Dermatology procedures: laser management and related therapies

Laser therapy is a new approach to treating cosmetic and medical skin conditions. Different laser units emit light at different wavelengths, and each wavelength acts on a different chromophore in tissue that is sensitive to the wavelength. Commonly targeted chromophores are hemoglobin (when vascular lesions are being treated), melanin (in pigmented lesions), and water (targeted to cause skin peeling that results in collagen remodeling). Ink is an exogenous chromophore targeted during laser treatments to remove tattoos. Lasers can be used to treat a variety of medical skin conditions, including psoriasis and onychomycosis. Care must be taken with lasers to avoid burns and inadvertent destruction of melanin-containing tissue in darker-skinned patients. Precautions also must be taken to prevent exposure of the eyes to the laser. Intense-pulsed light therapy differs from laser therapy in that it uses multiwavelength light, making it useful for managing many skin conditions with a single unit. However, this same characteristic can result in inadvertent damage to tissue adjacent to the treated site. Other approaches include radiofrequency, which uses radiofrequency energy to heat and destroy subcutaneous tissue, and photodynamic therapy, which uses a light source in combination with a photosensitizing agent.