SAN DIEGO The best laser for treatment of follicular disorders in individuals who have very dark skin is the neodymium:YAG laser, E. Victor Ross, M.D., reported at the annual conference of the National Medical Association.
Based on the optical properties of light in skin, the longer-wavelength lasers achieve an optimal combination of hair reduction and epidermal sparing, he said.
Dr. Ross presented the case of a 26-year-old African American man with Fitzpatrick skin type IV who had longstanding folliculitis decalvans.
The patient had received multiple therapies for 6 years, including courses of multiple antibiotics. He was initially treated with dicloxacillin. In addition, antimicrobial shampoos were used. According to Dr. Ross, the patient also underwent two 6-month trials of isotretinoin in 1997 and 1999, which produced some improvement in the disease. The condition reappeared after isotretinoin was discontinued.
The patient received one session of radiation therapy with an epilating dose of 450 cGy in 2001, said Dr. Ross, chief of the laser surgery department of dermatology at the Naval Medical Center, San Diego.
Then Dr. Ross and members of his clinic tested the patient with the 1,064-nm Nd:YAG laser on the affected area of the scalp. At follow-up sessions, the patient was premedicated before each procedure with 5 mg diazepam and 5 mg/500 mg hydrocodone/acetaminophen in conjunction with the topical anesthetic cream. The Nd:YAG laser was used with settings of 28 J/cm2, 3-ms pulse duration, a 12-minute spot, and dynamic cryogen spray cooling set at a 50-ms spray, a 20-ms delay.
Dr. Ross reported after eight treatments at 4- to 6-week intervals, the patient's scalp improved significantly, and he remained disease-free 6 months later.