Long pulsed dye laser with a back-to-back double-pulse technique and compression for the treatment of epidermal...

In the recent past, long pulsed dye lasers (LPDL) have been investigated for the treatment of epidermal pigmented lesions (EPLs). Using a pigmented lesion compression headpiece, blood is pushed laterally out of the laser field focusing laser energy on melanin. Recent studies have demonstrated excellent responses using a single-pulse at the following settings: 9-12 J/cm² , 1.5 milliseconds, 7-10 mm spot size with compression. However, the majority of these studies report patients requiring up to four treatments for lesion resolution. Herein, we describe our experiences utilizing a back-to-back double-pulse technique to decrease the total number of treatments needed for EPL clearance.

Thirty-six patients (27 females, 9 males; skin types I-IV) with benign facial EPLs were included. Each lesion received two back-to-back pulses (fluence of 9-12 J/cm² , 1.5 milliseconds duration, and 7 mm spot size). If needed, a second treatment was delivered 4-8 weeks later. Pre- and post-photos after the first treatment were evaluated by two independent board-certified dermatologists.

Lesion clearance after the first treatment was graded on a Likert scale as: 1 = poor (<25% clearance); 2 = fair (25-50%); 3 = good (51-75%); and 4 = excellent (>75%). Of the 36 participants, 23 had excellent clearing, 10 with good, 2 with fair and 1 with poor clearance. There was only one case of post-inflammatory hyperpigmentation that subsequently resolved, and no cases or scarring or hypopigmentation.

LPDL with compression continues to be a safe and effective modality for treatment of EPLs. Double-pulsing decreases the total number of treatments needed for lesion resolution, while maintaining safety and potentially decreasing cost. Lasers Surg. Med. 51:136-140, 2019. © 2018 Wiley Periodicals, Inc.