Dye Laser Applications in Cosmetic Dermatology: Efficacy and Safety in Treating Vascular Lesions and Scars

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript entitled "Dye laser applications in cosmetic dermatology" presents a known yet still interesting topic. Due to a variety of indications that can be ameliorated using the FPDL, knowledge about the therapeutic potential remains crucial.

You have clearly presented suitable indications for FPDL treatment as well as what can be expected as a realistic treatment result.

The methodology is suitable and most importantly includes the patients' perspective.

The results are discussed appropriately and therapeutic adjuncts and alternatives are presented according to the latest scientific evidence and clinical practice.

Clinical photographs are of excellent quality and the results presented are good.

I will recommend the manuscript for publication though I would change one issue:

The subjective treatment results as evaluated by the patients includes the classifications of 'unsatisfied', 'not very satisfied', 'satisfied' and 'very satisfied'.

I would venture to say that 'not very satisfied' is not appropriately named. Within the proposed ranking between 'unsatisfied' and 'satisfied', logically, it should either be 'neutral' or another term appropriately describing limited satisfaction but not dissatisfaction with the treatment results.

Apart from that, thank you for the great manuscript.

Author Response

REVIEWER 1 

 

R:  i would venture to say that 'not very satisfied' is not appropriately named. Within the proposed ranking between 'unsatisfied' and 'satisfied', logically, it should either be 'neutral' or another term appropriately describing limited satisfaction but not dissatisfaction with the treatment results. Apart from that, thank you for the great manuscript.

A: The classifications of 'unsatisfied,' 'not very satisfied,' 'satisfied,' and 'very satisfied' have been revised to: 'unsatisfied,' 'moderately satisfied,' 'satisfied,' and 'very satisfied' to more accurately describe limited satisfaction without implying dissatisfaction with the treatment results.

Reviewer 2 Report

Comments and Suggestions for Authors

This paper presents a good foundation on the use of flash-lamp pulsed-dye laser (FPDL) in cosmetic dermatology. However, there are areas for improvement to strengthen its impact and suitability for publication.

The current title is somewhat misleading as it says it focuses on "cosmetic dermatology" while the study addresses conditions that can have significant medical and psychological impacts albeit of some aesthetic concern. I suggest the following alternative title instead:  Efficacy and Safety of Flash-Lamp Pulsed-Dye Laser in Treating Vascular Lesions and Scars: This title is straightforward and accurately describes the study's focus.

Strengths:

• Clear Focus: The paper clearly focuses on the application of FPDL for a variety of skin concerns.
• Clinical Relevance: The study addresses common concerns like telangiectasia, port-wine stains, and scars, making it relevant to dermatological practice.
• Detailed Methodology: The methodology is well-described, including patient selection, laser parameters, and outcome assessment.
• Patient-Centric Approach: The inclusion of patient satisfaction surveys highlights the importance of patient perspectives in these procedures.
• Combination Therapy Discussion: The paper acknowledges the potential of combining FPDL with other modalities like fractional CO₂ laser, opening avenues for future research.

Weaknesses:

• Limited Novelty: While the study provides valuable clinical data, it largely confirms existing knowledge about FPDL's efficacy and safety. The paper needs to highlight its unique contribution more explicitly. Is it the specific combination of conditions treated, the detailed analysis of patient satisfaction in this population, or the refined treatment protocols?
• Lack of Statistical Analysis: The results primarily present descriptive statistics. Statistical analysis for satisfaction levels across different conditions would strengthen the conclusions and provide more robust evidence.
• Limited Follow-Up: The study mentions follow-up at 8 weeks post-treatment. Longer-term follow-up data would provide valuable insights into the longevity of results and potential for recurrence.
• Confusing Information: The introduction mentions the use of confocal microscopy, but this is not elaborated upon in the methodology or results. This discrepancy should be addressed.
• Clarity and Conciseness: Some sections, particularly the discussion, could be more concise and focused. Streamlining the arguments and avoiding repetition would improve readability.
• Language and Style: While generally well-written, some minor grammatical errors and inconsistencies in style should be corrected before submission.

Areas for Improvement:

• Highlight the Unique Contribution: Clearly state the novel aspects of this study compared to existing literature. This should include the specific patient population, the range of conditions treated, or the detailed analysis of treatment parameters and patient satisfaction.
• Statistical Analysis: Perform statistical analysis to support the findings and draw more robust conclusions about the efficacy and safety of FPDL.
• Longer-Term Follow-Up: Include data on longer-term follow-up data to assess the durability of results.
• Confocal Microscopy: Clarify the role of confocal microscopy. If it was used, include the findings in the results. If not, remove the mention from the introduction.
• Refine the Discussion: Focus the discussion on the key findings, their implications, and comparisons with existing literature. Avoid repetition and ensure a clear and concise narrative.
• Thorough Proofreading: Carefully proofread the manuscript to correct any grammatical errors, typos, and inconsistencies in style.

I believe by addressing these weaknesses and implementing the suggested improvements, the authors can significantly enhance the paper's quality and increase its suitability for publication.

Comments on the Quality of English Language

as stated above

Author Response

REVIEWER 2

 

R: I suggest the following alternative title instead:  Efficacy and Safety of Flash-Lamp Pulsed-Dye Laser in Treating Vascular Lesions and Scars: This title is straightforward and accurately describes the study's focus.

A: The title has been revised to better reflect the content of the article as: 'Dye Laser Applications in Cosmetic Dermatology: Efficacy and Safety in Treating Vascular Lesions and Scars.

 

R: Highlight the Unique Contribution: Clearly state the novel aspects of this study compared to existing literature. This should include the specific patient population, the range of conditions treated, or the detailed analysis of treatment parameters and patient satisfaction.

A:We have highlighted our unique contribution by presenting a refined treatment protocol combined with meticulous patient selection to achieve optimal results and the optimal scheduling time based on our experience (lines 263-268)

 

R:Statistical Analysis: Perform statistical analysis to support the findings and draw more robust conclusions about the efficacy and safety of FPDL.

A:In this study, we present only a descriptive statistical analysis; however, we will consider incorporating more robust statistical analyses in future works.

 

R:Limited Follow-Up: The study mentions follow-up at 8 weeks post-treatment. Longer-term follow-up data would provide valuable insights into the longevity of results and potential for recurrence.

A:We have included a longer-term follow-up (line 157-158).

 

R:Confusing Information: The introduction mentions the use of confocal microscopy, but this is not elaborated upon in the methodology or results. This discrepancy should be addressed.

A:We have removed mentions of the use of confocal microscopy. (lines 50-53)

 

R:Clarity and Conciseness: Some sections, particularly the discussion, could be more concise and focused. Streamlining the arguments and avoiding repetition would improve readability.

A:We have removed repetitions from the introduction (lines 55-57)

We have modified certain sections of the discussion and eliminated some repetitions.

 

 

Reviewer 3 Report

Comments and Suggestions for Authors

Dear Authors,

In my opinion, the paper does not present anything new; papers of this type were published in the 1990s. And the laser has been described as useful in the treatment of telangiectasias or rosacea. I ask the authors to indicate the novelty aspect and to emphasise it clearly in the paper.

The title of the paper suggests a review, not an original (research) paper.

The abstract of the paper should also be corrected to better reflect the content.

I suggest that the introduction to the paper should provide hard evidence for the effectiveness of the laser and the rationale for choosing this therapy to treat the skin problems indicated in the paper. When citing studies that specifically confirm the effectiveness of the method, the author should be cited. It is worth describing the mechanism of action correctly, as this will influence the choice of research group.

Figure 1. Is this the author's own work or a photograph taken from a source? It should be described. In addition, the figure should be introduced at the place in the paper where it should be looked at. Introducing the figure in the introduction section is not justified in this case.

Please describe the selection of the research group. Inclusion and exclusion criteria.

Please include the bioethics committee approval number.

Please state in the methodology section of the paper why sometimes there were 8 treatments of laser used and sometimes only 1. This is important for the evaluation of the paper.

Please describe how many patients were classified into each disease (skin problem), this is not clearly defined. It is not adequately tabulated.

The photos in the paper show the faces of the participants. Do the authors have permission to publish the images of the people in the photos? If not, the paper cannot be published in this form. It is unethical. People in the photos may be recognizable.

Which steroid cream was used? At what time of year were the treatments carried out? Was sunscreen used? Which antibacterial ointment was used?

In my opinion, the methodology in the paper is incomplete and should be thoroughly supplemented. I do not have the opportunity to repeat the study using these parameters. In what time frame were the studies carried out?

The results are basically just photos and a short description. What about the clinical evaluation? What was found? What were the deviations from the presumed protocol?

I would like to emphasise once again that I do not consider the inclusion of photographs in the discussion and in the introduction to be justified.

The discussion on the aspect of writing about selectivity and translating this into safety is, in my opinion, unjustified (lines 182-185). Instead of writing "the latest studies", please quote the author.

The discussion should refer to the results of other authors, as the use of this type of laser has been the subject of numerous considerations.

The authors evaluated 71 patients and presented only 5 cases in the paper. Why? The work should be divided appropriately and the case should be considered representative of the group. Produce robust supplementary material to document your results.

In reality, the paper is not a comprehensive review, but a collection of case studies, and in my opinion, it cannot be published in this form. I suggest you reject it, correct it and resubmit it as a new proposal for re-evaluation.

Kind Regards

Author Response

REVIEWER 3

 

 

R: The title of the paper suggests a review, not an original (research) paper.

A: The title has been revised to better reflect the content of the article as: 'Dye Laser Applications in Cosmetic Dermatology: Efficacy and Safety in Treating Vascular Lesions and Scars.

 

R: I ask the authors to indicate the novelty aspect and to emphasise it clearly in the paper.

A: We have highlighted our unique contribution by presenting a refined treatment protocol combined with meticulous patient selection to achieve optimal results and the optimal scheduling time based on our experience (lines 263-268)

 

R: The photos in the paper show the faces of the participants. Do the authors have permission to publish the images of the people in the photos? If not, the paper cannot be published in this form. It is unethical. People in the photos may be recognizable.

A: We have covered faces in Figures 6 and 7.

 

R: Is this the author's own work or a photograph taken from a source? .F I would like to emphasise once again that I do not consider the inclusion of photographs in the discussion and in the introduction to be justified.

A: The figures 1-2, and 6-7 have been moved to the Results section. All figures are author’s own work.

 

R: Please state in the methodology section of the paper why sometimes there were 8 treatments of laser used and sometimes only 1. This is important for the evaluation of the paper.

A: We have specified the rationale for performing an additional treatment ( lines 121-122)

 

R: The discussion on the aspect of writing about selectivity and translating this into safety is, in my opinion, unjustified (lines 182-185). Instead of writing "the latest studies", please quote the author.

A: Although the dye laser is considered a safe treatment due to its selectivity, we have rephrased the sentence to avoid directly linking the two concepts (line 205-206)

 

R: Which steroid cream was used? At what time of year were the treatments carried out? Was sunscreen used? Which antibacterial ointment was used?

A: We have specified the antibiotic cream used (line 115) We have specified the time of year during which these treatments were performed and the application of sunscreen (lines 117-118)

 

Other improvements:

A: We have included a longer-term follow-up (line 157-158).

We have removed mentions of the use of confocal microscopy. (lines 50-53)

We have removed repetitions from the introduction (lines 55-57)

We have modified certain sections of the discussion and eliminated some repetitions.

 

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

It is difficult to make a decision based on this current version. please upload a final corrected and complete version for a final review without showing track changes.

Author Response

We have uploaded the final version without revisions.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Dear Authors,

Please clarify whether the unique contribution is a novel concept? It may be the approach, the methodology employed in the delivery of therapy, or a novel technique that you have introduced, nut not a  unique contribution. Please endeavor to enhance this aspect.

It is recommended that the photographic material be improved so that the patients cannot be recognised. This may be achieved by cropping the photos or introducing stripes covering the eyes.

 

I believe the figures in the description should be identified as the author's own material. It should be described as "author materials".

The rationale for the number of treatments (lines 121-122) is inadequate and unsatisfactory. It is essential to ensure that the methodology is clearly delineated in order to draw valid conclusions regarding the effectiveness of the proposed approach. Decisions about using one or several treatments are crucial and should be described more clearly. 

Fusidic acid has the potential to cause phototoxic reactions and, therefore, should be avoided in patients with the characteristics described in your case. The frequency of photoprotection application has not been defined. The interval between the protocols has not been defined. It would be beneficial to standardise and present the data in tabular form. The methodology is not sufficiently clear. It should be presented in a way that eliminates any potential ambiguity, and allows for the study to be repeated in an external research centre.

The article has gained considerably in value; however, it would benefit from further enhancements. These include supplementing the methodology and improving the discussion by incorporating references to the works of other authors who have corroborated the data presented. As previously suggested, these data are already well-established, and your work effectively documents and compiles the lasers applications. It would be beneficial to review other studies and compare the protocols employed therein with those used in your own work, as this represents a novel contribution to the field. Please give this suggestion due consideration.

A significant further revision is recommended.

Author Response

R: Please clarify whether the unique contribution is a novel concept? It may be the approach, the methodology employed in the delivery of therapy, or a novel technique that you have introduced, nut not a  unique contribution. Please endeavor to enhance this aspect.

A: We believe that in lines 229-234, we provide an explanation of our approach, emphasizing the importance of patient selection and optimized parameters, including overlap pulses, which are often not mentioned in the literature

R: It is recommended that the photographic material be improved so that the patients cannot be recognised. 

A: We have improved the photographic material to ensure that patients are not recognizable.

R: The rationale for the number of treatments (lines 121-122) is inadequate and unsatisfactory. It is essential to ensure that the methodology is clearly delineated in order to draw valid conclusions regarding the effectiveness of the proposed approach. Decisions about using one or several treatments are crucial and should be described more clearly. 

A: We believe that in lines 106-111, we adequately described the method used to decide whether to perform an additional treatment. However, we are unsure which specific aspect you would like us to describe in greater detail.

 

 

 

Round 3

Reviewer 2 Report

Comments and Suggestions for Authors

Easier to read now

Formatting corrections: Suggest making sure table 1 starts at the beginning /top of the page of the each rather than being split on two pages as it's rather untidy

table 3 needs title sorting 

figure 5 needs updating to show final images in correct order 

Author Response

We have addressed the formatting issues and made the necessary corrections throughout the manuscript.

Reviewer 3 Report

Comments and Suggestions for Authors

Dear authors,

Your explanations are satisfactory. However, I suggest adding to the introduction, the purpose of the work, the brief information you have included in lines 229-234, this is important for the reader. The photographs have been corrected. However, you did not justify the number of procedures. This fact was passed over in silence, I do not know why. Was the number of procedures selected on the basis of data from the literature or in relation to other premises? If literature, then the references should be given in Table 1. If other premises, then an explanation should be provided in the methods section.

I propose to accept the paper after adding these corrections.

Kind Regards

Author Response

We have included the purpose of the work in the introduction (lines 64–72) and specified that the number of procedures was determined based on our clinical experience and the clinical and multispectral evaluations conducted at each follow-up visit (lines 115–118).