Two-Wavelength Laser Effective for Blood Lesions

GRAPEVINE, TEX. — A single laser device that can sequentially deliver both 585-nm and 1,064-nm laser pulses was effective for treating thick port-wine stains, facial telangiectasias, and leg veins in three separate studies reported at the annual meeting of the American Society for Laser Medicine and Surgery.

The Cynergy multiplex laser marketed by Cynosure is approved by the Food and Drug Administration, and is "clearly a nice advance," commented Dr. Jeffrey S. Dover, a dermatologist in private practice in Chestnut Hill, Mass., and cochairman of the session where the three reports were presented.

Many dermatologists have just begun to work with this device, which can sequentially fire a pulsed dye laser beam followed by an Nd:YAG beam with an intervening delay of as little as 50 milliseconds. "The marvel of this technology is to have two wavelengths in one box that fire sequentially and not fail. It's technically tricky," said Dr. Dover, who is also on the dermatology faculties at Yale University, New Haven, Conn., and Dartmouth Medical School, Hanover, N.H. He had no disclosed relationships with Cynosure.

Deciding how to optimally use this capability is "very complex, with a lot of parameters to choose from. It will take time to get the ideal settings," Dr. Dover said. "We've seen some port-wine stains that were stuck but then started to clear with this new laser. I think that in a year we'll see some very nice data" from use of the new laser.

The rationale behind the dual laser system is that an initial pulse from a pulsed dye laser at 585 nm generates heat within blood-containing vessels that converts oxyhemoglobin to methemoglobin. Methemoglobin is 3–5 times better able to absorb energy from an Nd:YAG laser at 1064 nm, which makes the sequential laser treatment more efficient than either of these two light energies is on its own.

The port-wine stain study reported at the meeting included 20 adults with lesions that had failed to improve by more than 20% following at least two treatments with a conventional pulsed dye laser at 595 nm.

Dr. Ashraf Badawi and his associates at the Laser Institute at Cairo (Egypt) University used the multiplex laser to first deliver 7.0–7.5 J/cm2 from the pulsed dye laser, followed by 60–80 J/cm2 from the Nd:YAG laser. Patients received an average of four treatments given at 3- to 4-week intervals. At the end of treatment, all patients had at least a 70% improvement, said Dr. Badawi, a dermatologist at Cairo University. Dr. Badawi did not have any financial disclosures for this study.

The study of facial telangiectasias enrolled 20 patients who were treated on a split-nose basis. One side of each nose was treated with sequential laser energy, first with a 10-millisecond pulse from the pulsed dye laser, using a 7-mm spot size and fluence of 10 J/cm2. This was followed after a 100-millisecond delay by a 15-millisecond pulse from the Nd:YAG laser at a fluence of 70 J/cm2. The other side of each nose was treated with either a pulsed dye or an Nd:YAG laser only.

After a single treatment, 18 of the sides treated with both lasers had at least 50% improvement in their telangiectasia appearance, compared with 4 of the 20 sides treated with a single laser reaching this level of improvement, reported Dr. Syrus Karsai, a dermatologist at the Laser Clinic in Karlsruhe, Germany. Dr. Karsai had no financial disclosures for this study.

The study of patients with leg veins included 25 patients. After two treatments with the multiplex laser, 19 patients had at least 50% clearance of their visible leg veins, and the remaining 6 patients had at least 25% clearance, reported Dr. Robert Adrian, a dermatologist in private practice in Washington. His regimen involved treatment with a 10-millisecond pulse of the pulsed dye laser with a 7-mm spot size and 7–8 J/cm2. After a 50–150-millisecond delay, the Nd:YAG was fired for 40 milliseconds with a 7-mm spot size and 60–70 J/cm2. Dr. Adrian received equipment from Cynosure.

'We've seen some port-wine stains that were stuck but then started to clear with this new laser.' DR. DOVER