For more than five decades, argon and carbon dioxide lasers have been used to treat benign dermatological conditions such as birthmarks and haemangiomas.
While the early use of lasers could lighten or alleviate skin conditions, one major side effect was a very high rate of scar formation. Over the last two decades, significant advances in laser technology have dramatically changed the use of laser treatment for numerous skin conditions, including vascular lesions and scars. Today, laser technologies are also used for skin resurfacing and restoration, including the removal of tattoos.
In 1963, Leon Goldman was the first to use a laser in dermatology. In his initial research studies, Goldman documented the effects of Maiman’s laser in the precise destruction of cutaneous pigmented structures, such as black hairs. He also described the likely use of ruby laser and the more advanced Q-switched device in tattoo removal and the potential treatment of various lesions, such as melanomas. Additionally, Goldman looked into the use of an argon laser in the treatment of vascular malformations, in addition to the use of carbon dioxide laser for the removal of skin lesions.
Older laser technologies like the continuous wave (CW) lasers of carbon dioxide and argon have been mostly replaced with more advanced quasi-CW mode lasers and pulsed laser systems.
Below are a few of the more common uses of laser technology in dermatology.
Lasers have been utilized effectively to help remedy various vascular lesions, including superficial vascular malformations and haemangiomas. The pulsed dye laser is regarded as the laser of choice to treat vascular lesions due to its exceptional efficiency and low risk profile. Its large spot size allows for large lesions to be handled rapidly and easily. Adverse reactions include postoperative bruising that may last a couple weeks and transient pigmentary modification. Crusting, textural transformations and scarring can be seen on rare occasions.
Pigmented lesions and tattoos
High-power, QS laser systems can effectively lighten or eliminate a wide variety of pigmented lesions, including freckles and birthmarks.
Treatment of these lesions involves confining the laser to melanosomes, which are the small granules containing melanin within pigment. The effectiveness of laser treatment is based on the depth of the melanin and the colour of the lesion. Superficially-situated pigment is best helped by shorter wavelength lasers while elimination of deeper pigment calls for longer wavelength lasers that permeate to greater tissue depths. Extreme care is necessary when treating darker skin as lasting hypopigmentation and depigmentation may take place. Also, treated lesions may recur after an effective treatment.
Lasers can be used to get rid of excessive and cosmetically debilitating hair as a result of hypertrichosis or hirsutism. Laser treatments can get rid of dark hair rapidly and it may take 3 to 6 months before regrowth occurs. Multiple treatment rounds, with the small breaks between treatments, are often necessary, based on the body region being treated.
Laser treatments are less uncomfortable and much faster than treatment by electrolysis. Problems are uncommon but superficial burns, pigmentary modifications and even scarring may take place. Raised development of fine dark hair in untreated areas near the treated area has been reported. Both boosted and decreased localised perspiration have been reported after treatment.
Wrinkles, scars, and sun-damaged skin
Facial laser resurfacing that uses high-energy, pulsed and scanned lasers has been effective in reducing and eliminating facial wrinkles, acne scarring and sun-damaged skin. High-power, pulsed, and scanned carbon dioxide laser is normally regarded as the gold standard for facial rejuvenation systems. Normally a 50% improvement is seen in patients receiving carbon dioxide laser treatment.
Side effects can include discomfort, redness, inflammation and scarring. The redness and discomfort last multiple weeks, while new skin grows over the location where the damaged skin has been eliminated. Secondary skin infection is a concern until the area is healed. Extreme care is necessary when treating darker skin as lasting loss or varied pigmentation may occur.