Kombinasi laser dalam terapi

NMRL snd QSRL

Theoretically the concept of selective photothermolysis suggests that the submicrosecond

pulses of QSRL targeted individual cells, whereas the longer pulse duration of the NMRL
could potentially target whole nests of cells that were not reached with QSRL. Combination
treatment with both QSRL and NMRL resulted in greatest reductions of nevomelanocytes in
both the junctional and dermal components of the nevus. Treatment first with QSRL to
diminish superficial pigment followed by NMRL may enhance the penetration of NMRL. In
keeping with Duke et al., Kono et al. found greater efficacy when NMRL was combined with
QSRL than when NMRL was used alone in a split lesion study of 15 CMN. NMRL (pulse
duration 1 ms, fluence 20 J/cm2 , spot size 10 mm) followed by three- to four-pass QSRL
(pulse duration 30 ns, fluence 7 J/cm2 , spot size 4 mm) resulted in good to excellent clinical
response for 31 CMN.

Research failed to find benefit of combined NMRL (pulse duration 1.2 ms, fluences 25–40
J/cm2 ) and QSRL (pulse duration 20–40 ns, fluences 7.5–10.0 J/cm2 ) in the treatment of 14
Caucasian children with CMN

combining pulsed dye laser (PDL; pulse duration 450 ms, fluence 6.0–10.0 J/cm2 , spot size
7.0 mm) with QSRL (pulse duration 28 ns, fluence 6.0– 10.0 J/cm2 ) in the treatment of large
to giant CMN in six patients aged 4–26 months. All patients responded to the combination
treatment, with a mean of 7.7 treatments required to achieve skin lightening. All of the
children had an abnormal skin texture and two of the six had hypopigmentation following
treatment. The authors conclude that combination of PDL and QSRL may be effective for
large to giant CMN.

Nd:YAG laser and alexandrite laser

Nd:YAG (1064 nm) and alexandrite laser (755 nm) was used. The maximum depth of
destruction was 0.20 mm for Nd:YAG versus 0.40 mm for QSRL. A study conducted by Kim
and Kang in 2005 treated 53 patients with CMN with Q-switched alexandrite laser (QSAL) .
Sixteen of these patients also received treatment with CO2 laser. 72 % improvement was seen
among those treated with QSAL with greater efficacy seen with comination treatment.
Eighty-three percent of patients experienced repigmentation after an average of 5.45 months
because alexandrite laser are sugested to downregulate E-cadherin and TNF-alpha that may
induce proliferation of melanocytes thus lead to repigmentation.

CO2 and Er:YAG ablative lasers

CO2 laser (10,600 nm) and Er:YAG laser (2940 nm) are ablative lasers that have been
studied both alone and in combination with pigment-specific lasers for the treatment of CMN.
A retrospective review of 12 patients with CMN treated by CO2 laser with discouraging
results; 6 of these patients developed hypertrophic scarring.

Co2 and QSRL

However when combine with a non-ablative laser like QSRL. (80 %) showed good to
excellent cosmetic result. The authors suggest that combination therapy with an ablative laser
reduces the total number of treatments needed to attain cosmetic benefit. Combination
therapy with an ablative laser required an additional 2–4 days of healing time compared to
QSRL therapy alone, which typically healed in less than 1 week. CO2 laser ablation
combined with Nd:YAG, with overall satisfactory results in ten patients with minimal
scarring

Co2 and Er:YAG

Er:YAG laser ablation is an alternative to CO2 laser ablation. Er:YAG lasers are believed to
cause less thermal damage to surrounding tissues than CO2 laser and have theoretical
decreased risk of scarring and pigmentation changes. A study shows Eight of the ten patients
had no or minimal recurrence on follow-up ranging from 3 to 36 months, whereas the other
two had significant repigmentation within 3 months.

Er:YAG and LP alexandrite

The most recent study combined Er:YAG laser with long-pulsed alexandrite laser in the
treatment of 58 acquired melanocytic nevi and 7 small CMN in Korean patients [32]. One
CMN (14.3 %) recurred within the 6-month follow-up period.

Semua di atas dari: Fleta N, Vidhi shah dll. Laser treatment of congenital melanocytic nevi: a
review of the literature. Laser Med Sci. 2015.1(015)1830-33

The latest research on Giant CMN found out that All medium CMN showed good-to-
excellent pigment removal after 1.83 sessions of combined laser treatment. Giant CMN
showed good pigment removal after a single treatment. No severe textural changes,
hypertrophic scars, or depigmentation were observed. Moderate hypertrophic scarring was
revealed in one patient; mottled hypopigmentation was observed in one patient; and persistent
erythema was noted in two patients, which decreased with further LPDL treatment.
Repigmentation or malignant transformation was not observed during the follow-up period of
2-9 months.

Ini dari:
Kyung T. Jung M. dkk. A Treatment of Medium-to-Giant Congenital Melanocytic Nevi with
Combined Er:YAG Laser and Long-Pulsed Alexandrite Laser. Medical Lasers.2017:6(2);77-
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