Role of light therapies in practice

Q&A YOUR INSIGHTS ON HOT TOPICS

Q DR. WHEELAND: What do you think is the biggest advance that has occurred in the laser field over the past 15 years?

As you point out, Dr. Wheeland, both of these categories of treatment are capable of providing precise and selective treatment due to a concept developed in 1983 known as selective photothermolysis (SPT). SPT allows for high precision when the right amount of energy is delivered for the proper time, using the best wavelength of light that is absorbed by the targeted tissues, and fewer complications result.

Q DR. WHEELAND: When do you believe is the ideal age to treat children with port wine stains (PWS)?

A: DR. GOLDBERG: Really as early as possible. Anytime after birth. In newborns, the blood vessels of a port wine stain are smaller and closer to the skin surface. This makes them easier to reach with laser technology. Therefore, they respond better. Multiple treatments are generally required over several years.

Q DR. WHEELAND: The treatment of PWS in young children is now possible because of the use of pretreatment skin chilling, longer pulses of light and longer wavelengths. In the pre-argon laser days, treatment had to be delayed until after puberty so the appendages of the skin could develop from which new epithelial cells could grow and help heal the injured tissue. With these new advances, that is no longer required.

A: DR. GOLDBERG: Yes. Also, while there are essentially no contraindications in lighter complected individuals, darker skinned individuals are more difficult to treat.

Q DR. WHEELAND: The "Godfather" of lasers in medicine, Dr. Leon Goldman, who is now deceased, used to say, "If you don't need to use a laser, then don't use a laser." It seems prudent to change that quote today to, "If you don't know how to best use a laser, then don't use it!" What qualifications should a physician have to safely and effectively treat patients with lasers?