Erbium-YAG laser therapy – analysis of more than 1,200 treatments

Background: Ablative laser treatment is widely used in dermatology. Different laser types are available. In contrast to that, the medical publication on erbium-YAG laser in dermatology often include small samples only. Objective: We want to demonstrate the versatility of classical erbium-YAG laser for medical conditions in dermatology in a single-center study. Materials and methods: This is a retrospective analysis of patients treated between 2003 and 2011 at our department for benign, premalignant and malignant disorders. Laser treatment was realized with a 2940 nm MCL 29 Dermablate erbium-YAG laser. Results: In total 1211 laser treatments have been performed. The age range of patients was between 8 years and 89 years. In 91% of treatments either no anesthesia or only topical prilocaine/ lidocaine ointment was necessary. Major indication for erbium-YAG laser treatment were hard to treat verrucae vulgares of hands and feet and other virus-induced lesions. The second largest disease group consisted of benign tumors with seborrheic keratosis on the lead. In most cases a single laser session was effective to remove the lesions completely. Adverse effects were rarely seen, such as pigment changes. Scars were commonly treated but they needed several laser sessions to obtain a >50% improvement. Laser treatment for scars should be combined with other treatment modalities for better results. Premalignant lesions are an important indication. The complete clearance rate was high. In chronic actinic cheilitis we obtained 100% complete and stable clearance. Smaller superficial cutaneous metastases can be treated by laser in a palliative setting with minor morbidity and good local control. Conclusion: Erbium-YAG is a versatile laser, a “working horse” for common cutaneous disorder. The treatment is comfortable for the patients with minor downtime, limited pain and mostly excellent outcome. Introduction The erbium-doped yttrium aluminium garnet (erbium-YAG) laser is a solid-state crystal laser. The laser light of 2,940 nm is strongly absorbed by water. This prevents laser cutting of skin and extensive scarring. Often either no anesthesia is needed or only topical anesthetic ointment. The pulsed 2,940 nm erbium-YAG laser is a precise ablative tool. Cavity expansion, collapse and associated acoustic transients are responsible for photoacoustic vaporization followed by phase explosion and material ejection [1]. Erbium-YAG laser produces a measureable skin contraction after superficial ablation of between 5% and 14%, a feature that is of interest in not only in esthetic surgery [2]. Collagen injury is less than with conventional CO2 laser and tissue regeneration is faster [3]. In comparison to CO2, the erbium-YAG led to clean ablation craters and precise cuts with only minimal adjacent tissue damage followed by excellent healing without apparent scarring. Longer pulse duration will increase thermal damage. This laser type has also bactericidal effects but does not coagulate effectively [4]. Erbium-YAG laser has been the working horse in many dermatologic clinics for years before the age of fractional lasers and other technical modifications. Surprisingly, larger studies on erbiumYAG laser in dermatology are sparse. Material and methods We evaluated the indications and treatment modalities as well the outcome and adverse effects of pulsed erbium-YAG laser therapy 2003-2011 at our department. During that time we used the laser MCL 29 Dermablate (Asclepion Laser Technologies, Jena, Germany). We included medical treatments only. The wavelength of this laser is 2,940 nm. The size of focus varied between 1.6 mm, 3 mm and 5 mm. In most cases we used a frequency of 8 Hz. The fluence was tailored to the skin type and type of lesion. In about 86% of treatments the pulse energy was between 600 to 800 mJ, resulting in fluences between 11.3 to 20 J/cm2. Thicker hyperkeratotic lesions needed a pulse energy of 1200 mJ. Patients and staff had protective goggles during laser treatment. Disinfection was performed before laser treatment and thereafter with a solution containing 0.1% octenidine dihydrochloride and 2.0% phenoxyethanol (Octenisept; Schülke & Mayr, Norderstedt, Germany) for facial and mucous lesions. Other body areas were disinfected by 72% propan-2-ol (Cutasept F; Bode, Hamburg, Germany). Anesthetic procedures were discussed with the patient before and Correspondence to: Prof. Dr. Uwe Wollina, MD, Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01309 Dresden, Germany, E-mail: [email protected]