This article discusses current practice in laser dermatology, the gaps in practice, and recommendations for improvement. As is the case with other areas of cosmetic dermatology, there is a rapid development of new laser and light devices with limited epidemiologic data available to inform best practice. The high fixed cost associated with new laser devices, limited space available in some practices, and inconsistent training may limit the adoption of needed therapies. Improving research in this area; training opportunities for physicians, residents, and staff; and cost-effective laser/light device rentals programs could improve quality of current practice.
Key points
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This article discusses current practice in laser dermatology, the gaps in practice, and recommendations for improvement.
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As is the case with other areas of cosmetic dermatology, there is a rapid development of new laser and light devices with limited epidemiologic data available to inform best practice.
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The high fixed cost associated with new laser devices, limited space available in some practices, and inconsistent training may limit the adoption of needed therapies. Improving research in this area; training opportunities for physicians, residents, and staff; and cost-effective laser/light device rentals programs could improve quality of current practice.
The first use of lasers in medicine was for the treatment of dermatologic disease by Leon Goldman in 1961. Goldman went on to become the director of dermatology at the University of Cincinnati, and the first president of the American Society for Laser Medicine and Surgery. Further research advances in laser dermatology and surgery were spearheaded by R. Rox Anderson at the Wellman Institute for Photomedicine at Harvard University, and his clinical counterpart, Kenneth A. Arndt, who also wrote the first textbooks in the field. Dermatology continues to be a major repository of laser expertise within medicine. In recent years, the dermatology laser field has enlarged to include broadband light as well as other energy sources, such as radiofrequency and therapeutic ultrasound. Clinical dermatology applications of lasers and energy devices have grown, and more dermatologists than ever before own and use instruments.
Part I. Practice gaps (in clinical dermatology practice)
Best Practice
Best practices for laser, light, and energy device procedures are largely similar to best practices for cosmetic dermatologic surgery (see previous section) ( Box 1 ). Additional best practices relevant to lasers and light devices include (1) availability of appropriate protective eyewear for patients and operators, and other in-room safety protocols; (2) scheduled preventive maintenance of devices, often within the context of ongoing service contracts; and (3) designation of a laser safety officer and training of all personnel who work with lasers and energy devices.
Best Practice
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Availability of appropriate protective eyewear for patients and operators, and other in-room safety protocols.
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Scheduled preventive maintenance of devices.
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Designation of a laser safety officer and training of all personnel who work with lasers and energy devices.
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Identifying contraindications for laser therapy and lower energy treatments to reduce risk when appropriate.
How Current Practices Differ from Best Practice
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Slow or variable adoption of novel device technologies with potential inability to offer a range of device options for different patients.
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Variability in staff training in laser safety, maintenance procedures, and operating procedures.
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Relative dearth of epidemiologic information regarding the procedures sought by patients, their ability to access these procedures, and their satisfaction after treatment.
Barriers to Best Practice Implementation
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Substantial fixed cost of acquiring lasers and energy devices, and the associated difficulty in covering these hardware costs in low-volume laser practices.
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Limited space in-office for storage of bulky lasers, with this being a particular issue in urban centers.
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Shortage of time available to research new devices, acquire new laser training and skills, incorporate new devices and procedures into the practice, and retrain all relevant staff.
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Reluctance to decrease general dermatology practice time to accommodate laser procedures.
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Inaccessibility or unavailability of reliable authorities or consultants who can advise dermatologists on upgrading their hardware and retraining themselves and their staff in a pragmatic, cost-efficient manner.
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Educational and training options for cutaneous laser and device surgery are not well advertised. There is no central repository that lists or vets all laser courses, programs of relevant professional societies, online educational modules, and preceptorship and fellowship opportunities.
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Limited research funding and inherent difficulties in comparing laser procedures side by side.
Strategies to Overcome Barriers
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Making laser use more cost-effective for dermatologists who have lower volume practices via rental or leasing programs that offer the latest products, come with appropriate training, and allow every dermatologist who wants to provide particular procedures to be able to do so.
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Investment in research to uncover and perfect novel medical indications for laser and energy devices.
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Easily accessible, comprehensive list of training opportunities.
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A match process for fellowships in laser and cosmetic surgery would also help advertise the availability of such more in-depth training options.
Related posts:
Psoriasis Trends and Practice Gaps
Practice Gaps and Training Gaps: Delineating What We Need to Fix
Clinical and Educational Gaps in Diagnosis of Nail Disorders
Practice and Educational Gaps in Dermatology
Practice and Educational Gaps in Surgery for Skin Cancer
Practice and Educational Gaps in Cosmetic Dermatologic Surgery
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