Pulsed Dye Laser
What is a pulsed dye laser?
These lasers are produced with help of dyes in pulsed mode, hence are called Pulsed Dye lasers or PDLs.
The wavelength is absorbed in blood capillaries and melanin pigme nts, leading to their destruction. hence they are useful in treatment of capillary malformations ( Angiomas, PWS or Portwine stains and pigmentations etc ).
Which is the best wavelength?
As per current practice, 595 nm PDL is the gold standard of vascular birth marks treatment.
What defects are treated with a pulsed dye laser?
- Red birthmarks e.g Capillary Haemangiomas or PWS
- redness of the face and neck
- telangiectasia (broken or dilated vessels)
- spider naevi
- Early scars and red stretch marks
- early changes of sun-induced ageing
How is treatment done?
Once you are comfortable, lying on the table, Your doctor will give necessary position depending upon the location of lesion. Both the patient and wear protective eye glasses.
Laser is calibrated and parameters set as per requirement of treatment, in consultation with the patient.
During and after treatment, you may feel tingling, redness and swelling etc. which may last for several days. With aggressive doses, sometimes it may result in spotty bruising resembling sun burns.
Treatment for conditions like port wine stains may result in whole area appearing bruised or blue discoloured following treatment.
Does it Pain?
Usually no anaesthetic is required, but most patients feel stinging sensation on the skin. The skin is additionally protected by Ice cooling, air cooling or contact chillers to protect the skin and minimise any side effects. Inhalational anaesthesia can be used in children who do not co-operate or are too young.
Is PDL treatment safe?
Yes. In fact, it is is so safe that it has been successfully used for last 2-3 decades for the treatment of port wine stain birthmarks.
Are the results permanent?
It depends on many factors, such as the condition and lifestyle of the patient. Spider naevi and facial blood vessels usually clear with therapy. Other conditions, like Rosacea and port wine stains may tend to recur due to internal factors.
However, excellent results are seen for years to come following successful therapy.
How soon can one see the results of PDL treatment?
The results depend on the condition and the number of sittings required for treatment, depending upon the energy used to treat the condition. Usually one notices improvement within the 4 to 8 weeks following treatment.
How many treatments are required?
It depends upon the underlying condition. In cases of redness and telangiectasia (blood vessels) one may require an average of 2 to 3 sittings. Patients with birthmarks like port wine stains(PWS) usually require 6-10 treatments to achive good results. Port wine stains on face usually do better, while ones on the hands and lower limbs may give less satisfactory results.
Are their any side-effects of treatment?
It is normal to have redness, swelling and bluish discouration following treatment. It usually goes away in next few days. Some bruising (purpura) may occur port wine stains due to higher energy and is to be anticipated in such situations.
This bruising usually fades away over a week or so.
Following treatment, cold packs can be used to decrease swelling and minimise discomfort.
Permanent side-effects of PDL are rare. Sometimes pitted scarring resembles a chicken-pox scar, which can be treated . The complication may occur in less than 1 in 1,000 patients.
Bruising of the skin may produces some brown staining of the skin, due to deposition of iron pigments. It usually fades away within two months or so. Use of sunscreen and sun avoidance helps to reduce complication rate and hastens the absorption of the pigment.
Some degree of difference between treated and untreated areas is quite common. Rosacea patients having background sun-induced redness, may wish to have whole ‘unit’ of the skin treated with PDL, such as full cheek, or even whole-face therapy if it appears to be indicated.
Crusting, scabbing and blistering may occur at high energy levels. Such crusting can be treated with a heavy moisturiser, or even a coating of Vaseline, and settles over one week. Secondary infection is a very rare side-effect of pulsed dye laser therapy.
Are there any special precautions necessary before or after treatment?
patients are advised to avoid sun exposure before and throughout treatment to get better results. they are also advised to use sunscreens during pre and post treatment.
Ice-packs help reduce swelling and discomfort.
Patienta are advised not to remove any crust by hands. Instead they are advised to apply vaseline or moisturising creams to soften the crust leading to their natural separation.