Dr. Godfrey Raj-Kumar, OB/GYN, Trinidad & Tobago
A female patient of Skin Type IV was offered a non-paying first visit at which a detailed explanation of the proposed treatment was given. Facial mirrors were used to identify the active lesions or comedones and the pitted scars resulting from chronic untreated lesions. At her second visit she voluntarily completed the informed consent form for usage of the Nd:YAG 1064 laser procedure. Her face was cleaned by swabbing with ethyl alcohol. The patient was cautioned of the very localized and potential brief stinging effect upon application of the light to the acute lesion by way of a single pass and a triple pass over the chronic pitted lesions. She was offered the local application of 5% EMLA, a local anesthetic cream and/or the need for a spray of Ethyl Chloride to each lesion. The latter is optional depending on the patient’s pain threshold and only applied immediately before the passage of the pulse to the individual lesion as accessed by the patient’s response upon treatment of the first few lesions.
The acute acne lesions were treated by setting the laser to a fluence of 159 J/cm2 on a spot size of 2 mm, a pulse width of 0.6ms and a single pass over each lesion. The chronic lesions were treated with a fluence of 21 J/cm2 on a 6mm spot, pulse width of 0.6ms and 3 passes over each lesion.
The active acne lesions were only treated at her first treatment visit and the patient then had her oral contraceptive usage of Yasmin or Yaz changed to Diane 35. In light of the finding of seborrheic dermatitis she was asked to use Auroplus (4% ketokonazole) concomittantly as a shampoo once per week and as a very dilute facial wash at night leaving same on overnight. She continued the use of these, unabated.
She had only one treatment of the acute lesions at her first treatment visit and the chronic lesions were treated at four week intervals thereafter. She has had three treatments of the chronic lesions to date and is satisfied that no more might be required, as of eight weeks since her last treatment.