A novel laser with cryogen cooling long-pulsed options of both 532nm and 1,064nm laser offers laser surgeons a safe and effective way to treat vascular and pigmented lesions with a single device and significantly different clinical endpoints, wrote Nicole M. Golbari, MD, of the University of California, Irvine, and colleagues in an abstract presented at the annual conference of the American Society for Laser Medicine and Surgery.

The researchers evaluated one-year data from use of a combination laser in more than 200 patients at four centers for overall skin rejuvenation and treatment of vascular and pigmented lesions. At the 532nm wavelength, the device had beam diameter, pulse width, and cooling similar to the 595nm pulsed dye laser, the researchers said. For deeper and larger venous targets, the long pulse 1,064nm laser may be used with suggested presets or changed based on the size and depth of vessels, as well as vascular response, they noted.

Longer pulse durations and larger beam diameters yielded more effective penetration. In some cases, treated areas showed a blue grey color that disappeared after several seconds; in other cases, intravascular coagulation occurred and either persisted in place or shifted in a way similar to that observed with pulsed dye laser, the researchers said. Swelling was more common after use of shorter pulse durations (5ms). However, pulse durations of 10 ms were associated with improvement of port wine birthmarks and rosacea and minimal purpura, the researchers said.

Immediate darkening and slight scaling were the clinical endpoints for the treatment of pigmented lesions. Pre-cooling is essential when treating vessels, but lentigenes and flat seborrheic keratoses require significant post-cooling, the researchers explained.

Clinical endpoints for treatment of pigmented lesions were immediate darkening and slight scaling. Since the target is very superficial for lentigines, lower fluences with shorter pulse durations (sub-milli or sub-micro) are recommended. Pre-cooling is essential to protect the epidermis when treating vessels. By contrast, lentigenes and flat seborrheic keratoses require no pre-cooling but significant post-cooling. Flat seborrheic keratoses require more heat than lentigines and longer pulse durations can be employed.

The researchers concluded that the combination device is an effective option for both vascular and pigmented lesions when providers treat to appropriate clinical endpoints, with minimal side effects.

Golbari NM et al., TARGETING CLINICAL ENDPOINTS FOR THE SUCCESSFUL TREATMENT OF VASCULAR AND PIGMENTED LESIONS WITH A NOVEL LONG-PULSED DUAL WAVELENGTH 532NM AND 1,064NM LASER. Presented at: American Society for Laser Medicine and Surgery 43^rd Annual Conference on Energy-based Medicine and Science. April 11-14, 2024; Baltimore.