Are Q-Switched Lasers the Gold Standard for Treating Skin and Subcutaneous Lesions?

🔍 Key Finding Q-switched lasers are effective and safe for treating various skin and subcutaneous lesions, including onychomycosis, melasma, tattoos, telangiectasias, and photoaging, with the 1064 nm wavelength often preferred and combination therapies showing promise. While generally safe, potential adverse effects like hyper- or hypopigmentation, thermal damage, and allergic reactions necessitate careful parameter selection and patient monitoring.

🔬 Methodology Overview

• Design: Review of published literature.
• Data Sources: Not explicitly stated, but references cite a variety of sources including clinical studies, case reports, and review articles.
• Selection Criteria: Focus on the application and effectiveness of Q-switched lasers in treating dermal and vascular lesions. Specific conditions covered include onychomycosis, melasma, tattoos, telangiectasias, and photoaging.
• Analysis Approach: Qualitative synthesis of findings from the selected studies. Comparison of Q-switched and picosecond lasers.
• Scope: Evaluation of the success rate, safety profile, and comparison to other therapeutic options for Q-switched laser treatments.

📊 Results

• Onychomycosis: Q-switched lasers (870nm, 930nm, 1064nm) are effective as adjunctive therapy. One study with 120 patients using a 1064nm laser at 600 mJ/cm² showed complete clinical and mycological responses after a single session. Another study with 131 patients using a 1064nm/532nm laser at 14 mJ/cm² achieved a 95.4% cure rate after two sessions.
• Melasma: Q-switched 1064nm lasers are effective. One study with 50 patients using 2.8 J/cm² showed 50-74% pigment reduction. Another with 40 patients using 1.2-2.0 J/cm² showed a 54.23% decrease in mMASI scores. Combining Q-switched lasers with tranexamic acid showed significant mMASI score reductions (e.g., 5.12 ± 2.66 to 2.33 ± 1.33 in one study).
• Tattoos: Q-switched lasers (ruby, alexandrite, Nd:YAG) are the “gold standard” for removal. A study with 20 patients using a 1064nm laser at 5.0 J/cm² achieved complete tattoo dye removal in all patients after six sessions. Another study with 7 patients using a 532nm laser at 1.4-6.4 J/cm² showed successful removal of red tattoos.
• Telangiectasias: Q-switched lasers are effective. A study with 54 patients using a 1064nm/532nm laser at 4.0-12.0 J/cm² showed excellent improvement in 91% of patients. Another study showed higher efficacy with 3.0-4.0 J/cm² compared to 1.0-2.0 J/cm² using a 532nm laser.
• Photoaging: Q-switched 1064nm lasers are effective. A study with 10 women using 6.0-13.0 J/cm² showed at least a one-point improvement in the Glogau scale in 60% of patients.
• Adverse Effects: Q-switched lasers are generally safe, but potential adverse effects include hyperpigmentation, hypopigmentation, blisters, burns, and allergic reactions.

💡 Clinical Impact Q-switched lasers offer a safe and effective treatment for various skin and subcutaneous lesions, including onychomycosis, melasma, tattoos, telangiectasias, and photoaging, potentially expanding treatment options in dermatological practice. The ability to adjust laser parameters allows for precise treatment, minimizing adverse effects and improving patient outcomes compared to some traditional therapies.

🤔 Limitations

• Relapses and skin hypopigmentation or hyperpigmentation may appear after Q-switched laser radiation.
• Adverse effects of Q-switched lasers include dry skin and itching.
• Q-switched lasers are not widely used.
• Blisters and burns may occur after Q-switched Nd:YAG laser application.
• Allergic reactions can occur during tattoo removal with a Q-switched laser.
• Thermal damage can be caused by laser therapy.

✨ What It Means For You Q-switched lasers offer a safe and effective treatment option for various dermatological conditions, including onychomycosis, melasma, tattoos, telangiectasias, and photoaging, allowing doctors to tailor treatment parameters for optimal results. While generally safe, doctors should be aware of potential adverse effects like hyper/hypopigmentation and thermal damage, and consider combination therapies for enhanced efficacy in some cases.

Reference Hałasiński P, Lubarska M, Lubarski K, Jałowska M. Lasers’ Q-switched treatment in skin and subcutaneous lesions - review. Adv Dermatol Allergol. 2023;XL(2):181-186. https://doi.org/10.5114/ada.2023.127636