Successful Treatment of Refractory Atopic Dermatitis With the Use of High-Peak Power 1064 nm Nd:YAG Laser Therapy

Abstract

Atopic dermatitis is a chronic inflammatory skin disease involving the complex association of genetic, immunologic, and environmental causes. Until recently, the treatment of eczematous processes was limited to the use of topical corticosteroids, systemic immunosuppressants, and controlling environmental triggers. Photobiotherapy offers a promising approach to the management of atopic dermatitis. Photobiotherapy is the clinical application of light for healing superficial wounds. We present 2 cases of patients with biopsy-proven, long-standing, poorly controlled atopic dermatitis successfully treated with a high-peak power 1064-nm neodynium:yttrium aluminum garnet (Nd:YAG) laser. Over the course of 9 years, each patient continued to undergo periodic laser treatments to maintain control over their disease. Both patients underwent a series of laser using high-peak power treatments with long-pulsed 1064-nm Nd:YAG laser (Cool Glide, Cutera, Brisbane, California) in “photorejuvenation/Genesis mode” over the course of 9 years. Case 1 received 29 treatments over a 9-year period. When financially able to, the patient had 1 treatment a month for 2 to 6 treatments a year. At the very least, she had a treatment during her worst flares. Case 2 received 19 treatments over 9 years with the timing being monthly when possible but with longer intervals between treatments if her disease was not flaring. One patient that was on systemic immunotherapy to control her atopic dermatitis was able to successfully come off this medication early in her treatment, and both patients experienced long-lasting improvement in their symptoms. The dramatic improvement in the skin eruption, symptoms, and quality of life in these patients further supports addition of the 300-µs 1064-nm Nd:YAG laser for the treatment of refractory atopic dermatitis. The authors are using this modality for less severe eczema that is refractory to topical therapies. However, a greater number of patients are needed as well as larger studies to further elucidate the mechanisms of lasers for eczematous processes. If further studies support this modality, it would be a safe alternative to systemic immunotherapies.