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At-home laser, light devices won't replace dermatologic expertise, clinician says

Dr. Schlessinger
Omaha, Neb. — The public seems to have a growing fascination with at-home hand-held laser and light devices, as dermatologists try to figure out how and if these products fit into practice, says Joel Schlessinger, M.D.

Dr. Schlessinger, a dermatologist in Omaha, Neb., and director of the Cosmetic Surgery Forum conference, spoke on the topic of hand-held devices at the 2011 Forum in Las Vegas. While available at-home options for hair removal and skin rejuvenation encroach in dermatologists' fee-for-service offerings, he says, the devices are not strong enough to replace what dermatologists do.

"I think that the hand-held devices are training wheels for people looking to get into these types of treatments. Despite the initial concerns that they would be competitors, I think they are going to be a first step on people's roads to having a more intense cosmetic experience with the dermatologist," Dr. Schlessinger says.

What's out there

There are several hair-removal devices on the market, according to Dr. Schlessinger. Among the more popular are no!no! (Radiancy), a thermal filament device, and Silk'n SensEpil (Home Skinovations), which uses pulsed light.

"The thermal filament device ends up burning or singeing the hair. And that's not actually even a laser device, but many people mistakenly believe it is based on the company's promotions," Dr. Schlessinger says.

While users can treat a small body area, to use today's hair-removal devices on a large area, such as the leg, would be time-prohibitive, he says.

A hand-held device, the PaloVia Skin Renewing Laser (Palomar Medical) shows more promise in the area of wrinkle reduction, according to Dr. Schlessinger. The device delivers low-level laser energy to the periocular area.

"PaloVia has a benefit from the standpoint that it is a true diode laser, with the ability for some of that laser energy to actually reach into the skin and penetrate," he says.

Images provided by manufacturer Palomar show a patient before (top) and after four weeks of daily treatments plus four weeks of twice-weekly maintenance treatments of the periocular area with the PaloVia Skin Renewing Laser. (Photos: Palomar Medical)
Cleared by the Food and Drug Administration, PaloVia is an at-home laser proven to reduce fine lines and wrinkles around the eyes. PaloVia delivers 250 microns coagulation and 15 mJ. It also has an elaborate safety system, Dr. Schlessinger says, which keeps it from damaging the eye.

Combining home-care regimens with office laser procedures helps dermatologists achieve better results when targeting almost any skin problem, says Ranella Hirsch, M.D., clinical assistant professor of dermatology, Boston University School of Medicine. Not only do patients benefit from the laser treatment, the home-care regimen can offer an "extra oomph," Dr. Hirsch says.

Because melanoma in children occurs very rarely, dermatologists should prioritize only those types of melanocytic nevi that can pose problems: Spitzoid nevi and large congenital melanocytic nevi (CMN), according to Elvira Moscarella, M.D.

Modern diagnostic skin evaluation tools such as dermoscopy and mole mapping with total body photography (TBP) have proven very useful in the diagnosis of suspicious cutaneous lesions and early recognition of malignant melanoma (MM). The combination of these two technologies can result in even more accurate assessment of the lesions viewed, according to Joseph Malvehy, M.D., coordinator, Melanoma Unit, department of dermatology, Hospital Clinic IDIBAPS, Barcelona, Spain, at the 2011 International Melanoma Congress.

The combination of a topical corticosteroid with a physiologic lipid-containing product is an effective approach for the management of atopic dermatitis and other steroid-responsive dermatoses because it simultaneously addresses disease-related inflammation and the barrier impairment that can be worsened by a topical corticosteroid alone, according to Matthew J. Zirwas, M.D.

Dermatologists are best positioned to accurately diagnose cellulitis, a common misdiagnosis for look-alike conditions ranging from stasis dermatitis to cutaneous cancers, according to Daniela Kroshinsky, M.D.