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Feature Article

Laser and energy-based devices. Use in common dermatological conditions

JOSHUA FARRELL, Robert Rosen
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© ALESSANDRO GRANDINI/ STOCK.ADOBE.COM
© ALESSANDRO GRANDINI/ STOCK.ADOBE.COM

Abstract

Laser and energy devices are increasingly being used for a growing number of dermatological indications from vascular and pigmented abnormalities to resurfacing and rejuvenation. Currently, there are no cohesive regulations surrounding the operation of laser and energy devices in Australia. It is therefore important that GPs advise patients to seek adequately trained providers for best outcomes.

Key Points

  • Lasers can be ablative or nonablative. Ablative lasers are destructive and are used for skin resurfacing. Nonablative lasers target pigment, such as vascular or pigmented lesions.
  • Lasers typically emit a specific wavelength, and therefore specific devices are required to target particular molecules.
  • Intense pulsed light (IPL) devices offer a spectrum of wavelength emission, thus a single device can be used to treat a range of problems.
  • Lasers and energy devices can result in side effects including swelling, scarring and postinflammatory pigmentation changes.
  • There is currently no consistent regulation for the qualifications and training of treatment providers across Australian states and territories.
  • Most injuries from laser and energy devices are the result of inadequate knowledge and experience of the treatment provider. It is therefore important that GPs recommend or advise patients to seek treatment from adequately certified and experienced practitioners.

Lasers (light amplification by stimulated emission of radiation) were first used in dermatology in the early 1960s, when Leon Goldman described the effect of a laser beam on the skin for pigmentation.1 Since then, the applications of lasers and energy devices such as intense pulsed light (IPL) have expanded to include the treatment of:

  • vascular lesions seen in rosacea, vascular malformations (port wine stains) and telangiectasias (dilated capillaries)
  • pigmented lesions such as lentigines and birthmarks 
  • unwanted hair
  • tattoo removal
  • skin remodelling such as acne scarring and removal of benign skin tumours.

This article will review how lasers work, common laser and energy devices and their current uses. 

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How lasers work

Einstein first proposed in 1906 that light delivers its energy in discrete units called photons. He further proposed that photons, when stimulated, could stimulate identical photons from excited atoms.2 However, the practical application of his idea was not achieved until 1960 when the first laser was constructed by Theodore Maiman, using ruby as the medium.3 It thus took almost 50 years for Einstein’s theories to be proven in practice.

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Figures

© ALESSANDRO GRANDINI/ STOCK.ADOBE.COM
© ALESSANDRO GRANDINI/ STOCK.ADOBE.COM
Dr Joshua Farrell is a Research Fellow at Southern Suburbs Dermatology, Sydney. Dr Robert Rosen is a Dermatologist, Dermatologic Surgeon and Medical Director of Southern Suburbs Dermatology Sydney; and Senior Lecturer at UNSW, Sydney NSW. He is also a Lieutenant Colonel in the RAAMC.