Journal of Cutaneous and Aesthetic Surgery
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EDITORIAL COMMENTARY Table of Contents   
Year : 2009  |  Volume : 2  |  Issue : 2  |  Page : 91
Editorial commentary


Consultant Dermatologist, Skin and Laser Clinic, Hyderabad, Andhra Pradesh, India

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Date of Web Publication24-Dec-2009
 

How to cite this article:
Aurangabadkar S. Editorial commentary. J Cutan Aesthet Surg 2009;2:91

How to cite this URL:
Aurangabadkar S. Editorial commentary. J Cutan Aesthet Surg [serial online] 2009 [cited 2019 Jun 18];2:91. Available from: http://www.jcasonline.com/text.asp?2009/2/2/91/58522


The authors have carried out an interesting study that is of relevance to the Indian population. Documented studies on the subject are few, therefore, the authors need to be complimented for their effort.

However, the study has certain limitations, which need to be considered while drawing conclusions:

  1. Majority of the patients in the study had compound nevi. Radiofrequency or surgical modalities are better alternatives than QS lasers for these lesions.
  2. Junctional nevi respond better to QS lasers; however, only six patients had junctional nevi in the study. Although both 1064 nm Q-switched Nd: YAG and frequency-doubled 532 nm Nd: YAG lasers can be used to treat junctional nevi, the 532 nm FD Nd: YAG laser gives better results in these superficial lesions, with a slightly increased risk of pigmentary alterations. The 1064 nm wavelength laser can also be used in the treatment of junctional nevi in darker patients as they are safer. However, the 1064 nm wavelength laser is less effective, necessitating multiple treatments as lesions may get only partially cleared or lightened. In this study, the authors have preferred the 1064 nm laser, but have used a higher-than-usual dose of 10 Hz, perhaps to obtain better results to compensate for its lack of efficacy. Such higher doses need to be used carefully as they may lead to stacking of pulses with excessive thermal build-up, leading to scarring. This is particularly so as junctional nevi are small lesions and a frequency of 2-3 Hertz (Hz) gives better control when treating with a QS laser. Readers are recommended to read a masterly review of this subject by Goldberg. [1]
  3. Adverse effects have not been mentioned in the study. It is common to see some pigmentary alterations such as post-inflammatory hyperpigmentation or hypopigmentation after QS laser therapy in darker individuals. This is relevant because the study was on skin types 5 and 6 and also, because of the higher fluences used. The period of follow-up was not mentioned in the study, which is an important factor because recurrences are seen, particularly when the 1064 nm wavelength laser is used.
  4. Generally QS lasers do not need aggressive cooling during treatment. However, the authors have used liquid nitrogen cryospray for cooling of the treated area during lasing, again perhaps because of the higher fluences used. It has been documented that cryoinjury may itself lead to post-inflammatory hyperpigmentation and hypopigmentation. Although liquid nitrogen may have been used for economic reasons, it is preferable to use air cooling in the form of 'Zimmer'.
  5. Congenital melanocytic nevi (CMN) have been treated in the study. The following relevant statement from IADVL taskforce guidelines may be quoted here:


CMN are generally dark and bulky and usually require either excision or excision and skin grafting. Response to laser treatment is unpredictable and lesions may clear only partially. Long-term follow-up is needed as the lesions may recur. [2]

 
   References Top

1.Pigmented lesions, tattoos, and disorders of hypopigmentation. In: Goldberg DJ, editor. Laser dermatology pearls and problems. 1 st ed. Massachusetts: Blackwell Publishing; 2008. p. 71-114.  Back to cited text no. 1      
2.Aurangabadkar S, Mysore V. Standard guidelines of care: Lasers for tattoos and pigmented lesions. Indian J Dermatol Venereol Leprol 2009;75:111-26.  Back to cited text no. 2    Medknow Journal  

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Correspondence Address:
Sanjeev Aurangabadkar
Skin and Laser Clinic, 1st Floor, Brij Tarang, Green Lands, Begumpet, Hyderabad 500 016, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


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