Laser Dermatology E-Book

David J. Goldberg

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 306

Veröffentlichungsjahr: 2011

Beschreibung

* The first all-inclusive text on the pitfalls, complications and controversies surrounding the use of lasers in dermatology and aesthetic medicine * Each chapter starts off by highlighting the key points and essential concepts, followed by a review of the associated pearls and problems * Provides the reader with tips on how to improve the safe and effective use of lasers * Images focus on the pearls and problems Laser Dermatology: Pearls and Problems is different from other laser dermatology books. Each of the five chapters begins by highlighting key points and essential concepts, then focuses on the pearls and problems for each area - based on the author's vast experience in the field of laser dermatology. Dr. Goldberg addresses: * Vascular Lasers * Laser Hair Removal * Pigmented Lesions, Tattoos, and Disorders of Hypopigmentation * Ablative Lasers and Devices * Non-Ablative Photorejuvenation and Skin Remodeling Dr. Goldberg goes beyond the standard "before and after" approach to use actual images to demonstrate the pearls and pitfalls discussed in the text.

Leseprobe

Contents

Foreword

Preface

1 VASCULAR LASERS

Introduction

Essential Concepts

Pearls And Problems

Conclusions

References

2 LASER HAIR REMOVAL

Introduction

Essential Concepts

Pearls And Problems

Conclusions

References

3 PIGMENTED LESIONS, TATTOOS, AND DISORDERS OF HYPOPIGMENTATION

Introduction

Essential Concepts

Pearls And Problems

Conclusions

References

4 ABLATIVE LASERS AND DEVICES

Introduction

Essential Concepts

Pearls And Problems

Conclusions

References

5 NON-ABLATIVE PHOTOREJUVENATION AND SKIN REMODELING

Introduction

Essential Concepts

Pearls And Problems

Conclusions

References

Index

The writing of any book requires hours of work, rework, and more work. This book could not have been written without the tireless efforts of my 2006 Procedural Dermatology fellow, Dr. Alexander L. Berlin. I cannot thank him enough.

© 2008 David J. GoldbergPublished by Blackwell PublishingBlackwell Publishing, Inc., 350 Main Street, Malden, Massachusetts 02148-5020, USABlackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UKBlackwell Publishing Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria 3053, Australia

The right of the Author to be identified as the Author of this Work has been asserted in accordance with the Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.

First published

1 2008

Library of Congress Cataloging-in-Publication Data

Goldberg, David J., M.D.Laser dermatology: pearls and problems/David J. Goldberg.p.; cm.Includes bibliographical references and index.ISBN-13: 978-1-4051-3420-01. Skin—Laser surgery. I. Title.[DNLM: 1. Skin Diseases—surgery. 2. Cosmetic Techniques. 3. Laser Surgery.4. Skin Aging. WR 650 G618L 2008]RL120.L37G64 2008617.4’770598—dc222007015635

ISBN-13: 978-1-4051-3420-0

Commissioning Editor: Martin SugdenEditorial Assistant: Jennifer SewardDevelopment Editor: Elisabeth DoddsProduction Controller: Debbie Wyer

For further information on Blackwell Publishing, visit our website: http://www.blackwellpublishing.com

The publisher’s policy is to use permanent paper from mills that operate a sustainable forestry policy, and which has been manufactured from pulp processed using acid-free and elementary chlorine-free practices. Furthermore, the publisher ensures that the text paper and cover board used have met acceptable environmental accreditation standards.

Blackwell Publishing makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check that any product mentioned in this publication is used in accordance with the prescribing information prepared by the manufacturers. The author and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this book.

Foreword

Enthusiasm and knowledge only go so far. But industrious capitalization of these features can result in infectious and significant achievements with long lasting benefits. And so David Goldberg’s excellent review of energy based systems entitled Laser Dermatology: Pearls and Problems is arriving at a most propitious time.

Not so long ago, there were only a few therapeutic lasers available and the choices were easy. It was all about how to use the continuous wave CO2 laser in one of its three modes— cutting, vaporization, or coagulation—which all related to spot size and power. Or how to improve the appearance of port wine stains with the argon or copper vapor lasers without scarring the heck out of the patient. In retrospect, we used to do a pretty good job considering the lack of selectivity and low tissue tolerance for these devices. There were few “Problems” and even fewer in the way of “Pearls.”

But now it’s a different ball game. The varying different energy based devices (not just lasers) are numerous, more selective, safer, and in many cases less effective than we would like them to be. Problems can exist if they are not used appropriately. Pearls come through the experience of using such devices effectively. This book moves beyond laser and light based wavelengths, fluences and pulse durations and focuses on the wealth of experience of one of today’s leaders in laser dermatology.

Dr. Goldberg should be congratulated for bringing together a very practical compilation of the pearls and problems in the current practice of laser dermatology. His well presented, organized series of concepts will be extremely useful for the experienced laser surgeon as well as the novice. Very evident in this book is the accuracy and honesty of the author. Laser dermatology is exciting. Laser Dermatology: Pearls and Problems is an essential read for all physicians interested in the nuances of this field.

Christopher B. Zachary, FRCPProfessor and ChairDepartment of DermatologyUniversity of California-IrvineJuly 2007

Preface

Laser Dermatology: Pearls and Problems is not meant to be just another book written about lasers in dermatology. There are plenty of such books already written on that topic – some by me. All other books dealing with this vast arena either focus on (a) the skin entities that can be treated with lasers; (b) the latest in dermatological lasers; or (c) complications that may induced by those lasers. Where this book is different is the manner in which it looks at lasers in dermatology. This book is divided into five chapters. Each chapter starts off by highlighting essential concepts. This is then followed by a focus on pearls and problems of five major areas of laser dermatology. In addition, the photographs contained within each of the chapters are meant to serve a different purpose than is seen with most textbooks. The focus of pictures in this book is not to present before and after photographs. Such a focus is contained in many outstanding textbooks. Although there are occasional before and after pictures contained within the text, the focus, in this book, is to use pictures to illustrate some of the many pearls and problems that can be seen in the realm of laser dermatology. Twenty years of laser dermatology have given me a chance to see the beauty of the “Pearls” and the difficulties of the “Problems” in Laser Dermatology. Enjoy!

David J. Goldberg, MD, JDMarch 2007

1 VASCULAR LASERS

Introduction

Essential Concepts

Vascular Laser Biology, Chromophores, and Tissue Targets

Laser Settings: Pulse Duration, Spot Size, Fluence, and Cooling Methods

Classification of Vascular Lesions

Pearls and Problems

PWS: Pulsed Dye Laser

PWS: Other Lasers and Light-Based Devices

Hemangiomas

Venous Malformations

Arterial and Arteriovenous Malformations

Facial Telangiectasias

Telangiectatic Leg Veins

Miscellaneous Vascular Lesions

Conclusions

KEY POINTS

The pulsed dye laser, originally only used in a purpuric mode, is now highly successful without the induction of purpura for the treatment of most vascular lesionsPulsed dye lasers used for the treatment of port-wine stains lead to the best results when the clinical endpoint is purpuraFacial erythema can be treated equally well with both pulsed dye laser and intense pulsed light treatmentTwenty years after pulsed dye laser treatment of port-wine stains was initiated, the exact number of treatments remains an enigmaSome leg spider veins can be treated with laser treatment; sclerotherapy remains the gold standard

Introduction

Cutaneous vascular lesions, especially those occurring on visible sites, such as the face, may cause significant psychological distress. This is true not only of port-wine stains (PWS), whose detrimental effect on patient is well recognized [1,2], but also of other vascular malformations, proliferations, and ectasias. Frequently, however, the latter conditions tend to be under-diagnosed and undertreated. The introduction of compact and more affordable lasers, being used in an outpatient setting, allowed for easier patient access with more reliable and cosmetically pleasing results.

The treatment of vascular lesions is one of the most commonly requested cutaneous laser procedures. Since the introduction of the argon laser, a variety of lasers and light sources have been used in the treatment of vascular lesions. These include visible and infrared lasers, as well as broadband light sources. Despite some limitations, lasers and light source devices remain the modality of choice for a variety of vascular lesions.