0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Research Letter |

A Simple Solution to the Common Problem of Ecchymosis FREE

Julie K. Karen, MD; Elizabeth K. Hale, MD; Roy G. Geronemus, MD
Arch Dermatol. 2010;146(1):94-95. doi:10.1001/archdermatol.2009.343.
Text Size: A A A
Published online

Postprocedural and traumatic ecchymosis is an extremely common occurrence. Patients are increasingly seeking minimally invasive procedures that potentially cause bruising. Oftentimes, patients are anxious to minimize bruising so that others do not notice that they had cosmetic intervention. Strategies to reduce ecchymosis are limited to agents of only modest benefit (eg, arnica and bromelain).1,2 Pulsed-dye laser (PDL) therapy is known to be beneficial for the treatment of vascular conditions. The objective of this study was to evaluate the effectiveness and safety of a long-pulse PDL (595 nm) for the treatment of ecchymoses.

Ten adults with skin types ranging from I to IV and at least 1 ecchymosis were enrolled in the study. Ecchymosis resulted from cosmetic procedures or traumatic injury. Duration of ecchymoses ranged from 48 hours (n = 6) to 72 hours (n = 4). Subjects received a single treatment with the 595-nm V-Beam PDA (Candela Corp, Wayland, Massachusetts) with the following settings: spot size, 10 mm; fluence, 7.5 J/cm2; and pulse duration, 6 milliseconds. The DCD (Dynamic Cooling Device; Candela Corp) was set at 30 milliseconds with a 20 millisecond delay. Each subject served as his or her own control: subjects with 2 ecchymoses had 1 treated; those with a single lesion had half treated. Photographs were taken before treatment and at 24 hours, 48 hours, and 7 days after treatment. Two blinded assessors graded bruise severity from 0 to 10 (0, no bruise; 10, worst bruising).

Relative to the untreated ecchymosis, treated lesions resolved more rapidly (Figure). In all 10 subjects, accelerated resolution of the treated bruise was evident within 24 hours. Benefit was apparent 6 hours after treatment in 1 patient. Twenty-four hours after treatment, the average improvement was 62% and 13% for treated and untreated bruises, respectively. Forty-eight hours after treatment, the average improvement was 76% and 37% for treated and untreated lesions, respectively. One week after treatment, treated and untreated bruises had improved by 87% and 81%, respectively. Adverse effects were minimal, but 2 patients experienced minor transient crusting.

Place holder to copy figure label and caption
Figure.

Two ecchymoses of equal duration on the inner aspect of the upper extremity. In each figure panel, the bruise labeled “A” on the patient's arm is the experimental bruise; the one labeled “B” on the patient's arm is the control bruise and never received treatment. All further citations herein to alphabetic labels refer to figure panel labels, not bruise labels. A, Before treatment with pulsed-dye laser (PDL); B, 6 hours after a single PDL treatment; C, 24 hours after treatment; D, 48 hours after treatment; E, 96 hours after treatment; and F, 1 week after treatment.

Graphic Jump Location

The precise mechanism by which laser treatment accelerates resolution of ecchymoses is unknown. Ecchymoses result when extravasated blood accumulates in tissue. The yellow color that develops in older bruises correlates with macrophage degradation of hemoglobin to bilirubin. The PDL emits yellow light (595 nm) matching an absorption peak of oxyhemoglobin. Bilirubin has a broad absorption peak at 460 nm.3

We observed the most dramatic responses in bruises with pronounced erythematous and/or violaceous components, suggesting that laser intervention is most effective if initiated when hemoglobin predominates. All of the bruises in our study were between 48 and 72 hours old. In a recently published study, DeFatta et al4 reported maximum efficacy of PDL treatment for ecchymoses resulting from facial cosmetic procedures when the PDL therapy was performed between 5 and 10 days postoperatively. Our greater success in treating younger bruises may relate to different bruise causes. In our study, bruises were the result of either minor trauma or nonsurgical cosmetic procedures. Relative to bruising due to surgery, such bruising is typically more superficial and associated with less tissue inflammation and edema, both of which potentially impede laser energy absorption. Furthermore, we used higher fluences than DeFatta et al used (7.5 J/cm2 vs 6 J/cm2).

In conclusion, this study demonstrates that the long-pulsed PDL can safely be used to improve ecchymoses. Further study will help to better define optimal laser parameters. This simple technique can help to alleviate the common stigma associated with cosmetic intervention by expediting healing.

ARTICLE INFORMATION

Correspondence: Dr Karen, Laser & Skin Surgery Center of New York, 317 E 34th St, New York, NY 10016 (jkkaren@gmail.com).

Accepted for Publication: July 17, 2009.

Author Affiliations: Laser & Skin Surgery Center of New York and New York University School of Medicine, New York.

Author Contributions: All authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Karen, Hale, and Geronemus. Acquisition of data: Karen, Hale, and Geronemus. Analysis and interpretation of data: Karen, Hale, and Geronemus. Drafting of the manuscript: Karen and Hale. Critical revision of the manuscript for important intellectual content: Hale and Geronemus. Administrative, technical, and material support: Karen, Hale, and Geronemus. Study supervision: Hale and Geronemus.

Financial Disclosure: Dr Hale serves as a consultant to Schering-Plough, Johnson & Johnson, and Sanofi-Aventis. Dr Geronemus serves as a consultant to Candela Corp and serves on the medical advisory boards for Photomedex, Lumenis, Candela, Zeltiq, Skin Cancer Company, and Endymion; he is also an investigator for Solta Medical, Candela, DUSA, DermTech, Syneron, Endymion, and Palomar and is a stockholder in Solta Medical.

Additional Contributions: Chris Hunzeker, MD, and Elliot Weiss, MD, assisted as our blinded assessors.

Seeley  BMDenton  ABAhn  MSMaas  CS Effect of homeopathic Arnica montana on bruising in face-lifts: results of a randomized, double-blind, placebo-controlled clinical trial. Arch Facial Plast Surg 2006;8 (1) 54- 59
PubMed Link to Article
MacKay  DMiller  AL Nutritional support for wound healing. Altern Med Rev 2003;8 (4) 359- 377
PubMed
Merrick  MFPardue  HL Evaluation of absorption and first- and second- derivative spectra for simultaneous quantification of bilirubin and hemoglobin. Clin Chem 1986;32 (4) 598- 602
PubMed
DeFatta  RJKrishna  SWilliams  EF  III Pulsed-dye laser for treating ecchymoses after facial cosmetic procedures. Arch Facial Plast Surg 2009;11 (2) 99- 103
PubMed Link to Article

Figures

Place holder to copy figure label and caption
Figure.

Two ecchymoses of equal duration on the inner aspect of the upper extremity. In each figure panel, the bruise labeled “A” on the patient's arm is the experimental bruise; the one labeled “B” on the patient's arm is the control bruise and never received treatment. All further citations herein to alphabetic labels refer to figure panel labels, not bruise labels. A, Before treatment with pulsed-dye laser (PDL); B, 6 hours after a single PDL treatment; C, 24 hours after treatment; D, 48 hours after treatment; E, 96 hours after treatment; and F, 1 week after treatment.

Graphic Jump Location

Tables

References

Seeley  BMDenton  ABAhn  MSMaas  CS Effect of homeopathic Arnica montana on bruising in face-lifts: results of a randomized, double-blind, placebo-controlled clinical trial. Arch Facial Plast Surg 2006;8 (1) 54- 59
PubMed Link to Article
MacKay  DMiller  AL Nutritional support for wound healing. Altern Med Rev 2003;8 (4) 359- 377
PubMed
Merrick  MFPardue  HL Evaluation of absorption and first- and second- derivative spectra for simultaneous quantification of bilirubin and hemoglobin. Clin Chem 1986;32 (4) 598- 602
PubMed
DeFatta  RJKrishna  SWilliams  EF  III Pulsed-dye laser for treating ecchymoses after facial cosmetic procedures. Arch Facial Plast Surg 2009;11 (2) 99- 103
PubMed Link to Article

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

5,077 Views
8 Citations
×

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Quick Reference

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Quick Reference