By George J. Hruza, MD
Xu LY et al. Histopathologic study of hidradenitis suppurativa following long-pulsed 1064-nmNd:YAG laser treatment.
Arch Dermatol 2010Sep 20; [e-pub ahead of print]. (http://dx.doi.org/10.1001/archdermatol.2010.245)
Aggressive treatment with hair removal laser such as Nd:YAG 1064 nm may have a positive effect on lesions of HS. Hidradenitis suppurativa (HS) is very resistant to both medical and surgical management — exacerbations, recurrence, and progression are the norm.
The observation that HS (aka Acne Inversa) may be related to follicular occlusion has led to attempts to treat HS with hair removal lasers. In this prospective, controlled clinical and histologic study,20 patients with Hurley stage II HS (skintype, Fitzpatrick III or VI) underwent treatment with a long-pulsed 1064-nm Nd:YAG laser.
Toenail fungus, aka onychomycosis, is a very common problem. The numbers vary depending on the source, but we are talking 20-30 million in the U.S. alone. Most are mild cases, which are not accounted for because people do not go to the doctor to diagnose their smelly feet with ugly deformed nails.
Several laser companies are working on clinical studies and FDA approvals, but practitioners do not have to wait – they are free to perform off label procedures with the lasers they own or rent.
Anecdotal evidence is growing to confirm that laser treatment of the fungus is a lot more efficacious (75-90% cure rate) than topical solutions (8-10%) and oral medication (30-40%). Lasers are quickly becoming a new way to treat nail infection by selectively irradiating fungi while leaving the nail and surrounding tissue intact.
Onychomycosis is more common among people over the age of 50 who should avoid toxic medication. Podiatrists and other physicians who have started performing these treatments charge from $850 to $1,400 per treatment (all toes have to be treated at the same time). Thus, the market for non-invasive, drug free (only topicals for prevention) and simple laser procedures is huge, a billion-dollar-plus per year huge.
Currently only a few hundred doctors in the U.S. offer the laser therapy and they are not easy to find. A medical referral service called Laser for Toe specializes in setting up free doctor appointments for people with toenail fungus. They can find a laser doc near you.
Warts are ugly but they are common, and there are many ways and means to remove them. I prefer to use a YAG laser to remove warts.
Surprisingly, this simple technique is not very common among dermatologists who typically freeze warts with nitrogen. That is painful and not very effective as in many cases more than one treatment is required.
Digging into the body of research on the subject I found a report on a study published in September 2009 by the Korean Academy of Medical Sciences.
This study was designed to evaluate the efficacy of long-pulsed Nd:YAG laser in the treatment of warts. Over the course of 1 yr, 369 patients with recalcitrant or untreated warts were exposed to a long-pulsed Nd:YAG laser. The following parameters were used:
Hidradenitis is a chronic disease of the apocrine glands (a form of sweat gland found on certain parts of the body). For unknown reasons, people with hidradenitis suppurativa develop plugging or clogging of their apocrine glands. It causes chronic scarring and pus formation of the underarms (axilla) and groin/inner thigh areas. In women it can also occur under the breasts. It is similar to acne, which is also a disease of the sebaceous glands. Hidradenitis is more common in people who have had acne. It may be an unusual type of adult acne.
Hidradenitis suppurativa is slightly more common in women and African-Americans. Hidradenitis usually starts as one or more red, tender, swellings in the groin or armpits. Over a period of hours to days the lesions enlarge and often open to the skin surface draining clear to yellow fluid. The involved area then heals with scarring. The condition usually continues for years with periods of flare and remission.
Available medical treatments for hidradenitis suppurativa, including systemic antibiotics, retinoids and biologics, have limited efficacy and significant side effects. Although surgery can be effective, it is associated with significant morbidity, including risks of infection and permanent scarring.
The long-pulsed 1,064 nm Nd:YAG laser provides safe and effective treatment for hidradenitis suppurativa, according to a study conducted by dermatologists Bassel H. Mahmoud, M.D., Ph.D.; Emily Tierney, M.D.; Camile Hexsel, M.D.; David Ozog, M.D.; and Iltefat Hamzavi, M.D., of the Henry Ford Medical Center, Detroit. The study group enrolled 22 patients (skin types II-VI) with Hurley stage II / III hidradenitis suppurativa that was bilateral and symmetric in distribution. Treatment sites included the axilla, inframammary region and/or groin. Areas of involvement on one side of the body were treated with topical antibiotics only, and the contralateral side was treated with topical antibiotics and the Nd:YAG laser. A total of four laser treatments were performed at monthly intervals and patients were followed for an additional two months thereafter.
The investigators speculate that the mechanism of action for the treatment benefit involves laser-induced hair removal and a photothermolysis effect leading to ablation and destruction of inflammatory lesions in the reticular dermis. These hypotheses are supported by findings from clinical evaluations and histopathologic studies.
Patients reported an early reduction in pain accompanied by an increase in discharge, which suggests the laser treatment worked similarly to surgical incision and drainage, ablating the hair follicle and allowing the discharge to escape through the follicular unit. “Our histopathology studies showed an early inflammatory reaction around the hair follicle, and evidence of follicular destruction at one month post-treatment,” Dr. Mahmoud says.
The differential responses of the three anatomic sites treated — the axillae, inframammary region and groin — are also consistent with the concept that hair removal is a primary mechanism of action.
Although improvement occurred at all three sites, when comparing the percentage changes from baseline LASI score, there was a statistically significant benefit for the combination treatment with the laser compared to the control only for the axillae and groin.
“Hairs in the groin and axillae are darker, terminal coarse hairs that respond better to photoepilation treatment than do the finer, vellus type hairs located in the inframammary region,” Dr. Mahmoud says.
This study is another example of the expanding diversity of treatments that can be performed with the 1064 nm wavelength.
Several subscribers have asked us how lasers can be used to remove a cyst.
A sebaceous cyst is a benign lesion of the skin, which looks like a closed sac or cyst below the surface of the skin that has a lining that resembles the uppermost part of a hair follicle that is filled with a fatty white, semi-solid material called sebum. Sebum is produced by sebaceous glands of the epidermis. More about Sebaceous Cyst.
Traditional techniques to remove cyst are:
For large cysts or cysts located in areas of thick skin, the cyst wall is more friable or not easy to squeeze. Complete cyst removal with a better cosmetic appearance in these cases is more difficult to achieve.
A new procedure for treating a Sebaceous Cyst was recently published by study group from China.
Chinese physicians have documented a what seems to be a very effective treatment protocol. They use laser punches to prepare the cyst for the removal of the content with a minimal excision.
The new method with two steps is proposed:
The method offers a good alternative for eradication of uninfected cysts with only a small scar, especially large cysts or cysts located in areas of thick skin or cosmetic concern. Images and more detailed description of the laser cyst removal procedure.