This is really good to hear .I hav seen dat two papers .I wld like know more abt the places wer this treatment is available.As i stay in India , i think Q-switched Nd:YAG (neodymium) laser mite not be available here.Plssss inform me abt dis.
If someone have tried this treatment and found it works
please let us know…
I have an appointment for March 14th with a doctor that uses a Erbium laser. I have NO clue if he will perform the treatments with the Erbium as every place I have contacted will not tell me anything with out first seeing me. The problem is that it takes 1-3months min. to get in most places.
The laser is called the “Coherent Ultrafine” which I have not yet been able to find specs for. I’m worried that this laser could possibly be inferior to the derma-k. Although from the little information I have dug up, it seems to be a quality laser. Anyone else that has any knowledge of lasers, I would love to hear your input on this laser.
I’m going to call around a bit more and see if I can find a derma-k, but no luck as of yet. After talking to many offices, I get the feeling that it may be hard to find treatment for this. The offices that are more open into answering questions do not have an Erbium. It seems as if every office that has an Erbium won’t tell me much of anything. I sent the study to a couple offices hoping to find a doctor that’s remotely interested. Unfortunately no doctors will take a min. to look at it and to tell me if its even a remote possibility. Personally I haven’t had many experiences with open-minded doctors either.
It has me a bit frustrated as it would probably take a doctor 2min. to know if he would be interested in just “maybe” doing treatment with the Erbium. As I think most will blow it off and tell me 1.) why it wont work 2.) why some other laser is better and will only take a million treatments at 1g a piece, lol…
The good news is that I now have money for the treatment, however finding treatment might be a problem, if I can’t find a doctor that will do treatment in 2-3 months I will probably settle for a tattoo. Also I’m located in northwestern Indiana, if anyone as any information on a place nearby that has an erbium and will possibly do treatments just let me know.
Oh and if you read this canboy, remember how you were joking about doing the treatments yourself. After talking with a couple of nurses, trying to get some information on lasers, (mind you these are nurses that USE these lasers, not just receptionists or something) I guarantee you would be much more qualified. I was pretty astonished on how little they knew. I’m guessing the doctor tells them what parameters to use, or maybe they have a chart and its fire-away! Wouldn’t be hard for them to mess up things like forgetting the overlap; so I really hope a doctor doesn’t leave this up to a nurse to treat…
Well good luck everyone…
hey, when are you done residency?
Youman,
Sorry to hear about your experiences so far. To tell you the truth, I’ve had similar ones here - I tried contacting a few places and it’s surprising how little anyone knows even about the type of laser used at a given clinic. I’ve specifically asked for Erbium and have gotten replies of "Yes, he have the Nd:YAG laser’ lol. It really seems as if I’ll have to fork over the money to actually get a consultation first, even if it won’t be a place I’ll end up choosing. You’re right about doctor’s not wanting to read a paper for 2 minutes - they’re all the same. While it’s very frustrating, I see their point - if every patient brought a paper in with them (and believe me, even from rotations I’ve done in other fields, many patients do bring papers in) physicians would be spending all their time doing reading instead of doing treatments. It’s a drag, but I don’t see this as changing in the future.
Anyway, I’m doing a rotation back home in Toronto in September, when I’ll have more time to ‘shop around’, so I might have to wait until then to actually have time to book multiple appointments unfortunately.
Now, back to the laser - I’ve done a bit more research into the derma-k. Apparently, it’s a combination Erbium AND CO2 laser, capable of working either in Erbium mode or combined mode. Erbium mode is for treating the epidermis while the combined mode will treat part of the dermis as well (although in the study Erbium ablated superficial dermis too?). The study didn’t mention the use of the combined mode specifically, and it probably didn’t b/c it talks about erbium only the whole time, but it’s important to keep this in mind.
Anyway, the laser was manufactured by ESC Medical Systems of Israel. I say was, b/c I have a feeling it’s not made any more. ESC has merged several times (ESC/Sharplan then Coherent) and is now known as Lumenis. I looked, and don’t see any erbiums in their line of lasers. It looks like they’re focusing more on CO2 lasers now. They claim their new ActiveFX system - a fractionated CO2 is ‘better’ than Erbium (hmm, I donno about this). The only laser I found that they make which is like the derma-K is the OpusDuo, but this is for dentists to cut teeth haha. I’m guessing this is some type of modification of the original Derma-K. I suppose you could go to a dentist and get them to use a lower power setting 
As for your UltraFine laser - I think it was manufactured by coherent (which is now part of Lumenis also). All the information I’ve gotten so far is that the laser is a 2000MJ / 500 Microsecond pulse which includes a scanner (???) and multi-spot size hand piece with 2, 3, 4 and 6 mm settings. Make sure he doesn’t have the Coherent ultraPULSE (that’s a CO2 laser!).
Anyway, the options are either find somewhere with a Derma-K (it’s a relatively older machine from the late 90’s) or another Erbium might have to do unfortunately. I’ve started reading up about CO2 lasers now as well - From what I’m understanding I don’t think these will be a great option, but I will look into the more recent ‘fractionated’ technology and will give you my opinion on this after I’ve read up more about this. Stay tuned.
Now, regarding what you said about the nurses - I can believe that too. I really know very little about laser therapy, but having a vested interest in treatment I’ve probably read up more about it than any of these nurses ever had. While I’m sure I could ‘sneak’ a few pulses with a laser if I did a rotation with a dermatologist that used one, I would likely get into some big trouble if caught. I know this sounds a bit crazy, but I actually looked into BUYING an Erbium. With a bit of searching I actually found a used DERMAK for $4000! (well plus shipping and customs for the huge thing) This is actually a steal, and I’d consider getting it (It’s probably not much more than actual treatment) but there is another snag - it’s illegal to sell these devices to non-physicians in the US. I think it’s a bit different here in Canada. Now, I’ll be a licensed physician (albeit a resident) in July of 2009, but I doubt the laser will still be available for sale in a year. The other used ones I’ve seen are in the 10-20k+ range.
I also started thinking about potentially doing laser work (only part time) if I decide to open my own practice rather than work at a hospital. Price ranges for lasers seem to be in the 30-60k range, which I suppose will pay for itself if it’s also used for other cosmetic procedures. Obviously, this is kind of jumping the gun here, since we don’t know whether an Erbium (or perhaps CO2) would even work well, but what I’m saying here is if it does work, I’d be willing to devote some of my time in attempting treatment using this type of laser. As far as I know, there are no physicians out there with an exclusive interest in Becker’s Nevi. Sure, many dermatologists or family physicians know about it, but none have it as a specific ‘niche’ interest as far as I’ve found. I’m not sure how much I can actually help but, again, since I’m affected as well, obviously I’m committed to doing what I can. If I DO do laser down the road, I’d have no problem reading papers or trying whatever setting you’d like on a laser… I’m not sure if you want to wait until I’m done residency though, but keep this in mind.
Ok, enough ranting for now. I’ll write some more on my opinions of the CO2 soon. Cheers.
Oh lol… if I do family medicine (GP) then I’ll be done in 2011, so only 3 more years. If I decide to specialize - 2014 Seems so far away :s
OK - some more interesting news (and youman, if you’re reading this, please see my previous post from last week too, I hope you see these before your consultation)…
I’ve found another paper. This is a very current one, from this past year.
Basically, the author has used an Erbium FRACTIONAL laser, which is relatively new (in this particular paper a Fraxel laser is used). This is, potentially, quite different from the ‘normal’ Er:YAGs mentioned previously.
Here it is: http://home.primus.ca/~skrausz/beckers3.pdf
(will only stay up for a few days)
Basically, a fractional laser splits the beam into thousands of microscopic ‘mini beams’. In an Erbium fractional, like the Fraxel described in the paper, each minibeam ablates both the dermis and epidermis as expected. HOWEVER, there is space between the individual beams, so normal tissue is retained, and this allows for much faster healing.
This presents several advantages, but several disadvantages as well as far as I understand. Healing time is greatly reduced with a fractional laser, because the normal tissue surrounding each microbeam grows in to heal the burned tissue. Potential complications such as scarring, hypopigmentation etc, which may be very real issues with a regular Erbium, ‘might’ be eliminated. The cons are that several treatments are required (in the paper they do about 5) b/c each time only approximately 20% of the lesion is actually burned off. Again, this is TOTALLY different concept from the 5-10 treatments commonly done with the Nd:YAG most are familiar with.
Also, one problem I was thinking about is inherent to the design of fractional lasers - some tissue remains after each session. In regular skin this tissue is fine for helping regrowth, but in Becker’s it is simply abnormal dermis. I suppose the study worked b/c subsequent sessions were done before the abnormal tissue had time to completely replace the ablated tissue.
In any case, the laser is still an Erbium, and thus capable of ablating both the epidermis and part of the dermis so it also seems promising. The study seems to imply that it works quite well actually, although there are only two patients here and follow up was only to 6 months. Also, again, approximately 5 treatments are required.
So…this might be a safer alternative to a traditional Er:YAG, definitely some pros, but also some cons - although it seems like it might work.
Better than the previously discussed Er:YAG? Hm. I don’t think so, but perhaps less side effects and might be easier to find.
Youman, you might want to ask about Fraxel or other Erbium fractional lasers in addition to a traditional Er:YAG. I have seen that the Fraxel in particular is commonly used in several clinics, but there are others. Keep in mind that there are also different fractional lasers as well - ie CO2 fractional which are NOT what you want. (although I will investigate CO2 lasers a bit as well still). Oh and I know know what the scanning component of the laser does if anyone is interested, but that’s another topic
Thoughts?
As an aside - it’s interesting to note the references in this paper. The 2 previous articles I posted are the first two references. The rest of the references are related to Nd:YAG’s and general laser issues. It really does seem that this is one of the only case reports written since the original studies performed. There really is hardly any research being done in this, and, frankly, I really lucked out in finding this latest paper!
Looks fascinating - somewhat away from the studies - is there anyone here
who is looking to try the Er:YAG that resides in the New York area?
Thanks for all the info canboy. I haven’t had a chance to read the new study you posted(I scanned through it) but will go through it throughly tomorrow. I did know the dermak was both a erbium and co2, but like I think you stated they seem to only use the erbium in the study. I’m not really to informed on the fractional lasers besides hearing bits and pieces of information. The co2 lasers seem way to risky to me at the energy needed to effectively treat BN.
Ya I understand that doctors probably do get a lot of papers from patients and can’t say much without seeing a patient first. I didn’t want them to answer questions or really read it throughly, just know what it was basically and if it would be something that they would possibly have some interest in if the right patient walked in. As hopeful as the study is, I can think of a million reasons that doctors won’t want to treat BN using the Erbium similar to the study. Hopefully I can talk him into at least performing a test spot which would be needed anywayz and see how that goes first.
I do plan to ask him a lot of questions which I should probably write down before I go. I’ll be careful and make sure it is right laser and make sure the parameters are followed exactly if treatment is possible(although the first meeting should be just a consultation). If there is any specific information about the laser/treatment that someone may want to know or think is important for me to ask let me know and I’ll try to remember and ask the doctor. Tho I’m sure I’ll forget somethings. I’ll ask about the fractional too, but since I’m willing to get a tattoo, I think I would be a little more willing to take the higher risk of the Er: yag. Even if the fractional was an option I really don’t know that I would be able to afford that many treatments right now either.
Sorry if I made a million typos and left some things out, I’ve had a long day.
Thanks again for all the info canboy, its really great that you were able to find these studies.
Shawn
Er yag sounds promising. I found that study from Spain a couple of years ago. What about long pulse ruby as a possible solution to beckers nevus? Ive had multiple treatments with the regular q switch with only minimal results.
http://www.consultantlive.com/display/article/10162/36614
“Surgical excision is generally avoided because it may result in scarring. In contrast, laser therapy (eg, erbium YAG laser and long-pulsed ruby laser) has been used to treat both hyperpigmentation and hypertrichosis with a good cosmetic outcome.”
hey just a quick update, I did see the doctor Friday with the Er:Yag. He seemed very knowledgeable and said he had some success treating Becker’s Nevus in the past, but typically it would take a span of about 2 years to see good results. He did however agree to do a test spot (which I would have wanted anywayz) with similar parameters and see what results the Er:Yag produces. My major concern with this procedure is that I don’t want to be left with major scarring/hypo-pigmentation which he also thought would be a very likely result. That being said, a certain amount of scarring/hypo-pigmentation is fine and expected as it would still be much less noticeable then the nevus; only major scarring/hypo would be my real concern. Also treatment is 3 times the amount I expected, but I do plan to have the test-spot done (Apr. 11), if results from the test-spot look really promising then I will consider full treatment.
cool. keep us posted.
Thanks for the post. I’m very interested to hear about the results. Would you be able to take a before/after photo of the test spot to share?
I’m also worried about the significant hypopigmentation/scarring, particularly since I scar easily myself. This is why I’m starting to consider the Fractionated Er:YAG as an option, even though it will require about 5-6 treatment.
Why did he say it requires 2 years of treatment? If he does it like the study, it should only require that one pass and about 6 months to heal completely… Are you sure he isn’t talking about 2 years using a Q-switched Nd?
Also, how much did he say it would cost? Is it the price for the single pass like you wanted?
Keep us posted.
Sorry I was not very clear, he said he has had some decent results treating Becker’s Nevus with ‘other’ various lasers, but only achieved acceptable results after roughly 2 years of treatments. He has never tried to use the Er:Yag to treat BN.
I also scar somewhat easily and have fair skin, so I should be a good test to see how bad the scarring will be. Also as you have probably read, the skin on other parts of the body such has the chest does not regenerate as it does on the face, which further increases chances of scaring/hypo.
I will take a picture before treatment and take a few pictures after at different time periods; such as the day after treatment, one week after, and one month after or until no changes are seen in the test-spot. Hopefully it will help, but I suspect the size of the test-spot will be very small and may not tell exactly what the results of a full treatment would really be. However, because only one treatment is really needed with the Er:Yag, it should tell more then it would with other lasers.
The doctor seems to be by far the best I have had the chance to talk with. If this wasn’t the case I would probably be looking for a cheaper Er:Yag to use. For the full Treatment he had quoted me at 2200-2400, while I was expecting 600-1000. The test-spot is only 75 dollars which I think is well worth it. If the test-spot is questionable I may not go for the full treatment unless I am in a better financial position at the time. Also the laser (Coherent Ultrafine) seems very capable and he has agreed to use basically the same parameters as the study.
Well hopefully I’m not forgetting anything, but if anyone has any other questions feel free to ask.
Shawn…
good luck shawn!
and jp36 - yes, I was talking about the Fraxel laser (one brand of fractoinated Erbium). there are other fractional lasers, some Erbium, some Nd and even some CO’s I think, but I’m focusing on the Er.
Any updates or new info?
I believe youman is having his test spot done with the standard Erbium on April 11th, so we’ll see what he reports. I’ve called a dermatologist in my area who uses fractionated Erbium and will be seeing her in late May for a consultation for that. I’ll keep everyone up to date with what she says.
Hey canboy, when u say fractionated erbium- is that the Fraxel laser?
Good luck Shawn, we can’t wait to see how it turns out!!! (crossing fingers)
Yep I have the test later today. I will take photos like I stated and if everything goes right it should take 7-10 days for my skin to peel completely after the treatment. Until my skin peels and shows some signs of healing there is little reason to post pics as they would be misleading. While I expect the test spot to be fairly red, I will try to post the first report with pics around the 2 week mark (give or take time depending on how the spot is reacting/healing). I do want to make it very clear to everyone that even at 2 weeks the results can be misleading in a number of ways and it is really the mid/long term results that count here. So I plan to keep posting updates with new pics of the test spot at different time periods as I stated in a previous post.
Well I am looking forward to getting the test spot today, however I’m still not very hopeful that it is really going to work, maybe it is just to hard to believe that something will work at this point. Either way I am really curious to see what kinda results it yields, especially in comparison with the study. If nothing else it is interesting to try something a bit different.
I think I need some sleep, lol. If you have any questions about the treatment just let me know and I’ll try to answer them as soon as possible.
Shawn…