Le Laser dans le traitement des problèmes cutanés

Dr Christophe HSU – dermatologist. Geneva, Switzerland

How is laser used to treat skin disorders?

• Laser is a very pure and intense light source.
• When the laser light shines onto the skin, a certain target in the skin absorbs the laser light.
• Different targets in the skin will absorb laser light of different characteristics. After absorption of the laser light, the target may be physically altered or destroyed.
• Therefore, laser is used to selectively destroy unwanted targets in the skin. For example, unwanted pigments and blood vessels. Specific laser system is needed to treat specific skin condition.

What are the skin disorders that can be treated by lasers?

• Unwanted skin growths

1. Carbon dioxide laser is selectively absorbed by water content within the cells of these growths, resulting in excessive heat generation within the growths and subsequent destruction of the growth.
2. Some of the skin growths that can be treated with laser include viral warts, seborrhoeic warts, sebaceous hyperplasia and syringomas.

• Unwanted wrinkles and scars

1. Carbon dioxide laser can be used to remove the superficial layers of skin to allow re-growth of healthier, firmer and better looking skin.

• Pigmentary disorders

1. Pigment laser light is selectively absorbed by the pigment target within the skin and results in selective destruction of the pigment target.
2. Some of the pigmented disorders that can be treated with the pigment lasers include unwanted tattoos, solar lentigines (sunspots, liver spots) and black birth marks.
3. Often multiple laser treatment are required.

• Blood vessel disorders

1. Vascular laser light is selectively absorbed by red blood cells within the blood vessels, resulting in heating within the vessels and subsequent sealing up of the vessels.
2. Vascular lasers can be used to treat blood vessel birthmarks (such as hemangiomas and port-wine stains) and broken veins (such as those on the nose and legs).
3. However, it is important to note that not all skin lesions, whether they are growths, pigmentation or blood vessel disorders can be treated with lasers. Your doctors will be able to advise you on the most appropriate treatment.

What do patients have to do before the laser skin treatment?

• The pre-operative treatment will differ depending on the type of laser surgery.
• In general, patients should avoid sun exposure and have good routine skin care.
• For patients undergoing laser treatment for wrinkles and scars, pre-operative creams and medications may be prescribed by your doctor.

What is involved in laser skin surgery?

• Laser skin surgery is carried out as an outpatient procedure.
• Local anesthetic creams or injections are given before the treatment to minimise pain.
• The appropriate laser system is then used to treat the specific skin disorders.
• The procedure is generally painless, although patients may experience some discomfort.
• The procedure will last from about 5 minutes to 45 minutes, depending on the type of procedure and extend of treatment.

What do patients have to do after the laser skin treatment?

• Good skin care is necessary to ensure optimal healing of the skin after laser surgery:

1. The treated area should be kept clean with skin cleanser and ointment.
2. Oral antibiotic antiviral and painkiller may be necessary after laser treatment for wrinkles and scars.

What are the risks involved in laser skin surgery?

• Laser treatment is generally safe. Some procedures, such as laser treatment for scars and wrinkles carry higher risk for side effects compared to other laser treatments. Some of the potential side effects include:

1. Redness of skin after treatment: This is usually transient and resolves within months.
2. Post-inflammatory hyperpigmentation (darkening of skin): This can be minimised by sun avoidance both pre-operative and post-operatively. It can also be treated with sunscreens bleaching agents. It usually fades with time.
3. Hypopigmentation (lightening of skin): This is less common but will improve with time as well.
4. Scarring: This is extremely rare if all the necessary precautions are taken. It usually occurs secondary to wound infection during the healing phase after laser surgery. Good wound care after laser surgery can help to reduce the risk of scarring.

Contributors

Dr Christophe HSU – dermatologist. Geneva, Switzerland

Dr Husain Ali Mahdi Juma  (دكتورحسين علي جمعه) – dermatologist. Manama, Bahrain

National Skin Centre. Singapore