Laser in Dermatology

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					                  Laser in Dermatology

First developed in 1960, 'LASER' is an acronym for 'light amplification by
stimulated emission of radiation'. These are sources of high intensity light
that have been increasingly used in the recent years in dermatology, to treat
various skin disorders. It uses a high intensity beam of a particular
wavelength, with negligible dispersion in a short range and focuses it on the
skin. There are three components of the skin which absorb the laser light
namely the melanin, hemoglobin and intracellular or extracellular water. The
laser beam causes precise tissue destruction of the focused lesion without
harming the surrounding skin.


Types of Lasers Used in Dermatology
There are various kinds of lasers being used, each with its own special utility.
The first lasers to be used 40 years ago, used carbon dioxide and argon to
treat vascular marks, such as port wine stains and haemangiomas. With
introduction of newer technologies, subsequent lasers used in dermatology
used the quasi-CW mode and pulsed laser light. The type of laser used for
any clinical application depends on the wavelength peaks of the laser light,
the pulse durations and absorption by the target skin.


Some commonly used lasers are:


      Carbon Dioxide laser
      Nd-YAG laser
      Pulsed dye laser
      Diode laser
      Argon laser
      Ruby laser
      Erbium YAG laser


Skin Conditions Treated by Laser
Vascular Lesions: The most common use of laser in dermatology is in the
treatment of vascular lesions using pulsed dye laser. It was used primarily for
treating port wine stains in children. However, with modifications of the initial
parameters which allow longer pulses and wavelengths, it is increasingly
being used in the treatment of blood vessel diseases and also for epidermal
cooling. Smaller superficial vascular malformations respond better than
treatment of deeper, larger blood vessels with an approximate 80% fading
after 8 to 10 treatments.


Pigmented Tattoos and Lesions: An important cosmetic laser treatment is the
removal of benign tattoos and pigmented lesions while minimizing the
scarring and other complications. Use of Q switched lasers, ruby, Nd-YAG
and alexandrite lasers causes the destruction of the melanin or the tattoo
pigments for subsequent removal of the macrophages. The most common
pigmented lesions that can be corrected include freckles and birthmarks as
well as, blue naevi, Becker naevi. T congenital melanocytic naevi and the
naevi of Ota/Ito. While Q lasers are effective in removing tattoos, it does
require multiple treatments and some colors might not respond or become
darker leading to complications while removing. As with other treatments
using laser, it might also lead to pigmentation and scars.


Hair Removal: Unwanted hair can be effectively removed or reduced using
lasers such as the long range ruby or Nd-YAG. These lasers target the
melanin within the hair shaft and bulb causing the destruction of cells. This
results in the slowing down the ability of hair growth.


Facial Resurfacing: Laser resurfacing allows the collagen in the skin to be
rebuilt, making a patient look younger by reducing the wrinkles in the skin.
Over the years erbium:YAG and carbon dioxide laser have been used,
however recently the noninvasive devices have been developed. The most
commonly used noninvasive device, LED or light emitting diodes have been
used to stimulate the fibroblasts in the skin to produce collagen, elastin and
glycosaminoglycans to rejuvenate the skin.


Lasers have also been used to remove viral warts, acne and psoriasis.
Keloids and hypertrophic scars, which have been traditionally difficult to
remove, can be eradicated by vaporising lasers like carbon dioxide and
erbium:YAG.


It is important that the personnel using laser devices should be thoroughly
trained and the patients and the clinic staff be given eye protection.
Patients should keep in mind that laser treatments are basically burns,
which can cause temporary pain, infection and redness. Understanding the
inherent risks and complications is crucial. So, before going for a laser
treatment, please consult a qualified laser surgeon.

				
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