REvrEW
DERMATOLOGIC
LASERS: THREE DECADES OF PROGRESS
TrNA S. AI.STER, M.D.,
ANIl
SlEVEN
1960, Theodore Mairnan at Hughes Aircraft Research
Laboratories actually developed the first laser, a ruby
laser.:' Many other types of lasers have subsequently
been developed, but Maimari's
original ruby laser
manifested all the important properties we associate
with today's lasers; it emitted light in a narrow, tightly
concentrated beam (collimated), all the light was the
same wavelength (monochromatic), and the light waves
were all aligned with each other (coherent).
In 1963, Leon Goldman and co-workers" performed
the initial experiments demonstrating
the effects of
lasers on human skin, using the only available laser at
the time, the ruby laser. Initially, normal white and
black skin was irradiated, with and without the addition of various superficial black substances." Subsequently, laser treatment of seborrheic keratoses and
hemangiomas was arrernpred.' While it became evident
that the damage inflicted was nonspecific thermal destruction of the irradiated site, laser treatment had one
major advantage over other destructive treatment methods, the ability to focus high intensity energy onto very
small sites. This precision did not enhance target selectivity, but it was inferred from these initial experiments
that more damage was induced by equivalent laser
pulses in darker lesions. This observation was important to the future development of lasers specifically designed to treat certain cutaneous lesions.
Thirty years have passed since the creation of the first
laser. Although significant applications for lasers were
forecast immediately, many subsequent developments
in their diagnostic and therapeutic uses in medicine
took decades to be realized. Laser technology has improved, and will continue to improve, health care delivery, diminishing the time, cost, and invasion of
many procedures. This review of the use of lasers in
dermatology will survey past and present developments and will outline and preview the possibilities of
laser techniques.
HISTORY OF LASERS
The word laser was coined as an acronym for Light
Amplification "by the Stimulated Emission of Radiation. While ordinary light is emitted spontaneously by
excited atoms or molecules, laser light occurs when an
atom or molecule retains excess energy until it is "stimulated" to emit it.
Albert Einstein was the first to suggest the existence
of stimulated emission.' Scientists believed that atoms
and molecules were more likely to emit light sponraneously, and that stimulated emission would be much
weaker. After World War II, however, physicists attempted to make stimulated emission dominate, seeking ways for one atom or molecule to stimulate many
others to emit light, amplifying it to much higher powers. The first to succeed was Charles H. Townes, who
instead of working with light, worked with microwaves, which have a much longer wavelength. Townes
built a device he called a "maser," which stood for Microwave Amplification by the Stimulated Emission of
Radiation.
Together with Arthur Schawlow, Townes outlined
the key concepts of stimulated emission in 1958.2 In
LASER I'RINCII'LES AND LASER-TISSUE INTERACTION
Fundamental to the diverse applications of laser light
are its unique properties; (1) coherence, (2) monochromaticity, (3) high intensity, (4) "compressibility" into
ultra-short pulses, and (5) runabiliry. Light waves are
said to be coherent if they are each in phase with the
other (the peaks and valleys of the light waves are
aligned). Monochromaticity involves emission of a single wavelength of light. Most known energy sources
emit radiation that consists of many different wavelengths. Lasers are also capable of emitting radiation
of extremely high intensity, thereby providing a high
concentration of light energy in the substance being irradiated. The ability to compress the light energy into
ultra-short pulses allows for the excitation of high-energy levels in the molecules specifically being irradiated, while tunability of the wavelength in the range
from infrared ro ultraviolet permits selective excitation
From the Departments of Dermatology and Pediatrics, Yale
University School of Medicine, New Haven, Connecticut,
Georgetown University School of Medicine, Washingron DC,
and Columbia UniversityCollege of Physiciansand Surgeons,
New York, New York.
Address for correspondence:
Tina S. Alstcr,
R. I<OHN, M.D.
M.D., Georgetown
University Medical Center, Washingtol' Institute of Dcrmato-
logicLaser Surgery,23] 1 M Street, N.\XI., Suite 504, Washington, DC 20037.
601
hucrnational Journal of Dermatology
Vol. 31, No.9, September 1992
eral, the longer the wavelength of laser light, the deeper
the penetration into tissue. More recently, it has been
shown that spot size is also an important parameter to
consider when monitoring laser-tissue interacrion.":"
Regardless of what tissue is absorbing the laser energy, once [his energy is converted to heat, it will spread
throughout the surrounding tissue. If the energy source
continues for roo long, damage {O normal stroma may
occur from heat dissipation, and the relative optical absorptive advantage gained by choosing the appropriate
wavelength and spor size will be lost. This can be prevented by consideration of a target's thermal relaxation
time. The thermal relaxation time is defined as the rime
required for a target to cool from the temperature
achieved immediately after laser irradiation to half that
temperature.' For example, the time that it takes for an
organelle to cool is in the order of a microsecond, whereas cell layers will cool in a millisecond, and large abnormal vessels in portwine stains may take tens of milliseconds. If the exposure duration is long compared
with the time required for diffusion of heat to surrounding structures, thermal damage will be extensive
and nonspecific regardless of how specifically the laser
light is absorbed and heats a target srructure.l" Confining the pulse duration of the laser to the thermal relaxation time of the target tissue limits the extent of thermal damage and demonstrates the advantage of pulsed
lasers (with short exposure time) over continuous wave
lasers (with longer exposure times).
of certain molecular species depending on the absorption spectrum of that molecule. A single laser can provide a combination of several of the above properties
ro suit a particular application.
The concept of "selective phororherrnolysis"
was
born from the idea that special properties inherent in
laser radiation could be adjusted and selected to confine thermal damage to a few pathologic lesions while
minimizing the destruction of normal rissue.? One control of laser-tissue interaction involves marching the
wavelength of laser light to the absorption spectrum
peak of the target tissue. The absorbing molecules (or
chrornophores) within the skin include hemoglobin,
melanin, carotenoid, and bilirubin." While no cutaneous lesions contain primarily carotenoid or bilirubin,
there are pathologic lesions that are composed primarily of hemoglobin/ or melanin. The naturally occurring
optical absorptive advantage of certain tissues, therefore, can be used to optimize laser-tissue interaction.
For instance, the beta 577 nm peak of oxyhemoglobin
has been shown to correspond most closely to the
wavelength demonstrating the best clinical and histologic respon e in the treatment of vascular lesions9-IO
because the absorption of melanin weakens toward the
longer visible wavelengths (Fig. 1).
In those cases where a pathologic lesion does not
have a naturally occurring optical absorptive advantage over normal tissue, an exogenous chromophore
(i.e., hematoporphyrin)
can be administered that is
preferentially taken up by the pathologic lesion, thereby simulating an absorptive advanrage.l+'! Exogenous
chromophore administration in the treatment of various dermatologic conditions, particularly tumors, is
still experimental, but has great potential.
Another aspect of tissue optics that must be taken
into account when trying to optimize laser parameters
is the depth of penetration of light into the skin. In gen-
f..
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The argon laser emits visible blue-green light with wavelength peaks at 488 and 514 nm. It is a continuous
wave system, although there are now "pulsed" systems
available, which use a mechanical or optical shuttering
device to break up a steady output beam. Absorption of
the blue-green light is achieved by chromophores of its
complementary colors, such as hemoglobin.
The argon laser has been u ed primarily in the treatmenr of vascular lesions, including portwinc stains
(Figs. 2 and 3),'-25 telangiectasia, 17.18.2H7 spider varicosiries.l - 0 pyogenic granulornas.!? cherry angiomas, 17
venous lakes.!" angiokeraromas.l!
and Kaposi's sarcoma.1I Theoretically, there should be selective absorption of the light by hemoglobin within the blood vessels
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Lasers can be categorized into one of three major groups
based on their active medium: solid, liquid, or gas
(Table 1). Each laser has predominant wavelength and
specific chromophore interaction capabilities. Several
different lasers have been used for a wide array of derrnarologic conditions. Each will be briefly summarized,
but without detailing the laser mechanics involved.
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: Mel.nin
10'
LASER TYPES
20<1
Figure 1. Absorption
(Hb02) and melanin.
30<1 400 500
coefficient
700
1000
spectrum
2000
A (nm1
of hemoglobin
602
Derrnmologic Losers
Al\It'T and Kohn
Table 1. Characteristics
of Lasers
Laser
Medium
Wavelength
Chromophore
Lesions
Treated
Argon
G~~
488 nm,
5]4 om
Hemoglobin
Melanin
Vascular
Pigrnenred
Dye
Liquid
Variable.
depends
on dye
Variable
Vascular
Pigmented
Ruby
Solid
694 nrn
Melanin
T arroo pigment
Pigmented
Tartoo
Nd:YAG
Solid
1060 nrn
CO!
Gas
10, 00 nrn
Vascular
Epidermal
Dermal
Excision
Water
comprising the lesion; however, several histologic studiesU-J5 have cast doubt on the specificity of the damage showing the argon laser effects possibly due to
nonspecific
thermal
destruction
of skin. It ha been
shown that the exposure
intervals used are too long
and exceed the thermal relaxation time of the target tissues, thereby increasing the risk of scarring and dyspigmentarion.Is
Several clinicians
have, nevertheless,
reported excellent results with lesion reg res ion and minimal scarring, .fspecially in those protocols
using very
low energies.F With the advent of newer, more vascu-
Figure 2. Porrwine stains on the nose and medial canthus of
a 21-year-old female with prior argon laser test site (mid-nose).
lar-specific
systems (pulsed dye lasers), however,
the
argon laser is falling out of favor as the laser of choice
for treatment of vascular lesions." 0
Because the wavelength
of light is well absorbed by
melanin, the argon laser has been used to treat pigrncnred lesions such as lentigo maligna
and benign
nevi,41-43 "cafe-au-lait"
pots,"
nevus of Ora,17 and
chloasma.!? Tattoos
success,25,44 bur there
have also been treated with some
have been reports of significant
postoperative
scarring. Nonpigmented
lesions reported
to be uccessfully removed by argon laser have included granuloma
faciale;'" and lymphocytoma
cutis;'?
both having a reddish-purple
hue that may selectively
ab orb the blue-green light.
:,-':iOjP
·H!.:'j"
Tunable
Dye Laser
The tunable dye lasers contain fluore cent dyes (of variOllS composition)
that absorb light at one wavelength
and then emit laser light at another. The output wavelength of these systems may be varied or tuned by the
operator by adjusting the dye used (ranging from approximately
400 to 1000 nm). They may be powered
by a number of systems such as a flash lamp or another la er [i.e., argon). The continuous
wave dye laser sys-
Figure 3. Porrwine stain of same patient (Fig. 2) 8 weeks after
three pulsed dye laser treatments.
which corresponds
to the third absorption
peak of
oxyhemoglobin.
When a very brief pulse duration (400
us) is delivered,
precise and localized vascular injury
occurs, with a histologic
appearance
resembling
vasculitis.32.4 '-52 More recently, it has been demonstrated
that a laser emitting
dye laser system provides
in the treatment
of va cular anornalie
va cular injury and continued vascular
of light, while the pulsed
inrerrnirrenr pulses of lighr.
The dye laser sy .rern ha ve been ;1 pplicd to the
treatment of vascular lesions, since the damage is highly specific to blood vessels, with
paring of adjacent
tissue clemenrs.J9.4b.47
The tunable dye laser, utilizing
the yellow
dye rhodamine
6G,
c,\n emit
at
5
nm,
5
ar formation
at
585 nrn is
tems provide a ready output
and pigment
alteration,
seen with the use of the argon
ed when
pulsed
the combination
dye laser system
, with deeper
specificity.52.swhich
has been
la er, has been eliminat-
of laser
i
even more effective
used.l2•49
parameters
10
the
Inlernnll<)nal Journal of n.rmnll.lo!\!
V,,1. 11. Nu. 9. Seprcrubcr 1992
The portwine
tain40.46.47 IS the most common
va cu-
lar
lesion treated
giomas,H-16
fa
with the pul ed dye laser, but hernania l telangiectasias
(Figs. 4 and 5),5-
poikilodermav"
lymphangioma
circurnscr iprurn,
~q
Ka-
spider va ricositic
of the legs with the pul ed dye
la5er."~-~~ bur hyperpigmentation
[borh persistent
and
transient)
plication.
posi's sarcoma.f" and blue rubber bleb nevi" have also
been treated succe: sfull)' using this la er system. One of
have
rhe most important
seen on histologic
advances
in the treatment
of port-
wine stains is the fact that rhe pulsed dye laser can be
safely used without scar formation
in chiidrenY·62.6J
Recently, there has been renewed interest in treating
treatment
remains a common
lesions such as "cafe-au-lair"
following
Pigmented
been treated
with
a dye laser tuned
length of 504 nrn,
comspots
to a wave-
with selective melanocyte
examination
of laser-treated
damage
skin."?
The cominuou
tunable dye laser ha been used in
photodynamic
therapy. This procedure involves the systemic administration
of a phororoxic agent (usually
hematoporphyrin
derivative), which is electively taken
up and retained by malignant cell, followed by delivery
of laser light, resulting in a toxic reaction that kills the
malignant cell population.
The hematoporphyrin
derivative is photoacrive when exposed to 630 nm light, which
is most often derived from a tunable dye laser, although
a non laser source may be used. Its antitumor
effect is
thought to result from singlet oxygen production
with
sub. equent necrosis of the irradiated
rumor." .69 Basal
cell carcinoma has been reported to re pond to photodynamic rherapy,70-73 but prolonged photo cnsitivity reactions following phoroactivarion of the h maroporphyrin
derivative have been encountered." limiting its practicality a a treatment
modality.
Ruby Laser
Figure 4.
Telangiectasias on the nose of a 60-year-old man.
The ruby laser emits a visible red light with a wavelength
of 694 nrn. The red light can be delivered via a longpul e system or a Q- witched (shorr pulse) system and is
preferentially
absorbed
by blue or black pigments. On
histologic examination,
melanosomal disruption with alteration of both epidermal and dermal pigment has been
observed when the ruby laser is u ed-'5.76 The ruby laser
ha , therefore, been u ed successfully in the treatment of
lentigines,"
nevoccllular nevi," nevus of Ora,77 and tattoos (Figs. 6 and 7).7N-82 Although initially used in the
treatment of vascular Iesions,19,34 ir i no longer indicated
for uch lesions becau e of exces ive scar formation. This
is due to minimal ab orption by both oxyhemoglobin
and deoxyhemoglobin
at 694 nrn.6.7
Neodynium
The
Yttrium
Aluminum
Nd:YAG laser emirs
Garnet
( d:YAG) Laser
in the invisible
near-infrared
portion of the spectrum at 1060 nm. It is a continuous
wave laser system without color specificity
in its absorption. It rends to be a high energy system with deep
tissue penetration,
leading to a large amount of nonselecrive thermal destruction.
Despite its nonselectiviry,
the
d:YAC laser has found
its way into dermatology.
Large cavernous hemangiomas
of the skin and mucosal
surfaces have been treated
uccess fully,KH7 as have
dark nodular porrwine stains.S~.8~ In addition, the Nd:YA •
Figure 5.
Same patient (Fig. 4) 6 weeks after single pulsed
dye laser treatment.
la cr has been used for tattoo rernoval.f" Even with the
recent development
of a frequency-doubled
variant of
this system
in which
a crystal
placed
in the beam path
Dcrmarologic Lasers
AISler and Kuhn
Figure 6. Previously untreated professional tattoo on arm
of a 21-year-old woman (photo courtesy of R. Rox Anderson, M.D.).
Figure 7. Tattoo 1 month after sixth ruby laser treatment
(see Fig. 6) (photo courtesy of R. Rox Anderson, M.D.).
halves the wavelength
the argon laser output
(giving a green color similar to
and, thus, slightly better absorp-
tion by hemoglobin),
there remains a significant amount
of nonspecific
tissue destruction,
with possible resultant scarring.t"
Perhaps the most interesting
future application
of
the Nd:YAG laser in dermatology
closure by laser welding. Laser
in diameter and the ability to seal nerve endings, allow
for better hemostasis
and less postoperative
pain and
edema
will be that of wound
welded wounds have
Carbon
Dioxide
and/or
foreign
(C02)
than with conventional
The C02
laser
techniques.
is best suited
to treat
body reaction."!
laser
Laser
rem. The
laser
laser, emitting
is the most
system
commonly
is usually
far-infrared
wave
such as balanitis
portion
xerorica
of the spectrum
at 10,600 nm. The energy from the
C02 laser is delivered to tissue through
sealed tubes
with excellent
cosmetic
and
tive swelling
and
angled
mirrors
because
it cannot
Queyrat.l"?
be delivered
and bowenoid
through optical fibers. The energy emitted by a C02
laser is nonselectively
absorbed
by both intracellular
and extracellular
water, and, because soft tissue is 80
changes
to 90% water,
ed with the C02
handy
ablate
mentary
properties,
in these
obliterans.l'"
papulosis'!"
erythroplasia
lesions
because
are confined
of
has been achieved
results and minimal
morbidity
laser. Hypertrophic
loss are common
is used in the removal
sion of keloidal
which it is used. Whether the laser is used in either a
defocused mode to vaporize tissue or a focused mode
unique
with
postopera-
the pathologic
to the squamous
epithelium of the epidermis (Figs. 8 and 9).
Tattoos!!!·!12 and keloidsll3-!!8
have also been treat-
total absorption
of the C02 laser is a
tool because it enables the surgeon to incise or
tissue, the outcome depending
on the mode in
to incise tissue, its other
ha ve been treated
the C02 laser. Successful C02 laser treatment of actinic
cheilitis,!OS,!06 lentigines.l'" and superficial penile lesions,
used laser sys-
a continuous
light at the invisible
le-
dermal lesions, including
syringomas,"
adenoma
sebaceum,95-98 epidermal nevi,93,99 xanthelasma, !OOtrichoepitheliomas/3,!O!
apocrine
hidrocystomas,
!02 myxoid
cysts,103 and neurofibromasl'"
The C02
epidermal
sions, because it works by tissue vaporization.
The most
common dermatologic
conditions
treated by the C02
laser arc verruca vulgaris and condyloma
acuminatum,
especially
when they are large and/or recalcitrant
to
other forms of treatment.92,93 A variety of epidermal and
been shown to heal similarly (by tensile strength measurements)
to conventionally
sutured
wounds,
with
less tissue manipulation
and without
introduction
of
foreign material into the wound, thus decreasing
the
risk of infection
up to 1.5 mm
ability to seal blood vessels and lymphatics
605
complications
of tartoos.
tissue showed
subsequent
reports with
same patients have shown
such as the
scarring
when this laser
While C02
promising
and piglaser exci-
initial results,
longrerrn follow-up of these
high recurrence rares.!19,120
International Journal of Dermatology
Vol. 3), Nn. 9, September
Figure B. Periungal warts prior to treatment
tesy of Jerome Garden, M.D.).
(photo cour-
Figure 9. Periungual warts after CO2 laser treatment
Fig. 8) (photo courtesy of Jerome Garden, M.D.).
The combination
of vaporization
and excision using
the CO2 laser in the defocused and focused modes, respectively, is useful in the treatment of rhinophyma 111.122
mechanism by which the CO2 laser works in these conditions is through conduction
of heat from the hot epidermis to the upper dermal blood vessels, producing
full-thickness
epidermal damage. This has been shown
to result in hypertrophic
scarring.128.129 Those clinicians who favor the use of the C02 laser now reserve
its use for debulking
large hypertrophic
port wine
stains and hemangiomas.
Utilizing laser technology,
many cutaneous disorders
are being treated more effectively and with less morbid-
Table 2. Specific Dermarologic Lesions Treated
with Laser Surgery
ity than with conventional
therapies. When determining
the appropriate
laser for use in a particular condition, it
is best to categorize the lesion into one of the following
groups: vascular, pigmented, tattoo, epidermal process,
or dermal process. The laser chosen should correspond
to the predominant
chromophore or absorbant tissue in
the lesion being treated (Table 2).
Lesions
Lasers Used
Vascular
Porrwine stains
Tela ngiectasias
Dye (585 nm)
Argon (488, 514 nm)
Hemangiomas
Blue rubber bleb nevi
angiomas
Spider veins
Cherry
Pigmented
Lentigines
"Cafe-au-lair"
Nevocellular
spots
Tattoos
CO2 (10,600 nm)
Ruby (694 nm)
Epidermal
Verrucae
Linear epidermal nevi
CO2 (10,600 nm)
Actinic cheilitis
Rhinophyma
2.8 to 4.2% of procedures.U" Hyperis the most frequently reported compli-
Nail plate abnormalities
Dermal
Keloids
Appendages] tumors
cation, while infection carries a low occurrence
rate,
estimated
at 0.2 to 0.6%. Reports of unintentional
606
Dye (504 rim)
Argon (488, 514 nm)
Ruby (694 nm)
nevi
OF LASER SURGERY
Lasers are versatile instruments
that are associated with
an acceptable
risk profile. A survey of complications
encountered wirh cutaneous laser surgery found the
rate to average
trophic scarring
(see
burns to personnel or patients have also been rare. Perhaps the 1110st worrisome
disadvantage
of laser use is
the unknown
risk of inhalation
of laser smoke. "Lungdamaging
dust" consisting of particles with diameters
between 0.1 and 1.0 urn has been found in laser plume
and can penetrate into distal lung branches.I'
1 In addition, intact human papillornavirus
DI'A 132.111 and HIVvirusJ34 have been isolated in laser smoke, and standard
surgical masks do not filter out particles of the size seen
in the laser plume of irradiated tissue, raising the obvious concern of infectivity of laser vapor. us Smoke evacuation systems
are necessary
during
laser therapy,
especially when using the C02 laser, because copious
amounts of vaporized material are generated.l "
and acne scars. The surface remodeling
using the defocused lower irradiance vaporization
technique
is akin
to a superficial dermabrasion
and yields excellent cosmetic results. In addition, cosmetic and functional
improvement
of nail plate abnormalities
may be seen
when the C02 laser is used in a focused mode to modify the nail rnarrix.P:'
The C02 laser has also been used in the treatment
of portwine stainsI24.125 and hernangiomas.t-v'<"
The
COMPLICATIONS
J9l1Z
D~rl1l.allJlog:it.:
UStTS
Alsrer and Kohn
12.
FUTURE USES OF LASERS IN DERMATOLOGY
Nelson JS, Sun CHC, Berns MW. Study of the tn uiuo and
capabilities of uroporphyrin 1
compared to photofrin II. Lasers Surg Med 1986; 6;
131-136.
ill vitro photosensitizing
While laser surgery of dermatologic
conditions
has
been based primarily on [he principles of selective phororherrnolysis,
there are other areas of intellectual
intrigue that may further the use of lasers both in treat-
13.
Berns M, Hammer-Wilson M, Walter R], et aL Uptake
and localization of HpD and active fraction in tissue
culture and in serially biopsied human tumors. Ad" Exp
Mcd Bioi 1983; 170:501-520.
14.
Tan OT, Motemedi M, Welch AJ, et al, Spotsize effects
on guinea pig skin following pulsed irradiation. J Invest
Dermatol1988;
90:877-881.
15.
Morernedi M, Welch A], Cheong WF, er al. Thermal
lensing in biologic media. IEEE Quantum Electronics
) 988; 24:696-699.
) 6.
Anderson RR, Parrish JA. Microvasculature can be selectively damaged using dye lasers: a basic theory and
experimental evidence in human skin. Lasers Surg Med
1981; 1:263-276.
17.
Apfelberg DB, Maser MR, Lash H, er al. The argon laser
for cutaneous lesions. JAMA 1981; 245:2073-2075.
18.
Apfelberg DB, Maser MR, Lash H. Argon laser treatment of cutaneous vascular abnormalities.
Ann Plasr
Surg 1978; 1:14-18.
) 9.
Goldman L, T rcHer R. Laser treatment of extensive
mixed cavernous and port wine stains. Arch Derrnarol
1977; 113:504-505.
20.
Cosman B. Experience in the argon laser therapy of porr
wine stains. Plast Reconsrr Surg 1980; 65:119-129.
21.
Noe JM, Barsky SH, Geer DE, et al. Porrwine stains
and the response to argon laser therapy: successful
treatment of the predictive role of color, age, and biopsy. Plasr Reconsrr Surg 1980; 65:130-136.
rnsnr and diagnosis.
The use of low-energy
healing,
presumably
blasts':"
or by some other
lasers
to accelerate
by stimulation
wound
of dermal
biostirnulative
fibro-
process138-J45
is but one area generating much interest in the scientific
community.
Laser induced photodynamic
therapy (PDT)
is another expanding
area, which is already showing
promise as a tool for selective cytotoxicity
using newer,
less toxic, but more photosensitizing
substances.r"
ditionally, liposomaJl47-149 or monoclonal
antibody
Adde-
livery systems
may
with laser-induced
release of drugs,
aid in the diagnosis and subsequent
treatment
of neoplastic or proliferative conditions.
In conclusion,
the future practice of dermatology
will be greatly benefited by laser technology.
We are
just now beginning to manipulate
laser effects on tissue
in order to maximize desired laser-tissue
interactions
and design new therapeutics
and diagnostics.
The benefits of lasers to medicine and mankind in the next 30
years are eagerTy anticipated.
REFERENCES
1.
Caruth JAS, Mckenzie AL. Medical lasers: science and
clinical applications. Bristol, UK: Adam Hilger, 1986.
22.
Hobby LW. Treatment of portwine stains and other cutaneous lesions. Conternp Surg 1981; 8:21-45.
2.
Schawlow AL, Townes CH. Infrared
Physiol Rev 1958; 112:1940-1949.
23.
Arndt K. Treatment technics in argon laser therapy.
Am Acad Derrnatol J 984; 11 :90-97.
3.
Maiman TH. Stimulated
ture 1960; 187:493-494.
24.
Cosman
4.
Goldman L, Blaney DJ, Kindel DJ, et al, Pathology of
the effect of the laser beam on the skin. Nature ] 963;
197:912-914.
5.
Goldman L, Blaney DJ, Kindel DJ, et al, Effect of the
laser beam on the skin. J Invest OermatoI1963; 40: 121122.
6.
Anderson RR, Parrish JA. Selective phororherrnolysis:
precise microsurgery by selective absorption of pulsed
radiation. Science 1983; 220:524-527.
optical masers.
optical radiation in ruby. Na-
B. Clinical exposure
in the laser therapy
J
of
porrwine stains. Lasers Surg Med 1988; 8: 133-152.
25.
Apfelberg DB, Maser MR, Lash H. Extended clinical
use of the argon laser for cutaneous lesions. Arch Dermato11979; 1 J5:719-721.
26.
Apfelberg DB, Maser MR, Lash H. Treatment of nevus
araneus by means of an argon laser. J Derrnarol Surg
Onco11978; 4:172-174.
27.
Arndt KA. Argon laser therapy of small cutaneous vascular lesions. Arch Derrnarol 1982; 118:220-224.
28.
Apfelberg DB, Maser MR, Lash H, et al. Use of the
argon and carbon dioxide lasers for treatment of superficial venous varicosities of the lower extremity. Lasers
Surg Med 1984; 4:221-232.
29.
Apfelberg DB, Smith T, Maser MR, er al, Study of three
laser systems for treatment of superficial varicosities of
the lower extremity. Lasers Surg Med 1987; 7:219-223.
30.
Lyons GD, Owens RE, Mouney DF. Argon laser destruction of cutaneous telangiectatic lesions. Laryngoscope 1981; 91: 1322-1325.
31.
Pasyk KA, Argenta Le, Schelbert EB. Angiokeraroma
J
7.
Anderson RR, Parrish jA. The optics of human skin.
Invest Oermatol1981; 77:13-19.
8.
Rosen S. Nature and evolution of porrwine stains. In:
Arndt K, Noe JM, Rosen S, eds, Cutaneous laser therapy: principles and methods. New York: John Wiley &
Sons, 1983: 75.
9.
Tong AKF, Tan OT, Boll j, et al. Ultrastructure: effects
of melanin pigment on target specificity using a pulsed
dye laser (577 nm). J Invest Oermatol1987; 88:847-852.
10.
Tan OT, Murray S, Kurban AK. Action spectrum of
vascular specific injury using pulsed irradiation. J Invest
Dermatol1989; 92:717-720.
11.
Sherwood KA, Murray 5, Kurban AK, et al, Effect of
wavelength on cutaneous pigment using pulsed irradiation. J Invest Oermatol1989; 92:717-720.
circumscriptum:
successful treatment with the argon
laser. Ann Plast Surg 1988; 20:183-190.
32.
607
Tan OT, Carney M, Margolis R, et al. Histologic responses of porrwine stains treated by argon, carbon
dioxide and dye lasers: a preliminary report. Arch Dermato11986; 122:1016-1022.
International Journal of Dermatology
Vol. 31, No, 9, September
33.
34.
Greenwald J, Rosen S, Geer DE, er al. Comparative histological studies of rhe runable dye (at 577 nrn) laser
and argon laser. J Invest Dcrmatol1981;
77:305-310.
53.
Solomon
54.
H, Goldman
topathology
J Invest
L, Henderson
B, er a l. His-
of the laser rrearmenr of port-wine lesions.
Derm:HoI1968; 50:141-146.
Apfelberg DB, Kosek j, Maser MR, er a]. Histology of
porrwine stains following argon laser trearmenr. Br J
Plasr Surg 1979; 32:232-287.
55.
36.
Dixon], Huether S, Rotering RH. Hypertrophic
scarring in argon laser treatment of portwine stains. Plasr
Reconstr Surg 1984; 73:771-780.
56.
38.
39.
Kurban AK, Sherwood KA, Tan QT. What are the optimal wavelengths for selective vascular injury? Lasers
Surg Med 1988; 8:189.
Ashinoff R, Geronemus
R. Capillary hemangiomas and
pulsed dye laser.
Arch Derrnarol 1991; 127:202-205.
treatment with the flash lamp-pumped
35.
37.
1992
Sherwood KA, Tan 01'. Treatment of a capillary hemangioma with [he flashlamp pulsed dye laser at 585 nm. J
Am Acad Dermatol1990;
22:136-137.
Glassberg E, Lask G, Rabinowitz LG, er al. Capillary
hemangiomas: case study of a novel laser treatment and
a review of rherapeutic options. J Derrnarol Surg Oncol
1989; ]5:1214-1223.
Finley jL, Barsky SH, Geer DE, et al. Healing of portwine stains after argon laser therapy, Arch Derrnarol
1981; 117:486-489.
Tan OT, Stafford TJ. Treatment of port wine stains at
577 nrn. Med Instrument 1987; 21 :218-221.
Garden jM, Pella LL, Tan ~T. The rrearrnenr of POrtwine stains by the pulsed dye laser: analysis of pulse duration and long-term therapy. Arch Dermarol 1988;
] 24:889-896.
57.
Lowe NJ, Behr KL, er al. Flash-lamp pumped dye laser
for rosacea-associated
telangiectasia and erythema. J
Dermarol Surg Onco11991; 17:522-525.
58.
Geronemus
26:547-548.
59.
Weingold D, White 1', Burton CS. Treatment of lymphangioma circumscriptum
with tunable dye laser.
Cutis 1990; 45 :365-366.
RG. Poikiloderma.
Arch Dermarol
1990;
40.
Morelli J, Tan OT, Garden j, et al. Tunable dye laser
(577 nm) rrearrnenrof
portwine stains. Lasers Surg
Med ]986; 694-699.
60.
Moritz DL, Lynch WS. Kaposi's sarcoma treated with
the Candela flash-lamp pulsed dye laser. Am Soc Derrn
Su rg I 990 (a bsrracr).
41.
Arndt KA. Argon laser treatment of lentigo maligna.
Am Acad Derrnarol 1984; 10:953-957.
J
6J.
Olsen TG, Milroy SK, Goldman L, er al, Laser surgery for
blue rubber bleb nevus. Arch Dermarol 1979; 115:81-82.
42.
Oshiro T, Maruyama Y. The ruby and argon lasers in
the treatment of naevi. Ann Acad Med Singapore 1983;
12:388-395.
62.
Reyes BA, Geronemus R. Treatment of POrt wine stains
during childhood with the flash lamp-pumped dye laser.
J Am Acad Derrnarol ] 990; 23: I '142.
43:
Goldman L, Igelrnan ]M, Richfield DF. Impact of rhe
laser on nevi and melanomas. Arch Derrnarol 1964; 90:
71-75.
63.
Ashinoff R, Geronemus R. Flashlamp-purnped
pulsed
dye laser for port-wine stains in infancy: earlier versus
later treatment. J Am Acad Dermatol1991; 24:467-472.
44.
Apfelberg DB, Druker D, Maser MR, er al. Argon laser
treatment of decorative tattoos. Br J Plasr Surg 1979;
32:232-237.
64.
Polin Ll., Tan OT, Garden JM, et al. Tunable dye laser
for the treatment of benign cutaneous vascular ectasia.
Derrnarologica
1987; 174:11-17.
45.
Apfelberg DB, Druker D, Maser MR, et al, Granuloma
faciale treatment with the argon laser. Arch Dermarol
1983; 119:573-576.
65.
46.
Garden JM, Tan OT, Polla L, er al. The pulsed dye
laser as a modality for treating cutaneous small blood
vessel disease processes. Laser Surg Med 1986; 6:259.
Goldman MP, Martin DE, Fitzpatrick RE, er al. Pulse
dye laser treatment of telangiectasia with and without
subrherapeuric
sclerotherapy: clinical and histologic examination in the rabbit ear vein model. J Am Acad Dermarol (in press).
66.
47.
Tan OT, Sherwood KA, Gilchrest BA. Successful treatment of children with portwine stains using the flashlamp pulsed tunable dye laser. N Engl J Med 1989;
320:416-421.
Goldman MP, Fitzpatrick RE. Pulsed-dye laser treatrnenr of leg telangiectasia: with and without simultaneous sclerotherapy . .I Derrnarol
Surg Oncol 1990; ] 6:
338-344.
67.
48.
Garden jM, Tan OT, Kerschmann R, er al. Effect of
dye laser pulse duration on selective cutaneous vascular
injury. J Invest Derrnatol 1986; 87:653-657.
Sherwood KA Kurban AK, Tan ~T. Selective melanocyte damage using pulsed irradiation over a variety
of wavelengths. Lasers Surg Med 1988; 8: 190.
68,
49.
Greenwald J, Rosen 5, Anderson RR, et al. Comparative histological studies of the tunable dye (at 577 nm)
laser and argon laser: the specific va cular effects of the
dye laser. J Invest Dermatol1981; 77:305-310.
Riesz P, Krishna CM. Phrhalocyanines and their sulfonated derivatives as phorosensitizers
in photodynamic therapy. Proc Sac Photo-Optic Insrrurn Eng 1987; 847:15-28.
69.
Sonoda M, Krishna CM, Riesz P. The role of singlet
oxygen in the phorohernolysis of red blood cells sensitized by phthalocyanine sulfonates. Photochern Photobioi 1987; 46:625-631.
70.
Dougherty TJ. Photodynamic therapy (PDT) of rnalignanr tumors. Crit Rev Oncol/Hernarol 1984; 2;83-] 16.
71.
Tomio L, Calzavara F, Zorar PL, et al. Phororadiarion
therapy for cutaneous and subcutaneous malignant rumors using hematoporphyrin.
Prog Clin Bioi Res 1984;
170:829-840.
72.
McCaughan jS Jr, Guy jT, Hicks W, er al. Photodynamic therapy for cutaneous and subcutaneous malignant neoplasms. Arch Surg 1989; 124:211-216.
50.
Tan 01', Whitaker D, Garden jM, et al, Pulsed dye
laser (577 nm) treatment of porrwine stains: ultrastructural evidence of neovascularization and mast cell degranulation in healed lesions. J Invest Dermarol 1988;
90:395-398.
51.
Nakagawa H, Tan OT, Parrish JA. Ulrrasrructural
changes in human skin after exposure to a pulsed laser.
J Invest Dermatol 1985; 84:396-400.
52.
Tan OT, Murray S, Kurban AK. Action spectrum of
vascular specific injury using pulsed irradiation. J Invest
Dermarol1989; 92:868-871.
608
Dcrmatologic Lasers
Alsu-r and Kohn
3.
74.
Berns MW. Me ullough
totherapy.
Arch Derrnarol
JL. Porphyrin
sensitized
] 986; 122:871-874.
93.
pho-
Zalar GL, Poh-Firzpatrick
M, Kr hn OL, er al. Induction of drug photo ensitization in man after parenteral
expo ure ro hematoporphyrin.
Arch
Dermarol
1977'
Folia
LL,
76.
77.
Dover
J
rarger of Qvswirched
Dermatol
,er 31. Melano ornes arc
ruby laser irradiation
in
guinea
pig skin. J invest
Dover
guinea
pulse.
./S, Margolis
RJ, Polla LL, er al. Pigmented
pig skin irradiated
with Qvswitched
ruby laser
Arch Derrnatol 1989; 125:43-49.
Wheeland
RG, Bailin PL, Kantor G, er al. Treatment
of
adenoma
sebaceum with carbon dioxide laser vaporization. J Dermarol Surg Onco11985;
J 1:861-864,
96,
Janniger
CK, Goldberg
DJ. Angiofibromas
in ruberou
sclerosis:
comparison
of treatment
by carbon dioxide
and argon
laser. J Dermarol
Surg Oncol
1990; 16:
Y. The ruby and argon la ers in the
of naevi. Ann Acad Med 1983; 12: 388-395.
Weston J, Apfelberg DB, Maser MR, et al. Carbon dioxide laserbrasion
for rrearrnenr of adenoma
sebaceurn in
tuberous sclerosis. Ann Plasr Surg 1985; 15:132-137,
98,
Spenler CW, Achauer
of extensive
adenoma
laser. Ann Plasr Surg
99,
Rarz JL, Bailin PL, lakeland
rrcarrnent
of epidermal
nevi.
1986; 12:567- -70,
100.
MJ, er al. Qvswirched
a 9-year experience.
Br
Apfelberg
DB, Maser MR, Lash H. er al. Treatment
of
xanthelasma
pa lpcbra rurn with the carbon
dioxide
la er. J Derrnarol Surg Oncol 1987; 13:149-151.
101.
Taylor CR, Gange R\Xl, Dover JS, er al. Treatment
of
rarroos
by Qvswirched
ruby laser: a dose response
tudy. Arch Dcrrnarol ] 990 (in press).
Wheeland
RG. Bailin PL, Kronberg
E. Carbon dioxide
(C02) laser vaporization
for the treatment
of trichoepitheliomata,
J Dermarol urg Oncol 1984; 10:470-4 4.
102.
Hickle}' LK, Goldberg
OJ. Multiple
apocrine
hidro ysrornas treated
hy CO! laser. J Dermarol
Surg Oncol
1989; 15:599-602,
103.
Huerter CJ, Whdland
RL, Bailin PL, er 31. Lasers: treatment of myxoid cysts with carbon dioxide laser vaporization, J Derrnarol Surg Oncol 1988; 29:357-369.
104.
Roenigk RK, Ratz Jl. C02
neurofibromas,
.I Derrnatol
190,
105,
David lM.
J Dermarol
106.
DB, Smith T, l.ash H, et al. Preliminary
report on the use of the neodynium- Y AG laser in pia tic
surgery. Lasers Surg Med 1987; 7:189-198,
Stanley RJ, Roenigk
the carbon
dioxide
230-2-,5.
107.
Ro enfeld H, Sherman
R. Treatment
of cutaneous
and
deep vascular
lesions with the
d: YAG laser. Lasers
Surg Med ] 986; 6:20-23.
Dover JS, Smeller BR, Stern
bon dioxide laser irradiation
rol 1988; 124:1219-1224.
108,
Rarz JL, Carbon
Goldman
L, Narh G, Schindler G, High-power
ium-YAG
laser surgery. Acta Derrn Venereol
1973; 53:45-49.
109.
P.I, Ritchie
A, er al.
of black tattoos.
Br
Reid WH, Mcleod
ruby laser treatment
1983; 36:455-459,
Qvswirchcd
J
Plasr Surg
80,
Taylor CR, Anderson
83.
RR, Dover JS, er al. Selective
phororherrnolysis
of dermal
pigmentation:
light and
electron
microscopic
analysi of black tattoos rrcarcd
with Qvswirched ruby laser (abstract) . .I Inve t Derma101 1989; 92:530,
Reid WH, Miller 10, Murph)'
ruby laser treatment
of tattoos:
J Plast SU[g ] 990; 43:663-669.
Apfelberg DB, Maser MR, White ON, er al. A preliminary srudv of rhe combined
effect in neodvnium.
YAG
las~r photocoagulation and direct steroid i'nstillation
in
rhe treatment
of capillary
cavernous
hemangiomas
of
infancy. Ann Plast Surg J 989; 22:94-104,
84,
Landrhaler
M, Haina 0, Brunner R, et al, NeodyniumYAG laser therapy for vascular lesions . .J Am Acad Dermato11986;
14:107-117.
85,
Shapshay
86,
87.
88.
89,
90,
SM, David LM, Zeieels S. Neodyniurn- YAG
laser phorocoagularion
of hemangiomas
of the head
and neck. Laryngo cope 1987; 97:323-330,
Apfelberg
xerorica
925-928.
neodyn(Srockh)
Dixon JA, Gilbertson
Jj. Argon and neodyniurn- YAC
laser therapy of dark nodular port wine stains in older
patients, Lasers Surg Med 1986; 6:5-11.
Abergel
Lasers Surg
RP, Lyons RF, White
Nd: Y AG
laser
welding,
I II.
itA, et al. Skin closure
Dermarol
by
1986;
McBurnev
EI Rosen DA. Carbon
dio ide laser
rnenr of \:erruca vulgaris. J Dermarol Surg Oncol
10:45-48.
Carbon
J Derrnarol
dioxide laser
Surg Oncol
laser rreatmenr of cutaneous
Surg Oncol 1987; 13: 187-
Laser vermilion ablation for actinic
Surg Oncol 1985; II :605-608.
obliterans.
cheilitis.
RK, Actinic cheilitis: treatment
with
laser. Mayo Clin Proc 1988; 63:
RS, et al. Low-fluence
carof lenrigines. Arch Derma-
dioxide
la er treatment
of balanitis
J Am Acad Dcrrnarol 1984; 10:
Greenbaum
,Glogau
R, Stegman
S. et al.
arbon
dioxide laser rrcarrnenr of erythroplasia
of Qucyrar, J
Derrnarol Surg Oncol 1989; 15:747-754.
Apfelberg
DB,
j
13 er MR,
Lash
H, et al. Cornpari
I 12. Bailin PL, Rarz J L, Levine HL. Removal of tatroos
CO~ laser, J Derrnatol Surg Onco11980;
6:997-1001.
14:810-814.
92.
RF.
on
of argon and carbon dioxide laser treatment
of decorarive tattoos: a preliminary
repnrt. Ann Plast Surg 1985;
14:6-15,
Med 1986; 6:38-42,
J Am Aead
BM, VanderKam
VM. Treatment
sebaceum
with a carbon dioxide
1988; 20:586-589.
I 10, Landthaler
M, Ilaina 0, Brunner R, er al, Laser therapy
of bowenoid
papulosis and Bowen's disease. J Dermatol
Surg Onco11986;
12:1253-12-7,
Apfelbcrg DB, Bailin P, Rosenberg H. Preliminary investigation of KTPI5 2 la er light in the treatment of hemangiomas and tattoo.
91.
317-320.
97.
Vance CA, McLcod
PJ, Reid WH, er al. Qvswirched
ruby laser rreatrnenr
of tattoos: a further study, Lasers
Surg Med 1985; 5: 179.
82,
utaNew
9 -.
1987; 89:281-286.
79.
81.
cutaneous
Wheeland
RG, Bailin Pl., Reynolds
0, er al, Carbon
dioxide (C02) laser vaporization
of multiple facial syringomas, J Dermarol
Surg Oneol 1986; 12:223-228.
Ahshiro T, Maruyama
treatment
78.
R./,
Margolis
a primary
laser for non-PWS
94,
113:1392-1397.
75.
Bailin PL. Use of the C02
lesions. In: Arndt KA, Noe Jl\'l, Rosen S, eds.
neous laser therapy:
prin iple
and methods.
York: John Wiley & Sons, 1983:187.
treatJ 984;
113.
Kantor
GR,
of earlobe
609
by
Wheeland
RG, Bailin PL, et al. Treatment
keloids with carbon dioxide laser excision: a
International journal of Dermatology
V,!1.31, No.~, Scrtemher 1992
report of ] 6 cases.
1063-1067.
J
Dermatol
Surg Oneol 1985; 11:
1 '2. Gardon JM O'Banion MK, Shelnitz LS, er al. Papillomavirus in the vapor of carbon dioxide laser-treated
verrucae. JAMA 1988; 259:1199-1202.
1'14. Wheeland RG. Excisional surgery performed with the
carbon dioxide laser. In: Wheeland RG, ed. La ers in
skin disease. New York: Thieme Medical Publishers,
13 . Sawchuk WS, Weber PJ, Low)' DR, er al. Infectious papillomavirus in the vapor of wart treated with carbon
dioxide laser or electrocoagulation: detection and protection. JAm Acad Dermawl1989;
20:41-49.
1988:105.
lIS.
Bailin PL Use of the CO. laser for non-PWS cutaneous
lesions. In: Arndt KA, Noe JM, Rosen S, eds, Cutaneous laser therapy: principles and methods. Chicester,
UK: John Wiley and Son, 1983: 187.
134. Baggish MS, Polesz BJ, jor er D, et a l. Presence of
human immunodeficiency
virus DNA in laser smoke.
Lasers Surg Med 1991; 11: 197-203.
116. Bailin PL, Rarz JL Use of the carbon dioxide laser in
derrnarologic surgery. In: Rarz JL, cd. Lasers in cutaneous medicine and surgery. Chicago: Year Book Medical Publishers, 1986:73.
.
135. Nezhar C, Winer WK, Nezhat F, et 31. Smoke from
laser surgery: is there a health hazard? Lasers Surg Med
1987; 7:376-382.
.136. Garden j M. The hazards of laser plume: a mid-year
committee report. AmSoc Laser Med Surg 1989; 3:6.
117. Rarz J1. Laser applications in dermatology and plastic
surgery. In: Dixon J, ed. Surgical applications of la ers.
Chicago: Year Book Medical Publishers, 1987:160.
.137. Basford JR, Hallman HO. Does low energy HeNe laser
irradiation alter "in vitro" replication of human fibreblasts? Laser Surg Med1988; 8:125-129.
118. Kanror GR, Ratz jL, Wheeland RG. Treatment of acne
keloidal is nuchae with carbon dioxide laser. J Am Acad
Dermatol1986'
14:263-267.
138. Mester E, Mester AF, Mester A. The biomedical effects
of laser application. Lasers Surg Med 1985; 5:31-39.
J 19. Apfelberg DB, Maser MR, Lash H, et al. Preliminary
result of argon and carbon dioxide laser rrearrnenr of
keloid scars. Lasers urg Med 1984; 4:283-290.
139. Lyons RF, Abergel RP, White RA, er 31. Biosrimularion
of wound healing in vivo by a helium-neon laser. Ann
Plasr Surg 1987; 18:47--0.
120. Apfelberg DB, Maser MR, White D ,et al. Failure of
carbon dioxide laser excision of keloids. Lasers Surg
Med 1989; 9:382-388.
140. Kana jS, Hurschenreiter G, Haina D, er al. Effects of
low-power density laser radiation on healing of open
skin wound in rats. Arch urg 1981; 116:293-296.
121. Bohigegian RK, Shapshay DR, Hybey RL. Management
of rhinophyma with carbon dioxide laser: Lahey Clinic
experience. Lasers Surg Med 1988; 8:397-401.
HI. Basford JR, Hallman HO, Sheffield CG, er al. Comparison of cold-quartz ultraviolet, low-energy laser, and ocelusion in wound healing in a swine model. Arch Phys
Med Rehabil1986; 67:151-154.
122. Haas A, Wheeland RG. Treatment of massive rhinophyma with the carbon dioxide laser. J Dermarol Surg
Oneol 1990; 16:645-649.
142. Saperia D. Glassberg E, Lyons RF, et al. Demonstration
of elevated r)'pe I and type rn procollagen
mRNA levels
in cutaneou wound. treated with helium-neon laser:
propo ed mechanism for enhanced wound healing.
Biochcm Biophys Res Cornrnun ) 986; 138:1123-1128.
123. Leshin B, Whitaker DL. Carbon dioxide la er marriectorny. J Dermarol Surg Oncol 1988; 14:608-611.
124. Ratz J, Bailin P, Levine H. COl 13 .er treatment of porr
wine stains: a preliminary
report. J Der marol Surg
Oncol 1982; 8:1039-1044.
125. Bailin PL Trearment of port wine stains wirh rhc
143. Braverman B, McCarthy R], Ivankovich AD, er al. Effect
of helium-neon and infrared laser irradiation on wound
healing in rabbits. Lasers Surg Med 1989; 9:50-58.
0,
laser: early results. In: Arndt KA, Noe JM, Ro en S,
eds. Cutaneous laser therapy: principles and methods.
New York; John Wiley & 50ns,1983: 129-136.
144. Hunter J, Leonard L, Wilson R, er al. Effects of low energy laser on wound healing in a porcine model. Lasers
Surg Med 1984; 3:285-290.
126. Apfelberg DB, Maser MR, Lash H. Review and usage
of argon and carbon dioxide laser for pediatric hemangiomas. Ann Plasr urg 1984; 12:353-359.
145. Surinchak JS, Alago ML, Bellamv RF, et al. Effect of
low-level energy lasers on the healing of full-thickness
skin defects. Lasers Surg Med 1983; 2:267-274.
127. Apfelberg DB, Maser MR, Lash H, er al. Benefits of the
CO2 laser in oral hemangioma excision. Plasr Reconsrr
Surg 1985; 75:46-50.
128. Buecker JW, Rarz JL, Richfield DF. Histology of port
wine stain treated with carbon dioxide la er. J Am
Acad Dermatol1984;
10:]014-1019.
146. Glassberg E, Lewandow ki L, Lask G, et al. Laser-induced photodynamic
therapy with aluminum phythalocynine terra ulfonare as the photo ensirizer: differential
photoroxiciry in normal and malignanr human cells in
vitro. J Invest Dermatol1990;
94:604-610.
129. Van Gernert M]C, Welch AJ, Tan OT, er a l. Limitations of carbon dioxide lasers for treatment of portwine stains. Arch Dermatol1987;
123:71-73.
147. Khoobehi B, Char CA, Peyrna n GA. Assessment of
laser-induced release of drugs from liposornes: an 1/1
vitro study. Lasers Surg Med 1990; 10:60-65.
130. Olbricht SM, Stern RS, Tang SV, er al. Complications
of cutaneous laser surgery: a survey. Areh Dcrrnarol
1987; 123:345-349.
148. Zeimer R ,Khoobehi B, Niesman MR, et al. A potential
method for local drug and dye delivery in the ocular vascularure. Invest Ophrhalrnol
Vis Sci 1988; 29:1179-1 ) 83.
131. Wentzell JM, Robinson ]K, Wenrzell JR JR, er al. Phy ical properties of aerosols produced by derma bra ion.
Arch Dermatol1989;
12-:1637-164.3.
149. Weinstein J. Liposomes in the diagno is and rrearmenr
of cancer. In: 0 tIO MJ, ed. Liposomes from biophysics
to rherapeurics. New York: Marcel Dekker, 19S7:277.
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1992 by the International
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