Treatment of other skin lesions
Different lasers have been used for the treatment
of various skin lesions. The carbon dioxide (CO2)
laser is the most common application. The Neodymium:Yttrium-Aluminum-Garnet
Laser, Argon Laser, the Pulsed-Dye Pigmented Laser
and Q-Switched Ruby Laser have also been used effectively
for the treatment of skin lesions.
The CO2 laser has a wavelength of 10,600 nm, a
superficial penetration depth that makes it useful
for treatment of benign lesions and ensures lesser
surrounding healthy tissue damage. The argon laser
with wavelengths in the range of 488 and 514.5
nm has a limited penetration capacity. The Nd:YAG
has a wavelength of 1064 nm with preferential absorption.
The Pulsed-DyePigmented Laser has a wavelength
of 510 nm and the Q-Switched Ruby Laser gives 694
nm. The Pulsed Dye Laser at 585 nm with high energy
and short pulse duration is highly specific and
causes minimum damage to surrounding tissues and
hence less scarring.
The various skin lesions that can be treated with
the lasers mentioned above:
PDL is now the preferred choice over CO2 laser
in the treatment of refractory warts, though initially
it was the latter that was used especially for
plantar and periungual warts and condyloma. Plantar
and periungual verrucae are types that are unmanageable
by other treatment modes like electrodesiccation
and curettage, cryotherapy, and salicylic acid
therapy. In these cases, CO2 lasers have shown
varying results which are greatly dependent on
Other comparative studies have reported the following
rates of cure and scarring respectively, but all
with more accurate control over thermal damage:
- Continuous-wave CO2 - 68% and 54%
- The superpulsed
CO2 - 68% and 33%
- The ultrapulsed CO2 - 90%
However, limited penetration is a disadvantage
of ultrapulsed laser, which also increases the
treatment duration and number of pulses. Moreover,
there are risks of infection for the operators
in case of the CO2 treatment of verrucae and stringent
precautions are necessary.
Rhinophyma are skin lesions on the nose. CO2 laser
treatment has the advantages of high precision,
effective hemostasis and least heat conduction
for this disease. However, the newer, short-duration,
higher peak power CO2 lasers are preferred over
the older continuous-wave CO2 types to reduce scarring
due to heat conduction. However, CO2 lasers are
not too suitable for thick rhinophymas due to the
short ablations involved.
CO2 lasers have made treatment of epidermal nevi
a lot easier and reduced recurrence that occurs
with dermabrasion and scarring caused by more forceful
applications like excision. The ultrapulsed CO2
laser is preferred over the continuous wave CO2
laser. The higher-peak power, shorter-duration
CO2 lasers is more accurate but could cause scarring.
Thick and large seborrheic keratoses have been
removed with a single treatment in some experiments
with the continuous-wave CO2 or superpulsed CO2
lasers, but with some atrophic scarring. The ultrapulsed
CO2 laser however showed no scarring and less thermal
damage. However, most of the results are operator
The Nd:YAG is also effective on early seborrheic
keratoses and the pulsed-dye pigmented lasers are
efficient on flat seborrheic keratoses. The argon
laser is also a treatment option, but since it
is a continuous type it can cause scarring. The
Q-Switched Ruby Laser reports a 75% success with
Angiofibromatous and angiolymphoid lesions
CO2 lasers with minimum heat damage, high-peak
power, shorter-exposure is best suited for highly
fibrous lesions like adenoma sebaceum, angiokeratoma,
pyogenic granuloma, and lymphangioma circumscriptum.
It also causes less scarring and is more effective
than the argon laser.
CO2 and Neodymium: yttrium-aluminum-garnet (Nd:YAG)
laser have shown good results on chronic ulcers.
If well debrided and sterilized by these two processes
it can ensure a speedy healing.
Verrucae are a virally infected tissue, with 10
% prevalence. PDL at 585 nm has been successfully
implemented in a study upon recalcitrant verrucae.
The process has been ensured with selective destruction
of the infected tissues thus reducing surrounding
tissue damage and associated scarring.
Pulsed Dye Laser at 585 nm in 2 to 3 treatment
sessions is effective in clearing nonfibrous angiofibromas.
It has the advantage of lesser scarring. Argon
laser also works well on angiofibromas, but has
a limited penetration till the upper 1 mm of the
dermis and risk of scarring.
PDL is suitable for the treatment of the vascular
constituents of the inflammatory acne rosacea,
which is accompanied with telangiectasia and erythema.
It has a success rate of 59%. Argon lasers work
well on telangiectasia.
Superficial dermal lesions
The various benign superficial dermal tumors that
have been successfully cleared by the continuous-wave
and superpulsed CO2 lasers are:
- Myxoid cyst
- Sebaceous hyperplasia
- Apocrine hidrocystoma
- Adenoma sebaceum
- Chondrodermatitis nodularis
Other inflammatory conditions that can be treated
with CO2 laser include:
- Darier’s disease
- Lichen sclerosus
- Zoon’s balanitis
- Hailey-Hailey disease
- Lichen planus