Journal of

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Pulse Dye Laser (PDL) is mainly used to treat vascular lesions but several studies performed in different research centers have shown the efficacy of this safe laser in the treatment of non-vascular lesions as well. The aim of this study was to review, sum up and summarize these studies.PDL is a known alternative for cryotherapy in the treatment of some viral lesions such as periungual warts and molluscum contagiosum.The effect of this laser in the management of inflammatory lesions is not yet known and there have been controversial results. PDL has a very little effect on these dematoses and it is limited to the lesions with a clear vascular component, such as psoriasis and acne. Finally, regarding collagen remodeling and its usage in rejuvenation and in the treatment of hypertrophic scars, keloid and striae, the results from various studies are different and while they confirm its possible effect, more studies have to be conducted in order to determine appropriate treatment parameters.

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Background and Aim: Xanthelasma is a benign condition considered which is mainly as a cosmetic problem. There are many destructive treatment options that may result in scar formation and dyspigmentation such as cryotherapy and electro-cauthery. According to these side effects finding a non-invasive solution could be important. At this study we aimed to evaluate the effect of PDL laser in the treatment xanthalasma.
Methods: Patients with bilateral palpebral xanthelasma having normal serum lipid profile were eligible for the study if they had no history of a collagen vascular disease or dermatologic disorders that were associated with Koebner phenomenon. All patients had two separate pulsed dye laser (PDL) treatment sessions, with a four-week gap in between and were photographed before every laser treatment session and four weeks after the second session. Visual analogue scale (VAS) scoring system was used to determine effect of treatment by two academic dermatologists blinded to the study as the referees. Mean healing score by the two referees considered as final score.
Results: Nine patients with a mean age (±standard deviation) of 38.0 (±9.2) years were included. All patients were female. The commonest site of lesions was upper lid, and final resolution score for all patients was less than 25%. There were no significant differences between viewpoints of the two referees. There were no major post operative complications. Patients followed for six months after the end of the treatment and there was no adverse effect.
Conclusion: The present study failed to demonstrate therapeutic efficacy of PDL in the treatment of xanthelasma. PDL with limited session numbers could not be considered as an alternative treatment for xanthelasma palpebrarum.

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Background and Aim: Liposuction is one of the most popular procedures for removing unwanted body fat deposits now. The conventional methods for liposuction however have many drawbacks among them is long recovery time, scars, bruising, skin flaccidity and excessive blood loss. Considering the increasing demand for body sculpting, the need to improve these techniques is of vital importance. One of these newly proposed techniques is laser assisted lipolysis. Laser lipolysis is now widely used for body contouring and sculpting. Less trauma, bleeding and pain is among the main advantages of this method.

Methods: Photons propagation and scattering within the biological tissues can effectively investigated by using numerical methods. In this study we used the Monte Carlo simulation method to simulate photons directions, absorption and scattering inside the tissue. This method uses a random number generator for photons creation, moving inside the tissue and termination. In this simulation we considered both the wavelength and fluence variations effects on the photon absorption rate and penetration depth inside the fat tissue.

Results: Our study showed the increasing of penetration depth with decreasing of absorption coefficient. We observed that deepest penetration depth for 920 nm wavelength as it has lowest absorption coefficient. We also concluded that increasing the laser power (increase in fluence of laser) resulted in increasing the penetration depth of laser radiation. Increasing the radius of laser beam (decreasing the fluence) on the other hand resulted in reduction in penetration depth.

Conclusion: Monte Carlo simulation of radiation propagation within the biological tissue has proved to be an efficient method. This method effectively simulates the physical components of laser radiation. Our findings indicate that to have laser lipolysis more efficient and safe, it is essential to choose suitable wavelength.

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Background and Aim: Hirsutism is one of the most common reasons for which women visit dermatology and beauty clinics. Lasers have got considerable popularity during last two decades because they can reduce unwanted hairs. This study was conducted to evaluate the satisfaction of patients with hirsutism traeted with diode laser, IPL or combination of both. Methods: In this retrospective study, hirsute patients referred to Yazd Laser Center from October 2011 until October 2012 were studied. Patient satisfaction from the amount of hair loss one month after starting treatment, one month after the end of treatment and 6 months after treatment were asked using telephone. Results: Patient satisfaction one month after the end of the treatment with diode laser was higher than the other two methods (P=0.034). Patient satisfactions at one month after initiation of the treatment and six months after the end of the treatment were not the statistically significant. The number of laser sessions was similar in the three groups. Conclusion: Results of the current study revealed that there was no significant difference in the patient satisfaction with diode laser, IPL and combination of both methods in the treatment of hirsutism 6 months after the end of the treatment.

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Background and Aim: Unwanted hair growth (hirsutism) is a cosmetic problem, which has been resulted in a large number of researches regarding its treatment. Patient satisfaction after treatment using hair removal lasers has been different. The aim of this study was to investigate the satisfactaion rates of the patients with hirsutism after being treated with a diode laser. Methods: In this study satisfaction rates of 50 women with hirsutism were evaluated based on an audio-visual evaluation in Haj Daii clinic in Kermanshah, Iran. Results: Fifty patients with a maen±standard deviation age of 32.5±9.2 years were categorized in three groups in accordance with their skin phototypes. Patient satisfaction after using laser diode hair removal with 25-40 J/cm2 was 74.6%. The most common side effect was transient post laser erythema (28.3%). The highest satisfaction rate was obtained in patients who were taking hormone regulating drugs (85.0%). The lowest satisfaction was obtained in patients with irregular menstrual cycle who were not taking any hormon drugs (73.3%). There was a direct correlation between the number of laser sessions and patients satisfaction (r=0.51, P<0.05). Conclusion: Findings of the present study showed that diode laser is an effective method in treatment of hirsute patients and patients satisfaction rates are good.

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Postsurgical scars are of significant concern to both the patients and surgeons. Different laser systems have been used to accelerate and improve the healing process in surgical scars. Some studies have demonstrated the benefits of prophylactic laser application on pre-scars. It seems that using laser energy in the early phase of the healing process may produce changes in the physiology of wound healing toward a more fetal-like tissue regeneration and healing. Laser-Assisted Skin Healing (LASH) is a new approach in which laser irradiation is applied immediately after surgery in order to improve the resulting surgical scars. LASH produces controlled homogenous heating throughout the full thickness of the skin around the wound which accelerates wound healing without thermal damage to the tissue.

The purpose of this paper is to provide an overview of the available peer-reviewed research literature on the application of LASH, the in-vitro, animal and human studies and the suggested mechanisms of action. Further studies are necessary to optimize the best laser parameters especially according to different skin phototypes and  better understanding of the mechanisms of action.

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Background and Aim: Among destructive treatments for removal of unwanted hair, hair removal laser devices have widely replaced the old fashion methods due to their safety and effectiveness. The purpose of this study was to analyze the effective factors on treating unwanted hairs with a laser device.
Methods: This retrospective study, was performed on records of 122 patients who referred to a hair and skin clinic .Patients with hirsutism or other diseases were excluded. Hair thickness and color, skin color, number of laser sessions, age and sessions interval were evaluated. The collected data were analyzed by compeutering program SPSS version 21, analytic tests chi-square and logistic regression (P less than 0.05 considered meaningful).
Results: The average age of participants was 31.3±6.6 years. The average number of laser sessions was 5.4±2.1 and the most satisfying outcome was observed in dark hairs and more than 5 sessions (P<0.05). Multivariate logistic regression model illustrated that the number of sessions directly impacts the effectiveness of treating unwanted hair (P<0.05). Level below the rock curve and the sensitivity were 0.71(0.61-0.81) and 0.759, respectively.
Conclusion: This study showed that hair thickness and color, number of laser sessions are important factors on hair removal treatments by laser. For optimal outcome more sessions with longer follow up is recommended.

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Rosacea is an inflammatory, chronic and cosmetically annoying common dermatologic disorder which presents with cutaneous telangiectasia, sustained erythema with courses of flares and flushings, papulopustular lesions, ocular involvement or disfigurating phymas. Although there are many relative effective medical therapies, however there are not any promissable treatment. Due to chronic nature of disease and exhausting usage of topical or systemic therapies , we decided to review Pubmed’s literature for non-medical physical therapies, looking for more effective modalities and minimal side effects, particularly in intractable cases.

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Background and Aim: Melasma is a common disease affecting quality of life. Available treatments result in the gradual and partial clearance of melasma, and are accompanied with high risk of recurrence after discontinuing treatment. Tranexamic acid has been successfully evaluated in several studies. In addition, laser has been proposed as an enhanced drug delivery method. This study is designed to evaluate this enhancing effect.

Methods: Twenty-five patients with bilateral epidermal and mixed type melasma were recruited in the study and applied tranexamic 5% gel bilaterally on face two times a day and randomly underwent fractional CO2 laser treatment on one side of the face monthly. They were evaluated before starting treatment and then every 4 weeks by measuring modified melasma area severity index (mMASI) and melanin index by Dermacatch (Colorix, Switzerland). Also, quality of life was measured and compared in a subset of patients with MELAS QoL questionnaire before and after treatment. The results were analyzed by SPSS software version 18 and the results were compared by paired t test. Due to multiple comparisons, p value of 0.0125 was considered significant.

Results: The mMASI and melanin index were not significantly different between two sides in each follow up (P>0.0125). The mMASI and melanin index significantly decreased after treatment with tranexamic acid with or without fractional CO₂ laser (P<0.001 and P<0.001, respectively)

Conclusion: Although tranexamic acid 5% gel is effective in the treatment of melasma, however, our study did not show additive therapeutic effect by adding fractional CO₂ laser to it.

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Diode 1470 nm laser is a minimally invasive laser used for skin lifting and tightening. It can reduce laxity and excessive fat tissue. Three patients with facial fat lump due to past facial fat injection treated by this laser in one session.

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Background and Aim: Atrophic scars constitute a common complication of acne and various methods have been proposed for their treatment. This study aims at comparing the efficacy of fractional CO₂ laser with microneedling in the management of atrophic acne scars.

Methods: Patients with atrophic acne scars presenting to dermatology clinic of Hamadan’s Sina hospital between March 2016 and March 2018 were included in the study. Every 3 weeks, each patient received fractional CO₂ laser on one side of the face and microneedling on the other side, for a total of 4 sessions. Patient’s satisfaction and the severity of scars (based on Goodman and Baron’s scar scale) were assessed 1, 2 and 6 months thereafter.

Results: Overall, 24 participants were included. Prior to intervention, no significant difference was observed between groups in terms of mean scar score (P=0.726). At 1, 2 and 6month follow-up visits, the scar score of the side treated with laser was significantly lower than the microneedling side (P for 1, 2 and 6month follow-up visits: 0.033, 0.008 and 0.014). No significant difference was observed between groups in terms of patient’s satisfaction (P for 1, 2 and 6 month follow-up visits: 0.589, 0.469 and 0.840). The most prevalent side effect was erythema in 3 patients treated with laser. Due to low prevalence, statistical analysis of side effects between groups was impossible.

Conclusion: Compared to microneedling, fractional CO₂ laser was more effective in reducing the scar score of patients. The prevalence of side effects in both treatments were low.

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Background and Aim: Warts are benign tumors caused by different types of human papillomavirus. Different methods are used in the treatment of warts. The aim of this study was to compare the effectiveness, side effects and number of treatment sessions of CO₂ laser and cryotherapy in the treatment of plantar warts

Methods: Seventy patients (140 feet) with plantar warts on both feet who referred to the dermatology clinic of Farshchian (Sina) Hospital in Hamadan during 2019-2020 were selected by convenience sampling method. The warts were randomly treated with either CO₂ laser or cryotherapy on each foot. After treatment, patients were evaluated every two weeks for up to five sessions for requirement of treatment repetitions and assessment the extent of healing. In the cases with
non-healing lesion, treatment was repeated once every two weeks for up to five sessions. 

Results: The mean age of the patients was 22.11±8.73 years, and 35.7% were male and 64.3% were female. In the CO₂ laser and cryotherapy groups, the frequency of recovery rate was 81.4% and 41.4%, (P<0.001), and the mean number of treatment sessions was 1.90±0.84 and 3.55±0.69 (P<0.001) respectively. Frequency and type of side effects in the CO₂ laser and cryotrapy group was pain 25.7% and 94.3% (P<0.001), itching zero and 32.9% (P<0.001), blisters 2.9% and 82.9% (P<0.001) and hyperpigmentation with zero and 12.9% (P=0.003), respectively.

Conclusion: CO₂ laser is more effective than cryotherapy in less number of sessions and with less side effects for the treatment of plantar warts

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Background and Aim: Alopecia by reduction of hair follicles at the wound healing site is a complication of cryosurgery that creates an unpleasant appearance in the scar of healed tissue. The aim of this study was to evaluate the effect of low level laser on preventing necrosis of hair follicles and increasing hair follicles in cryosurgery induced wounds.

Methods: Fifty male Wistar rats were randomly divided into 2 main experimental and control groups (with and without low power laser) and 5 subgroups. Histopathological examination of the amount of hair follicle count and angiogenesis at intervals of 3, 7, 14, 21 and 28 days was performed in the laboratory. SPSS software was used for statistical analysis. 

Results: There was no significant difference in the  angiogenesis had significantly index between the main groups on days 14 and 21 (P>0.05), but on days 3, 7 and 28, the experimental group had significantly higher angiogenesis than the control group. Throughout the days, both groups showed a significant increase in angiogenesis (P<0.05), except for the third and seventh days in the control group, and in both groups between the 21^st and 28^th days (P>0.05). In the comparison of hair follicle index, there was an increase on all days, which was significantly higher in the experimental group than the control group (P<0.05). However, no statistical difference was observed between the third and seventh days (P>0.05).

Conclusion: The use of low-power lasers on cryosurgery induced wounds with scars and alopecia can prevent hair follicles necrosis and subsequent increase in their numbers in rats.

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Background and Aim: Undesirable appearance of the scar tissue after aesthetic surgery can affect the outcomes and patient satisfaction. In recent years, early laser therapy had been encouraged to reduce the scar tissue formation. However, the available evidence regarding the outcomes of laser therapy utilizing combined lasers are limited. In the current study, the effects of combined laser therapy using pulsed dye laser (PDL) and fractional CO2 laser on the appearance of the scar tissue after aesthetic surgeries were investigated.

Methods: There were 15 patients enrolled in the current study including 13 mammoplasty and 2 abdominoplasty patients. In mammoplasty, each breast was randomly assigned to the laser therapy or control group. In abdominoplasty, split scar design was used. In laser therapy group, at the end of the third postoperative week, PDL 585 nm was radiated. Furthermore, at the end of the sixth week, fractional CO2 laser was radiated. The patients were followed for 6 months after the last laser therapy session. Visual analogue scale was used to rate the appearance of the scar tissues by 3 surgeons blinded to the treatment of scars. The appearance of the scars was determined as poor, fair, good or excellent. 

Results: VAS averaged 5.5±0.8 in laser therapy group and 4.8±0.8 in the control group. The difference was not statistically significant (P=0.057). There was no scar with excellent appearance in the current study. All of the scars were fair and good in the laser therapy group. In the control group, 13 scars were fair. The difference was not significant (P=0.227).

Conclusion: Early combined laser therapy using PDL and fractional CO2 laser was associated with improved appearance of the scar tissue in short-term follow up, however, the effects were not statistically significant.

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Background and Aim: Oral lichen planus is a chronic
muco-cutaneous immunopathological disorder that commonly affects the oral mucosa. Candida albicans is the most common pathogen associated with oral candidiasis. The aim of this study was to determine the effect of 810 nm low power laser wavelength as an adjuvant in the treatment of
nystatin-resistant C.albicans in patients with oral lichen planus.
 

Methods: In this experimental study, 5 nystatin-resistant C.albicans were isolated from the oral cavity of patients with ulcerative lichen planus. Drug susceptibility testing was performed based on CLSI-M27-A3 and showed that these isolates were resistant to nystatin. The fungal suspension with a dilution of 0.5 McFarland was exposed to a diode laser with a wavelength of 810 nm and a density energy of 20.38 j / cm2 with a time of 20 seconds. Then the results of minimum inhibitory concentration (MIC) were recorded for each group.
 

Results: 810 nm laser caused a significant reduction in nystatin-resistant C.albicans colonies (P<0.001). The MIC did not decrease significantly after the exposure.
 

Conclusion: Laser irradiation reduces the number of nystatin-resistant C.albicans colonies. But this effect does not necessarily change the MIC. Dentists should be aware that in cases of resistant Candida strains, a low-power diode laser with a wavelength of 810 nm can play a role in reducing colonies and responding better to standard treatment.

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Portwine stains (PWS) lesions are one of the most common childhood vascular malformations that gradually increase in color and thickness without treatment and have profound devastating psychological effects on the child. For this reason, and also because the lesions become resistant to treatment over time, early treatment of these lesions is very important. pulsed dye laser (PDL) is currently the treatment of choice for these lesions. In almost all aspects of the treatment of these lesions with PDL laser, disagreement and sometimes contradictory data are found among various studies. These include the uncertainty of the optimal number of treatment sessions, the appropriate age to start treatment, the optimal parameters to start treatment with and possible methods to increase the effectiveness of PDL, possible treatment side effects and how to deal with them, as well as using different methods to reduce patient discomfort during treatment. The present article collects and reviews existing studies in this field.

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Background and Aim: Lower limb telangiectasias are commonly seen in the general population and especially in females. This disorder not only causes cosmetic problems but also can cause pain and related problems of increased venous blood pressure. These varicose veins are one of the most common causes that patients refer to dermatology clinics. Considering some complications and limitations of sclerotherapy, we decided to investigate the efficacy and safety of the Long-Pulsed Nd:YAG 1064-nm laser as an alternative method.
 

Methods: 29 patients underwent at least three sessions of 1064 nm Nd: YAG laser treatment at intervals of 4 weeks. Before the first treatment session, after each session, and six months after the last session, photos were taken of the treatment site. Finally, clinical response and satisfaction rate with the treatment were recorded based on the score of a secondary dermatologist and the patient himself based on the improvement criteria from 0 to 4.
 

Results: According to the dermatologist's judgment, the average satisfaction with the treatment is 3.38 out of 4 with a standard deviation of 0.5, and based on the patient's assessment, it is 3.2 out of 4 with a standard deviation of 0.71, which is equivalent to more than 76% of the effectiveness of Nd:YAG 1064 nm laser in the treatment of telangiectatic veins. The pain during laser treatment was recorded as 6.27 with a standard deviation of 2.64 based on The VAS Scale.
 

Conclusion: Our experience has demonstrated that the long-pulsed 1064 nm Nd:YAG laser is an effective, reliable, safe method in the treatment of telangiectatic and reticular veins of the lower limbs with minimal side effects and complications.