This study tests two types of lasers (ND YAG 1064 short and ultra-short pulses) to treat hyperchromic skin lesions secondary to venous hypertension (stasis dermatitis)
Women or men aged 18 to 89 years with stasis dermatitis secondary to venous hypertension
Agreement with the terms of the survey and signing of the informed consent form
Availability to make the necessary appointments for treatment and follow-up
Provide consent to avoid pregnancy during treatment
Men and women with CEAP 2 to 6, low mobility, no stasis dermatitis.
Peripheral arterial disease.
History of known allergy to the drugs used in this study
Presence of other types of dermatitis in the lower extremities, such as allergic stasis eczema.
Parallel
short-pulse ND: YAG 1064 laser
Procedure/SurgeryNd: YAG 1064 nm short pulse laser (5 nanoseconds), 4 mm spot size, from 100 to 1000 mJ total energy, treatment scheduled for six visits with pre-defined dates, with intervals of 28 to 35 days. The device will be Omer Smart, a Q-Switch Laser produced by Medical San (Lajeado, RS, Brazil).
ultra-short-pulse ND: YAG 1064 laser
Procedure/SurgeryNd: YAG1064 nm ultra-short pulse laser (400 picoseconds), 2 to 10 mm spot size, from 100 to 1000 mJ total energy, treatment scheduled for 6 visits with pre-defined dates, with intervals of 28 to 35 days. The device will be Omer Premium, a picolaser produced by Medical San (Lajeado, RS, Brazil).
cold cream
DrugThe control vehicle is a cold cream, supplied by HERVA'S manipulation pharmacy. The composition of cold cream will be beeswax, acetyl palmitate, BHA, cetearyl alcohol, propylparaben, and water. This topical agent will be applied to patients daily throughout the treatment period. It is scheduled for six visits with pre-defined dates, with intervals of 28 to 35 days.
Colorimetry
The skin tone dissimilarity (expressed as ΔE) at treated and adjacent areas measured with digital calorimetry. The ΔE value derives from the differences in the International Commission on Illumination L\*a\*b\* (CIELAB) color space. It is a structured approach to quantifying color differences, with specific intervals indicating varying levels of perceptibility with different intensities of pigmentation: * 0 \< ∆E \< 1 - the difference is unnoticeable * 1 \< ∆E\< 2 - the difference is only noticed by an experienced observer (mild), * 2 \< ∆E \< 3.5 - the difference is also noticed by an inexperienced observer (light), * 3.5 \< ∆E \< 5 - the difference is noticeable (moderate), * 5 \< ∆E - gives the impression that these are two different colors (intense) In all sessions, patients will be submitted to colorimetric analysis. The ∆E is the skin color difference between the treated and adjacent areas.
Photographic analysis
The co-primary outcome will be the incidence of post-procedure skin hyperpigmentation improvement after six treatment sessions, evaluated through before-and-after photo documentation analysis by three experienced, independent, and blind observers. All the evaluators will have access to high-definition before-and-after pictures of the patient's legs that were designated for them. Then, according to their expertise, they will answer the question, "Do you think there's post-treatment improvement in hyperpigmentation in the treated areas of this limb, yes or no?" for the affected limb. The answers chosen by most of the evaluators will be considered for data analysis.
Number of participants with treatment-related adverse events as assessed by clinical evaluation.
Safety analysis will be carried out by clinical evaluation in all pre-scheduled visits. It includes clinical analysis of potential skin alterations such as abnormal redness, swelling, temporary changes in skin pigmentation (hyper- or hypopigmentation), petechia, scarring, or burns. It will be reported as the number of participants with treatment-related adverse events.
DLQI - quality-of-life
The DLQI will be applied in the baseline and final visits and includes 10 questions: 1. Symptoms: How itchy, sore, painful, or stinging the skin has been. 2. Embarrassment: How embarrassed or self-conscious one has been due to their skin. 3. Daily Activities: How much has the skin condition interfered with shopping, home care, or gardening? 4. Clothing: How much has the skin condition influenced the clothes worn? 5. Social/Leisure: How much has the skin condition affected social or leisure activities? 6. Sport: How much the skin condition has made it difficult to do sports. 7. Work/Study: Whether the skin condition has prevented working or studying, and if not, how much it has been a problem. 8. Personal Relationships: How much the skin condition has created problems with close relationships. 9. Sex: How much the skin condition has caused sexual difficulties. 10. Treatment: How much the treatment for the skin condition has been a problem, considering factors like time or mess.
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