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The Use of Excimer Phototherapy in the treatment of various skin diseases

About the Author

Professor Thierry PASSERON is a dermatologist, academic professor and researcher who works for INSERM and based in CHU of Nice, south of France. Pr. PASSERON is a worldwide specialist in vitiligo and has been among the first users of excimer phototherapy. He ran several studies on vitiligo, psoriasis and alopecia areata using 308 nm lasers and lamps.

Abstract

Excimer phototherapy refers to dermatological treatments using the monochromatic light at 308nm. It has been introduced in the early 2000’s and is now used to treat a wide range of skin disorders such as vitiligo, psoriasis, and atopic dermatitis. This paper presents our use of excimer devices in our everyday practice at the Hospital of Nice.

Introduction

UV light is well known to have a benefic impact on many skin diseases. The mechanism of action is the reduction of T-Cell proliferation by cellular apoptosis. Among UV wavelengths, 308nm has been found to be the most effective wavelength to induce the apoptosis of lymphocytes.

The last two decades have seen significant technological advances, expanding the options for patient who needs phototherapy. Numerous clinical studies showed the efficacy of excimer in the treatment of various skin diseases including pigmentation disorders and/or inflammatory skin reaction.

Material

The dermatology department of the university hospital of Nice has a long experience with UVB light. Our first excimer device was a Xenon- Chloride laser (Talos from Wavelight Aesthetic). This technology is very efficient but is also very bulky and very costly. We then switched to a handheld excimer lamp (308 from Alma Lasers) with the same clinical efficiency than our laser. We now use a smaller and much more powerful excimer lamp (Exci308nm from Aerolase). This later device is as efficient as bigger excimer devices (lasers and lamps) but treatments are faster and the Exci308 is lighter, ergonomic and much more convenient to use.

Protocol and treatment

In our experience, whatever the indication is, the best results are achieved when the UV light exposure results in a light pink erythema that last no more than 24 hours. Our usual protocol consists in finding this exact excimer dose by increasing or decreasing the delivered dose sessions after sessions.

For vitiligo lesions, we usually perform the first treatment at the starting dose of 100mJ/cm2, whatever the skin phototype of the patient. This dose is safe and do not lead to any side effect. We then increase the dose by 50mJ/cm2 or 100mJ/cm2 at each session until we reach the expected endpoint. The delivered dose is then stabilized and the treatment is continued until patient satisfaction is achieved or no more improvement is visible.

To treat psoriatic patients, the same protocol is used but the starting dose depends on induration. We usually start with a dose equal to 3 minimal erythema dose (MED) and increase by 0.5 or 1 MED depending on the result of the previous session.

MED test might be useful in early stages of excimer therapy, but is no longer performed in our practice. Indeed, with practitioner experience, using skin phototype and location of the lesion to treat are enough to determine the required dose.

The side effects include erythema and transient perilesional hyperpigmentation. Higher doses sometimes lead to blisters with our laser on psoriasis lesions. We now gave up doing very aggressive protocols (10 MED).

When possible, treatment is performed twice a week. It has been shown that the efficiency of the treatment depends on the total number of sessions rather than on frequency. Twice a week appears to be the best compromise for fast improvements and low side effects.

Therapeutic indications

Vitiligo is probably the best indication for excimer phototherapy devices. The localized exposure associated with the best wavelength gives excellent results. We showed in a previous study that the excimer laser and excimer light are equivalent in terms of efficacy and safety and are better than Nb-UVB. Nevertheless, improvement highly depends on the treated area. Most of the time, a complete regimentation is observed on the face when Exci308 is used in combination with Tacrolimus 0.1% or Pimecrolimus 1% twice a day. Good results are also observed on neck or trunk. Fingers and toes respond less to treatment, including excimer light. During the treatment, it is important to expose the edges of the white patches to stimulate the migration of the surrounding melanocytes.

In our practice, Exci308 phototherapy is used in combination with topical treatment for localized vitiligos.

Vitiligo: before and after Exci308 treatment

Psoriasis is a well-recognized indication for excimer devices. Many studies have been published and show excellent improvement in PASI score. In our practice at the university hospital, we use excimer phototherapy only as second line treatment for psoriasis. It is often very efficient to cure hard-to-treat remaining lesions. For these difficult cases, it is helpful to diminish the flakes with a salicylic acid based cream and to perform the treatment in association with topical steroids.

The delivered excimer dose for psoriasis is much higher compared to other indications. It can reach 6 to 7 times the MED. For this level of treatment intensity, it is very preferable to use a powerful device with a large spot size but surrounding healthy tissues must be perfectly protected!

In the dermatology department, we also use the Exci308 for Leukoderma (post-surgical, post- CO2 laser, post-cortisone injection, etc.) with encouraging results that need to be maintained with spaced complementary sessions. We also got an excellent response on Lichen amyloidosis for which dermatologists rarely have a treatment to offer.

Conclusion

Exci308 phototherapy is very useful in our everyday practice. It is not only a well-demonstrated effective and safe treatment for vitiligo and to a lesser extent for psoriasis. Most of the time, it can be combined with other therapies to optimize the clinical results.

Exci308 phototherapy has zero running cost and can be performed by doctors or nurses in a very short time. It is therefore an important equipment for phototherapy dermatologists of our department.

Interested in the Exci308®?

Table of Contents

Laser Optical Engineer

Aerolase is the fastest growing medical laser company, serving the high growth dermatology and aesthetic laser market. Nestled in the picturesque Hudson Valley in Tarrytown, NY, the location is also ideal for access to NY City and other areas of the Northeast and Mid-Atlantic U.S. We are hiring in many areas and currently seek laser optical engineers with a passion for creating new things. The company offers a friendly, team-oriented work environment and competitive compensation including salary, bonus, stock options, 401k, and health/dental/life insurance plans.

About the Team:

  • We are a diverse team of friendly, creative hard-working people with a passion for achieving our objectives
  • We are creative, hands-on and innovative with a strong orientation toward high customer satisfaction
  • We have created a very team-spirited company culture and believe it is important to have open and effective cross-functional collaboration and communications – and enjoy our work!

About the Role:

We’re looking for an enthusiastic, creative and detail-oriented problem solver to help support the production, service and repair of our unique solid-state laser devices.

Must have expertise working with assembly and/or development of small, sensitive, high precision instruments, preferably solid-state laser technology, with a high caliber technology company.  We prefer design and hands-on experience in multiple laser technologies including solid state lasers, semiconductor lasers, non-linear optical materials and devices, optical benches, and beam directors. Experience with the technical aspects of developing laser and laser-based products is strongly preferred.

Candidates should have proven ability to address complex challenges with ingenuity and innovation, and capability to work independently to manage multiple simultaneous tasks, and see all tasks to completion. Also should have the ability to work well in a collaborative multidisciplinary team environment, define and analyze system performance specifications, and ensure adherence to those specifications in the application environment.

  • Perform sensitive manual optical assembly of lasers.
  • Test, troubleshoot repair and assemble lasers, subassemblies and various components, including high-voltage laser power supplies and other electronics.
  • Support the development and implementation of test fixtures, equipment, procedures and documentation for the engineering and operations functions.
  • Support product design and development activities related to new products and product improvements.
  • Support development and maintenance of quality and regulatory documents and procedures.
  • Provide customer technical support as needed including product service, maintenance, and troubleshooting.
  • With suppliers, act as a technical and operational liaison as needed.
  • Maintain thorough, complete and accurate written records; comply fully with the company’s quality system and any regulatory requirements.
  • Follow safety rules for working with high-voltages and high-power lasers.
  • Perform other duties as completion of responsibilities necessitates or as assigned by supervisor.
  1. Minimum 5 years of experience in an engineering role involving sensitive high precision instruments, preferably involving solid state lasers.
  2. Theoretical and practical knowledge and skills of adequate policies and procedures for the control of laser hazards and high voltage hazards, using relevant protective equipment, ensuring adequate safety education and training of other personnel.
  3. Understanding of system and component design, testing and troubleshooting.
  4. Enjoy working with your hands/mechanical ability.
  5. Strong analytical and problem solving skills.
  6. Proven technical and project management skills.
  7. Experience with manufacturing within a Quality Management System (especially medical).
  8. Strong interpersonal and communication skills.
  9. Self-motivated, detail oriented and well organized. Ability to make decisions and work independently Strong work ethic and desire to help the company successful by producing a reliable product.
  10. Not afraid to ask questions and make suggestions for improvement.
  11. Be able to work under pressure due to customer demands.
  12. Strong computer skills (Windows™ software).
  13. Ability to successfully manage multiple projects and daily responsibilities. Ability to discern and appropriately communicate sensitive issues.
  14. Ability to walk, stand, bend, reach, stoop/squat, and crouch. Ability to carry heavy items.
  15. Will require working indoors and outdoors – work environment includes the office, the production areas, mechanical rooms, and customer and supplier facilities. Also includes regular contact with high-voltage equipment and laser light emissions.

BS. in Physics, Mechanical or Optical Engineering, Master’s Degree preferred

  • We are a diverse team of friendly, creative hard-working people with a passion for achieving our objectives
  • We are creative, hands-on and innovative with a strong orientation toward high customer satisfaction 
  • We have created a very team-spirited company culture and believe it is important to have open and effective cross-functional collaboration and communications – and enjoy our work!

We’re looking for an enthusiastic, creative and detail-oriented problem solver to help support the production, service and repair of our unique solid-state laser devices.

Must have expertise working with assembly and/or development of small, sensitive, high precision instruments, preferably solid-state laser technology, with a high caliber technology company.  We prefer design and hands-on experience in multiple laser technologies including solid state lasers, semiconductor lasers, non-linear optical materials and devices, optical benches, and beam directors. Experience with the technical aspects of developing laser and laser-based products is strongly preferred.  

Candidates should have proven ability to address complex challenges with ingenuity and innovation, and capability to work independently to manage multiple simultaneous tasks, and see all tasks to completion. Also should have the ability to work well in a collaborative multidisciplinary team environment, define and analyze system performance specifications, and ensure adherence to those specifications in the application environment.

  • Perform sensitive manual optical assembly of lasers.
  • Test, troubleshoot repair and assemble lasers, subassemblies and various components, including high-voltage laser power supplies and other electronics.
  • Support the development and implementation of test fixtures, equipment, procedures and documentation for the engineering and operations functions.
  • Support product design and development activities related to new products and product improvements.
  • Support development and maintenance of quality and regulatory documents and procedures.
  • Provide customer technical support as needed including product service, maintenance, and troubleshooting.
  • With suppliers, act as a technical and operational liaison as needed.
  • Maintain thorough, complete and accurate written records; comply fully with the company’s quality system and any regulatory requirements.
  • Follow safety rules for working with high-voltages and high-power lasers.
  • Perform other duties as completion of responsibilities necessitates or as assigned by supervisor.
  1. Minimum 5 years of experience in an engineering role involving sensitive high precision instruments, preferably involving solid state lasers.
  2. Theoretical and practical knowledge and skills of adequate policies and procedures for the control of laser hazards and high voltage hazards, using relevant protective equipment, ensuring adequate safety education and training of other personnel.
  3. Understanding of system and component design, testing and troubleshooting.
  4. Enjoy working with your hands/mechanical ability.
  5. Strong analytical and problem solving skills.
  6. Proven technical and project management skills.
  7. Experience with manufacturing within a Quality Management System (especially medical).
  8. Strong interpersonal and communication skills.
  9. Self-motivated, detail oriented and well organized. Ability to make decisions and work independently Strong work ethic and desire to help the company successful by producing a reliable product.
  10. Not afraid to ask questions and make suggestions for improvement.
  11. Be able to work under pressure due to customer demands.
  12. Strong computer skills (Windows™ software).
  13. Ability to successfully manage multiple projects and daily responsibilities. Ability to discern and appropriately communicate sensitive issues.
  14. Ability to walk, stand, bend, reach, stoop/squat, and crouch. Ability to carry heavy items.
  15. Will require working indoors and outdoors – work environment includes the office, the production areas, mechanical rooms, and customer and supplier facilities. Also includes regular contact with high-voltage equipment and laser light emissions.

BS. in Physics, Mechanical or Optical Engineering, Master’s Degree preferred

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Staff Accountant / Junior Accountant

Aerolase Corporation, a leading aesthetic laser innovator, seeks a Staff Accountant / Junior Accountant. Having made the Inc. 5000 list as one of the world’s fastest growing private companies as well as annual best-in-class product awards, Aerolase has transformed the market with products that provide uniquely tolerable treatments to the patients and exceptionally high ROI for the practitioners. The company offers competitive and an exciting high-growth company culture.

Duties:

• Provide support to the Controller and the management team
• Maintain day-to-day financial accounting functions, including A/P, A/R, expense tracking
• Support the month-end close process, ensuring accurate and timely monthly, quarterly, and year-end financial statements.
• Uploading annual budget and tracking actual to budget variances
• Use of financial reporting software
• Support external auditors and other required outside reporting requirements
• Participation in quarterly inventory reconciliations
• Assist team with projects such as policy creation, system implementation, client support etc.

• Some experience with and strong understanding of the monthly close process and technical accounting
• Detailed oriented, with ability to see the big picture
• Self-starter who can work independently and employ time management skills to meet deadlines.
• Knowledge of MS Excel (V-lookup, formulas, pivot tables).
• Strong interpersonal and communication skills
• Sound judgment and problem-solving skills

• Bachelor’s or master’s degree in Accounting a MUST, good understanding of GAAP
• 1-3 years’ experience in an accounting function (including internship)
• General Ledger/Operational Accounting experience
• Knowledge of Quickbooks or other reporting software a plus (more the better)
• Industry experience a plus

Senior Accountant

Aerolase Corporation, a leading aesthetic laser innovator, seeks a Senior Accountant. Having made the Inc. 5000 list as one of the world’s fastest growing private companies as well as annual best-in-class product awards, Aerolase has transformed the market with products that provide uniquely tolerable treatments to the patients and exceptionally high ROI for the practitioners. The company offers competitive and an exciting high-growth company culture.

Duties:

• Provide support to the Controller and the management team
• Own day-to-day financial accounting functions, including A/P, A/R, expense tracking
• Assist in establishing and maintaining policies & procedures in accordance with GAAP and Aerolase policy
• Key contributor to the month-end close process, ensuring accurate and timely monthly, quarterly, and year-end financial statements.
• Assist in the preparation of management reports – (cash management, various projections, month end reporting package)
• Involvement with the annual budget process
• Use of financial reporting software
• Support external auditors and other required outside reporting requirements
• Prepare and submit payroll
• Participation in quarterly inventory reconciliation to the perpetual
• Ad hoc projects

• Strong knowledge of the monthly close process and technical accounting

• Detailed oriented, with ability to see the big picture

• Experience in continuous improvement and accounting best practices

• Self-starter who can work independently and employ time management skills to meet deadlines.

• System savvy – ability to learn new financial software

• Intermediate knowledge of MS Excel (V-lookup, formulas, pivot tables).

• Global consolidations experience a plus

• Strong interpersonal and communication skills

• Sound judgment and problem-solving skills

• Bachelor’s or master’s degree in Accounting a MUST, good understanding of GAAP

• 3+ years’ experience working as a staff/senior accountant

• General Ledger/Operational Accounting experience a must

• Extensive knowledge of Quickbooks and other reporting software

• Prior involvement with system implementation

• Prior public accounting experience (any size firm) a plus

• Industry experience a plus

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