Vbeam^® 595-nm Pulsed Dye Laser Treatment of Actinic Keratosis

Author: Andrea De Pascalis, MD, Dermaland^®, Milan, Italy

Actinic keratoses (AKs) are premalignant skin lesions that arise due to the proliferation of keratinocytes with varying degrees of dysplasia in the epidermis and have the potential to progress to squamous cell carcinoma (SCC).¹ These lesions typically appear as rough, reddish or brown, scaly patches or bumps, especially in sun-exposed areas such as the head, neck, and extremities.² AKs are a very common skin condition affecting the quality of life of many, especially among the elderly population, with a worldwide prevalence of 11–25%. In the United States, prevalence varies from 11 to 26%, where the condition accounts for a third of dermatological consultations and is the second most frequent diagnosis.³

The goals of AK therapy are to eradicate clinical and subclinical lesions, prevent the progression into invasive squamous cell carcinoma, provide a good aesthetic outcome, and reduce the probability of relapses. Treatment and management recommendations prioritize UV protection; sun-protective clothing, sun avoidance, and broad-spectrum sunscreen preferably with a high Sun Protection Factor (SPF).⁴ Other interventions include cryotherapy, topical medications (creams and gels), photodynamic therapy (PDT), and surgical removal. There is no single “gold standard” therapy, and individualization is key to optimizing outcomes and adherence. While some of these treatments assist with lesion clearance, some may include treatment burden in the form of high sensation of pain, skin reactions, and extensive treatment duration, all of which may risk patient’s participation and adherence to the treatment regimen.

Interestingly, AKs exhibit distinct vascular components, with increased vascularization and disorganized vessel patterns becoming more pronounced with increasing AK grade. These vascular alterations are significant indicators of the condition’s presence and can even predict treatment resistance.⁵

The Vbeam^® 595-nm pulsed dye laser (PDL) is widely used in dermatology to treat various skin conditions, including wrinkles, rosacea, spider veins, port-wine stains, sunspots and cutaneous lesions such as actinic keratosis.* Vbeam’s 595-nm wavelength is highly absorbed by hemoglobin and may address some of the underlying vascular components of AK, particularly when it presents with redness, visible blood vessels or is associated with pronounced erythema. Treatment may also provide supplemental cosmetic improvement of the skin appearance and texture.

Vbeam laser treatment is generally considered tolerable, gentle enough to treat the pediatric population. Sessions are typically quick, often lasting only a few minutes depending on the area being treated.