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Biomedical subjects

R G Geronemus

Publications and source records attributed to R G Geronemus.

At least 37 records · Page 2Linked to original sources
PubMed1997

Effect of dynamic cooling on 585-nm pulsed dye laser treatment of port-wine stain birthmarks.

BACKGROUND AND OBJECTIVE: The objective of this study was to determine the effectiveness of a dynamic cooling device (DCD), spraying the skin with a brief spurt of cryogen prior to the laser pulse, in reducing transient pain associated with 585-nm pulsed dye laser (PDL) treatment of port-wine stains (PWS), and reducing epidermal damage (hypo/hyperpigmentation) caused by this laser during PWS treatment. MATERIALS AND METHODS: Matched treatment sites were compared with and without the use of the cryogen spray in 47 patients at two investigational sites. Pain ratings, clearance of the PWS, and pigmentation changes were assessed. The results were analyzed by skin type and patient age. RESULTS: A statistically significant reduction in pain ratings was found in all patient groups using the DCD without changing the efficacy of PWS clearance. Pain reduction was most remarkable in patients with darker skin types. Dynamic cooling prevented the occurrence of epidermal damage or pigmentation change in most cases. CONCLUSIONS: This study suggests that dynamic cooling can dramatically diminish pain during PWS treatment with the 585-nm PDL without reducing treatment efficacy. The absence of epidermal damage in most patients suggests that precooling with the DCD may allow the use of higher laser fluences to expedite clearance without inducing epidermal change. Dynamic cooling has potential use with other lasers and different lesions where discomfort and epidermal effects limit therapy.

Adolescent↗
PubMed1997

The short- and long-term side effects of carbon dioxide laser resurfacing.

BACKGROUND: Carbon dioxide (CO2) laser resurfacing has become a very popular method of rhytide and scar removal in the recent past. Preliminary studies have been published describing the method, histology, and clinical results of CO2 laser resurfacing. However, none of these studies has dealt with long-term follow-up results. OBJECTIVE: To review all side effects resulting from CO2 laser resurfacing with regard to both short- and long-term effects. METHOD: Retrospective analysis of 104 patients who have undergone CO2 laser resurfacing for either facial rhytides and/or scarring with follow-up periods of 4-23 months (average, 8.2 months). RESULTS: The incidence of side effects are generally very low for CO2 laser resurfacing, including scarring, postinflammatory hyperpigmentation, and infection. However, there is a significant and previously unreported risk of hypopigmentation in an area of the population who often seek improvement in the appearance. CONCLUSIONS: CO2 laser resurfacing of facial rhytides and acne scars can be a very safe procedure by an experienced laser operator. However, careful patient selection, thorough patient instruction, and proper aesthetic analysis of treatment sites must be followed to insure the most favorable outcomes with CO2 laser resurfacing.

Adult↗
PubMed1996

Histology of high-energy pulsed CO2 laser resurfacing.

Cutaneous laser resurfacing is already proving to be a highly effective tool for improving photodamaged or scarred skin. The clinical and histological effects of the new high-energy, pulsed carbon dioxide (CO2) systems compare favorably with other treatments such as dermabrasion and chemical peels. The tissue-tightening effect noted after laser treatment may account for the claims of superior clinical improvement and needs further investigation.

Cicatrix↗
PubMed1996

Tattoo formation from absorbable synthetic suture and successful removal with Q-switched ruby laser.

BACKGROUND: Traumatic tattoos result from accidental or unintentional deposition of exogenous pigment within injured skin. Pigments may consist of heavy metals, vegetable matter, or commercial dyes. OBJECTIVE: The clinical and histologic description of a traumatic tattoo resulting from a surgical procedure using undyed, braided, synthetic, absorbable suture material and its removal with the Q-switched ruby laser (694 nm, 28 nsec). METHODS: The pigmented linear lesion was biopsied and processed using standard histological methods. Subsequently, the area was treated on two occasions with the Q-switched ruby laser. RESULTS: The pigmented lesion was completely removed with the Q-switched laser treatments. CONCLUSION: We report on the occurrence of a traumatic tattoo resulting from synthetic suture material and complete removal with the Q-switched ruby laser.

Basal Cell Carcinoma↗
PubMed1996

Treatment of small and medium congenital nevi with the Q-switched ruby laser.

BACKGROUND: The Q-switched ruby laser has been used successfully to treat a variety of benign pigmented lesions. In this study, congenital nevi (diameter, < or = 5 cm) in 18 prepubertal children were treated with the Q-switched ruby laser. OBSERVATIONS: Photographic evaluation revealed an average of 57% clearance of pigmentation in all treated nevi by the fourth treatment session and an average maximum clearance of 76% after approximately eight sessions. Greater than 90% clearance of pigment was attained in five patients. Partial repigmentation was seen in all patients who were followed up after discontinuation of therapy. Findings from histopathologic studies, obtained from one patient, revealed reduction of nevus cells in papillary dermis and upper reticular dermis that correlated with clinical lightening. There was no such reduction in the lower reticular dermis. side effects were limited to transient erythema and hypopigmentation. CONCLUSIONS: The Q-switched ruby laser effectively lightens and may clear pigmentation and eliminate superficial nevus cells from small and medium congenital nevi safely without scarring. However, these results are not permanent. The Q-switched ruby laser may be a viable alternative for providing cosmetic improvement for unresectable lesions, but it should not be considered definitive treatment. Additional studies are needed to address the long-term results of this therapy.

Adolescent↗
PubMed1996

A histopathological comparison of "char-free" carbon dioxide lasers.

BACKGROUND: New "char-free" carbon dioxide lasers are capable of precise tissue vaporization with minimal residual thermal damage. These lasers operate either by producing high energy, rapid pulses or by scanning a highly focused continuous mode beam. OBJECTIVE: To determine the depth of ablation and the depth of residual thermal injury produced with one to three passes of the pulsed and scanned systems. METHODS: The distal ends of preauricular donor skin from 12 patients requiring full-thickness skin grafts following Mohs micrographic surgery were treated with zero to three passes of each of the lasers, and fixed for histopathological analysis. RESULTS: The three lasers tested produced vaporization of thin (20-50 microns) layers of tissue and narrow (20-150 microns) zones of thermal injury following one, two, or three passes on intact skin. CONCLUSION: The pulsed and scanned technologies are capable of producing "char-free" tissue ablation with minimal residual thermal damage.

Burns↗
PubMed1995

Pulsed dye laser treatment of warts.

OBJECTIVE: To determine the safety and efficacy of the flashlamp-pumped pulsed dye laser for the treatment of uncomplicated and recalcitrant warts. DESIGN: Observational study. PATIENTS: A total of 142 patients with 703 recalcitrant and 25 previously untreated warts consecutively referred to two tertiary care laser centers from July 1993 through January 1994. INTERVENTION: Photocoagulation with the flashlamp-pumped pulsed dye laser. MAIN OUTCOME MEASURES: Complete resolution of treated warts after a follow-up ranging from 3 to 9 months. RESULTS: The overall response rates were 99% for body, limb, and anogenital warts; 95% for hand warts; 84% for plantar warts; and 83% for periungual warts. Side effects were limited and infrequent. CONCLUSION: Pulsed dye laser therapy is a highly effective and safe method used to selectively destroy warts without damaging the surrounding skin.

Adolescent↗
PubMed1995

Adverse effects associated with the 577- and 585-nanometer pulsed dye laser in the treatment of cutaneous vascular lesions: a study of 500 patients.

BACKGROUND: The flashlamp-pumped pulsed dye laser has been used in the treatment of cutaneous vascular disorders since 1986. Although this laser is now widely used for the treatment of port-wine stains, telangiectases, and hemangiomas, the incidence of adverse reactions has not been clearly defined in a large series of patients. OBJECTIVE: We assessed the incidence of adverse effects associated with the use of the pulsed dye laser in the treatment of vascular lesions. METHODS: We studied 500 patients undergoing pulsed dye laser treatments for port-wine stains, telangiectases, and hemangiomas. All patients were examined during the course of their treatment to assess the incidence of adverse effects associated with the use of the pulsed dye laser. RESULTS: There were no cases of hypertrophic scarring. The incidence of atrophic scarring was less than 0.1%. A spongiotic dermatitis was seen in 11 of 297 patients (0.04%) after multiple treatments of port-wine stains. Hyperpigmentation was seen in five of 500 patients (1%), whereas transient hypopigmentation was seen in 13 (2.6%). CONCLUSION: These findings demonstrate that the flashlamp-pumped pulsed dye laser is safe for the treatment of port-wine stains, telangiectases, and hemangiomas in children and adults.

Adolescent↗
PubMed1995

Repetitive pulsed dye laser treatments improve persistent port-wine stains.

BACKGROUND: Approximately 50-75% lightening of port-wine stains is achieved within two to three treatments with pulsed dye laser therapy, but the incidence of complete clearing is variable. OBJECTIVE: This study was designed to: 1) assess the ability of continued repetitive pulsed dye laser treatments to further lighten persistent port-wine stains; 2) evaluate the factors contributing to the resistance of port-wine stains to laser therapy; and 3) determine the relative risk of adverse effects following repetitive treatments to the same area. METHODS: A retrospective photographic analysis was performed of 69 patients that failed to achieve greater than 75% lesional lightening within nine treatment sessions. The percentage improvement was assessed by comparing the degree of lightening at the last treatment to that of the midway point of treatment. RESULTS: Significant improvement in port-wine stain lightening, from the midway to last treatment, was seen in patients who had 10-25 repetitive treatments. CONCLUSION: Repetitive treatments with the pulsed dye laser can lead to improvement in the overall lightening of persistent port-wine stains without an increased risk of adverse effects.

Adolescent↗
PubMed1995

Skin resurfacing of fine to deep rhytides using a char-free carbon dioxide laser in 47 patients.

BACKGROUND: Recent advances in carbon dioxide (CO2) laser technology have resulted in the development of lasers that can precisely remove thin layers of skin with minimal thermal damage to the surrounding tissue. These lasers rely on rapid pulsing or scanning of the laser beam. The effects of these lasers are predictable and reproducible, making them ideal for skin resurfacing. Clinical results have been promising, however, to date, no published series exist. OBJECTIVE: To evaluate the effectiveness and side effect profile of laser resurfacing utilizing a CO2 laser with a scanning device, and make recommendations for patient selection and treatment protocol. METHODS: Patients with perioral, periorbital, and glabellar rhytides were treated with a CO2 laser with a scanning device. Utilizing chart review and photographic evaluation, patients treated between November 1994 and April 1995 were retrospectively evaluated for effectiveness of therapy, healing time, and complication rates. RESULTS: A total of 47 patients were evaluated. Photographic evaluation or chart review revealed good to excellent cosmetic results in all anatomic areas studied. All patients experienced posttreatment erythema lasting 1-6 months. Other minor complications were limited to contact dermatitis to topical preparations, transient postinflammatory hyperpigmentation, and milia formation. One patient experienced a primary herpes simplex virus infection during reepithelialization and required intravenous therapy. Minor focal atrophy was seen in one patient. No hypertrophic scarring or permanent pigmentation changes were seen. CONCLUSIONS: A CO2 laser system with a scanning beam can effectively and safely improve or remove glabellar, perioral, and periorbital rhytides.

Adult↗
PubMed1995

Tattoo removal with the Q-switched ruby laser and the Q-switched Nd:YAGlaser: a comparative study.

The Q-switched ruby and the Q-switched neodymium YAG lasers are both widely used in the treatment of amateur and professional tattoos. Comparative evaluation of these two laser systems has not previously been performed; thus, the advantages of each laser have not been delineated. Forty-eight amateur and professional tattoos were treated with both the Q-switched ruby and Q-switched Nd:YAG lasers. The tattoos were divided in half and one side of the tattoo was treated with each laser. After one treatment, the patients returned for evaluation to assess the degree of lightening achieved by each laser. The Q-switched ruby laser was found to be superior in lightening black dye in both professional and amateur tattoos. A significant advantage was noted for the ruby laser in the removal of green tattoo pigment. The differences with the Q-switched ruby laser and the 1064 nm option of the Q-switched YAG laser were not clinically significant in the lightening or removal of other colors. The 532 nm option of the Q-switched YAG laser was superior to the Q-switched ruby and the 1064 nm option of the YAG laser in the removal of red tattoo colors in professional tattoos. Hypopigmentation was found more commonly with the Q-switched ruby laser, while textural change was noted more commonly with the Q-switched Nd:YAG laser. One of the patients treated with the Nd:YAG laser at 1064 nm showed a hypertrophic scar.

Adolescent↗
PubMed1993

Rapid response of traumatic and medical tattoos to treatment with the Q-switched ruby laser.

Traumatic tattoos can be very difficult to remove. Excision is often not possible because of the extent of the tattoo, and dermabrasion may not be able to reach the area of pigment without significant scarring. Six patients with traumatic (n = 5) or medical (n = 11) tattoos were treated with the Q-switched ruby laser with complete or nearly complete resolution after one to six treatments without cutaneous scarring or permanent pigmentary alteration.

Adolescent↗
PubMed1993

Pulsed dye laser treatment of vascular lesions in children.

BACKGROUND: The flashlamp-pumped pulsed dye laser (577,585 nm) with 300 to 450 microseconds pulsewidths has been demonstrated to effectively and safely treat port-wine stains, telangiectases, and superficial hemangiomas in children. OBJECTIVE: The objective of this manuscript is to review the indications of the pulsed dye laser in the treatment of vascular lesions in children. CONCLUSION: Pulsed dye laser treatment of port-wine stains can remove or lighten the lesions with multiple treatment sessions. Spider telangiectases respond with complete resolution, usually within one to two treatment sessions. Superficial hemangiomas respond quite easily and effectively with the pulsed dye laser, while a more variable response is noted in deeper hemangiomas, early proliferative lesions, and ulcerated hemangiomas. This procedure is safe with a low incidence of scarring and pigmentary alteration.

Adolescent↗