The use of lasers and IPL technology in dermatology and aesthetic medicine requires practitioners not only to have high levels of training and experience, but also to exercise professional judgment. In spite of all of the precautions taken, the risk of complications and side effects can be reduced but not completely eliminated.

Background and Objective: Due to its delicate location near the eye and the high recurrence rate, the therapy of xanthelasma palpebrarum is a difficult surgical task. Besides chemical, physical, and surgical procedures, various laser systems have been used to treat these lesions (argon laser, pulsed dye laser, and CO2 laser). This study was designed to critically evaluate the use of the ultrapulsed CO2 laser for the treatment of xanthelasma palpebrarum. Study Design / Materials and Methods:We report about the standardized treatment of 23 patients (52 periorbital xanthelasmas) and the results obtained after one treatment with a new generation, ultrapulsed CO2 laser (COHERENT Ultrapulse 5000C, Palo Alto, CA; 250-500 mJ; 600-900 µsec; 10,600 nm). The followup time was 10 months. Results: All lesions could be removed completely with a single laser treatment. As for side effects, only transient pigmental changes (4% hyperpigmentations, 13% hypopigmentations) and no visible scarring was observed. Three patients (13%) developed a recurrence of xanthelasma. Conclusions:The ultrapulsed CO2 laser is an effective and safe therapeutic alternative to the hitherto described approaches.

Background and Objectives: The conventional pulseddye laser (wavelength 585 nm, pulse duration 0.5 milliseconds) is seen as the standard treatment for port wine stains (PWS). Using the pulsed-dye laser at wavelengths of 590, 595, and 600 nm and at varying pulse durations of 1.5-40 milliseconds is one of the newest developments in the field, the therapeutic value of which has been examined in only a few studies. Treatment of PWS with short-and longpulse dye lasers. Comparison of two wavelengths (585 nm vs. 595 nm) and two pulse durations (0.5 milliseconds vs. 20 milliseconds). Study Design/Materials and Methods: Fifteen patients with untreated PWS were included in a randomized prospective study with three different laser settings. Patients underwent one treatment session. The following treatment parameters were chosen at a uniform spot size of 7 mm: (1) 585 nm/0.5 milliseconds/5.5 J/cm 2 , (2) 595 nm/0.5 milliseconds/5.5 J/cm 2 , and (3) 595 nm/20 milliseconds/13 J/cm 2 . The clearance as well as side effects was evaluated. All treatments were performed with cold air-cooling. Follow-up took place immediately, 2 days and 4 weeks after the treatment. The PWS was assigned a clearance score (CS) from 1 to 4 (1 ¼ poor to 4 ¼ excellent). Results: Descriptively, 585 nm/0.5 milliseconds generated the best average CS of 2.7, followed by 595 nm/20 milliseconds (2.5) and 595 nm/0.5 milliseconds (1.6)); statistically, there is no difference between the CS of 585 nm/ 0.5 milliseconds and 595 nm/20 milliseconds. The best lightening rates overall were achieved in purple PWS (CS ¼ 3.5) versus red (CS ¼ 2.5) and pink (CS ¼ 2.0). Purple PWS responded best to 585 nm/0.5 milliseconds; red and pink PWS yielded similar results with 585 nm/0.5 milliseconds and 595 nm/20 milliseconds. The setting, 595 nm/ 0.5 milliseconds was clearly not as effective as the other laser settings. Purpura, pain, and crusting were most commonly reported after treatments with 585 nm/0.5 milliseconds (93%/93%/33%), closely followed by treatments at 595 nm/20 milliseconds (86%/93%/20%). The settings 595 nm/0.5 milliseconds yielded the lowest rate of adverse effects (67%/60%/0%). Hypopigmentation only occurred in one case (585 nm/0.5 milliseconds), and there were no reports of hyperpigmentation or scarring. Conclusions: With respect to treating PWS, the conventional pulsed-dye laser set to 585 nm/0.5 milliseconds yields a significantly greater clearance rate than it does at a setting of 595 nm (with the same pulse duration, fluence, and spot size), although the former also entails the highest spectrum of adverse effects. In this study, purple PWS treated at these parameters showed the best results. In dealing with pink PWS, the results were similar to those of the conventional pulsed-dye laser when the pulse duration was increased to 20 milliseconds and fluence was increased. As a rule, the clearance rate corresponded to the extent of the postoperative purpura.

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Background and Objective: Analgesic cooling technologies are firmly established in dermatologic laser therapy. We present cold air as a novel method of cooling and compare it with those methods that are already in use. Study Design/Materials and Methods:We treated 166 patients with the diagnoses hypertrichosis, port wine stains, hemangioma, essential telangiectasias, and tattoos with different laser systems (long-pulsed alexandrite laser [LPIR], pulsed dye laser, Q-switched Nd:YAG laser, Q-switched ruby laser). In a prospective study, we collected data about the analgesia of the cooling method and the thermal protection of the epidermis (reduction of the extent and duration of erythema, purpura, blisters, hyper-/hypopigmentations, edemas, crusting), compared with the cooling method with ice gel. Additionally, we measured air and skin temperatures with an infrared thermometer at different application modalities. Results: Three percent of the treated patients refused the cold air therapy altogether. Eleven percent found that it was as good as the other cooling methods; 86% clearly preferred the cold air therapy. Leaving out the perinasal area, the percentage rises to 97%. On average, the analgesic effect was by 37% better than through cooling with ice gel. The increased thermal protection of the epidermis made it possible to use laser energy levels that were higher by 15-30% and, at the same time, to reduce the rate of side effects (in 63% of the patients erythema persisted for a shorter period, in 70% the purpura was reduced, 83% had less crusting). Conclusion: In dermatologic laser therapy, the use of cold air in analgesia can be considered as an effective, inexpensive, and well-accepted (by both patients and doctors) alternative to currently applied cooling methods. Nevertheless, further prospective studies are necessary to determine whether treatment results can really be improved by using higher laser energy levels.