Objectives: The future that lies before us is very bright and promising because there are now a myriad of lasers and light-based tools for treating various dermatological lesions, all characterized by specific advantages and disadvantages, and all offering a very favorable risk benefit ratio, but only when used by skilled physicians.

Introduction: Extreme power, coherence, well-defined wavelength, ability to generate very brief pulses, and to focus tightly, are features of lasers important to their medical applications. In dermatology we use lasers mainly as surgical tools to heat or vaporize cells and tissue with precision and often with selectively, affecting light-absorbing targets within the skin.

Materials / method: A specific and honest discussion with the patient is essential before the laser session; during this consultation realistic objectives, potential complications and side effects should be always discussed with the patient.A careful discussion of the laser procedure with photographic images is useful to increase the compliance of the patient.

Results: The physicians should always keep in mind two famous phrases “If you don’t need the laser, don’t use it, Leon Goldman” and “Nil nocere, Hippocrates”.

Conclusion: The selection of the correct laser equipment and settings, the pre and post-operative care are crucial for the success.

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Objectives: Review of LHR complications based on the literature

Introduction: Laser hair removal – using alexandrite, long pulsed diodes, long pulsed Nd:YAG lasers and IPLs- is today regarded as the most efficient and safe method for reduction of unwanted hair and is now usable on all skin types. Complications are extremely rare if the following conditions are applied: selective photo-thermolysis principles, proper choice of wavelength, adapted pulse durations in the millisecond range, adapted settings to skin phototype, chromophore and area of the body.

Materials / method: Description of laser hair removal complications based on an extensive review of the literature and clinical cases of personal and French Laser's Group experiences.

Results: - Burns and dyspigmentations: Superficial burns and subsequent transient dyspigmentations are the most frequent adverse effects in all series and reports since 1996. Burns are rarely more severe with post-burn permanent scarring and/or persistent dyschromia (technical errors: wrong assessment of skin color or tanning, inappropriate settings, misalignment of the cooling device…). The risk is higher for dark phototypes. Pain is the key symptom of alarm and must always be bearable.
- Resistant hypopigmentation after LHR of the legs (patient with a preexisting Sutton nevus)
- Paradoxical hypertric

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Objectives: To provide an overview of the commonest challenges and adverse effects of topical photodynamic therapy and how to manage them

Introduction: Photodynamic therapy is a widely used treatment for actinic keratoses in field-cancerized skin. Its advantages include treatment of large skin areas in a single session and excellent cosmetic result.
However, PDT is associated with different local and, more rarely, global adverse effects.

Materials / method: A broad literature search in Pubmed, Embase and Clinical Trials using key words photodynamic therapy, PDT, actinic keratoses and field cancerization was performed.
Both conventional PDT and daylight PDT was included in the search.

Results: The commonest adverse effect for conventional PDT was illumination-associated pain, which was generally non-existing in daylight PDT. Whealing and associated itching also occurred.
For conventional PDT and daylight PDT immediate skin reactions included erythema, crusting, scaling and sterile pustules were most frequent followed by a range of more rare adverse effects. New measures were capable of reducing inflammatory reactions.

Conclusion: PDT is a first line treatment for field cancerization and holds well-described and relatively short lived adverse effects.

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Objectives: The objective of the presentation is to present the evidence for laser therapy in Congenital Melanocytic Nevi.

Introduction: Congenital melanocytic nevi (CMN) have an incidence of 1 to 2% in new-borns. They are present at birth or develop early in life. They can be a great burden and reduce patient’s quality of life, due to their cosmetic appearance. More recent studies indicate a much lower overall incidence of melanoma in CMN of approximately 0.7% to 2.9%. As a result, the treatment paradigm has shifted from radical excision at any cost towards cosmetically acceptable, less invasive treatment options such as laser treatment. However, the laser literature is quite confusing and partly contradictory.

Materials / method: In a recent systematic review we critically appraised the efficacy and safety of laser therapy for CMN using the GRADE approach.

Results: We identified 24 eligible studies using 20 different laser modalities. Often combinations of lasers were used like the CO2 laser with a Q-switched laser. These combinations were used either in the same session or in different sessions.
The Q-switched laser was most frequently used. Ablative lasers were used especially for large or giant CMN. Due to the variety of laser modalities and the heterogeneity between studies, comparison between laser modalities was not possible. No report of malignant change after laser therapy was found.

Conclusion: Lasers in CMN showed rather good results for clearing of hyperpigmentation on the short term. Most studies report short-term improvement of CMN after laser therapy but there is no evidence for the efficacy and safety of laser modalities in CMN on the long term.
In order to obtain evidence on the efficacy and safety of laser treatment in CMN, well-designed, well-conducted and well-reported prospective studies are required.

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Objectives: The aim of this study is to compare between the efficacies of microneedling combined with platelet-rich plasma and Fractional erbium YAG laser in the treatment of post-traumatic atrophic scars.

Introduction: Different methods of treatment have been tried for atrophic post traumatic scars but to date no definite effective modality has been determined.

Materials / method: This comparative study was performed on 45 patients with atrophic post traumatic scars the patients were subdivided into three groups. Group I included fifteen patients subjected to four sessions of skin microneedling treatment by automated microneedling device followed by topical application of platelet-rich plasma immediately after each session at two-week intervals. Group II included 15 patients subjected to the same protocol of treatment but for six sessions. While group III included fifteen patients subjected to four sessions Fractional erbium YAG laser 1,340 nm at two-week interval

Results: All patients in both groups showed significant clinical improvement and were satisfied. The percent of change of modified Manchester score and patient satisfaction were significantly higher in group III compared to group I (p < 0.001). on the other hand, this difference were not significant when group III compared to Group II. Histopathological assessment using morphometric analysis revealed increased in the epidermal thickness, post treatment collagen fibres and elastic fibres coloured percent area in the three groups after treatment

Conclusion: microneedling is effective and well tolerated procedure in treatment of atrophic post traumatic scars, with fewer side effects and shorter down time and could be as effective as fractional laser when combined with platelet rich plasma and for more frequent sessions.

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Objectives: A comparative split face study was designed to evaluate the
efficacy and safety of low-fluence Q-switched 1,064 nm Nd: YAG , low power fractional CO2 laser and combined Q-switched Nd: YAG and low power fractional CO2 .

Introduction: Melasma is a common, multifactorial pigmentation disorder, usually manifested in females during the childbearing period. It is characterized by symmetrical irregular brown patches affecting mainly sun exposed areas. Various therapeutic modalities were suggested for the treatment of this condition ranging from topical skin whitening agents to different dermatologic in- office procedures. However, both the risk of post-inflammatory hyperpigmentation and the high rate of recurrence post therapy still remained as a dilemma facing dermatology practitioners.

Materials / method: Thirty patients were divided in two groups; Group A patients were subjected to skin toning using Q switched Nd-YAG in the form of a session every 2 weeks to one side of the face, and low power fractional CO2 to the other side as one monthly session. Group B patients were subjected to Q swithched Nd YAG on one side and combined Q switched Nd YAG and low power fractional CO2 to the other side. Patients were evaluated by modified MASI score, photography, blinded dermatologists’ evaluation and by spectrophotometer during the 4 month treatment period and the 2 month follow-up period.

Results: Skin toning, using Q switched NdYAG laser proved to be more effective in the treatment of melasma than fractional CO2. The combination of Q-switched Nd: YAG and low power fractional CO2 yielded even better results. However, two complications did arise during the course of treatment with Q switched Nd YAG in the form of hypopigmentation. One patient developed vitiligo like depigmentation and 4 patients developed rain drop hypopigmentation.

Conclusion: Q switched Nd YAG whether alone or combined with fractional CO2 is effective in the treatment of melasma yet still holds the risk of hypopigmentation in susceptible patients.

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Objectives: IMCAS ALERT: Alert allows you to receive expert advice on complications, cases or procedures in two easy steps. First, simply select the topic in which your case belongs. Then, submit your case anonymously. Your case will then be visible to the IMCAS Academy community of experts for them to answer.
Going through the presented cases and the discussions around each case is a learning experience by itself which enhances the knowledge of physicians and helps in improving the standards of patients care in our field.

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