LASERS IN DERMATOLOGY
- Light Amplification by Stimulated Emission of
Radiation (LASER) produces an intense beam of light of particular
wavelength with insignificant dispersion over a short
distance. This property is utilized in dermatology to treat various
does laser help in dermatology?
- When a laser beam is directed at the skin, it is
absorbed by the water, naturally occurring pigments like melanin and
hemoglobin. It is also absorbed by artificial pigments introduced by
means of tattooing.
Lasers causes very precise tissue destruction of the lesion in focus
and leaves the skin tissue in the immediate surrounding undamaged. It
is this precision that has generated tremendous interest among
dermatosurgeons to use it as an operative tool.
are the different kind of lasers ?
- There are various kind of lasers available today
depending on the source producing the laser. Each of them have specific
range of utility, depending on its wavelength and penetration.
Some commonly used lasers are enumerated below.
- CARBON DIOXIDE LASER
Carbon dioxide laser produces an infra red laser which is absorbed by
water. It can be used as a focused or defocused laser. The
focused laser is used for skin resurfacing in super pulsed
mode which is also called 'laserbrasion' (rapid pulsing of powerful
laser beam). It is used for treating acne scars, chicken pox scars,
fine lines, wrinkles, sun damage, rhinophyma, actinic chelitis.
In defocused mode there is a large spot of laser
that is less intense and pulsed. It removes thin very superficial
layers of skin without penetrating deeper.It can be used to remove skin
tags, dermatosis papulosa nigra, warts, syringomas, moles, seborrhoeic
keratosis, milia, sebaceous hyperplasia.
Carbon dioxide laser is a powerful tool but it has high incidence of
scarring and pigmentary disturbances in inexperienced hands.
- Nd YAG / ERBIUM YAG LASER
'Neo dynamium - Yttrium Aluminum Garnet laser' (Nd YAG laser ) is a
versatile laser. It has a wave length of 1064 nm and has the capability
to reach deeper layers of skin tissue. In Q - switched mode
Nd YAG produces two wavelengths, one in the infrared range (1064nm),
this is used for blue tattoos, deep (professional) tattoos and dermal
pigmented lesions. Second is 532nm which is useful for superficial
brown lesions,solar lentigenes,freckles and red / orange tattoos.
Pigment removal is done by rapid short pulsed laser beams. Long pulsed
beams are used for epilation & telangiectasia.However,white
hairs cannot be removed.
Erbium YAG is has a wave length of
2940 nm. It produces laser in the infrared range. In pulsed mode it is
used for treatment of wrinkles, acne scars (resurfacing), precancerous
lesions and for 'laser peels'.
- The 1540 erbium glass laser is used for
rejuvenation of skin.
- PULSED DYE LASER
As the name suggests this laser uses a liquid dye (Rhodamine 64). It
produces yellow laser which is delivered in short flashes. This is
absorbed by the hemoglobin present in the blood and tissues and
produces heat damage. This is therefore use to treat vascular lesions
like Portwine stains,nevus flemmus, hemangiomas, keloids, hypertrophic
scars. It is also used to treat pigmented nevi.
Long pulsed dye laser is used to treat fine veins,telangiectasia and
- DIODE LASER
Diode laser is a semiconductor laser. It produces laser beam in the
wave length of 800 nm. It is most popularly used for removal of black
/brown hair. (white hair are not targeted by laser beam) Innovative
devices with cooling mechanisms give better results with less scarring.
Diode lasers have been found to work well on dark skin (Gallium
Aluminum Arsenide Semiconductor Diode laser, 810 nm). In dark skin long
pulsed diode laser is preferred. diode laser in long pulsed mode is
also used for treatment of leg veins.
- ALEXANDRITE LASER
Alexandrite laser produces beam in the wavelength of 755 nm. It is also
available in the Q - switched mode. It is absorbed
by the melanin and the artificial tattoos in the skin. Rapid pulsed
alexandrite is used to remove tattoos, benign pigmented lesions.
Long pulsed Alexandrite laser is used for hair removal.
- ARGON LASER
- Argon laser has the wavelength of 488 nm and 514
nm. It produces blue and green colored lasers which are absorbed by
pigments like Hemoglobin and Melanin. Argon laser is used to treat skin
diseases like A-V malformations, Hemangiomas, fine veins, spider nevi
and acne rosacea.
- RUBY LASER
Ruby laser produces red beam in the wavelength of 694 nm. It is also
available in Q - switched mode. In high energy rapid pulsed mode it is
used to remove tattoos, brown pigmented disorders like actinic
lentigenes, freckles, nevi and 'cafe-au-lait' spots,dilated blue
veins,peri orbital pigmentation.
are the skin conditions which can be treated by lasers?
Q - switched Ruby laser is commonly used to remove red and orange
tattoos. Blue, grey & black tattoos are removed with Q switched
Nd Yag laser. Multiple sessions over many months may be required to
attain favorable results. Color of the tattoo and the depth of the
pigment influence the duration and the out come of the laser treatment.
- Portwine stains
can be removed with Pulsed dye laser.It requires multiple sittings but
results are satisfying.
- Spider nevi can
be treated with Pulsed dye laser and Long pulsed Nd YAG laser. Lesions
on the face can be treated with KTP laser.
a viral infection caused by Human Papiloma virus are effectively
removed by Carbon dioxide or Pulsed dye lasers.
like acne scars, ice pick scars are resurfaced with Erbium YAG laser or
Carbon dioxide laser. Hypertrophic scars are flattened with Pulsed dye
- Moles and Nevi
are removed for medical or cosmetic reasons using Carbon dioxide, Ruby
or Erbium YAG laser depending on the type. Pulsed Dye Lasers are also
used to treat 'Giant pigmented nevi'. Becker's nevus can be treated
with Q switched Ruby or Q Switched Nd Yag or Q switched Alexandrite
- Lentigenes (age
spots) are removed using Ruby laser or Q switched Nd yag
- Hair removal temporary
or long term has become an easier task with advent of lasers. Largely,
laser hair removal gives excellent results in fair skinned people.
Listed below are a few lasers used for hair removal.
- Long pulsed Nd YAG
- long pulsed Alexandrite laser
- Long pulse diode
The lasers are absorbed by hair follicle and
spares other skin appendages. Cooling devices further prevent the heat
damage to rest of the skin. Laser hair removal needs multiple sessions.
Re-growth of hair after each session may take from 3 months to up to a
year where latter is considered as a 'very good result'. The re-growth
is thinner, slower and scantier after each session.
is done effectively using lasers for acne scars, pits and small pox
scars. Wrinkles are also treated by this technique. This procedure
involves precise removal of very thin layer of irregular skin. Carbon
dioxide laser and Erbium YAG laser are used for laser-ablation.
Q - switched Nd YAG laser is used for non-ablative resurfacing.