Comparative effectiveness of purpuragenic 595 nm pulsed dye laser versus sequential emission of 595 nm pulsed dye laser and 1,064 nm Nd:YAG laser: a double-blind randomized controlled study

Abstract

Introduction: Erythematotelangiectatic rosacea is a common condition in Caucasians. The most frequently used lasers to treat this condition are pulsed dye laser (PDL) and neodymium:yttrium-aluminum-garnet laser (Nd:YAG). This study compares the treatment efficacy of purpuragenic PDL with that of sequential emission of 595 nm PDL and 1,064 nm Nd:YAG (multiplexed PDL/Nd:YAG). Methods: We performed a prospective, randomized, and controlled split-face study. Both cheeks were treated, with side randomization to receive treatment with PDL or multiplexed PDL/Nd:YAG. Efficacy was evaluated by spectrophotometric measurement, visual photograph evaluation, the Dermatology Quality of Life Index questionnaire, and a post-treatment questionnaire. Results: Twenty-seven patients completed the study. Treatment was associated with a statistically significant improvement in quality of life (p < 0.001). PDL and multiplexed PDL/Nd:YAG modalities significantly reduced the erythema index (EI; p < 0.05). When comparing the degree of EI reduction, no differences were observed between the two treatment modalities. PDL was associated with a higher degree of pain and a higher percentage of purpura. Multiplexed PDL/Nd:YAG modality was associated with fewer side effects and greater global satisfaction, and 96.3% of the patients would recommend this treatment to a friend. Conclusions: Both laser modalities are efficacious in the treatment of erythematotelangiectatic rosacea. The multiplexed PDL/ Nd:YAG modality was preferred by the patients.

Efficacy Comparison of Pulsed Dye Laser vs. Microsecond 1064-nm Neodymium:Yttrium-Aluminum-Garnet Laser in the Treatment of Rosacea: A Meta-Analysis

“…Although six RCT studies implemented the blinding of subjects, the clinicians were not blinded; thus the evaluations of the “Blinding of participants and personnel” for all three included studies were “unclear risk”. Only Alam et al ( 17 ), Campos et al ( 30 ), and Kim et al ( 27 ) reported specific randomization, while the studies by Alam et al ( 17 ) and Seo et al ( 23 )reported allocation concealment. All three studies showed low risks in terms of “detection bias”, “attrition bias”, “reporting bias”, and “other bias”.…”

“…Two studies ( 17 , 30 ) reported the pain score of the PDL group, and one study reported the pain score of the Nd:YAG group. Based on the visual analog scale (VAS) as the pain outcome index, the combined result of the PDL group showed a mean (95%CI) = 4.60 (3.17–6.04), indicating not significantly higher ( P = 0.115) pain sensation of patients treated with PDL than that in patients treated with Nd:YAG, mean (95%CI) = 3.07 (1.82–4.32) ( Figure 5 ).…”

Treatment of pyogenic granuloma with copper vapor laser radiation

“…При недостаточно эффективном поглощении кровью для удаления патологического очага требуется многократная обработка (до шести процедур) [28]. При фототермической облитерации микрососудов дермы в области ПГ применение ЛПМ позволяет избежать развития ранних побочных эффектов в виде пурпуры, которые наблюдаются при использовании импульсного лазера на красителе с продолжительностью импульса 450 мкс [29]. Применение неодимового лазера позволило добиться высокой эффективности удаления ПГ, но после его использования у 40% пациентов возникали побочные эффекты в виде рубцевания [17], что связано с фотодеструкцией соединительнотканных компонентов ретикулярного слоя дермы, вследствие проникновения до проксимальной границы дермы ближнего ИК-излучения из-за низкого поглощения кровью.…”

Updates and Best Practices in the Management of Facial Erythema

“…Some laser devices combine both PDL and Nd:YAG technology, allowing the firing of the PDL component milliseconds prior to the Nd:YAG wavelength. 37 Some believe that this technique enhances the effectiveness of the Nd:YAG laser by a factor of 3–5 due in part to the transformation of oxyhemoglobin to methemoglobin by the PDL. 37 There has also been a suggestion of reduced purpura in the combined device compared to PDL alone when treating blood vessels.…”

“… 37 Some believe that this technique enhances the effectiveness of the Nd:YAG laser by a factor of 3–5 due in part to the transformation of oxyhemoglobin to methemoglobin by the PDL. 37 There has also been a suggestion of reduced purpura in the combined device compared to PDL alone when treating blood vessels. 38 Karsai et al demonstrated, in a split-face randomized study, that use of the dual wavelength PDL-Nd:YAG delivered higher and statistically significant rates of telangiectasia clearance in one treatment that use of a single wavelength PDL or Nd:YAG.…”