ArticlePDF Available

Combination Therapy of Infections Caused by Injection of Paint Using Medical Laser

120 Therapy of infections by medical laser /Vol.6/No.1/January /Vol.6/No.1/January 2017
Combination Therapy of Infections Caused by
Injection of Paint Using Medical Laser
Shahrokh Attarian1*, Afsaneh Karami2, Faezeh Ayatolahi3
Doubtlessly, one of the most important developments in medical
science has been the discovery of antibiotics and their use in the
treatment of infectious diseases caused by the various bacteria.
However, every day we witness the emergence of resistant strains
of bacteria which their resistance power against the antibiotics
are increasing; although scientists discover new antibiotics every
year to supply the consumption market, antimicrobial resistance
is a much faster trend and therefore it slows the healing process of
many infectious diseases.1 In the modern medical technologies, it
is tried to eliminate the germs and remove pus of the lesion, as
well as draining out the infection site using alternative solutions
rather than the use of antibiotics.2
Laser is a new technology which in recent years, it has found
many applications in various scientic elds such as military and
civilian industries as well as various branches of medical science.
The action mechanism of laser energy is to absorb the light
energy by the molecules in the tissue which causes the certain
tissue molecules becoming warm, hot and ultimately destroys
them; whereas laser is a mono-wavelength beam of light, it is
able just to heat up and destroy specic structures.3 Some anti-
inammatory effects of laser were previously mentioned.4-6
On May 25th 2013, a 27-year old woman visited the Emergency
Department of Ayatolah Mousavi Hospital with the history
of schizophrenia, drug use, and hyper-lipidemia. During the
examination, it was found that the patient was injected the
paint into the left forearm and right thigh last week which led
to the edema and erythema at the injury site. Two days after the
injection, purulent discharge was observed at the injury. She was
hospitalized initially at the burn unit of the hospital, and then the
patient was transferred to the infectious diseases unit of Valiasr
Hospital due to the severe infection of soft tissue at the injury.
Body temperature=8/36, HR=86, RR=19, BP=10/6.
Through the examination, erythematous lesions were observed
with the necrotic center of 6-7 cm diameter having purulent
discharge on the forearm to the elbow, and also the erythematous
and edematous lesions containing scattered pustules in an
undulation form were seen on the patient’s right thigh injury.
The drugs, including clindamycin, vancomycin, ciprooxacin
and ryfampy have been prescribed for the treatment, as well as
uvoxamine, inderal, respridone, thiothixene, clonazepam, and
pethidine according to the psychiatrist. Later, the arterial and
venous Doppler ultrasound was performed on the injury site with
1. Plastic Surgery, Zanjan University of
Medical Sciences, Zanjan, Iran;
2. Infectious disease specialists, Zanjan
University of Medical Sciences, Zanjan,
3. Laser Ward, Zanja n University of Medical
Sciences, Zanjan, Iran
*Corresponding Author:
Shahrokh Attarian, MD;
Department of Plastic
Universit y of
Zanjan, Iran
Received: Decemb er 2 ,2015
Revised: August 8, 2016
Accepted: December 1, 2016
Letter to Editor
Attarian et al. /Vol.6/No.1/January /Vol.6/No.1/January 2017
following results.
The venous blood ow in the auxiliary vein,
brachial vein, and cephalic and bazilic proximal
vein network of left elbow was within the normal
range; the arterial blood ow and spectrum
Doppler in the auxiliary and brachial arteries of
the left upper limb was observed in the normal
range. It was not possible to examine the radial
and ulnar arteries due to the dressing on the left
forearm, however, arterial profusion of all left
hand ngers was observed natural.
bone scan: (i) Bony lesion in the right knee
region due to osteomy elitis, and (ii) there
was infection in the soft tissue of the right
thigh as well left lower arm. WBC=11000
(P=70%, L=18%, EO=4%, Mon=8%), Hb=10/7,
PLT=65000, ESR=102, BUN=5/5, CR=0/6, U/
A=normal, NA=142, K=4/2, BS=108, AST=107,
ALT=27, ALP=335, LDH=338, Iron=52,
TIBC=405, Retic=0/8, and Ferritin=736/4.
Later: WBC=11000, HB=11/6, PLT=281000,
ESR=70, and U/C=E. coli.
The major reason of the positive charge
of lesion is the presence of metal cations and
metalloids, such as iron of the hemoglobin in
red blood cells, or calcium and other metals
which exist in the basal membrane. It should be
noted that the reactions between positively and
negatively charged molecules plays an important
role in antimicrobial defense, healing and tissue
growth. Using laser leads the positive charge to
be increased in the lesion site through inuencing
on metals, releasing the electron from valence
shell (outermost electron-occupied shell in the
atom), and transferring it to the amine circuit,
hydroxyl or methyl and ethyl branches of proteins
which contributes considerably in antimicrobial
defense and healing; however, that effect is more
effective in the wave lengths ranged 1064 nm to
532 nm, - i.e. out of the infra red wave length
range, and in the biophotonic form. Note that, for
the wave lengths of infra red, such as 10640 nm
related to CO2 laser, the effects will be mainly
biothermic and biomechanical with the action
of debridement on the lesion or increasing the
vessels surrounding the edge of lesion in a way
that inuences on the healing process. The above
mentioned characteristics lead the CO2 laser to
become one of the most appropriate solutions
for the supplement treatment accompanied with
antibiotics in some of the infectious diseases.7-9
According to the surgeon at the center, it was
more likely to be occurred necrotisin fasciitis,
and the surgeon recommended the debridement.
After the patient examination, the orthopedist
diagnosed the amputation; while, after the
hematological evaluation, it was recommended
to perform a control test in relation to the anemia
and thrombocytopenia according to the normal
blood lamella. During the patient examination
by the plastic surgeon, there was no fever
symptom observed, while septicity and pus of
the lesion was evident; hence, the plastic surgeon
recommended the CO2 and Ar laser therapy as
the treatment of septicity and pus.
The laser treatment was followed by the
treatment has been performed in three below
stages: (i) Discharging the dye from the lesion;
(ii) Draining the infectious site; and (iii) Filing
the lesion site. The abscess stage was performed
in a therapy session in the operation room under
the sedation. The CO2 surgical laser was used
to discharge the paint and pus from the abscess
and prepare the lesion site for the remaining
treatment stages. The technical specications
and light of utilized laser device are as follows:
Wave Length: 10640 nm, Super Plus, and
Continuous. 15 watt
Neutralization of the toxic metals of paint and
also destroying microbes stage was performed
in two sessions on the out-patient basis within
one week interval utilizing the laser device with
below technical specications: Q Switch
2000 MJ, 6 HTZ, 400
At the fourth week, and after the completion
of treatment, the lesion was dressed and the
treatment was considered successful. For
treatment of complex and complicated lesions,
it is possible to utilize the laser technology
in accordance with the standard protocols,
especially photodynamic therapy as the
supplement for the antibiotic therapies and
healing the resistant cases.
The authors declare no conict of interest.
Laser; Therapy; Infections
Please cite this paper as:
Attarian S, Karami A, Ayatolahi F. Combination
Therapy of Infections Caused by Injection of
122 Therapy of infections by medical laser /Vol.6/No.1/January /Vol.6/No.1/January 2017
Paint Using Medical Laser. World J Plast Surg
2017;6 (1):120-122.
1 Noorbakhsh Sabet N, Japoni A, Mehrabani
D, Japoni S. Multi-drug resistance bacteria
in Qom hospitals, Central Iran. Iran Red
Crescent Med J 2010;12:501-3.
Relf I, Chow R, Pirotta M. Blinding
techniques in randomized controlled trials
of laser therapy: an overview and possible
solution. Evid Based Complement Alternat
Med 2008;5:383-9.
Maltese G, Karalliedde J, Rapley H, Amor
T, Lakhani A, Gnudi L. A pilot study to
evaluate the efcacy of class IV lasers on
nonhealing neuroischemic diabetic foot ulcers
in patients with type 2 diabetes. Diabetes
Care 2015;38:e152-3.
Hopkins JT, McLoda TA, Seegmiller JG,
David Baxter G. Low-Level Laser Therapy
Facilitates Supercial Wound Healing in
Humans: A Triple-Blind, Sham-Controlled
Study. J Athl Train 2004;39:223-229
5 Shah GK. Efcacy of diode laser for treating
acne keloidalis nuchae. Indian J Dermatol
Venereol Leprol 2005;71:31 - 4
6 Gundogan C, Greve B, Raulin C. Treatment
of alopecia areata with the 308-nm xenon
chloride excimer laser: case report of two
successful treatments with the excimer laser.
Lasers Surg Med 2004;34:86-90.
7 Kagan LS, Heaton JT. The effectiveness of
low-level light therapy in attenuating vocal
fatigue. J Voice 2016;S0892-1997: 30 231 - 4.
Kassir R, Gilbreath J, Sajjadian A.
Combination surgical excision and fractional
carbon dioxide laser for treatment of
rhinophyma. Word J Plast Surg 2012;1:36-40.
Liapakis IE, Englander M, Sinani R, Paschalis
EI. Management of facial telangiectasias with
hand cautery. World J Plast Surg 2015;4:127-33.
ResearchGate has not been able to resolve any citations for this publication.
Full-text available
Objectives: Low-level light therapy (LLLT) is effective in reducing inflammation, promoting wound healing, and preventing tissue damage, but has not yet been studied in the treatment of voice disorders. The objective of this study was to investigate the possible effectiveness of LLLT in attenuating symptoms of vocal fatigue created by a vocal loading task as measured by acoustic, aerodynamic, and self-reported vocal effort. Methods: In a randomized, prospective study, 16 vocally healthy adults divided into four groups underwent a 1-hour vocal loading procedure, followed by infrared wavelength LLLT (828 nm), red wavelength LLLT (628 nm), heat, or no heat-light (control) treatment targeting the laryngeal region of the ventral neck surface. Phonation threshold pressure (PTP), relative fundamental frequency (RFF), and the inability to produce soft voice (IPSV) self-perceptual rating scale were recorded (1) at baseline, (2) immediately after vocal loading, (3) after treatment, and (4) 1 hour after treatment. Results: Vocal loading significantly increased PTP and IPSV and decreased onset and offset RFFs, consistent with a shift toward vocal dysfunction. Red light significantly normalized the combination of PTP, IPSV, and RFF measures compared to other conditions. Conclusions: RFF is sensitive to a vocal loading task in conjunction with PTP and IPSV, and red LLLT may have a normalizing effect on objective and subjective measures of vocal fatigue. The results of this study lay the groundwork and rationale for future research to optimize LLLT wavelength combinations and overall dose.
Full-text available
Facial telangiectasias are superficial cutaneous vessels that can result in noticeable aesthetical imperfections. This study presents a technique for the removal of facial telangiectasias using hand cautery. Twenty-five patients with facial telangiectasias were treated using hand cautery (Medicell Inc, Athens, Greece) during 2009-2013. Photo documentation was performed for each patient before and immediately after treatment. Treatment was performed by cauterization at 800°C, delivered via a 30G tip directly to the lesions for milliseconds. Twenty two out of 25 patients (88%) exhibited complete resolution of telangiectasias using hand cautery. In 5 (20%) patients, single application achieved complete resolution of lesions and in 10 patients (40%) re-treatment was required after 3 weeks. Four patients (16%) required 3 consecutive treatments from which 2 patients (8%) showed slight improvement and one patient (4%) no improvement. No major complications were associated with this procedure except the formation of a white scar in two patients that became inconspicuous after 3 months. Minor complications included skin irritation and edema immediately after the treatment, which resolved within 2-3 days without intervention. Hand cautery is a very safe, effective and inexpensive tool for the treatment of facial telangiectasias. It is simple, cheap, and requires minimal training, although it is limited to the treatment of more superficial and small lesions. We believe that this technique is suitable for office based setting. The advantage of using inexpensive and portable instruments will also be beneficial in developing counties where access to more expensive equipment is limited. Results are satisfactory but more patients are needed to validate the technique.
Full-text available
Rhinophyma is a severe late complication of rosacea, which is characterized by progressive hyperplasia of sebaceous glands and connective tissue involving the lower two-thirds of the nose. It can be an emotionally devastating disorder, and serve as a medium for occult cancers and other health problems. Many surgical treatments have been advocated, as well as dermabrasion and laser therapy. In light of the problems faced with these individual therapy modalities, we advocate a combination therapy of surgical debulking and fractionated Carbon dioxide laser therapy. By excising the tissue first, we not only decreased the amount of time needed for the procedure, we were also able to preserve a histopathologic specimen that can be examined for occult cancers. After debulking, the fractionated carbon dioxide laser is then used to blend. By using fractionated carbon dioxide, we avoided the complications associated with non-fractionated carbon dioxide lasers, such as delayed healing times, hypopigmentation, hyperpigmentation, scarring, and persistent redness. We report our experience in two patients with rhinophyma who underwent a combination of surgical excision and fractional Co2 laser therapy for treatment. Pre- and postoperative protocols and treatment parameters are discussed. Both patients had excellent cosmetic and functional results and were followed for at least one year.
Full-text available
Background and Objectives Alopecia areata is a common disease of unknown etiology; it causes significant cosmetic and psycho-social distress for most of the people it affects. We report on an innovative form of treatment in two patients with typical alopecia areata on the capillitium.Study Design/Patients and Methods We successfully treated two patients whose alopecia areata had worsened progressively for 3 and 14 weeks. The treatment involved the use of a 308 nm xenon chloride excimer laser (dosage 300–2,300 mJ/cm2 per session).ResultsAfter 11 and 12 sessions within a 9-week and 11-week period, the entire affected focus showed homogenous and thick regrowth. No relapse was observed during the follow-up period of 5 and 18 months.Conclusions The use of the excimer laser is an effective, elegant, and safe means of treatment and has good tolerability. Analogous to topical treatment of alopecia areata, the immunosuppressive mechanism of the excimer laser can be interpreted as an induction of T-cell apoptosis. This new means of treatment has yet to be discussed in medical literature. Further studies with greater numbers are needed to assess its potential more precisely and evaluate the excimer laser in treating alopecia areata. Lasers Surg. Med. 34:86–90, 2004. © 2004 Wiley-Liss, Inc.
Full-text available
Low-level laser therapy has evidence accumulating about its effectiveness in a variety of medical conditions. We reviewed 51 double blind randomized controlled trials (RCTs) of laser treatment. Analysis revealed 58% of trials showed benefit of laser over placebo. However, less than 5% of the trials had addressed beam disguise or allocation concealment in the laser machines used. Many of the trials used blinding methods that rely on staff cooperation and are therefore open to interference or bias. This indicates significant deficiencies in laser trial methodology. We report the development and preliminary testing of a novel laser machine that can blind both patient and operator to treatment allocation without staff participation. The new laser machine combines sealed preset and non-bypassable randomization codes, decoy lights and sound, and a conical perspex tip to overcome laser diode glow detection.
Full-text available
OBJECTIVE: Low-level laser therapy (LLLT) has been promoted for its beneficial effects on tissue healing and pain relief. However, according to the results of in vivo studies, the effectiveness of this modality varies. Our purpose was to assess the putative effects of LLLT on healing using an experimental wound model. DESIGN AND SETTING: We used a randomized, triple-blind, placebo-controlled design with 2 within-subjects factors (wound and time) and 1 between-subjects factor (group). Data were collected in the laboratory setting. SUBJECTS: Twenty-two healthy subjects (age = 21 +/- 1 years, height = 175.6 +/- 9.8 cm, mass = 76.2 +/- 14.2 kg). MEASUREMENTS: Two standardized 1.27-cm(2) abrasions were induced on the anterior forearm. After wound cleaning, standardized digital photos were recorded. Each subject then received LLLT (8 J/cm(2); treatment time = 2 minutes, 5 seconds; pulse rate = 700 Hz) to 1 of the 2 randomly chosen wounds from either a laser or a sham 46-diode cluster head. Subjects reported back to the laboratory on days 2 to 10 to be photographed and receive LLLT and on day 20 to be photographed. Data were analyzed for wound contraction (area), color changes (chromatic red), and luminance. RESULTS: A group x wound x time interaction was detected for area measurements. At days 6, 8, and 10, follow-up testing revealed that the laser group had smaller wounds than the sham group for both the treated and the untreated wounds (P < .05). No group x wound x time differences were detected for chromatic red or luminance. CONCLUSIONS: The LLLT resulted in enhanced healing as measured by wound contraction. The untreated wounds in subjects treated with LLLT contracted more than the wounds in the sham group, so LLLT may produce an indirect healing effect on surrounding tissues. These data indicate that LLLT is an effective modality to facilitate wound contraction of partial-thickness wounds.
Acne keloidalis nuchae is usually treated with oral antibiotics, local antiseptics or intralesional steroids but with limited success. I assessed the efficacy of diode laser for treating the inflammatory and keloidal papules of acne keloidalis nuchae in two cases. The lesions in both the cases showed about 90 to 95% clearance after 4 treatment sessions at one to one and half month intervals. No new lesions were observed during the follow up period of six months after the last laser treatment. Thus, after clearing bacterial infection, laser hair epilation can be used as the first line of therapy for treating papules of acne keloidalis nuchae. This is the first attempt at treating acne keloidalis nuchae with a diode laser.