cm were enrolled in this prospective study. Scars were randomly divided into three equal sections. The different fields were randomly chosen to receive treatment (two out of three fields) or remain as control (one field). The two fields chosen to be treated received treatment with the 585-nm PDL using a 7-mm spot size at 4.0 J. One of the treated sections was randomly selected to receive a pulse duration of 450 µs, and the other section to receive a 1.5-ms pulse. The remaining scar section was designated as control (no treatment). The three sections were mapped and recorded. The patient received treatment immediately after the sutures were removed from the wound and then monthly for 3 months. Evaluations were performed before each treatment and 1 month after the last treatment. The short-pulse and long-pulse 585-nm PDL-treated sections demonstrated a statistically significant overall average improvement of the VSS of 92 and 89%, respectively, compared to 67% for the control site (Fig.  1 ). Further, for individual parameters of the Vancouver scar scale (VSS), there were significant ( p  < 0.05) differences between control and treatment groups for all parameters, but there were no differences between the short- and long-pulse treatment groups for any parameter. Both short-pulse and long-pulse PDL are safe and effective in improving the quality and cosmetic appearance of surgical scars in skin type’s I–IV starting on the day of suture removal with no significant difference between the two pulse durations.

The aim of this study was to compare the effects of the pulsed-dye laser (PDL) at a wavelength of 585 nm with those at 595 nm in the treatment of post-surgical scars, starting on the day of suture removal. The study was a prospective, non-randomized, double-blind, controlled, clinical trial, set in an outpatient clinic. Fifteen outpatients with 21 post-operative scars at least 3 cm long were recruited, and 14 patients with 19 scars completed the study. Scars were divided into three equal portions. Each outer portion was randomly allocated to PDL at 585 nm or at 595 nm (3.5 J/cm 2 , 450 μs, 10 mm spot size), and the center was an untreated control; treatment was composed of three laser sessions at 4-week intervals. A blinded examiner evaluated the three scar sections using the Vancouver scar scale for pigmentation, vascularity, pliability, and height. Cosmetic appearance was evaluated with a visual analog scale. Punch biopsies of three randomly selected scars were evaluated. Pigmentation : more scars after laser treatments were of normal color than in the control, but the difference was not statistically significant. Vascularity : after treatment, more scars had normal vascularity in all three groups than at baseline ( P  < 0.05); the largest increase was with a wavelength of 585 nm (10.5–94.7%), then 595 nm (15.8–78.9%), then control (5.2–36.6%). Pliability : there was more normal pliability in all three groups than at baseline ( P  < 0.05), with greater improvements in the laser-treated groups. Height : significantly more flat scars after 585 nm PDL (63.2%) than at baseline (21.1%) ( P  < 0.05). We observed a slight but non-significant decrease in the scar heights with 595 nm PDL in comparison with the control. Histology : after laser irradiation, the treated sections were more similar to a non-scarring process than the control. Cosmetic outcome : visual analog scales increased in all groups ( P  < 0.05), but the greatest increases were observed in the 585 nm and 595 nm laser-treated groups (50% and 60%, respectively) compared with controls (30%). There were significantly higher scores with the lasers than for the control ( P  < 0.001) at each visit after baseline. Both the 585 nm and 595 nm PDL treatments were effective in improving the appearance and normalizing the vascularity and pliability of post-operative scars. Both wavelengths improved the scars’ visual appearance more than controls. We found that 585 nm appears to be the preferred wavelength, as it substantially normalized the height in addition to the vascularity and pliability in a significant number of scars.