The ExSys EXCIMER laser 308 nm

Dr Sagoo, one of the leading cosmetic doctors in the UK, is proud to be the first and only doctor in the UK to offer the latest laser in the world, which may improve symptoms of vitiligo, psoriasis, alopecia areata, resistant dermatitis, acne and other inflammatory skin conditions that do not respond to conventional treatments.

We introduce to you the ExSys Excimer laser. Having undergone speciality training in Germany with leading world-renowned experts in vitiligo, Dr Sagoo can now exclusively offer the excimer laser to patients at the Solihull Medical Cosmetic Clinic, the No 1 clinic in the Midlands.

The ExSys Excimer Laser 308 nm offers a revolutionary new treatment that may improve the skin of patients suffering from vitiligo, eczema and psoriasis. This laser uses a carefully focused beam of light delivered through a sophisticated fibre optic device. The Excimer system allows the practitioner to use high doses of UVB light necessary for the treatment of the eczematous patches, whilst minimizing the risk of exposure to healthy skin. For patients with resistant eczema, this new laser allows for quick, painless therapy that is effective for many patients. Patients can often obtain relief in just four to eight brief sessions, compared to 25 to 30 treatments with conventional phototherapy. Remissions are expected to last up to a few months for many patients. Because each patient is an individual, results may vary from person to person.

Benefits of  The ExSys EXCIMER laser 308 nm

• May produce effective clearing, often in as few as four sessions.
• May improve eczema.
• May improve Alopecia areata (bald patches in scalp).
• May improve white scars.
• May improve white pigmentation induced by trauma, medical procedures.
• May improve laser-induced hypopigmentation.
• May improve vitiligo.
• May improve psoriasis.
• May provide long-lasting relief, typically several months free of symptoms.
• Quick, easy treatment sessions last only a few minutes.
• Relief without messy creams and daily skincare regime.

Vitiligo

What is vitiligo?

Vitiligo is a skin disorder that is characterized by depigmented spots that can be distinguished from their surroundings. It can affect any age and any sex. It usually has a slowly progressive course, but sometimes it may have a rapidly progressive course. It can affect any part of the skin and sometimes it spreads to involve the skin of the whole body.

Vitiligo, an acquired pigmentary disorder of unknown origin, is the most frequent cause of depigmentation worldwide, with an estimated prevalence of 1% around the world and in the UK. The disorder can be psychologically devastating and stigmatising, especially in dark-skinned individuals.

What does vitiligo look like?

Vitiligo is characterized by white, depigmented areas of the skin ranging from 5 millimetres to 5 centimetres in diameter, or more. The degree of pigment loss can vary within each vitiligo patch. There may be different shades of pigment in a patch, or a border of darker skin may circle an area of light skin. These patches may be either symmetrical on the body, or localized to one region, and may affect the hands, fingers, face, scalp, body folds, underarms, genitalia, and orifices such as the eyes, mouth, navel, and anus.

The condition varies from person to person. Some people only get a few small, white patches, but others get bigger white patches that join up across large areas of their skin.

There is no way of predicting how much skin will be affected. The white patches are usually permanent.

Who gets vitiligo?

The onset of vitiligo may be attributed to physical trauma, illness, or emotional stress. Patients with vitiligo often report that the death of a relative, a severe accident, or even a harsh sunburn had occurred directly preceding the appearance of their vitiligo. More recently, data suggest a genetic link to certain types of vitiligo. This may be especially true if there are other family members affected with vitiligo and/or autoimmune diseases in the family.

The course and severity of pigment loss differ with each person. Fair-skinned people may only notice the contrast between paler areas of vitiligo and suntanned skin during the summer. Year-round, vitiligo is generally more obvious on people with darker skin. Individuals with severe cases can lose pigment all over the body. There is no way to predict how much pigment an individual will lose.

What are the causes of vitiligo?

There are many theories that had been hypothesized to explain the causes of vitiligo, but we still don’t know the exact cause of this disorder. Some of the possibilities include:

• Immunity disorders.
• Skin nerve disorders.
• Skin pigment self-destruction.
• All the above theories combined.

Types of vitiligo

There are two main types of vitiligo:

• Non-segmental vitiligo.
• Segmental vitiligo.

In rare cases, it’s possible for vitiligo to affect your whole body. This is known as universal or complete vitiligo.

Non-segmental vitiligo

In non-segmental vitiligo (also called bilateral or generalised vitiligo), the symptoms of vitiligo often appear on both sides of your body as symmetrical white patches. Symmetrical patches can appear on the:

• Backs of your hands.
• Arms.
• Eyes.
• Knees.
• Elbows.
• Feet.

Non-segmental vitiligo is the most common type of vitiligo, affecting up to 9 out of 10 people with the condition.

Segmental vitiligo

The white patches may sometimes only affect one area of your body. This is known as segmental, unilateral or localised vitiligo.

Segmental vitiligo is less common than non-segmental vitiligo, although it’s more common in children. Segmental vitiligo usually starts earlier and affects 3 in 10 children. Vitiligo can occur in the occasion with diseases as autoimmune disease, thyroid diseases, anaemia, diabetes mellitus, constitutional muscular anomalies, and alopecia. Family history is found in up to 38% of cases which denotes a hereditary susceptibility.

Treating vitiligo

Treatment for vitiligo is aimed at improving your skin’s appearance by restoring its colour. However, the effects of treatment are not usually permanent, and it cannot always control the spread of the condition.

Protection from the sun

Sunburn is a real risk if you have vitiligo. You must protect your skin from the sun and avoid sunbeds. When skin is exposed to sunlight, it normally produces a pigment called melanin to help protect it from ultraviolet light. If you have vitiligo, there is not enough melanin in your skin, so it is not protected.

Always apply a high-factor sunscreen, ideally with a sun protection factor (SPF) of 30 or above, to protect your skin from sunburn and long-term damage. This is particularly important if you have fair skin.

Protecting your skin from the sun will also mean that you don’t tan as much. This will make your vitiligo less noticeable.

Vitamin D

If your skin is not exposed to the sun, there is an increased risk of vitamin D deficiency. Vitamin D analogues – such as calcipotriol, Vitamin D is essential for keeping bones and teeth healthy. Sunlight is the main source of vitamin D, although it’s also found in some foods, such as oily fish.

Skin camouflage

Skin camouflage involves applying coloured creams to the white patches on your skin. These creams are specially made to match your natural skin colour. The cream may help to blend in the white patches with the rest of your skin, making them less noticeable.

You need to be trained in using the camouflage creams, but the service is free (although donations are welcome) and some creams are prescribed on the NHS.

Camouflage creams are waterproof and can be applied anywhere on the body. They last up to four days on the body and 12-18 hours on the face. You can also get skin camouflage cream that contains sunblock or has an SPF rating.

The ExSys Excimer laser (308nm wavelength)

The ExSys Excimer laser has been shown in scientific research to cause significant improvements in the treatment of vitiligo patches for many patients. This laser emits light energy at a certain wavelength (308nm), which stimulates the pigment-producing cells in the depigmented area of the skin. Therefore over a course of sessions, which only take minutes to carry out, repigmentation may be achieved, and can in some cases reach nearly 100%.

Topical corticosteroids

Corticosteroids are a type of medicine that contains steroids. Topical means that the medicine is applied to the skin, such as a cream or ointment.

Topical corticosteroids are sometimes used for the treatment of vitiligo. They will not completely reverse the condition, but they can sometimes stop the spread of the patches, and may restore some of your original skin colours.

Using topical corticosteroids

You may be prescribed a cream or an ointment, depending on what you prefer and where it will be used. Ointments tend to be greasier. Creams are better in your joints – for example, inside your elbows. After one month, if your vitiligo is not improving or the treatment is causing side effects, you may need to stop using corticosteroids.

Side effects

Side effects of topical corticosteroids include:

• Streaks or lines in your skin (striae).
• Thinning of your skin (atrophy).
• Visible blood vessels appearing (telangiectasia).

• Non-steroid topical creams

• A type of medicine called calcineurin inhibitors may also be used to treat eczema in children or adults. They are particularly commonly indicated if :

• Your face is affected and you want further treatment.
• You cannot use topical corticosteroids because of the risk of side effects.
• You have segmental vitiligo and want further treatment.
• Treatment with topical corticosteroids has not worked.

Phototherapy

Phototherapy (treatment with light) may be used for children or adults if:

• Topical treatments have not worked.
• The vitiligo is widespread.
• The vitiligo is having a significant impact on their quality of life.

Evidence suggests that phototherapy, particularly when combined with other treatments, has a positive effect on vitiligo for many patients. However, phototherapy may increase the risk of skin cancer because of the extra exposure to UVA rays.

Although you may be able to buy special sunlamps to use at home for light therapy, these are not recommended. They are not as effective as the phototherapy you will receive in hospital. The lamps are also not regulated, so may not be safe.

Skin grafts

A skin graft is a surgical procedure that involves removing healthy skin from an unaffected area of the body and using it to cover an area where the skin has been damaged or lost. To treat vitiligo, a skin graft can be used to cover the white patch. This type of treatment is time-consuming and is not widely available in the UK.

Other possible treatments include:

• A medicine that suppresses your immune system (the body’s natural defence system), which may be used with phototherapy.
• A type of oral corticosteroid, which has also been used with phototherapy in some patients, although it can cause side effects.

• Complementary therapies

Some complementary therapies claim to relieve or prevent vitiligo. However, there is no evidence to support their effectiveness, so more research is needed before they can be recommended.

Excimer Exsys laser 308 nm for Psoriasis

1. 1. What is Psoriasis?

      Psoriasis is a non-contagious, inherited skin disease caused by an overactive immune system that stimulates a higher-than-normal turnover of skin cells. This results in recurring red plaques with silvery scales, on either localized or generally dispersed regions of the skin. A very difficult disease to treat, psoriasis often causes shame, embarrassment, and humiliation to individuals, and sometimes lasts throughout their entire lifetime.

   2. What Does Psoriasis Look Like?

      Psoriasis is characterized by salmon-pink, round, well-bordered bumps and plaques with silvery scales on their outer layer. Psoriasis plaques can either itch or feel sore. The scales are loose and easily removed by scratching, which often results in minimal bleeding. Psoriasis may be localized to one area such as the nails or genitals, dispersed to an entire region such as the scalp, or universally distributed to the skin throughout the entire body. Common areas include the elbows, knees, palms, shins, nails, arches of feet, lower back, genitals, and anal folds. Psoriasis may also cause a type of arthritis called “Psoriatic Arthritis” with joint pain, weakness, chills, and fever. Without early recognition and treatment, psoriatic arthritis can potentially be disabling and crippling.

   3. Who Does Psoriasis Affect?

      Psoriasis can begin at all ages, but most commonly begins near or around two age peaks of 23 years and 55 years, and occurs equally among males and females. Smoking and obesity also appear to be associated with psoriasis, though the cause and effect relationship is not clear.

   4. What Causes Psoriasis?

      Psoriasis begins in the immune system. For reasons yet unknown, T cells are mistakenly activated and begin signalling skin cells to shorten their normal cell cycle duration. This causes a much faster turnover of skin cells and an increase of up to 30 times the normal production. Swelling and inflammation ensue. The long-term result is a significant reddening, thickening and scaling of the affected region.

   5. What Triggers Psoriasis?

      Certain triggers may exacerbate pre-existing psoriasis plaques, or cause a sudden onset of plaques, especially in areas that have been affected once before. These factors include physical trauma such as rubbing and scratching, bacterial infections, alcohol consumption, smoking, stress, weather changes, dry climates, or certain medicines.

   6. How Can My Psoriasis Be Treated?

      Although management and control of psoriasis are very difficult, it is certainly possible and can be attained for many patients with a well-planned treatment regimen. Phototherapy for psoriasis in the form of narrow-band UVB phototherapy may help to improve large areas of the skin without the side effects of oral or topical medications.
      The Exsys Excimer laser has been extremely successful in treating psoriasis for many patients. The excimer 308 nm laser uses a carefully focused beam of narrow-band UVB light delivered through a sophisticated fibre-optic device and allows higher doses of narrow-band UVB light with minimal exposure of nearby, healthy skin.

2. Excimer Exsys laser 308 nm for Psoriasis

   1. What is Irritant Contact Dermatitis?

   Irritant dermatitis is an irritating skin reaction to specific compounds or agents outside of the body that the skin contacts repeatedly, such as chemicals, detergents, or oils. It may involve swelling, redness, itching, blistering, “weeping” clear fluid, crusting, the formation of clear vesicles, pustules, dryness, peeling, or allergic-like reactions of the involved area. Irritant dermatitis may continue for months at a time.

   2. What Does Irritant Contact Dermatitis Look Like?

   Acute cases of irritant dermatitis may involve multiple small, clear fluid-filled blisters on well-bordered, raised, red patches. These small blisters often burst and cause a yellow crust to form around the irritated region. Irritant contact dermatitis lasting longer than one week may appear as red bumps forming entire plaques across the skin having indistinct borders, as well as dryness, itching, peeling and scabbing throughout the affected region. This appearance may be difficult to discern from other types of dermatitis, such as atopic dermatitis (i.e. eczema) or allergic contact dermatitis (i.e. nickel allergy). Secondary bacterial infection may cause the formation of pustules, which may become tender and eventually burst. Chronic cases involve dull red, extremely itchy, cracking, peeling, thickened and leathery skin. Symptoms are localized only to areas which the irritating chemical or causative agent has contacted.

   3. Who Does Irritant Contact Dermatitis Affect?

   Irritant dermatitis may affect individuals of all ages working with or around possible skin irritants, such as abrasive substances, detergents, acids, alkaline agents, oxidants, reducing agents, plants, animals, enzymes, or particulate fibers such as fiberglass or wood dust. Irritant dermatitis may affect anyone, given sufficient exposure to irritants, but those with atopic dermatitis are particularly susceptible. 80% of cases of occupational hand dermatitis are due to irritants, most often affecting cleaners, hairdressers and food handlers.

   4. What Causes Irritant Contact Dermatitis?

   Irritant dermatitis is caused by the immune system’s reaction to chemical or mechanical damage to the skin. With each new exposure, the irritating agent kills or damages skin cells, causing an amplified release of inflammatory agents from the immune system. These agents promote itching, redness, and flaking. The end result is a chronic inflammation of the skin, as well as a perpetual migration of blood cells and immune system cells to the affected location.

   5. What Triggers Irritant Contact Dermatitis?

   Certain factors may trigger irritant dermatitis, especially in workers exposed regularly to chemicals, powders, or the irritating agents listed above. Factors exacerbating the condition include continued exposure to the causative agent, previously diagnosed atopic eczema, and activities such as car maintenance, gardening, or hobbies causing repeated skin abrasion. In all cases of irritant dermatitis, rubbing and scratching are behaviours that worsen the condition by introducing secondary bacterial infections to the involved areas.

   6. How Can My Irritant Contact Dermatitis Be Treated?

   Identification and reduction of exposure to a specific irritant in an individual’s daily environment is the primary means of preventing irritant dermatitis. For recurring flares, topical anti-itch lotions may help control excessive itching and rubbing. Topical steroid creams may help to reduce inflammation, and topical anti-bacterial lotions or oral antibiotics may be given to decrease secondary bacterial infections, reducing pustules at the site. Laser treatments may also be used and may decrease symptoms in small areas. Hydration using unscented moisturizing lotions is important in preventing dryness, and non-liquid soaps should be avoided. For more information on available treatments for irritant dermatitis, or to schedule a visit, please call and speak with a representative at the Berman Skin Institute.

1. What is Eczema?

   Eczema is a very common, inflammatory reaction of the skin to any of a wide number of causative agents. Atopic dermatitis, the most common form of eczema, is a skin disorder involving an overly sensitive immune system reacting to otherwise normal substances that the skin or body contacts. Eczema may involve swelling, redness, itching, blistering, “weeping” clear fluid, crusting, the formation of pustules, dryness, peeling, or allergic-like reactions of the involved area. While some cases of eczema are shorter lasting, others may continue for months or even years at a time.

2. What Does Eczema Look Like?

   Eczema may display a variety of characteristics. Eczema in its mildest form may appear as dry, itching, and flaking skin. In addition, eczema may appear as red bumps forming entire plaques with indistinct borders, as well as dryness, itching, peeling and scabbing throughout the affected region. Secondary bacterial infection can cause tenderness. Chronic cases may involve dull red, extremely itchy, cracking, thickened and leathery skin. Eczema tends to occur in the flexural regions (backside of elbows, knees), neck, wrists, ankles, creases of the body, face and scalp (in infants).

3. Who Does Eczema Affect?

   Eczema is very common and affects many different types of individuals. The prevalence of eczema is estimated at 15-20% among children, and 2-10% of all adults, with males slightly more likely to be affected than females. The children of individuals with eczema have a 60% chance of being affected. Eczema usually begins in infancy and may persist through childhood and into adult life. Certain factors may elicit a response in children, such as certain protein-containing foods, dust mites, or microbial agents. Other contributing factors may include skin dehydration, pregnancy, menstruation, cold climates, irritating clothing, and most significantly, emotional stress.

4. What Causes Eczema?

   Eczema is caused by the immune system’s over-sensitive reaction to unidentifiable substances, either foreign or regularly contacting the skin. These “triggering” events often lead to a chronic cycle of exacerbations and remissions in the affected areas. With each new exposure, the irritating or causative agent stimulates certain antibodies to cause an amplified release of inflammatory agents from immune system cells. These agents promote the formation of small red bumps, itching, swelling, and flaking of the skin. The end result is a chronic inflammation of the skin, as well as a perpetual migration of blood cells and immune system cells to the affected location. An eczema flare may often be associated with other allergic-like reactions in individuals such as hay-fever, sinusitis and congestion.

5. What Triggers Eczema?

   Certain factors may trigger an eczema response, especially in children. These include protein-containing foods such as eggs, milk, peanuts, soy products, fish, and wheat, as well as dust mites, airborne allergens, or microbial agents. Other exacerbating factors may include skin dehydration, pregnancy, menstruation, cold climates, wool and other irritating clothing, and of especially great importance, emotional stress. Exposure to adverse weather conditions or climates may also trigger or worsen an eczema response. In all cases of eczema, rubbing and scratching are behaviors that worsen the condition by introducing the possibility of secondary bacterial infections to the involved areas.

6. How Can My Eczema Be Treated?

   Although childhood eczema frequently subsides before adulthood, adult eczema often lasts years at a time and requires special management. Topical anti-itch lotions may help to control excessive itching and rubbing. Topical steroid creams may help to reduce inflammation. Topical anti-bacterial lotions or oral antibiotics may be given to decrease the risk of secondary bacterial infections. Laser treatments may also be used to treat small areas. In research, the Exsys Excimer laser has been extremely successful in helping to improve small patches of eczema. This laser uses a carefully focused beam of narrow-band UVB light delivered through a sophisticated fibre optic device and allows higher doses of narrow-band UVB light with minimal exposure of nearby, healthy skin. Hydration using unscented moisturizing lotions is important in preventing dryness, and non-liquid soaps should be avoided. Finally, identification and reduction of emotional stress factors may help prevent unnecessary eczema flares. Eczema can be a difficult, frustrating condition. The natural human desire to scratch or rub an itchy rash just makes the condition worse, and treatments can be slow and are not always completely effective.

Contact Irritant Dermatitis Before

After several sessions with Exsys Excimer laser.