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Tempark T, Lueangarun S, Chatproedprai S, Panchaprateep R, Pongprutthipan M, Wananukul S. Sun protection behavior and knowledge of patients attending laser clinic to prevent adverse events of laser: A cross-sectional, single-center, tertiary care study. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2018; 34:374-386. [DOI: 10.1111/phpp.12400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/05/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Therdpong Tempark
- Division of Dermatology; Department of Pediatrics; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
| | - Suparuj Lueangarun
- Division of Dermatology; Chulabhorn International College of Medicine; Thammasat University; Pathumthani Thailand
| | - Susheera Chatproedprai
- Division of Dermatology; Department of Pediatrics; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
| | - Ratchathorn Panchaprateep
- Division of Dermatology; Department of Medicine; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
| | - Marisa Pongprutthipan
- Division of Dermatology; Department of Medicine; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
| | - Siriwan Wananukul
- Division of Dermatology; Department of Pediatrics; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
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Datz E, Schönberger C, Zeman F, Koller M, Berneburg M, Landthaler M, Karrer S, Hohenleutner U, Hohenleutner S. Fractional carbon dioxide laser resurfacing of skin grafts: long-term results of a prospective, randomized, split-scar, evaluator-blinded study. Lasers Surg Med 2018; 50:1010-1016. [DOI: 10.1002/lsm.22950] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Elisabeth Datz
- Department of Dermatology; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Carmen Schönberger
- Department of Dermatology; University Medical Centre Regensburg; 93042 Regensburg Germany
- Operative Dentistry and Periodontology; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Florian Zeman
- Centre for Clinical Studies; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Michael Koller
- Centre for Clinical Studies; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Mark Berneburg
- Department of Dermatology; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Michael Landthaler
- Department of Dermatology; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Sigrid Karrer
- Department of Dermatology; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Ulrich Hohenleutner
- Department of Dermatology; University Medical Centre Regensburg; 93042 Regensburg Germany
| | - Silvia Hohenleutner
- Department of Dermatology; University Medical Centre Regensburg; 93042 Regensburg Germany
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Meesters AA, Nieboer MJ, Kezic S, de Rie MA, Wolkerstorfer A. Parameters in fractional laser assisted delivery of topical anesthetics: Role of laser type and laser settings. Lasers Surg Med 2018; 50:813-818. [DOI: 10.1002/lsm.22936] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Arne A. Meesters
- Department of Dermatology; Netherlands Institute for Pigment Disorders; Academic Medical Center; University of Amsterdam; NL-1105 AZ, Amsterdam The Netherlands
| | - Marilin J. Nieboer
- Department of Dermatology; Netherlands Institute for Pigment Disorders; Academic Medical Center; University of Amsterdam; NL-1105 AZ, Amsterdam The Netherlands
| | - Sanja Kezic
- Coronel Institute of Occupational Health; Academic Medical Center; University of Amsterdam; NL-1105 AZ, Amsterdam The Netherlands
| | - Menno A. de Rie
- Department of Dermatology; Academic Medical Center; University of Amsterdam; NL-1105 AZ, Amsterdam The Netherlands
- Department of Dermatology; VU Medical Center; VU University; NL-1081 HV, Amsterdam The Netherlands
| | - Albert Wolkerstorfer
- Department of Dermatology; Netherlands Institute for Pigment Disorders; Academic Medical Center; University of Amsterdam; NL-1105 AZ, Amsterdam The Netherlands
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Clinical and Histological Evaluations of Enlarged Facial Skin Pores After Low Energy Level Treatments With Fractional Carbon Dioxide Laser in Korean Patients. Dermatol Surg 2018; 44:405-412. [DOI: 10.1097/dss.0000000000001313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lueangarun S, Tempark T. Efficacy of MAS063DP lotion vs 0.02% triamcinolone acetonide lotion in improving post-ablative fractional CO2
laser resurfacing wound healing: a split-face, triple-blinded, randomized, controlled trial. Int J Dermatol 2018; 57:480-487. [DOI: 10.1111/ijd.13922] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 12/27/2017] [Accepted: 01/01/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Suparuj Lueangarun
- Division of Dermatology; Chulabhorn International College of Medicine; Thammasat University; Amphur Klongluang Pathumthani Thailand
| | - Therdpong Tempark
- Department of Pediatrics; Faculty of Medicine; Chulalongkorn University; Pathumwan Bangkok Thailand
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Silpa-Archa N, Kohli I, Chaowattanapanit S, Lim HW, Hamzavi I. Postinflammatory hyperpigmentation: A comprehensive overview: Epidemiology, pathogenesis, clinical presentation, and noninvasive assessment technique. J Am Acad Dermatol 2017; 77:591-605. [PMID: 28917451 DOI: 10.1016/j.jaad.2017.01.035] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/13/2017] [Accepted: 01/22/2017] [Indexed: 01/19/2023]
Abstract
Postinflammatory hyperpigmentation (PIH) commonly occurs after various endogenous and exogenous stimuli, especially in dark-skinned individuals. PIH is one of the most common complications of procedures performed using laser and other light sources. The severity of PIH is determined by the inherent skin color, degree and depth of inflammation, degree of dermoepidermal junction disruption, inflammatory conditions, and the stability of melanocytes, leading to epidermal and dermal melanin pigment deposition. The depth of melanin pigment is the key factor to predict prognosis and treatment outcome. Epidermal hyperpigmentation fades more rapidly than dermal hyperpigmentation. Various inflammatory disorders can eventually result in PIH. The evaluation of pigmentation using noninvasive tools helps define the level of pigmentation in the skin, pigmentation intensity, and guides therapeutic approaches. This first article in this 2-part series discusses the epidemiology, pathogenesis, etiology, clinical presentation, differential diagnoses, and investigation using noninvasive assessment techniques that objectively determine the details of pigmentation.
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Affiliation(s)
- Narumol Silpa-Archa
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan; Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Indermeet Kohli
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Suteeraporn Chaowattanapanit
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan; Department of Medicine, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.
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Fractional carbon dioxide laser for the treatment of facial atrophic acne scars: prospective clinical trial with short and long-term evaluation. Lasers Med Sci 2017; 32:2047-2054. [PMID: 28894992 DOI: 10.1007/s10103-017-2322-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
The aim of this study was to evaluate the efficacy and safety of fractional carbon dioxide laser for the treatment of acne scars. Thirty-one participants, 15 female and 16 male, whose mean age was 34.84 ± 10.94 years, were included in this prospective study. The study took place between 2012 and 2016. Participants were evaluated with the "ECCA Grading Scale" before the first session, 3 months (short-term evaluation) and 3 years after the last session (long-term evaluation). Participants received two or three treatment sessions at 4-week intervals, with a 10,600 nm fractional carbon dioxide laser with pulse energies ranging between 100 and 160 mJ, 120 spot type, 75-100 spot/cm2 density, and 30 W power. Self-assessments by the participants were done 3 months and 3 years after the last session. The mean ECCA score was 107.90 ± 39.38 before the first session, and 82.17 ± 36.23 at the time of short-term evaluation (p = 0.000). The grade of improvement at the short-term evaluation was as follows: no improvement, mild, moderate, and significant improvement for 7 (22.6%), 11 (35.5%), 9 (29%), and 4 (12.9%) of the participants, respectively. Regarding self-assessments, 80.6 and 61.3% of the participants rated themselves as having at least mild improvement at the short-term and the long-term follow-up periods, respectively. The results of this study suggest that fractional carbon dioxide laser is an efficient treatment option for acne scars. Furthermore, self-assessment results show that more than half of the participants still experience at least mild improvement at the end of 3 years.
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Treatment of Facial Acne Scarring With Fractional Carbon Dioxide Laser in Asians, a Retrospective Analysis of Efficacy and Complications. Dermatol Surg 2017; 43:1137-1143. [PMID: 28746258 DOI: 10.1097/dss.0000000000001219] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Fractional carbon dioxide (CO2) laser resurfacing unites the idea of fractional photothermolysis with an ablative 10,600-nm wavelength. This technology permits effective treatment of acne scarring, with shorter recovery and a decreased side effect profile as compared to traditional CO2 laser resurfacing. OBJECTIVE The aims of this study were to study the efficacy and safety of fractional CO2 laser for acne scars in Asian patients. METHODS This was a retrospective study of all patients treated with the fractional CO2 laser for facial acne scarring between January 2, 2008, and December 31, 2010, at the National Skin Centre, Singapore. Data reviewed included sex, age, and severity of acne, type of scarring, previous treatment history, frequency of treatments, adverse events, and efficacy. RESULTS Two hundred and ten fractional CO2 laser treatments for facial acne scars were performed on 107 patients (65 men and 42 women, Fitzpatrick skin Types II to V) during the study period. Sixteen of 107 patients experienced (15.0%) adverse events. The adverse events include hyperpigmentation (6.4%), blistering (4.0%), crusting (2.9%), aggravation of inflammatory acne lesions (1.7%), and scarring (0.6%). There were no reported side effects of hypopigmentation, bacterial or viral infection. Follow-up results after final laser treatment showed that 66.4% of patients reported Grade 1 skin texture improvement, that is, <25% (n = 71); 30.0% had Grade 2 improvement, that is, 25% to 50% improvement (n = 31); 3.7% had Grade 3 improvement, that is, 51% to 75% improvement (n = 4); and 0.9% had Grade 4 improvement, that is, >75% improvement (n = 1). CONCLUSION The study demonstrated the efficacy and safety of a fractional CO2 laser in the treatment of acne scars in Asian. Future studies are required to establish optimum treatment parameters and achieve better clinical results.
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Thanasarnaksorn W, Siramangkhalanon V, Duncan DI, Belenky I. Fractional ablative and nonablative radiofrequency for skin resurfacing and rejuvenation of Thai patients. J Cosmet Dermatol 2017; 17:184-192. [DOI: 10.1111/jocd.12413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Wilai Thanasarnaksorn
- Division of Dermatology; Faculty of Medicine; Ramathibodi Hospital, Mahidol University; Bangkok Thailand
- Doctor Younger Clinic; Bangkok Thailand
| | | | | | - Inna Belenky
- Clinical Department; Viora Inc.; New York NY USA
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DeBruler DM, Blackstone BN, Baumann ME, McFarland KL, Wulff BC, Wilgus TA, Bailey JK, Supp DM, Powell HM. Inflammatory responses, matrix remodeling, and re-epithelialization after fractional CO 2 laser treatment of scars. Lasers Surg Med 2017; 49:675-685. [PMID: 28489283 DOI: 10.1002/lsm.22666] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Fractional CO2 laser therapy has been used to improve scar pliability and appearance; however, a variety of treatment protocols have been utilized with varied outcomes. Understanding the relationship between laser power and extent of initial tissue ablation and time frame for remodeling could help determine an optimum power and frequency for laser treatment. The characteristics of initial injury caused by fractional CO2 laser treatment, the rates of dermal remodeling and re-epithelialization, and the extent of inflammation as a function of laser stacking were assessed in this study in a porcine scar model. MATERIALS AND METHODS Full-thickness burn wounds were created on female Red Duroc pigs followed by immediate excision of the eschar and split-thickness autografting. Three months after injury, the resultant scars were treated with a fractional CO2 laser with 70 mJ of energy delivered as either a single pulse or stacked for three consecutive pulses. Immediately prior to laser treatment and at 1, 24, 96, and 168 hours post-laser treatment, transepidermal water loss (TEWL), erythema, and microscopic characteristics of laser injury were measured. In addition, markers for inflammatory cytokines, extracellular matrix proteins, and re-epithelialization were quantified at all time points using qRT-PCR. RESULTS Both treatments produced erythema in the scar that peaked 24 hours after treatment then decreased to basal levels by 168 hours. TEWL increased after laser treatment and returned to normal levels between 24 and 96 hours later. Stacking of the pulses did not significantly increase the depth of ablated wells or extend the presence of erythema. Interleukin 6 and monocyte chemoattractant protein-1 were found to increase significantly 1 hour after treatment but returned to baseline by 24 hours post laser. In contrast, expression of transforming growth factor β1 and transforming growth factor β3 increased slowly after treatment with a more modest increase than interleukin 6 and monocyte chemoattractant protein-1. CONCLUSIONS In the current study, the properties of the ablative zones were not directly proportional to the total amount of energy applied to the porcine scars with the use of triple stacking, resulting in only minor increases to microthermal zone (MTZ) depth and width versus a single pulse. Re-epithelialization and re-establishment of epidermal barrier function were observed in laser treated scars by 48 hours post therapy. Finally, many of the inflammatory genes up-regulated by the laser ablation returned to baseline within 1 week. As a whole, these results suggest that microthermal zones created by FXCO2 treatment re-epithelialize rapidly with the inflammatory response to the laser induced injury largely resolved within 1 week post treatment. Further study is needed to understand the relationship between laser stacking and MTZ properties in human scars in order to evaluate the clinical applicability of the stacking technique. Lasers Surg. Med. 49:675-685, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Danielle M DeBruler
- Department of Materials Science and Engineering, The Ohio State University, Columbus, Ohio
| | - Britani N Blackstone
- Department of Materials Science and Engineering, The Ohio State University, Columbus, Ohio
| | - Molly E Baumann
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | - Kevin L McFarland
- Department of Research, Shriners Hospitals for Children, Cincinnati, Ohio
| | - Brian C Wulff
- Department of Pathology, The Ohio State University, Columbus, Ohio
| | - Traci A Wilgus
- Department of Pathology, The Ohio State University, Columbus, Ohio
| | - J Kevin Bailey
- Department of Surgery, Division of Critical Care, Trauma and Burns, The Ohio State University, Columbus, Ohio
| | - Dorothy M Supp
- Department of Research, Shriners Hospitals for Children, Cincinnati, Ohio.,Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Heather M Powell
- Department of Materials Science and Engineering, The Ohio State University, Columbus, Ohio.,Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
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Dai R, Xie H, Hua W, Li XH, Li L. The efficacy and safety of the fractional radiofrequency technique for the treatment of atrophic acne scar in Asians: A meta-analysis. J COSMET LASER THER 2017; 19:337-344. [PMID: 28388236 DOI: 10.1080/14764172.2017.1314507] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Ru Dai
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Heng Xie
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Wei Hua
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Xiao-hua Li
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Li Li
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, P.R. China
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Cohen SR, Goodacre A, Lim S, Johnston J, Henssler C, Jeffers B, Saad A, Leong T. Clinical Outcomes and Complications Associated with Fractional Lasers: A Review of 730 Patients. Aesthetic Plast Surg 2017; 41:171-178. [PMID: 28032173 DOI: 10.1007/s00266-016-0767-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Fractional lasers were introduced to provide increased safety, while maintaining high efficacy and patient satisfaction. Patients with virtually all Fitzpatrick skin types could be safely treated using a wide spectrum of wavelengths and a broad array of skin conditions, and aging could be addressed. Although safety studies have been reported for ablative CO2 and erbium lasers, surprisingly few data are available on adverse events and complications associated with fractional lasers. OBJECTIVE We report the frequency of adverse events, skin improvement and complications in a broad range of skin types using a standardized protocol that can be safely tailored to the patient's presenting complaints by varying the laser wavelength and number of treatments. MATERIALS AND METHODS The medical records of 730 patients (>90% females, age ranged from 50.5. to 59.9 years.) who had been treated at FACES+ Aesthetic Facility were reviewed. Patients were followed from 1 to 10 months and were reviewed to determine the frequency of complications, as well as their frequency, type, cause, treatment and resolution thereof. Patients were categorized by Fitzpatrick skin type (I-IV) to determine whether skin type was related to the frequency of complications. Improvement in skin condition (wrinkles, nasolabial folds and pigment) was rated by a technician before and after treatment using a Likert scale, 0-5, with 0 being no change and 5 being the most improvement. RESULTS Seven hundred thirty patients underwent procedures using fractional lasers in our center. Procedures were carried out with 3 different laser wavelengths, depending on the condition(s) treated (wrinkling vs. pigmentation issues, etc.) and the patients' desired length of downtime. The fractional Fraxel 1927-nm laser was used in 224 patients [Fitzpatrick skin type I (2.2%), II (38.4%), III (46.0%), IV (12.5%)]; the fractional Fraxel 1550-nm laser was used in 334 [type I (4.5%), II (31.9%), III (50.0%), IV (13.3%)], and the fractional Fraxel CO2 laser was used in 172 [type 1 (4.7%), II (49.7%), III (41.5%), IV (4.1%)]. The Fraxel CO2 laser showed greater improvement in wrinkles and naso-labial fold (p < 0.001). The greatest improvement in pigmentation was seen with the Fraxel 1927-nm laser (p < 0.001). Adverse events and complications occurred in 31 of 730 patients (4.2%). There was no significant difference in the rate of complications among the three treatments (p = 0.26). Complications were generally minor, and all resolved completely with treatment. Complications occurred in 4.0% of patients having the fractional Fraxel 1927-nm laser, 3.3% of patients having the fractional Fraxel 1550 nm and 6.4% of patients having the fractional Fraxel CO2 laser. Complications included 5 herpes simplex virus breakouts, 13 acne eruptions, 1 abrasion, 1 bacterial infection, 9 dermatitis, 1 drug eruption, 4 prolonged erythema, 1 hyperpigmentation, 1 increased swelling and 1 telangiectasia. There was no significant relationship between Fitzpatrick skin type and incidence of complications (p = 0.37). CONCLUSIONS Fractional lasers in general have reduced complication rates, while maintaining high degrees of patient satisfaction. Since their inception in early 2004, our clinic has utilized fractional lasers to treat patients from a variety of ethnic backgrounds and diverse skin types with an overall complication rate of 4.2%, all of which resolved. Comprehensive care of patients with facial aging is not limited to surgery alone and should include these types of strategies to appropriately and safely address photo-damage and photo-aging. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Fractional Erbium-Doped Yttrium Aluminum Garnet Laser Versus Microneedling in Treatment of Atrophic Acne Scars: A Randomized Split-Face Clinical Study. Dermatol Surg 2017; 43 Suppl 1:S47-S56. [DOI: 10.1097/dss.0000000000000951] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Karmisholt KE, Taudorf EH, Wulff CB, Wenande E, Philipsen PA, Haedersdal M. Fractional CO 2 laser treatment of caesarean section scars-A randomized controlled split-scar trial with long term follow-up assessment. Lasers Surg Med 2016; 49:189-197. [PMID: 27862066 DOI: 10.1002/lsm.22606] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Caesarean section (c-section) scars can be pose functional and cosmetic challenges and ablative fractional laser (AFXL) treatment may offer benefit to patients. We evaluated textural and color changes over time in AFXL-treated versus untreated control scars. MATERIALS AND METHODS A randomized, controlled, intra-individual split-scar trial with three sessions of AFXL-treatments for mature c-section scars. Settings of AFXL were adjusted to each individual scar. End-points were blinded on-site clinical evaluations at 1, 3, and 6 months follow-up (Patient and Observer Scar Assessment Scale [POSAS] and Vancouver Scar Scale [VSS]), blinded photo-evaluations, reflectance measurements, tissue histology, and patients satisfaction. RESULTS Eleven of 12 patients completed the study. At 1 month follow-up, AFXL-treated scars were significantly improved in pliability (POSAS P = 0.01 VSS P = 0.02) and smoother in surface relief (POSAS P = 0.03) compared to control scars. At 1-3 months, overall scar appearance was dominated by transient erythema and hyperpigmentation, confirmed by reflectance measurements (erythema% and pigmentation% peaked at 1 and 3 month follow-up, respectively). At 6 months follow-up, AFXL-treated scars improved on POSAS-total score though not significantly (P = 0.06). Correspondingly, blinded photo-evaluation found AFXL-treated scars significantly improved compared to controls (VAS P = 0.02). Histology indicated new dermal collagen and elastic fibers on AFXL-treated scars. At 6 months follow-up, a majority of patients (64%) favored subsequent AFXL-treatment of their untreated control scar tissue. CONCLUSIONS Scar remodeling is initiated 1 month after AFXL treatment, but overall scar improvement is concealed until laser-induced color changes resolve. At 6 months follow-up, the benefit of AFXL treatment on c-section scars emerges. Lasers Surg. Med. 49:189-197, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Katrine E Karmisholt
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth H Taudorf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Camilla B Wulff
- Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Emily Wenande
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter A Philipsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Lee SJ, Suh DH, Lee JM, Song KY, Ryu HJ. Dermal Remodeling of Burn Scar by Fractional CO2 Laser. Aesthetic Plast Surg 2016; 40:761-8. [PMID: 27519176 DOI: 10.1007/s00266-016-0686-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/29/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Ablative CO2 fractional lasers have recently been introduced for burn scar treatment because of pronounced clinical outcomes with fewer treatment sessions than nonablative fractional laser. OBJECTIVE This study was conducted to observe clinical as well as histologic changes of burn scars after treatment with CO2 fractional laser. MATERIALS AND METHODS Eleven patients (one female and 10 males, aged 31-59 years) with skin phototypes III to V with burn scars received 10 sessions of fractional CO2 laser treatments (UltraPulse(®) Encore; Lumenis, Santa Clara, CA, USA) over an average 5-week interval. Two passes were performed using the following parameters: deep FX mode, 12.5-30 mJ, with a density setting of 5-10 %. Clinical evaluations by three blinded dermatologists were obtained at baseline and at 6 months after the final treatment via photographs using the Vancouver scar scale (VSS). Skin biopsies were done on four patients before and after treatment. RESULTS All patients showed clinical improvement in their scars with significant decrease in VSS. Histologic findings showed the changes in the upper dermis with newly formed dermal papilla. This characteristic upper dermis change was presented as improvement in surface smoothness and skin tension clinically. Postinflammatory hyperpigmentation and itching sensation were the most common adverse effects. CONCLUSION Burn scar treatment by fractional CO2 laser is effective by forming new collagen fibers mainly in the upper dermis. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Sang-Jun Lee
- Dermatology, Arumdaun Nara Dermatologic Clinic, Seoul, Korea
| | - Dong-Hye Suh
- Dermatology, Arumdaun Nara Dermatologic Clinic, Seoul, Korea
| | - Ji Min Lee
- Department of Dermatology, Korea University College of Medicine, Inchon-ro 73(Anam-dong 5ga), Seongbuk-gu, Seoul, 136-705, Korea
| | - Kye-Yong Song
- Department of Pathology, College of Medicine Chung-Ang University, Seoul, Korea
| | - Hwa Jung Ryu
- Department of Dermatology, Korea University College of Medicine, Inchon-ro 73(Anam-dong 5ga), Seongbuk-gu, Seoul, 136-705, Korea.
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Roh NK, Yoon YM, Lee YW, Choe YB, Ahn KJ. Treatment of periorbital wrinkles using multipolar fractional radiofrequency in Korean patients. Lasers Med Sci 2016; 32:61-66. [DOI: 10.1007/s10103-016-2084-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/19/2016] [Indexed: 12/13/2022]
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Wat H, Wu DC, Chan HHL. Fractional resurfacing in the Asian patient: Current state of the art. Lasers Surg Med 2016; 49:45-59. [PMID: 27605303 DOI: 10.1002/lsm.22579] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Fractionated photothermolysis (FP) has revolutionized modern laser technology. By creating selective columns of microthermal damage, fractionated devices allows for greater treatment depths to be achieved without the prolonged downtime and risk of complications seen in traditional fully ablative laser resurfacing. Fractional resurfacing is a proven method to treat a variety of cutaneous conditions. In the Caucasian patient, a wide range of devices and treatment settings can be utilized safely and effectively. However, ethnic skin requires special consideration due to its unique pigmentary characteristics and clinical presentations. In this review article, we detail the current indications and strategies to optimize results and mitigate complications when utilizing fractional resurfacing for the Asian patient. METHODS A review of the MEDLINE English literature was conducted on fractionated laser devices studied in the Asian population. Articles included describe non-ablative devices including fractionated erbium glass, thulium fiber, diode, and radiofrequency devices; and ablative devices including fractionated carbon dioxide (CO2 ) laser, erbium yttrium aluminum garnet and yttrium scandium gallium garnet (YSGG) laser. These data were integrated with the expert opinion of the authors. CONCLUSION Taking into account the unique characteristics and cosmetic concerns of the Asian population, fractional resurfacing can be considered a safe and effective option for the treatment of atrophic and hypertrophic scarring, and photorejuvenation in ethnic skin types. Select cases of melasma may be treated with fractionated non-ablative devices, but utilized with caution. The predominant complication associated with fractional resurfacing for these conditions is post-inflammatory hyperpigmentation (PIH) and rebound worsening of melasma. A greater number of treatments at lower density settings and wider treatment intervals typically produce the lowest risks of PIH without compromising treatment efficacy. Lasers Surg. Med. 49:45-59, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Heidi Wat
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada, T6G 2G3
| | - Douglas C Wu
- Goldman, Butterwick, Groff, Fabi, and Wu Cosmetic Laser Dermatology, San Diego, California, 92121
| | - Henry Hin Lee Chan
- Division of Dermatology, Department of Medicine, University of Hong Kong, Hong Kong, SAR, China.,Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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68
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Laser Revision and Rehabilitation of Mohs Micrographic Surgical Scars. CURRENT DERMATOLOGY REPORTS 2016. [DOI: 10.1007/s13671-016-0144-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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69
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Clinical Assessment of the Safety and Effectiveness of Nonablative Fractional Laser Combined with Transdermal Delivery of Botulinum Toxin A in Treating Periocular Wrinkles. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1004. [PMID: 27622085 PMCID: PMC5010349 DOI: 10.1097/gox.0000000000001004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 06/29/2016] [Indexed: 11/26/2022]
Abstract
The upper and lower eyelids are traditionally contraindicated for subcutaneous botulinum toxin A (BTX) injection because of possible complications. We assessed the clinical safety and effectiveness of nonablative fractional laser (NAFL) combined with transdermal delivery of BTX in the treatment of periocular wrinkles. Thirty patients who had periocular wrinkles were treated with 1,565-nm NAFL in combination in the left periocular area and normal saline in the corresponding area of the right eye. VISIA skin detector was used to photograph and compare the changes induced by treatment. We also recorded the comfort level of the patients. All 28 patients could tolerate the pain caused by the laser treatment and showed no apparent discomfort during percutaneous drug delivery. No chromatosis or ptosis of upper eyelids occurred after the treatment. We used VISIA to detect changes at 1 week, 1 month, 3 months, and 6 months, respectively, after the treatment. The periocular wrinkles decreased, and the flabbiness of eyelids was significantly reduced. The upper and lower eyelids are traditionally contraindicated for subcutaneous BTX injection, as it may cause complications. The treatment combining 1,565-nm NAFL and transdermal delivery of BTX can decrease periocular wrinkles and flabbiness while avoiding complications to the greatest extent. None of the 28 patients who had completed the treatment suffered from complications or adverse effects; all were satisfied with the treatment outcome.
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Firooz A, Rajabi-Estarabadi A, Nassiri-Kashani MH. Treatment of atrophic facial acne scars with fractional Er:YAG laser in skin phototype III-IV: A pilot study. J COSMET LASER THER 2016; 18:204-7. [PMID: 26963802 DOI: 10.3109/14764172.2016.1157354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Fractional ablative lasers have recently been used for the treatment of skin scars. The objective of this study was to assess the efficacy and safety of the fractional erbium-doped yttrium aluminum garnet (Er:YAG) laser (2940 nm) in the treatment of skin scars. MATERIALS AND METHODS A total of 9 patients (8 female, 1 male) with Fitzpatrick skin types III and IV suffering from atrophic facial acne scars were treated with a fractional Er:YAG laser for 2-5 (mean 3.3) sessions 4-6 weeks apart. One independent investigator assessed the efficacy, using standardized photographs, before and 1 month after the last treatment. The patients' satisfaction rate was also evaluated. RESULTS The treatment was well tolerated by all patients without any anesthesia. The downtime was 2-3 days. All patients showed improvement in scars: excellent in 1, good in 1, and fair in 7 patients. Six patients were highly satisfied and 3 were satisfied with treatment. No adverse effect was noted. CONCLUSION A fractional Er:YAG laser can deliver an effective and minimally invasive treatment for acne scars.
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Affiliation(s)
- Alireza Firooz
- a Center for Research and Training in Skin Diseases and Leprosy , Tehran University of Medical Sciences , Tehran , Islamic Republic of Iran
| | - Ali Rajabi-Estarabadi
- a Center for Research and Training in Skin Diseases and Leprosy , Tehran University of Medical Sciences , Tehran , Islamic Republic of Iran
| | - Mohammad Hassan Nassiri-Kashani
- a Center for Research and Training in Skin Diseases and Leprosy , Tehran University of Medical Sciences , Tehran , Islamic Republic of Iran
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Thermal Response of In Vivo Human Skin to Fractional Radiofrequency Microneedle Device. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6939018. [PMID: 27247943 PMCID: PMC4876222 DOI: 10.1155/2016/6939018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/05/2016] [Indexed: 11/18/2022]
Abstract
Background. Fractional radiofrequency microneedle system (FRMS) is a novel fractional skin resurfacing system. Data on thermal response to this fractional resurfacing technique is limited. Objectives. To investigate histologic response of in vivo human skin to varying energy settings and pulse stacking of a FRMS in dark-skinned subjects. Methods. Two female volunteers who were scheduled for abdominoplasty received treatment with a FRMS with varying energy settings at 6 time periods including 3 months, 1 month, 1 week, 3 days, 1 day, and the time immediately before abdominoplasty. Biopsy specimens were analyzed using hematoxylin and eosin (H&E), Verhoeff-Van Gieson (VVG), colloidal iron, and Fontana-Masson stain. Immunohistochemical study was performed by using Heat Shock Protein 70 (HSP70) antibody and collagen III monoclonal antibody. Results. The average depth of radiofrequency thermal zone (RFTZ) ranged from 100 to 300 μm, correlating with energy levels. Columns of cell necrosis and collagen denaturation followed by inflammatory response were initially demonstrated, with subsequent increasing of mucin at 1 and 3 months after treatment. Immunohistochemical study showed positive stain with HSP70. Conclusion. A single treatment with a FRMS using appropriate energy setting induces neocollagenesis. This wound healing response may serve as a mean to improve the appearance of photodamaged skin and atrophic scars.
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72
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Zawar VP, Agarwal M, Vasudevan B. Treatment of Postinflammatory Pigmentation Due to Acne with Q-Switched Neodymium-Doped Yttrium Aluminum Garnet In 78 Indian Cases. J Cutan Aesthet Surg 2016; 8:222-6. [PMID: 26865787 PMCID: PMC4728904 DOI: 10.4103/0974-2077.172196] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Postinflammatory hyperpigmentation (PIH) is a common sequela seen in the Indian population following affliction by acne. It is psychologically extremely disturbing for the patients and can severely affect the quality of life. Very few therapeutic modalities have proved to be really efficacious in this condition. AIMS The aim was to review our experience with 1,064-nm Q-switched neodymium-doped yttrium aluminum garnet (QSNY) laser in the treatment of PIH. MATERIALS AND METHODS Seventy-eight patients with postacne hyperpigmentation were included in the study. They were treated with six sessions at two weekly intervals using a 1,064-nm QSNY laser. Patient and physician scores were assessed at 1 month and 3 months after the last treatment. Clinical photographs also were reviewed to determine the efficacy. Adverse effects were noted. RESULTS Seventy percent of the patients reported significant improvement in hyperpigmentation as compared to the baseline. The majority of the adverse events were limited to mild, brief erythema. CONCLUSION The 1,064-nm QSNY laser is an effective modality for the treatment of PIH caused by acne.
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Affiliation(s)
- Vijay P Zawar
- Department of Dermatology, Skin Diseases Centre, Nashik, Maharashtra, India
| | - Madhuri Agarwal
- Department of Dermatology, Skin and Aesthetic Clinic, Mumbai, Maharashtra, India
| | - Biju Vasudevan
- Department of Dermatology and STD, INHS Ashwini, Mumbai, Maharashtra, India
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73
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Yu JN, Abat K. Safety and efficacy of hybrid energy and trifractional technologies in the treatment of acne scars: An open-label clinical trial. J COSMET LASER THER 2016; 18:60-5. [PMID: 26820256 DOI: 10.3109/14764172.2015.1063658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This study determines the safety and efficacy of a novel device--Surgen that utilizes hybrid energy (HE) technology and trifractional (TF) technology in the treatment of acne scars in Filipino patients. METHODS Open-label clinical trial on eight subjects who underwent 4 weekly HE treatments followed by 2 TF treatments spaced 3 weeks apart. Efficacy was evaluated by dermatologists' (investigator and two blinded dermatologists) and patients' assessment and grading of post-treatment digital photographs. Subjects also reported level of satisfaction and comfort. Adverse events were recorded. RESULTS Dermatologists' grading of acne scars improvement--58.3% of subjects showed slight to moderate improvement, 8.3% showed marked improvement, and 33.3% was graded as unchanged after HE treatments. After 2 additional TF treatments grades improved further, with 37.5% showing mild to moderate improvement, 37.5% showing marked improvement, and 25% graded as unchanged. Dermatologist's scoring using the global acne scoring system resulted in improvement of 75% of patients after 4 HE sessions and 100% after TF treatments. Subjects' grading showed a similar trend: 75% of subjects reported that they were satisfied and 25% slightly satisfied after the complete protocol. CONCLUSION A treatment protocol combining HE and TF technology is safe, effective, and comfortable in the treatment of acne scars.
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Affiliation(s)
| | - Katrina Abat
- a Skin and Cancer Foundation, Inc ., Manila , Philippines
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74
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You HJ, Kim DW, Yoon ES, Park SH. Comparison of four different lasers for acne scars: Resurfacing and fractional lasers. J Plast Reconstr Aesthet Surg 2016; 69:e87-95. [PMID: 26880620 DOI: 10.1016/j.bjps.2015.12.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/03/2015] [Accepted: 12/22/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acne scars are common and cause cosmetic problems. There is a multitude of treatment options for acne scars, including dermabrasion, chemical peeling, and fillers, but the advent of laser technology has greatly improved the treatment of acne scars. Although several laser systems are available, studies comparing their efficacy are limited. This study compares the results of treatments using resurfacing (carbon dioxide, CO2; erbium-doped yttrium aluminum garnet, Er:YAG) versus fractional (nonablative fractional laser, NAFL; ablative fractional laser, AFL) lasers. METHODS A retrospective photographic analysis of 58 patients who underwent laser treatment for facial atrophic acne scars was performed. Clinical improvement was assessed by six blinded investigators with a scale graded from 0 to 10. Adverse events were also noted. RESULTS Mean improvement scores of the CO2, Er:YAG, NAFL, and AFL groups were 6.0, 5.8, 2.2, and 5.2, respectively. The NAFL group showed a significantly lower score than the other groups. The mean number of treatments was significantly greater in the fractional laser groups than in the resurfacing laser groups. The resurfacing laser groups had a prolonged recovery period and high risk of complications. The Er:YAG laser caused less erythema or pigmentation compared to the CO2 laser. CONCLUSIONS Although the CO2 laser, Er:YAG laser, and AFL improved the acne scars, the CO2 laser had a greater downtime. Three consecutive AFL treatments are as effective as a single treatment with resurfacing lasers, with shorter social downtime periods and less adverse effects.
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Affiliation(s)
- Hi-Jin You
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Deok-Woo Kim
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eul-Sik Yoon
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seung-Ha Park
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Republic of Korea.
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75
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Phothong W, Wanitphakdeedecha R, Sathaworawong A, Manuskiatti W. High versus moderate energy use of bipolar fractional radiofrequency in the treatment of acne scars: a split-face double-blinded randomized control trial pilot study. Lasers Med Sci 2015; 31:229-34. [PMID: 26712714 DOI: 10.1007/s10103-015-1850-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 12/08/2015] [Indexed: 11/29/2022]
Abstract
Bipolar fractional radiofrequency (FRF) device was firstly FDA-approved for treating atrophic acne scar in 2008 through the process of dermal coagulation and minimal epidermal ablation. The average energy at 60 mJ/pin was widely used to treat atrophic acne scars. However, the higher energy was delivered, the deeper ablation and coagulation were found. At present, the new generation of a device with bipolar FRF technology with electrode-pin tip was developed to maximize ability to deliver energy up to 100 mJ/pin. The objective of the study was to explore and compare the efficacy of utilizing high energy (100 mJ/pin) and moderate energy (60 mJ/pin) of bipolar fractional radiofrequency in treatment of atrophic acne scar in Asians. This is a split-face, double-blinded, randomized control trial, pilot study by using parallel group design technique. Thirty healthy subjects with Fitzpatrick skin phototype III-IV diagnosed as atrophic acne scares were enrolled. All subjects received four monthly sessions of bipolar FRF treatment. Left and right facial sides of individual patients were randomly assigned for different energy (high energy at 100 mJ/pin versus moderate energy at 60 mJ/pin). Acne scars improvement was blinded graded by dermatologist using global acne scarring score (GASS) which was subjectively evaluated at baseline, 1-, 3-, and 6-month follow-up. Objective scar analysis was also done using UVA-light video camera to measure scar volume, skin smoothness, and wrinkle at baseline, 3-, and 6-month follow-up after the last treatment. Side effects including pain, erythema, swelling, and crusting were also recorded. Thirty subjects completed the study with full 4-treatment course. The mean GASS of high energy side and moderate energy side was significantly reduced at 1-, 3-, and 6-month follow-up visits. At 1 month follow-visit, high energy side demonstrated significant improvement compared with moderate energy side (p = 0.03). Postinflammatory hyperpigmentation (PIH) developed in 21/120 sessions in high energy side (17.5 %) and 16/120 sessions in moderate energy side (13.3 %). Pain score and the duration of erythema after treatments were significant higher on the side that was treated with high energy. Bipolar FRF device was safe and effective in the treatment of atrophic acne scars in Asians. High energy setting demonstrated significant higher efficacy at 1 month follow-visit. However, the efficacy of both energy settings was comparable at 3- and 6-month follow-up. In addition, side effects were significantly more intense on the side treated with high energy.
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Affiliation(s)
- Weeranut Phothong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Pran-nok Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Rungsima Wanitphakdeedecha
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Pran-nok Road, Bangkoknoi, Bangkok, 10700, Thailand.
| | - Angkana Sathaworawong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Pran-nok Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Woraphong Manuskiatti
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Pran-nok Road, Bangkoknoi, Bangkok, 10700, Thailand
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76
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Park JY, Lee EG, Yoon MS, Lee HJ. The efficacy and safety of combined microneedle fractional radiofrequency and sublative fractional radiofrequency for acne scars in Asian skin. J Cosmet Dermatol 2015; 15:102-7. [DOI: 10.1111/jocd.12195] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Jae Yang Park
- Department of Dermatology; CHA Bundang Medical Center; CHA University; Seongnam Korea
| | - Eo Gin Lee
- Department of Dermatology; CHA Bundang Medical Center; CHA University; Seongnam Korea
| | - Moon Soo Yoon
- Department of Dermatology; CHA Bundang Medical Center; CHA University; Seongnam Korea
| | - Hee Jung Lee
- Department of Dermatology; CHA Bundang Medical Center; CHA University; Seongnam Korea
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77
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Siadat AH, Rezaei R, Asilian A, Abtahi-Naeini B, Rakhshanpour M, Raei M, Hosseini SM. Repigmentation of Hypopigmented Scars Using Combination of Fractionated Carbon Dioxide Laser with Topical Latanoprost Vs. Fractionated Carbon Dioxide Laser Alone. Indian J Dermatol 2015; 60:364-8. [PMID: 26288404 PMCID: PMC4533534 DOI: 10.4103/0019-5154.160481] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Fractionated carbon dioxide (CO2) can treat hypopigmented scars. Latanoprost is a prostaglandin analog used to treat glaucoma. It can cause adverse effects, such as periocular hyperpigmentation. The aim of this study was to assess the efficacy and safety of latanoprost plus CO2 laser on the repigmentation of hypopigmented scars. Patients and Methods: 28 patients with hypopigmented scars were divided randomly into two groups. The patients in group A were treated in six sessions (1-month intervals) with 10600-nm fractional CO2 laser plus latanoprost 0.005% and those of group B fractionated CO2 laser plus placebo (distilled water). Digital photographs were taken at baseline and 3 months after the last treatment session. The blinded dermatologist compared the photographs and evaluated the efficacy of treatment in the hypopigmented scars using a 4-scale point (grade 1-4). Patient satisfaction was scored from 0 to 10 on a visual analog scale. Results: Follow-up results 12 weeks after the last treatment session demonstrated that 11 of the 14 patients in group A had more than 50% improvement in hypopigmentation The difference in improvement of the two groups was statistically significant (P = 0.027). The mean of the VAS scores of patients in group A was 6.50 ± 1.45 and in group B 4.57 ± 1.6. The difference in mean satisfaction of the two groups was statistically significant (P = 0.003). Side effects were mild and resolved within 1 to 5 days. Conclusion: The fractional CO2 laser resurfacing plus topical latanoprost can be used as a safe and efficacious method to treat hypopigmented scars.
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Affiliation(s)
- Amir Hossein Siadat
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Rezaei
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Asilian
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahareh Abtahi-Naeini
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran ; Department of Dermatology, Medicine Students' Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrdad Rakhshanpour
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Raei
- Department of Epidemiology and Biostatistics, School of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Seyed Mohsen Hosseini
- Department of Epidemiology and Biostatistics, Isfahan University of Medical Sciences, Isfahan, Iran
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78
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Laser Resurfacing for Latin Skins: The Experience with 665 Cases. Aesthetic Plast Surg 2015; 39:582-8. [PMID: 25907154 DOI: 10.1007/s00266-015-0489-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND CO2 resurfacing and CO2 microfractionated laser systems are reliable tools to improve different facial pathologic skin conditions but are associated with a high rate of complications specially in Fitzpatrick III, IV, and V skin phototypes, predominant in the Latin population, which has pushed many surgeons to change technologies and abandon its use. OBJECTIVE To compare patient results with the CO2 resurfacing laser and microfractionated CO2 laser resurfacing in all skin types and show similar results to those obtained worldwide in patients with phototypes III, IV, and V. METHODS Standardized review of medical records from a database of private practice patients treated since January 1998 to July 2012 with SlimE30 MiXto SX(®) CO2 laser. Evaluation of outcomes, complications, and satisfaction of three different modalities of treatment (CO2 ablative laser, CO2 microfractionated and a combination of both) was made. RESULTS A total of 665 treated patients were included. Ablative CO2 was applied to 80.3 %, CO2 microfractionated to 15.1 %, and mixed treatment to 4.5 % of cases. Globally, hyperpigmentation rates were 30.4 % in the CO2 resurfacing group, 16.3 % when a combination of modalities was applied and 11 % in microfractionated CO2 cases. A steady increase of these rates is shown as the phototype becomes higher. Satisfaction rates were high for all groups: 86.7 % in the mixed group, 82.2 % in the microfractionated CO2, and 79.6 % in the CO2 ablative. CONCLUSIONS Good results and an acceptable rate of complications in latin skins are obtainable after treating patients with CO2 ablative and microfractionated CO2 systems alone or in combination. Staged treatments and adequate post-procedure care reduce these complications.
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79
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Meesters AA, Bakker MM, de Rie MA, Wolkerstorfer A. Fractional CO2laser assisted delivery of topical anesthetics: A randomized controlled pilot study. Lasers Surg Med 2015; 48:208-11. [DOI: 10.1002/lsm.22376] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Arne A. Meesters
- Department of Dermatology; Netherlands Institute for Pigment Disorders; Academic Medical Center; University of Amsterdam; city, Amsterdam the Netherlands
| | - Myrna M. Bakker
- Department of Dermatology; Netherlands Institute for Pigment Disorders; Academic Medical Center; University of Amsterdam; city, Amsterdam the Netherlands
| | - Menno A. de Rie
- Department of Dermatology; Academic Medical Center; University of Amsterdam; city, Amsterdam the Netherlands
- Department of Dermatology; VU Medical Center; VU University; city, Amsterdam the Netherlands
| | - Albert Wolkerstorfer
- Department of Dermatology; Netherlands Institute for Pigment Disorders; Academic Medical Center; University of Amsterdam; city, Amsterdam the Netherlands
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80
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Kaminaka C, Uede M, Matsunaka H, Furukawa F, Yamamoto Y. Clinical studies of the treatment of facial atrophic acne scars and acne with a bipolar fractional radiofrequency system. J Dermatol 2015; 42:580-7. [DOI: 10.1111/1346-8138.12864] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 02/11/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Chikako Kaminaka
- Department of Dermatology; Wakayama Medical University; Wakayama Japan
- Department of Cosmetic Dermatology and Photomedicine; Wakayama Medical University; Wakayama Japan
| | - Mikiko Uede
- Department of Dermatology; Wakayama Medical University; Wakayama Japan
| | - Hiroshi Matsunaka
- Department of Dermatology; Wakayama Medical University; Wakayama Japan
| | - Fukumi Furukawa
- Department of Dermatology; Wakayama Medical University; Wakayama Japan
| | - Yuki Yamamoto
- Department of Dermatology; Wakayama Medical University; Wakayama Japan
- Department of Cosmetic Dermatology and Photomedicine; Wakayama Medical University; Wakayama Japan
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81
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Qin X, Li H, Jian X, Yu B. Evaluation of the efficacy and safety of fractional bipolar radiofrequency with high-energy strategy for treatment of acne scars in Chinese. J COSMET LASER THER 2015; 17:237-45. [PMID: 25588035 DOI: 10.3109/14764172.2015.1007070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Xiaolei Qin
- a Department of Dermatology , Peking University Shenzhen Hospital , P. R. China
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82
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Al-Dhalimi M, Jaber A. Treatment of atrophic facial acne scars with fractional Er:Yag laser. J COSMET LASER THER 2015; 17:184-8. [DOI: 10.3109/14764172.2015.1007067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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83
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Effect of an Epidermal Growth Factor-Containing Cream on Postinflammatory Hyperpigmentation After Q-Switched 532-nm Neodymium-Doped Yttrium Aluminum Garnet Laser Treatment. Dermatol Surg 2015; 41:131-5. [DOI: 10.1097/dss.0000000000000197] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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84
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Gadkari R, Nayak C. A split-face comparative study to evaluate efficacy of combined subcision and dermaroller against combined subcision and cryoroller in treatment of acne scars. J Cosmet Dermatol 2014; 13:38-43. [PMID: 24641604 DOI: 10.1111/jocd.12071] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acne scars occur consequent to abnormal wound healing following sebaceous follicular inflammation in acne. Various types of acne scars are icepick, rolling, boxcar, hypertrophic, and keloidal. Different modalities of treatment include subcision, dermaroller, cryoroller, punch excision, chemical peeling, and lasers. OBJECTIVES To compare the efficacy of combined subcision and dermaroller vs. combined subcision and cryoroller in acne scar treatment. METHODS Thirty patients (19 males and 11 females) with grade 2, 3, and 4 postacne scarring (Goodman and Baron qualitative grading system) were enrolled in the study. Three sittings each at 1-month interval were carried out of subcision under nerve block on the entire face followed by derma roller (2.5 mm) and cryoroller on one half of the face. Standardized digital photography was performed preprocedure and at 6 months. Grading of acne scar photographs using the Goodman and Baron qualitative and quantitative grading scale was carried out by a blinded observer pre- and postprocedure at 6 months. Patients' own evaluation based on patient scar severity perception scale of 1-10 was also taken into account. RESULTS Assessment using the quantitative grading scale showed a 57% improvement using combined subcision and cryoroller against 40% improvement with combined subcision and dermaroller. Average improvement perceived by the subjects was 61% with combined subcision and cryoroller against 45% with combined subcision and dermaroller. The data were analyzed using Wilcoxon signed rank test and found statistically significant. Postinflammatory hyperpigmentation on the cryoroller side and erythema, edema, and hematoma formation due to subcision was transient. CONCLUSION Combined subcision and cryoroller is more effective than combined subcision and dermaroller for treatment of acne scars.
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Rerknimitr P, Chitvanich S, Pongprutthipan M, Panchaprateep R, Asawanonda P. Non-ablative fractional photothermolysis in treatment of idiopathic guttate hypomelanosis. J Eur Acad Dermatol Venereol 2014; 29:2238-42. [DOI: 10.1111/jdv.12763] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 09/05/2014] [Indexed: 11/26/2022]
Affiliation(s)
- P. Rerknimitr
- Division of Dermatology; Department of Medicine; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
- Dermatology Unit; Department of Medicine; King Chulalongkorn Memorial Hospital; Thai Red Cross Society; Bangkok Thailand
| | - S. Chitvanich
- Division of Dermatology; Department of Medicine; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
- Dermatology Unit; Department of Medicine; King Chulalongkorn Memorial Hospital; Thai Red Cross Society; Bangkok Thailand
| | - M. Pongprutthipan
- Division of Dermatology; Department of Medicine; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
| | - R. Panchaprateep
- Division of Dermatology; Department of Medicine; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
- Dermatology Unit; Department of Medicine; King Chulalongkorn Memorial Hospital; Thai Red Cross Society; Bangkok Thailand
| | - P. Asawanonda
- Division of Dermatology; Department of Medicine; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
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86
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Objective Evaluation of the Clinical Efficacy of Fractional Radiofrequency Treatment for Acne Scars and Enlarged Pores in Asian Skin. Dermatol Surg 2014; 40:988-95. [DOI: 10.1097/01.dss.0000452625.01889.c3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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87
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Kim DH, Ryu HJ, Choi JE, Ahn HH, Kye YC, Seo SH. A Comparison of the Scar Prevention Effect Between Carbon Dioxide Fractional Laser and Pulsed Dye Laser in Surgical Scars. Dermatol Surg 2014; 40:973-8. [DOI: 10.1097/01.dss.0000452623.24760.9c] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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88
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Ibrahim ZA, Eltatawy RA, Ghaly NR, Abd El-Naby NM, Abou El Fetouh HM, Abd Elateef AE, Abdou S, Tahaa A, El Afandy M. Autologus bone marrow stem cells in atrophic acne scars: A pilot study. J DERMATOL TREAT 2014; 26:260-5. [DOI: 10.3109/09546634.2014.946379] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Patel L, McGrouther D, Chakrabarty K. Evaluating evidence for atrophic scarring treatment modalities. JRSM Open 2014; 5:2054270414540139. [PMID: 25352991 PMCID: PMC4207294 DOI: 10.1177/2054270414540139] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Atrophic scars cause significant patient morbidity. Whilst there is evidence to guide treatment, there does not appear to be a systematic review to analyse the efficacy of treatment options. Objectives To retrieve all evidence relating to atrophic scar treatment and evaluate using the Clinical Evidence GRADE score in order to allow clinicians to make evidence-based treatment choices. Method Searches were performed in Medline, EMBASE, CINHL and Cochrane to identify all English studies published evaluating treatment of atrophic scars on adults excluding journal letters. Each study was allocated a GRADE score based on type of study, quality, dose response, consistency of results and significance of results. The end score allowed categorisation of evidence into high, moderate, low or very low quality. Results A total of 41 studies were retrieved from searches including randomised controlled trials, observational studies, retrospective analyses and case reports of which 7% were allocated a high-quality score, 10% a moderate score, 7% a low score and 75% a very low score. Treatment modalities included ablative laser therapy, non-ablative laser therapy, autologous fat transfer, dermabrasion, chemical peels, injectables, subcision, tretinoin iontophoresis and combination therapy. Conclusion There is a paucity of good-quality clinical evidence evaluating treatment modalities for atrophic scarring. Evidence supports efficacy of laser, surgery and peel therapy. Further biomolecular research is required to identify targeted treatment options and more randomised controlled trials would make the evidence base for atrophic scar treatment more robust.
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Affiliation(s)
- Lopa Patel
- Department of Plastic Surgery and Burns Care, University Hospitals of South Manchester, Wythenshawe, Manchester M23 9LT, UK
| | - Duncan McGrouther
- Department of Plastic Surgery and Burns Care, University Hospitals of South Manchester, Wythenshawe, Manchester M23 9LT, UK
| | - Kaushik Chakrabarty
- Department of Plastic Surgery and Burns Care, University Hospitals of South Manchester, Wythenshawe, Manchester M23 9LT, UK
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Yoo KH, Kwon TR, Kim SY, Song YS, Cheon YS, Kim YM, Yeo IK, Ko EJ, Li K, Kim MN, Kim BJ. Observation of in vivo morphologic changes after carbon dioxide ablative fractional laser in a mouse model using noninvasive imaging modalities and comparison with histologic examination. Photochem Photobiol 2014; 90:1423-6. [PMID: 25041574 DOI: 10.1111/php.12313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 07/07/2014] [Indexed: 11/30/2022]
Abstract
Ablative fractional carbon dioxide (CO2) lasers have been widely used for several types of cosmetic dermatosis. A number of previous studies have evaluated this technique in animals or human beings by observing morphologic changes using an invasive modality such as skin biopsy. In this study, we assessed in vivo skin changes after CO2 ablative fractional laser treatment in a mouse model using noninvasive imaging modalities (Folliscope(®) and Visioscan 98(®)), and each results was compared with data from histologic examination. An ablative fractional CO2 laser was applied with different pulse energy between 7 to 35 mJ/microspot. As results of above methods, we also confirmed that the CO2 ablative fractional laser generated injuries with increasing width and depth with increasing pulse energy. Although numerous papers have described application of this laser in vivo skin specimens, our study evaluated the feasibility of using relative noninvasive imaging modalities for assessing the outcome of laser ablation. Based on our data, we suggest that these technologies may be useful alternative modalities for assessing laser ablation that are easier to perform and less invasive than skin biopsy.
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Affiliation(s)
- Kwang Ho Yoo
- Department of Dermatology, College of Medicine, Chung-Ang University, Seoul, Korea
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91
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Alexis AF. Lasers and light-based therapies in ethnic skin: treatment options and recommendations for Fitzpatrick skin types V and VI. Br J Dermatol 2014; 169 Suppl 3:91-7. [PMID: 24098905 DOI: 10.1111/bjd.12526] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2013] [Indexed: 01/21/2023]
Abstract
Ethnic skin or 'skin of colour', which is characterized by increased epidermal melanin, labile melanocytes and reactive fibroblast responses, poses special challenges for the use of laser and light-based therapies. These therapies are associated with a greater risk of dyspigmentation and scarring in ethnic skin and therefore require careful selection of device and treatment parameters to minimize complications. Whereas early-generation lasers for hair removal and resurfacing were generally contraindicated for individuals with Fitzpatrick skin phototypes (SPT) IV-VI, advances in the past decade have given rise to a range of devices that can be safely used in ethnic skin. Longer wavelength lasers such as the 810 and 1064 nm Nd:YAG; intense pulsed light and monochromatic excimer light (308 nm); fractional lasers; and radiofrequency devices have all been used safely for hair removal, pigmentary abnormalities, resurfacing and skin tightening in ethnic skin, respectively. Notwithstanding these advances, nuances in the laser or light treatment of darker skin types remain and must be considered to ensure safe therapeutic outcomes. The vast majority of published data pertaining to lasers and light treatments in nonwhite skin involve patients of East Asian ethnicity (e.g. Korean, Japanese, Chinese, Thai). By contrast, there is a paucity of studies involving individuals of African ancestry or those with SPT V or VI. This article will review laser and light-based modalities that are considered safe and effective for individuals with richly pigmented skin.
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Affiliation(s)
- A F Alexis
- Skin of Color Center, St Luke's Roosevelt Hospital, 1090 Amsterdam Avenue Suite 11B, New York, NY, 10025, U.S.A; Department of Dermatology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, 12th Floor, New York, NY, 10032, U.S.A
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92
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Yuan XH, Zhong SX, Li SS. Comparison study of fractional carbon dioxide laser resurfacing using different fluences and densities for acne scars in Asians: a randomized split-face trial. Dermatol Surg 2014; 40:545-52. [PMID: 24645970 DOI: 10.1111/dsu.12467] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ablative 10,600-nm carbon dioxide (CO2 ) fractional laser treatments have shown favorable outcomes for atrophic acne scars. OBJECTIVE To compare the efficacy and complications of fractional CO2 laser treatments with different fluences and densities for acne scars. METHODS Twenty patients were treated using a single session of fractional CO2 laser in Deep FX mode. In Group A (n = 10), half of the face was treated with 20 mJ, density 10% and the other half with 20 mJ, density 20%. In Group B (n = 10), half of the face was treated with 10 mJ, density 10% and the other half with 20 mJ, density 10%. Patients were evaluated at baseline and 3 days, 1 week, 1 month, and 3 months after the procedure. RESULTS There was no significant difference in efficacy between different laser settings within the groups, although adverse effects were more evident in patients treated with higher densities or fluences. CONCLUSION Factional CO2 laser treatment using the Deep FX mode may provide a significant efficacy with lower fluence and density with fewer complications than with higher energies for acne scars.
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Affiliation(s)
- Xing-Hua Yuan
- Department of Dermatology and Venereology, First Hospital of Jilin University, Changchun, China; Department of Dermatology and Venereology, Yanbian University Hospital, Yanji, China
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Sardana K, Manjhi M, Garg VK, Sagar V. Which type of atrophic acne scar (ice-pick, boxcar, or rolling) responds to nonablative fractional laser therapy? Dermatol Surg 2014; 40:288-300. [PMID: 24447255 DOI: 10.1111/dsu.12428] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Few studies have examined the role of fractional lasers in individual acne scars (ice-pick, box car, rolling) using objective assessment tools in darkly pigmented skin. OBJECTIVE To evaluate the effect of 1,540-nm fractional lasers on individual acne scars. METHODS AND MATERIALS A prospective interventional study was conducted in 35 patients using a 1,540-nm fractional laser. Six sessions were performed with four passes per session and a dose varying from 70 to 100 mJ to maximize the DWR. A self-devised objective assessment tool with dose settings to optimize the depth-to-width ratio (DWR) and a visual analog scale (VAS) were used to count individual atrophic scars. Final results were assessed 6 months after final laser treatment. RESULTS Acne scar reduction efficiency was used to validate the improvement of individual scars, a meaningful difference was considered as 51% or greater improvement. The boxcar scars (52.9%) responded better than the rolling (43.1%) and ice-pick scars (25.9%), with statistically significant improvement (p < .05) seen in boxcar scars after four sessions. Overall VAS scores revealed significant improvement (p < .001). CONCLUSION Using an objective evaluation tool, an erbium-doped glass laser was found to improve atrophic acne scars, markedly so for boxcar and rolling scars. The VAS score overestimated improvement because of its subjective nature.
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Affiliation(s)
- Kabir Sardana
- Department of Dermatology and Sexually Transmitted Diseases, Maulana Azad Medical College and Lok Nayak Hospital, Delhi, India
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94
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Choudhary S, McLeod M, Meshkov L, Nouri K. Lasers in the treatment of acne scars. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.10.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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95
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Yin R, Lin L, Xiao Y, Hao F, Hamblin MR. Combination ALA-PDT and ablative fractional Er:YAG laser (2,940 nm) on the treatment of severe acne. Lasers Surg Med 2014; 46:165-72. [PMID: 24391075 DOI: 10.1002/lsm.22219] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Scarring is a very common complication of severe acne and is difficult to treat by conventional methods. 5-Aminolevulinic acid (ALA) photodynamic therapy (PDT) is a novel treatment for improving acne lesions. Fractional laser resurfacing is a promising treatment for scar treatment because of its unique ability to stimulate the wound healing response and its depth of penetration. OBJECTIVE To evaluate the efficacy of combination therapies of ALA-PDT and ablative fractional Er:YAG laser (2,940 nm) for scarring lesions in severe acne patients. METHODS A prospective, single-arm, pilot study. Forty subjects with severe acne were treated with 15% ALA-PDT for four times at 10-day intervals. They then received ablative fractional Er:YAG laser treatment five times at 4-week intervals. Three independent investigators evaluated subject outcomes at 1, 3, 6, and 12 months post-treatment (primary outcome); patients also provided self-assessments of improvement (secondary outcome). RESULTS Significant reductions in acne score (P < 0.01) were obtained at follow-up visits after 1, 3, 6, and 12 months. After 6 month, the lesions showed overall improvement in all of subjects (good to excellent in acne inflammatory lesions), 80% overall improvement in acne scars. After 12 months, most of subjects had improved hypertrophic/atrophic scars (good to excellent in 85%) and no one had recurrent acne inflammatory lesions. Patient self-evaluation also revealed good to excellent improvements (on average) in acne lesions and scarring, with significant improvements in self-esteem after 6 months post-treatment. CONCLUSIONS PDT can control the inflammation and improve the severity of acne lesions. Fractional resurfacing is a promising new treatment modality for scars by stimulating wound healing and remodeling. The combination therapy is a promising option for severe acne to prevent and improve car formation.
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Affiliation(s)
- Rui Yin
- Department of Dermatology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
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96
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Wanitphakdeedecha R, Phuardchantuk R, Manuskiatti W. The use of sunscreen starting on the first day after ablative fractional skin resurfacing. J Eur Acad Dermatol Venereol 2013; 28:1522-8. [PMID: 24320057 DOI: 10.1111/jdv.12332] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 11/12/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND The most common side-effect of ablative fractional skin resurfacing in Asians is post inflammatory hyperpigmentation (PIH). Various attempts have been made to reduce the occurrence of PIH after laser treatment including sun avoidance, the use of preoperative and postoperative treatment regimens, and treatment using conservative energy settings and epidermal protection. OBJECTIVES To determine whether the use of broad-spectrum sunscreen with anti-inflammatory agents starting on the first day after fractional CO2 laser skin resurfacing reduces the incidence of post laser PIH. MATERIALS AND METHODS Thirty patients were treated with ablative fractional CO2 resurfacing on both sides of their faces at 10 mJ and 10% density. Each subject was randomly treated on one side of the face with petrolatum ointment four times a day for the first week after laser treatment and on the other side of the face with petrolatum ointment four times a day plus broad-spectrum sunscreen with anti-inflammatory agents in the morning starting on the first day after laser treatment. Transepidermal water loss was recorded at baseline and every day for 1 week. Melanin and erythema indexes were measured at baseline, 1-, 2-week, 1-, 2- and at 3-month post treatment. RESULTS Of the 30 patients involved in the study, 26 received the treatment and attended 1-, 2-week, 1-, 2- and 3-month post-treatment visits. Four patients were withdrawn from the study because they could not attend every follow-up visit. There was no statistically significant difference in transepidermal water loss at baseline, immediately after laser treatment, or at the D1 to D7 follow-up visits. Erythema index had no significantly statistical difference at baseline, 1-, 2- and at 3-month after laser treatment. Furthermore, there was a statistically significant difference in melanin index at 1-week post laser treatment between both sides (P = 0.001). Melanin index at the 1-week follow-up visit on the side treated with broad-spectrum sunscreen with anti-inflammatory agents starting on the first day after laser treatment was significantly less than the control side. CONCLUSION The use of broad-spectrum sunscreen with anti-inflammatory agents starting on the first day after ablative fractional skin resurfacing can decrease the incidence of PIH after laser treatment at 1-week postoperatively.
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Affiliation(s)
- R Wanitphakdeedecha
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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97
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Magnani LR, Schweiger ES. Fractional CO2 lasers for the treatment of atrophic acne scars: a review of the literature. J COSMET LASER THER 2013; 16:48-56. [PMID: 24131097 DOI: 10.3109/14764172.2013.854639] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This review examines the efficacy and safety of fractional CO2 lasers for the treatment of atrophic scarring secondary to acne vulgaris. We reviewed 20 papers published between 2008 and 2013 that conducted clinical studies using fractional CO2 lasers to treat atrophic scarring. We discuss the prevalence and pathogenesis of acne scarring, as well as the laser mechanism. The histologic findings are included to highlight the ability of these lasers to induce the collagen reorganization and formation that improves scar appearance. We considered the number of treatments and different laser settings to determine which methods achieve optimal outcomes. We noted unique treatment regimens that yielded superior results. An overview of adverse effects is included to identify the most common ones. We concluded that more studies need to be done using uniform treatment parameters and reporting in order to establish which fractional CO2 laser treatment approaches allow for the greatest scar improvement.
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98
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Hwang YJ, Lee YN, Lee YW, Choe YB, Ahn KJ. Treatment of acne scars and wrinkles in asian patients using carbon-dioxide fractional laser resurfacing: its effects on skin biophysical profiles. Ann Dermatol 2013; 25:445-53. [PMID: 24371392 PMCID: PMC3870213 DOI: 10.5021/ad.2013.25.4.445] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 10/08/2012] [Accepted: 11/16/2012] [Indexed: 11/24/2022] Open
Abstract
Background Although ablative fractional resurfacing is known to be effective against photoaging and acne scars, studies on its efficacy, safety and changes in the skin characteristics of Asians are limited. Objective The aim of this study is to assess the efficacy and safety of carbon dioxide fractional laser (CO2FL) in Koreans treated for wrinkles and acne scars, and to define the changes in skin characteristics during recovery period. Methods We administered one session of CO2FL on 10 acne scar patients and 14 wrinkles patients with skin types IV and V. The surveillance of efficacy and side effects along with the measurement of biophysical properties was carried out before 1 day, 1 week, 1 month and 3 months after treatment. Results Using a non-invasive method, skin barrier damage, erythema and bronzing of skin during the recovery period were assessed, and all of the items eventually returned to the pre-treatment level. Skin elasticity was measured in the wrinkle group, and the statistically significant effect was sustained throughout the next three months. The outcome of treatment was found to be better than 'moderate improvement' in both the acne scar and wrinkle groups. Further, there were no serious side effects three months post-procedure. Conclusion CO2 FL is thought to be an effective and safe method for treating moderate to severe acne scars and wrinkles in Asians.
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Affiliation(s)
- Young Ji Hwang
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Yu Na Lee
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Yang Won Lee
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Yong Beom Choe
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Kyu Joong Ahn
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
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100
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Vejjabhinanta V, Wanitphakdeedecha R, Limtanyakul P, Manuskiatti W. The efficacy in treatment of facial atrophic acne scars in Asians with a fractional radiofrequency microneedle system. J Eur Acad Dermatol Venereol 2013; 28:1219-25. [DOI: 10.1111/jdv.12267] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 08/14/2013] [Indexed: 11/27/2022]
Affiliation(s)
- V. Vejjabhinanta
- Department of Dermatology; Faculty of Medicine Siriraj Hospital; Mahidol University; Bangkok Thailand
| | - R. Wanitphakdeedecha
- Department of Dermatology; Faculty of Medicine Siriraj Hospital; Mahidol University; Bangkok Thailand
| | - P. Limtanyakul
- Department of Dermatology; Faculty of Medicine Siriraj Hospital; Mahidol University; Bangkok Thailand
| | - W. Manuskiatti
- Department of Dermatology; Faculty of Medicine Siriraj Hospital; Mahidol University; Bangkok Thailand
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