Usage of LASER in Dermatology and Skin Care

Introduction:

The word LASER is an acronym for light amplification by stimulated emission of radiation. Lasers have been widely used in dermatology and general medicine for the last 30 years. No single laser system is capable of treating all cutaneous lesions, and the search for the perfect system still persists.

What Are the Properties of Lasers?

Laser radiation as a form of light is a part of the electromagnetic spectrum. The laser light differs from the normal light in a number of aspects:

1. Laser light is monochromatic. It consists of a single wavelength.

2. Laser light is coherent. The waves of energy are in phase with each other.

3. Laser light is also collimated; that is, the rays are always parallel to each other.

What Is the Mechanism of Action of Lasers?

When a beam of light falls on the skin surface, it may reflect back, may scatter within the tissue, or get absorbed by the tissue. Only the absorbed light will bring out the biological reactions. Once absorbed, the light energy is converted into heat energy. When tissues are heated to about 60 degrees Celsius, protein denaturation will occur and lead to tissue necrosis. If a tissue is very rapidly brought to 100 degrees Celsius, cellular water will be converted to steam, which brings about the explosion of the cell wall. This is known as vaporization. This type of destruction minimizes thermal damage to adjacent tissues.

What Are the Types of Lasers?

There are several types of lasers. They are;

• Surgical Lasers:

1. CO2 laser.

2. Erbium laser.

3. Holmium laser.

• Vascular Lasers:

1. Argon laser.

2. Pulsed dye laser.

3. Neodymium: yttrium-aluminum-garnet [Nd: YAG] laser.

4. Diode laser.

5. Holmium laser.

6. Krypton laser.

7. Excimer laser.

8. Q- switched ruby laser.

9. Copper vapor laser.

10. Flash lamp Q switched alexandrite laser.

How Is Laser Technology Utilized by Dermatologists?

Laser treatments have been a part of dermatology for many years and continue to evolve.

A dermatologist can use a laser to treat various skin conditions, such as:

1. Acne Scars: Laser treatment targets different skin layers to remove damaged tissue, stimulate new collagen cells, and promote healthy skin growth, improving the appearance of acne scars.

2. Hair Removal: Laser hair removal effectively removes unwanted facial and body hair by targeting the pigment in the hair follicles, making it a popular choice for many individuals.

3. Thread Veins: Laser therapy can treat thread veins by destroying small blood vessels in the skin using pulses of light. Different types of lasers are used depending on the size and depth of the veins.

4. Rosacea: Laser treatments can help manage rosacea by reducing redness and visible blood vessels in the face. Laser resurfacing can also minimize skin thickening and stimulate new tissue growth, improving the overall appearance of the skin.

What Are the Uses of Carbon Dioxide Lasers?

• Seborrheic keratoses.

• Actinic cheilitis.

• Actinic keratoses.

• Epidermal nevi.

• Scars.

• Sebaceous adenomas.

• Balanitis xerotic obliterans.

• Warts.

• Basal cell epithelioma.

• Erythroplasia of queyrat.

• Stains (melanin).

• Neurofibromas.

• Oral papillomatosis.

• Resurfacing and rejuvenation.

• Rhinophyma (glandular type).

• Syringomas.

• Trichoepitheliomas.

• Xanthelasmas.

• Chondrodermatitis nodularis helix.

• Skin resurfacing and rejuvenation.

Where Are Er: YAG Lasers Indicated?

• Sebaceous adenomas.

• Seborrheic keratosis.

• Acne scars.

• Favre-racouchot disease.

• Xanthelasmas.

• Neurofibromas.

• Epidermal nevi.

• Spots.

• Resurfacing and rejuvenation.

• Rhinophyma (remodeling phase).

• Syringomas.

• Trichoepitheliomas.

What Are the Clinical Indications of Vascular Lasers?

• DYE laser - Used for facial telangiectasias, spider veins, pyogenic granulomas, rosacea, poikiloderma of Civatte, and cutaneous vascular ectasia. This laser has a liquid solution with a Rhodamine pigment contained in a cylindrical cell.

• Nd: YAG laser - Used for telangiectasias of face and legs, hemangioma, and spider veins. This laser has a crystal of aluminum garnet and yttrium doped with neodymium.

• Argon laser - It is indicated in ruby angiomas, angiokeratomas, and Kaposi’s sarcoma.

• Alexandrite laser - Used for facial telangiectasias.

• Diode laser consists of a semiconductor diode and is used for telangiectasias.

• The Holmium laser is also used for telangiectasias.

• Copper vapor laser is indicated for facial telangiectasias.

What Are the Other Uses of Lasers in Dermatology?

• Vascular Abnormalities: Port-wine stain, cherry angioma, pyogenic granuloma, telangiectasia, etc.

• Tumors: Syringoma, trichoepithelioma, adenoma sebaceous, neurofibroma, epidermal nevi, lymphangioma, and seborrheic wart.

• Pigmented Lesions: Melasma, lentigines, cafe au lait spots, freckles, nevus of Ota and Ito, post-inflammatory hyperpigmentation, and other melanocytic nevi.

• Malignancies: Superficial basal cell carcinoma, squamous cell carcinoma, and digital angiosarcoma.

• Photodynamic Therapy.

• Miscellaneous: Tattoo removal, xanthelasma, actinic cheilitis, pearly penile papules, rhinophyma, keloids, scalp reduction, blepharoplasty, etc.

• Hair Removal: Lasers are used to remove excessive and esthetically disabling hair caused by hypertrichosis or hirsutism. Lasers attract the dark hairs quickly to remove, and it takes 3 to 6 months for regrowth of the hair to be evident. Several treatment sessions are needed in a spaced 6 months interval, and the treatment spacing depends on the area of the body being treated. Laser treatments are much quicker than electrolysis and are a less painful procedure. Complications might occur, such as pigmentary changes, superficial burns, and even scarring, and are rare. Increased growth of dark hairs in untreated areas is noticed close to the treated ones. Also, both increased and reduced localized sweating after treatment occurs. The suitable devices used for hair removal are long-pulsed ruby and alexandrite lasers, millisecond Nd: YAG, a diode (810nm), and non-laser intense pulsed light.

How Are Lasers Helpful to Remove Tattoos?

The QS laser system helps destroy the tattoo without causing much damage to the surrounding tissues. The tattoo pigment is removed from the skin by scavenging the tissue macrophages and white blood cells. The choice of laser for tattoo removal depends on the color, depth, and chemical nature of the ink used for the tattoo. Two to ten treatments are often necessary for tattoo removal, where yellow, green, and orange are the most difficult colors to remove. The lasers used for the removal of black, green, yellow, orange, and red inks are,

• Black Color: QS ruby laser, alexandrite laser, or Nd: YAG laser.

• Blue and Green: QS ruby laser, alexandrite laser.

• Yellow, Orange, Red: QS ruby laser and Nd: YAG laser.

What Are the Adverse Effects of Laser Treatment?

Laser treatments can cause some adverse effects, such as burns. Some side effects that may occur are,

• Temporary pain.

• Redness.

• Bruising.

• Blistering.

• Crusting.

• Infection, including reactivation of herpes simplex.

• Pigmentary alterations may be permanent.

• Scarring.

• Texture damage.

• Local infection.

What Are the Advantages and Disadvantages of Lasers?

Advantages:

• It gives a good cosmetic result.

• Minimal postoperative pain is involved.

• It can be done in office environments.

• Fewer chances of keloid formation.

• It is a bloodless field procedure.

Disadvantages:

• It is an expensive procedure.

• Laser treatments can be done with specialized training professionals.

• A single laser system cannot treat all conditions, and it may require multiple sessions and systems.

What Are the Laser Safety Measures to Be Followed?

The safety precautions will depend on the type of laser system used and where the procedure is done. They are,

• Eye protection is highly essential for the patient and clinic staff.

• Usage of non-reflective instruments.

• Pasting a warning notice outside the procedure room.

• Thoroughly trained personnel should perform the procedure.

• Avoiding the usage of flammable materials.

Conclusion:

Laser beams are strong, focused lights that target specific body areas with a single wavelength. They are used in various dermatological treatments, with different types of lasers suited for different purposes. For example, lasers can target melanin, hair follicles, or water to remove layers of skin. Laser therapy offers several benefits to patients, including being minimally invasive and providing long-lasting results.