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The use of lasers to treat vascular lesions began in the late 1960s with the introduction of argon laser. More recently pulsed laser and intense pulsed light techniques have further improved results and reduced side effects. Their function is based on the principle of selective photothermolysis. Simultaneous application of cooling methods (contact cooling, cold air, cryogen spray) has become standard procedure for these types of therapy, whose most important indications are port-wine stain, hemangioma, and telangiectasia. A persistent difficulty is their limited penetration, resulting in limited or no effect on deeper dermal layers. New approaches therefore include combinations with bipolar radio frequency or the use of two different laser systems, e.g., dye and Nd:YAG lasers. The different lasers are described along with their effectivity, limitations and indications.

As skin resurfacing has become more common, the number of patients developing post-treatment hypopigmentation has increased. No effective treatment for this complication has been developed. Some hypopigmented disorders, including vitiligo, have been treated with the excimer laser. We used the XeCl excimer laser to successfully treat a 78-year-old woman with perioral leukoderma following CO(2) laser skin resurfacing. The repigmentation was stable for at least 16 months. Larger prospective studies of this new therapeutic intervention are recommended to evaluate its efficacy and long-term stability.

Hypopigmented skin developed following tattoo removal with the Q-switched Nd:YAG laser. The hypopigmented area remained unchanged for over 4 years, until the use of the 308-nm xenon-chloride excimer laser induced a significant repigmentation in 40 sessions over 14 months. The excimer laser has the potential to influence the reduced activity of the melanocytes, as demonstrated with electron microscopy.

Reticulohistiocytoma is a rare non-Langerhans-cell histiocytosis. On exposed skin areas it is a cosmetic problem and can cause mechanical irritation due to its prominent nature. We successfully treated a histologically confirmed reticulohistiocytoma on the back of a 60 year old woman with a pulsed dye-laser (wavelength 585 nm, pulse 0.45 msec). The lesion regressed significantly after the first treatment (spot size: 7 mm, fluence 7.8 J/cm(2)). After another laser treatment, the lesion completely disappeared. At 28 month follow-up, no recurrence was seen. Permanent side effects were not observed. In our case report the use of the pumped pulsed dye-laser has proven to be an elegant and low risk treatment option for reticulohistiocytoma. The mechanism of action remains unknown.

Background and Objective: Pigment fanning or spread is one complication of decorative tattooing, but is also seen after traumatic tattoos. The reason for this spreading remains unclear. While excision of the diffused pigment was previously considered the treatment of choice, today destruction of the pigment with Q-switched laser systems is the therapy with the highest efficiency and lowest rate of side effects. Therefore areas of pigment spread should be excised only in rare exceptional cases., Patients/methods: 4 patients with pigment fanning after permanent make up and traumatic tattooing of the periorbital region were treated with the Q-switched ruby (694 nm) and Q-switched Nd:YAG (1064 nm) lasers., Results: All patients showed a significant (70-80%) clearance of the spread pigment; two had complete clearing. Side effects such as hyper- or hypopigmentation, scarring or ink darkening were not seen., Conclusions: The Q-switched ruby- and Q-switched Nd:YAG-lasers are a therapeutic modality for pigment fanning with high efficiency and low rate of side effects. Attempts of explanation for pigment spread after tattoos are given, but further histological and electron microscopical investigations are needed to find the pathogenetic mechanism.

The medical indications for laser therapy have been somewhat overlooked, perhaps because of the success of cosmetic laser therapy. As a result, many effective medical treatments are not covered by insurance companies. Lasers are helpful in many aspects of dermatologic treatment. Examples include pigmented lesions (Becker nevus), benign tumors (organoid nevi, adenoma sebaceum), dyschromias (traumatic tattoos), inflammatory diseases of the skin and subcutaneous tissue (lupus erythematosus, scars), hypertrichosis, premalignant lesions, and vascular lesions (hemangiomas and malformations). The various disorders which can effectively be treated with lasers are reviewed.

In the past few years, the spectrum of indications for ablative lasers in dermatology and aesthetic medicine has been expanded due to technological innovations. In the following, technical basics, laser-tissue interactions, indications for the CO(2) and Er:YAG laser and laser treatment management are described. In addition, side effects and reactions associated with the use of these laser systems are listed and compared.

Currently, ablative laser therapy (with CO2/Er:YAG lasers) and deep chemical peeling are effective and promising methods of skin rejuvenation. The induction of collagen synthesis was observed after peelings with trichloroacetic acid or phenol as well as after treatments with the CO2 laser. In past years, the undesirable side effects and risks of these methods have led to intensified research in the fields of non-ablative facial rejuvenation and subsurfacing by means of ablative laser systems and intense pulsed light systems. The objective is to achieve selective, heat-induced denaturalisation of dermal collagen that leads to subsequent reactive synthesis but does not damage the epidermis. Recently, the results of numerous clinical and histological studies have indicated that these new technologies are successful. After critical review and assessment of current literature, we can say that in terms of their efficacy, non-ablative methods are not a comparable alternative to ablative skin resurfacing.

Background and Objective: Benign melanosis of the lip represents a cosmetic problem for many of those who are afflicted. It responds well to therapy with Q-switched lasers. The value of previous studies has been limited by small numbers of cases or short follow-up times., Patients/methods: In a retrospective study 9 patients were treated by the Q-switched ruby laser (694 nm, pulse duration 25-40 ns, spot size 4 mm, energy density 10 J/cm2) in the period from 5/94 to 10/99. The benignity of the lip melanosis was determined dermatoscopically. In one case, the diagnosis was also confirmed histologically by a punch biopsy. The follow-up time was between 6 months and 5 1/2 years., Results: In 3 cases a complete clearance of the melanosis was achieved after one session, while in 6 patients a second treatment was required. There were no recurrences. Scars or pigment alterations were likewise not observed., Conclusions: The treatment of benign melanosis of the lip with the Q-switched ruby laser is an elegant and safe method with excellent cosmetic results.

Background and Objective: There is a wide variety of methods for the treatment of mollusca contagiosa. Especially with anxious children, most of them are not applicable because they are often invasive, painful, time intensive or difficult to conduct (e.g. if a stay in hospital is necessary). In order to verify the existing case reports, this paper evaluates the application of the pulsed dye laser as a possible therapy alternative in cases of mollusca contagiosa., Patients/methods: In a prospective study 20 patients with mollusca contagiosa were treated with the pulsed dye laser., Results: The therapy was well tolerated; no scars or pigment anomalies were observed. 95.9% of the lesions healed after the first treatment, the other 4.1% after the second. This larger study verifies the positive findings indicated in case studies., Conclusions: For exposed sites, difficult cases or if other treatment methods have failed, the pulsed dye laser is an effective, quick, bloodless and elegant therapeutic alternative for mollusca contagiosa with a low rate of side effects.

During the last few years the fast development of different laser and laser-like systems for photoepilation and their one-sided representation in media has led to confusion among physicians and patients. The object of this review is to give a structured report of different pulsed laser and laser-like systems (Epilight, Photoderm, long-pulsed ruby-, alexandrite- and diodelaser) that are available in Germany, including their side effects and complications. The current status of scientific investigation in this field is discussed.

The neodymium:yttrium-aluminium-garnet-(Nd:YAG) laser is one of the most versatile and interesting lasers in dermatological laser medicine. Almost no other laser has such a wide spectrum of applications. Depending on wave length (1064 nm, frequency-doubled 532 nm) and mode (continuous, Q-switched, long-pulsed), benign pigmented lesions (tattoos, traumatic tattoos, naevus of Ota, cafe-au-lait-macules, lentigines) and vascular lesions (hemangiomas, portwine stains, essential teleangiectasias, angiomas) can be treated. Additionally this laser has been occasionally used to remove Kaposi sarcomas and epithelial skin tumors.

A 17-year old female patient with extragenital lichen sclerosus et atrophicus was treated with the pulsed dye laser. Local and systemic therapy before treatment showed no effect. The lesions were removed completely with four treatment sessions. As for side effects, no pigment changes and no visible scarring was observed. The patient experienced no recurrence within a follow-up time of 7 months. The mechanism whereby lichen sclerosus et atrophicus is altered by the pulsed dye laser is unknown.