Laser Therapy: Potential and Challenges

Nov 16, 2023

Laser therapy can be effective for various cutaneous lesions, but a number of challenges are involved with the procedure, according to findings in a study published in Dermatologic Therapy.

Researchers evaluated laser applications in various vascular, infectious, and hyperpigmented cutaneous lesions after conducting a literature review from 1973 to January 2022. They assessed the relevant clinical trials, observational studies, and systematic reviews.

Hemangiomas are the most common vascular tumor occurring in children, for which laser therapy with pulsed dye laser (PDL) has shown to be effective. PDL laser therapy generally also has had favorable outcomes in children with pyogenic granulomas. For noninvoluting congenital hemangiomas in children, improvement has been shown with use of a multiplex laser of 595 nm PDL and 1064 nm neodymium-doped yttrium aluminum garnet (Nd: YAG), although the procedure requires general anesthesia.

PDL is generally regarded as the best option for erythema erythemotelangiectatic rosacea in adults. Other lasers, such as the potassium-titanyl-phosphate, may be used for perinasal and facial telangiectases. Comparative studies between PDL and intense pulsed light for diffuse facial erythema and telangiectases have been inconclusive.

In vitro studies have shown that Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa may respond to low-level laser radiation, and Nd: YAG laser has been demonstrated to be effective for onychomycosis. PDL and long-pulsed Nd: YAG lasers have been effective for cutaneous warts, and PDL is more frequently used for plantar warts.

For café-au-lait macules, the 532 nm QS Nd: YAG laser is preferable, particularly for light-skinned patients, noted the investigators. Repetitive sessions of the QS laser with low fluencies has been useful for melisma, and short-pulsed pigmented lasers are the gold standard for the healing of freckles. In addition, QS lasers are recommended for freckles in light-skinned patients with minimal complications, and long-pulsed lasers have been found to be equally effective in dark-skinned patients.

Laser therapy is associated with a number of challenges, however, according to the study authors. Those challenges include burns and excessive heating, ocular injury due to direct exposure, and recalcitrant lesions in some vascular lesions. In addition, infections such as herpes simplex virus can be reactivated after laser therapies. Hairy areas may be difficult, it was noted, as the melanin acts as a competing chromophore in some procedures including nonablative skin rejuvenation. The patient's age, particularly for vascular malformations, and scars following ablative therapies of the neck are other issues associated with laser use.

"There are no sufficient studies regarding discriminatory laser therapy for the aggressive types of the vascular tumors," the researchers commented. "Accordingly, this might determine the necessity of generating innovative laser treatments. To maximize the benefit of light therapy it is mandatory to recognize its challenges and consider it deeply in our field of research."

Saftawy EE, Sarhan R, Hamed A, Elhawary E, Sameh A. Lasers for cutaneous lesions: an update. Dermatol Ther. Published online June 17, 2022. doi:10.1111/dth.15647