1
|
Wang H, Yang F, Wang H, Qin T, He J, Zhao C. Effect of CO2 fractional laser combined with recombinant human epidermal growth factor gel on skin barrier. Medicine (Baltimore) 2024; 103:e37329. [PMID: 38489702 PMCID: PMC10939677 DOI: 10.1097/md.0000000000037329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 03/17/2024] Open
Abstract
To evaluate the impact of CO2 fractional laser combined with recombinant human epidermal growth factor (rhEGF) gel on skin barrier in acne scar patients. In a retrospective analysis, we examined 105 acne scar patients admitted between July 2018 and August 2021. Of these, 51 received only CO2 fractional laser (control group), while 54 underwent a combination of CO2 fractional laser and rhEGF gel (observation group). We assessed treatment efficacy, symptom relief, skin barrier parameters, pre- and posttreatment inflammatory factors, adverse reactions, posttreatment quality of life, and patient satisfaction. The observation group exhibited a higher overall response rate, significantly shorter wound healing, scab formation, and scab detachment times. Additionally, this group showed increased stratum corneum water content, decreased pH, and transdermal water loss (TEWL), and reduced hypersensitive C-reactive protein and interleukin-6 expression posttreatment. Quality of life scores were higher, with fewer adverse reactions and greater treatment satisfaction. Combining CO2 fractional laser with rhEGF gel markedly improves acne scar treatment efficacy, enhances skin barrier function, reduces inflammation, and elevates quality of life. Its safety profile supports its broader clinical adoption.
Collapse
Affiliation(s)
- Hua Wang
- Dermatological Department (Department of Cosmetic Dermatology, Department of Surgery of Traditional Chinese Medicine), Baoji Hospital of Traditional Chinese Medicine, Baoji, Shaanxi, China
| | - Fan Yang
- Dermatological Department (Department of Cosmetic Dermatology, Department of Surgery of Traditional Chinese Medicine), Baoji Hospital of Traditional Chinese Medicine, Baoji, Shaanxi, China
| | - Hui Wang
- Dermatological Department (Department of Cosmetic Dermatology, Department of Surgery of Traditional Chinese Medicine), Shaanxi University of Chinese Medicine, Xixian New Area, Shaanxi Province, China
| | - Tao Qin
- Dermatological Department (Department of Cosmetic Dermatology, Department of Surgery of Traditional Chinese Medicine), Baoji Hospital of Traditional Chinese Medicine, Baoji, Shaanxi, China
| | - Jia He
- Dermatological Department (Department of Cosmetic Dermatology, Department of Surgery of Traditional Chinese Medicine), Baoji Hospital of Traditional Chinese Medicine, Baoji, Shaanxi, China
| | - Chan Zhao
- Dermatological Department (Department of Cosmetic Dermatology, Department of Surgery of Traditional Chinese Medicine), Baoji Hospital of Traditional Chinese Medicine, Baoji, Shaanxi, China
| |
Collapse
|
2
|
Hong N, Sheng B, Yu P. Early postoperative interventions in the prevention and management of thyroidectomy scars. Front Physiol 2024; 15:1341287. [PMID: 38523809 PMCID: PMC10958159 DOI: 10.3389/fphys.2024.1341287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
Thyroidectomy scars, located on the exposed site, can cause distress in patients. Owing to the cosmetic importance of thyroidectomy scars, many studies have been conducted on its prevention and treatment. Scar formation factors mainly include inflammatory cell infiltration, angiogenesis, fibroblast proliferation, secretion of cytokines such as transforming growth factor (TGF)-β1, and mechanical tension on the wound edges. Anti-scar methods including topical anti-scar agents, skin tension-bearing devices, and local injections of botulinum toxin, as well as lasers and phototherapies, that target these scar formation factors have been developed. However, current studies remain fragmented, and there is a lack of a comprehensive evaluation of the impacts of these anti-scar methods on treating thyroidectomy scars. Early intervention is a crucial but often neglected key to control hyperplastic thyroidectomy scars. Therefore, we review the currently adopted early postoperative strategies for thyroidectomy scar reduction, aiming to illustrate the mechanism of these anti-scar methods and provide flexible and comprehensive treatment selections for clinical physicians to deal with thyroidectomy scars.
Collapse
Affiliation(s)
- Nan Hong
- Department of Burn and Plastic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Department of Dermatology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Bin Sheng
- Department of Medical Cosmetology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Pan Yu
- Department of Burn and Plastic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| |
Collapse
|
3
|
Wu HH, Chen MQ, Liu JH, Song LL, Luo DQ, Lu JF, Zhao YK. Combination of fractional carbon dioxide laser with recombinant human collagen in periocular skin rejuvenation. J Cosmet Dermatol 2024; 23:124-133. [PMID: 37526257 DOI: 10.1111/jocd.15942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/15/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND The most visible sign of facial aging is often seen in the periocular area. However, periocular rejuvenation remains challenging due to the particularity of periocular anatomic locations. AIMS We aimed to evaluate the efficacy and safety of the fractional-ablative CO2 laser-facilitated recombinant human collagen permeation in periocular rejuvenation. PATIENTS/METHODS This 3-month prospective single-blinded and self-controlled trial enrolled 26 patients with periocular aging who underwent the treatments of fractional-ablative CO2 laser along with laser-facilitated recombinant human collagen permeation. Following the treatments, the patients were quantitatively assessed by various periocular skin aging indices before and after the treatment and monitored for any related adverse events. RESULTS The patients showed significant improvements with the periocular skin aging indices 3 months after the treatments, which were detailed with a 47.3% decrease in lower eyelid skin rhytids, a 41.4% decrease in the lower eyelid skin texture, a 35.0% decrease in the static crow's feet, a 29.3% decrease in the amount of upper eyelid laxity, and a 20.2% increase in the MRD1 as compared with baseline (p < 0.05). Moreover, total skin thickness under ultrasound was increased in both upper and lower eyelids (5.6% and 3.3%, p < 0.05, respectively). Moreover, six patients (23.1%, 6/26) had erythema for 2 weeks, and two (2/26, 7.7%) had mild hyperpigmentation for 3 months. CONCLUSIONS Fractional-ablative CO2 laser combined with laser-facilitated recombinant human collagen permeation can be a safe and effective treatment for periocular rejuvenation.
Collapse
Affiliation(s)
- Hui-Hui Wu
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mei-Qing Chen
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The East Division of The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Juan-Hua Liu
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lu-Li Song
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Di-Qing Luo
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing-Fa Lu
- Department of Dermatology, The First Affiliated Hospital of Gannan Medical College, Ganzhou, China
| | - Yu-Kun Zhao
- Department of Dermatology, The East Division of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
4
|
Waibel JS, Waibel H, Sedaghat E. Scar Therapy of Skin. Facial Plast Surg Clin North Am 2023; 31:453-462. [PMID: 37806679 DOI: 10.1016/j.fsc.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Scar therapy is truly important in medicine. Patients experience great loss in quality of life with scars. There are many treatment modalities that help treat scars, including topical, intralesional, surgical, and energy-based devices. In addition, early intervention can help mitigate scar formation. Lasers represent a major innovation in the treatment of all types of scars. Treating scars is a multimodal and multispecialty endeavor. This article highlights the use of many therapies to treat scars and scar symptoms including pruritus, pain, and range of motion. This also highlights key literature including multiple recent consensus guidelines in treating scars.
Collapse
Affiliation(s)
| | - Hannah Waibel
- Southern Methodist University; Private Practice: Miami Dermatology and Laser Institute, 7800 Southwest 87th Avenue Suite B200, Miami, FL 33173, USA; Baptist Hospital, Miami, FL, USA; Dermatology Faculty, Miller School of Medicine, University of Miami
| | | |
Collapse
|
5
|
Duplechain JK. Ablative Laser Therapy of Skin. Facial Plast Surg Clin North Am 2023; 31:463-473. [PMID: 37806680 DOI: 10.1016/j.fsc.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Laser skin rejuvenation was introduced in the mid-1990s. Early ablative laser devices relied on scanner technology that provided significant ablation and longer time on tissue treatments. These early treatments provided significant improvement in the appearance of the skin, but because of the longer treatment times and in some cases excessive treatment, complications such as scarring and hypopigmentation were significant. More recent advances in skin resurfacing technology have now minimized these risks providing certain key principles are observed. These parameters are reviewed in detail to improve the reader's ability to propose and execute proper skin resurfacing treatments.
Collapse
Affiliation(s)
- J Kevin Duplechain
- Division of Facial Plastic Surgery, Department of Otolaryngology, Tulane Medical School, 1103 Kaliste Saloom Road, Suite 300, Lafayette, 70508, LA, USA.
| |
Collapse
|
6
|
Lotfi E, DellAvanzato R, Ahramiyanpour N, Shadmanyazdi F, Khosravi S. Evaluation of eyebrow position and upper eyelid laxity after endolift laser treatment. Skin Res Technol 2023; 29:e13498. [PMID: 37881059 PMCID: PMC10570406 DOI: 10.1111/srt.13498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/27/2023] [Indexed: 10/27/2023]
Abstract
The periorbital area is one of the most sensitive areas in the face, and many techniques are used to change the eyelid laxity and position of the eyebrows. Recently the use of noninvasive or minimally invasive techniques is developed so, the amount of surgical procedures has decreased. In the present study. We evaluate the effect of Endolift laser as a non-invasive method on upper eyelid laxity and eyebrow position. Nine patients underwent Endolift laser and evaluated for eyelid laxity and change in eyebrow position. Two blinded physicians assessed the cosmetic outcome of improvement in upper eyelid tightening via photography 6 months post-treatment. The physicians evaluated the patient's improvement degree using the photographs by two clinical factors: skin laxity and total cosmetic result. Also, eyebrow height from the center of the pupil (CPEBH), Central eyebrow height (CEBH), Lateral eyebrow height (LEBH), Medial eyebrow height (MEBH) were measured by ImagJ before and 6 months post Endolift laser treatment. Our results showed eyelid laxity and eyebrow height were significantly changed after treatment.
Collapse
Affiliation(s)
- Elaheh Lotfi
- Yousef Abad Skin and Hair CenterTehranIran
- Ambers LaserklinikGothenburgSweden
| | | | - Najmeh Ahramiyanpour
- Department of DermatologyAfzalipour faculty of MedicineAfzalipour HospitalKerman University of Medical SciencesKermanIran
| | | | - Somayeh Khosravi
- Imam Khomeini Hospital ComplexAdvanced Medical Technologies & Equipment InstituteTehranIran
| |
Collapse
|
7
|
Guo H, Zhang X, Li H, Fu C, Jiang L, Hu Y, Huang J, Chen J, Zeng Q. Dynamic panoramic presentation of skin function after fractional CO 2 laser treatment. iScience 2023; 26:107559. [PMID: 37649701 PMCID: PMC10462835 DOI: 10.1016/j.isci.2023.107559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/29/2023] [Accepted: 08/02/2023] [Indexed: 09/01/2023] Open
Abstract
Fractional CO2 laser, as a typical ablative laser, has been used to assist in the treatment of many skin diseases, such as photoaging, atrophic scar, hypertrophic scar, superficial pigmentation, vitiligo, and so on. However, the dynamic changes in skin function after fractional CO2 laser treatment are still unclear. This study explored the changes in local skin function and possible regulatory mechanisms after fractional CO2 laser treatment for 1, 3, 5, and 7 days through transcriptome high-throughput sequencing. The results showed that fractional CO2 laser tended to transform the "lesions" into "normal skin", regulate the skin barrier, coordinate the rearrangement of collagen, enhance the local microvascular circulation, activate the immune system to secrete a large number of cytokines, and act as an auxiliary tool to assist drug transport. In conclusion, according to the basic principle of destruction before reconstruction, fractional CO2 laser plays a key role of balancer in skin reconstruction.
Collapse
Affiliation(s)
- Haoran Guo
- Department of Dermatology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Xiangyu Zhang
- Department of Pulmonary and Critical Care Medicine, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Hui Li
- Department of Dermatology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Chuhan Fu
- Department of Dermatology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Ling Jiang
- Department of Dermatology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Yibo Hu
- Department of Dermatology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Jinhua Huang
- Department of Dermatology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Jing Chen
- Department of Dermatology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Qinghai Zeng
- Department of Dermatology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| |
Collapse
|
8
|
Benitez-Roig V, Martínez-Carpio PA, Trelles MA, Cosmina-Timircan A, Arias-Salgado EG, Perona R. Clinical and laboratory results in vaginal wall restoration using a fractional-pixel-CO 2 laser: histological findings and changes in the Ki67 protein and telomere length. Lasers Med Sci 2023; 38:206. [PMID: 37682379 DOI: 10.1007/s10103-023-03875-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/02/2023] [Indexed: 09/09/2023]
Abstract
Thermal deposition of laser energy in the vaginal epithelium in genitourinary syndrome of menopause (GSM) results in clinical and biological effects, but many cellular and molecular changes indicating cell proliferation or senescence inhibition are unknown. The aim of this study is to evaluate the clinical efficacy of the fractional-pixel-CO2 laser in the possible improvement of GMS signs and symptoms that can be correlated with histological changes or with cellular or molecular indicators of restoration. A detailed prospective study was designed to assess 17 women diagnosed with GSM who were treated intravaginally with two laser sessions. Seven non-treated women diagnosed with GSM were used as controls. Three validated outcome questionnaires for assessment of quality of sexual life and urinary incontinence were performed. Vaginal biopsies were collected before the first laser treatment and 4 months following the second session. Histological status, elastin, collagen, and hyaluronic acid content of the biopsies were also evaluated. Cell proliferation was assessed by Ki67 staining. Telomere length (TL) was measured by qPCR. The results show an improvement of the clinical symptoms of GSM (p < 0.05), vaginal epithelium recovery and enhancement of collagen (p < 0.05), elastic fibers (p < 0.005), and hyaluronic acid (p < 0.0005) content in the lamina propria after fractional-pixel-CO2 laser treatment. The laser treatment induced a significant rise on the TL of vaginal epithelial cells (VECs), and a positive correlation was found between the improvements of the collagen and hyaluronic acid content and TL changes (r = 0.82, p < 0.05; r = 0.38, p < 0.05). The percentage of proliferative Ki67-positive VECs was increased in patients whose vaginal TL lengthened after laser treatment (p < 0.05). In conclusion, the results indicate that laser treatment may induce restoration of the vaginal epithelium which is associated to increased TL and proliferation in the VECs. Performing a TL assay could be a suitable tool to evaluate the efficacy of vaginal laser treatment.
Collapse
Affiliation(s)
| | | | - Mario A Trelles
- Vilafortuny Laser Centre, Jumeirah, Dubai, United Arab Emirates
| | | | - Elena G Arias-Salgado
- Instituto de Investigaciones Biomédicas, CSIC/UAM, C/Arturo Duperier 4, 28029, Madrid, Spain.
| | - Rosario Perona
- Instituto de Investigaciones Biomédicas, CSIC/UAM, C/Arturo Duperier 4, 28029, Madrid, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain.
- Instituto de Salud Carlos III, Madrid, Spain.
| |
Collapse
|
9
|
Blackstone BN, Malara MM, Baumann ME, McFarland KL, Supp DM, Powell HM. Laser Micropatterning Promotes Rete Ridge Formation and Enhanced Engineered Skin Strength without Increased Inflammation. Bioengineering (Basel) 2023; 10:861. [PMID: 37508888 PMCID: PMC10376754 DOI: 10.3390/bioengineering10070861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/11/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
Rete ridges play multiple important roles in native skin tissue function, including enhancing skin strength, but they are largely absent from engineered tissue models and skin substitutes. Laser micropatterning of fibroblast-containing dermal templates prior to seeding of keratinocytes was shown to facilitate rete ridge development in engineered skin (ES) both in vitro and in vivo. However, it is unknown whether rete ridge development results exclusively from the microarchitectural features formed by ablative processing or whether laser treatment causes an inflammatory response that contributes to rete ridge formation. In this study, laser-micropatterned and non-laser- treated ES grafts were developed and assessed during culture and for four weeks post grafting onto full-thickness wounds in immunodeficient mice. Decreases in inflammatory cytokine secretion were initially observed in vitro in laser-treated grafts compared to non-treated controls, although cytokine levels were similar in both groups five days after laser treatment. Post grafting, rete ridge-containing ES showed a significant increase in vascularization at week 2, and in collagen deposition and biomechanics at weeks 2 and 4, compared with controls. No differences in inflammatory cytokine expression after grafting were observed between groups. The results suggest that laser micropatterning of ES to create rete ridges improves the mechanical properties of healed skin grafts without increasing inflammation.
Collapse
Affiliation(s)
- Britani N Blackstone
- Department of Materials Science and Engineering, The Ohio State University, 140 W 19th Avenue, Columbus, OH 43210, USA
| | - Megan M Malara
- Department of Materials Science and Engineering, The Ohio State University, 140 W 19th Avenue, Columbus, OH 43210, USA
| | - Molly E Baumann
- Department of Biomedical Engineering, The Ohio State University, 140 W 19th Avenue, Columbus, OH 43210, USA
| | - Kevin L McFarland
- Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267, USA
| | - Dorothy M Supp
- Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267, USA
- Center for Stem Cell & Organoid Medicine (CuSTOM), Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
- Shriners Children's Ohio, 1 Children's Plaza, Dayton, OH 45404, USA
| | - Heather M Powell
- Department of Materials Science and Engineering, The Ohio State University, 140 W 19th Avenue, Columbus, OH 43210, USA
- Department of Biomedical Engineering, The Ohio State University, 140 W 19th Avenue, Columbus, OH 43210, USA
- Shriners Children's Ohio, 1 Children's Plaza, Dayton, OH 45404, USA
| |
Collapse
|
10
|
Kitagawa H, Sugimoto I, Bito T, Yamanaka K, Terashi H. Partial Excision and Ablative Carbon Dioxide Fractional Laser Therapy for Multiple Apocrine Hidrocystomas on the Periorbital Regions and Cheeks. Case Rep Dermatol Med 2023; 2023:6318220. [PMID: 37470046 PMCID: PMC10353895 DOI: 10.1155/2023/6318220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023] Open
Abstract
A 51-year-old Japanese woman presented with translucent papules on the periorbital area and cheeks that had progressively enlarged over five years. She underwent a skin biopsy and was diagnosed with multiple apocrine hidrocystomas. Her lesions became more pronounced and obscured her vision when her body warmed up, such as during bathing. To alleviate her symptoms, we began treatment by partially resecting the tumors on the lower eyelids. After surgery, her vision was no longer obscured. Approximately 1.5 years later, she underwent ablative 10,600 nm carbon dioxide fractional laser therapy for the mildly enlarged apocrine hidrocystomas on her lower eyelids and cheeks. At roughly six months of follow-up, the symptoms had improved, and the cosmetic results were satisfactory, although minor scarring and hypopigmentation were still evident. These case findings underscore the effectiveness of ablative carbon dioxide fractional lasers in treating apocrine hidrocystomas.
Collapse
Affiliation(s)
- Hiroshi Kitagawa
- Department of Dermatology, Mie University, Graduate School of Medicine, Tsu, Mie 514-8507, Japan
- Department of Plastic and Aesthetic Surgery, Kobe University, Graduate School of Medicine, 7-5-2 Kusunokicho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Isao Sugimoto
- Department of Aesthetic and Plastic Surgery, Sugimoto Aesthetic and Plastic Surgery Clinic, 5-4-10 Kotonocho, Chuo-ku, Kobe, Hyogo 651-0094, Japan
| | - Toshinori Bito
- Department of Dermatology, Bito Dermatology Clinic, City-Plaza F3, 4-1-4 Asahi-Dori, Chuo-ku, Kobe, Hyogo 651-0095, Japan
| | - Keiichi Yamanaka
- Department of Dermatology, Mie University, Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Hiroto Terashi
- Department of Plastic and Aesthetic Surgery, Kobe University, Graduate School of Medicine, 7-5-2 Kusunokicho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| |
Collapse
|
11
|
Wasson E, Thandi C, Hitchens E, Thomas K, Keith D. An audit of the use of fractional CO2 laser for hypertrophic burn scars: a real-life perspective. Lasers Med Sci 2023; 38:144. [PMID: 37347311 DOI: 10.1007/s10103-023-03814-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 06/14/2023] [Indexed: 06/23/2023]
Affiliation(s)
- Elizabeth Wasson
- Foundation School, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
| | - Charankumal Thandi
- Department of Dermatology, North Bristol NHS Trust & Bristol Laser Centre, Bristol, UK
| | - Emma Hitchens
- Department of Dermatology, North Bristol NHS Trust & Bristol Laser Centre, Bristol, UK
| | - Kay Thomas
- Department of Dermatology, North Bristol NHS Trust & Bristol Laser Centre, Bristol, UK
| | - Daniel Keith
- Department of Dermatology, North Bristol NHS Trust & Bristol Laser Centre, Bristol, UK
| |
Collapse
|
12
|
Bonan P, Pieri L, Fusco I, Madeddu F, Zingoni T, Conforti C, Piccolo D. Ex Vivo Human Histology Fractional Treatment with a New CO 2 Scanner: A Potential Application on Deep Scarring. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1117. [PMID: 37374321 DOI: 10.3390/medicina59061117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/29/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: For many years, fully ablative laser treatments, particularly those performed with a carbon dioxide (CO2) laser, were regarded as the gold standard for resurfacing. This study's goal is to assess the depth that can be reached by a new CO2 scanner system, through a skin model with greater dermal thickness, to use in the treatment of deep scarring. Materials and Methods: Male human skin tissue was laser-treated using a CO2 fractional laser and a new scanning system, and all samples were fixed in 10% neutral buffered formalin, dehydrated using a series of crescent alcohol, embedded in paraffin, sectioned in series (4-5 µm thick), stained with haematoxylin and eosin (H&E), and then analysed under an optical microscope. Results: From the epidermis through the underlying papillary and reticular dermis to various depths of the dermis, microablation columns of damage and coagulated microcolumns of collagen were observed. The reticular dermis was fully penetrated up to 6 mm at higher energy levels (210 mJ/DOT), resulting in deeper tissue injury. Although the laser might penetrate further, the skin stops there, leaving just the fat and muscular tissue. Conclusions: The deep layers of the dermis can be penetrated by the CO2 laser system throughout the entire dermal thickness when using the new scanning system, suggesting that this laser's potential impact, at the selected settings, covers all skin targets required to perform superficial or deep treatments on any dermatological issue. Finally, patients who have problems, such as morbid scar-deep complications, which affect their quality of life, are more likely to profit from this innovative technique.
Collapse
Affiliation(s)
- Paolo Bonan
- Laser Cutaneous Cosmetic and Plastic Surgery Unit, Villa Donatello Clinic, 50019 Florence, Italy
| | | | | | | | | | - Claudio Conforti
- Dermatology Clinic, University of Trieste, Piazza dell'Ospitale 1, 34125 Trieste, Italy
| | | |
Collapse
|
13
|
Zorina A, Zorin V, Isaev A, Kudlay D, Vasileva M, Kopnin P. Dermal Fibroblasts as the Main Target for Skin Anti-Age Correction Using a Combination of Regenerative Medicine Methods. Curr Issues Mol Biol 2023; 45:3829-3847. [PMID: 37232716 DOI: 10.3390/cimb45050247] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
This article includes the data from current studies regarding the pathophysiological mechanisms of skin aging and the regenerative processes occurring in the epidermis and dermis at the molecular and cellular level, mainly, the key role of dermal fibroblasts in skin regeneration. Analyzing these data, the authors proposed the concept of skin anti-age therapy that is based on the correction of age-related skin changes by stimulating regenerative processes at the molecular and cellular level. The main target of the skin anti-age therapy is dermal fibroblasts (DFs). A variant of the cosmetological anti-age program using the combination of laser and cellular methods of regenerative medicine is presented in the paper. The program includes three stages of implementation and defines the tasks and methods of each stage. Thus, laser technologies allow one to remodel the collagen matrix and create favorable conditions for DFs functions, whereas the cultivated autologous dermal fibroblasts replenish the pool of mature DFs decreasing with age and are responsible for the synthesis of components of the dermal extracellular matrix. Finally, the use of autological platelet-rich plasma (PRP) enables to maintenance of the achieved results by stimulating DF function. It has been shown that growth factors/cytokines contained in α-granules of platelets injected into the skin bind to the corresponding transmembrane receptors on the surface of DFs and stimulate their synthetic activity. Thus, the consecutive, step-by-step application of the described methods of regenerative medicine amplifies the effect on the molecular and cellular aging processes and thereby allows one to optimize and prolong the clinical results of skin rejuvenation.
Collapse
Affiliation(s)
- Alla Zorina
- The Human Stem Cells Institute, Moscow 119333, Russia
- SKINCELL LLC, Moscow 119333, Russia
| | - Vadim Zorin
- The Human Stem Cells Institute, Moscow 119333, Russia
- SKINCELL LLC, Moscow 119333, Russia
| | - Artur Isaev
- The Human Stem Cells Institute, Moscow 119333, Russia
| | - Dmitry Kudlay
- Department of Pharmacology, The I.M. Sechenov First Moscow State Medical University (The Sechenov University), Moscow 119991, Russia
| | - Maria Vasileva
- The N.N. Blokhin National Medical Research Oncology Center, The Ministry of Health of Russia, Moscow 115478, Russia
| | - Pavel Kopnin
- The N.N. Blokhin National Medical Research Oncology Center, The Ministry of Health of Russia, Moscow 115478, Russia
| |
Collapse
|
14
|
Contini M, Hollander MHJ, Vissink A, Schepers RH, Jansma J, Schortinghuis J. A Systematic Review of the Efficacy of Microfocused Ultrasound for Facial Skin Tightening. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1522. [PMID: 36674277 PMCID: PMC9861614 DOI: 10.3390/ijerph20021522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
Objective: to systematically review the efficacy of microfocused ultrasound (MFU) for facial skin tightening. Methods: A systematic search was performed (Pubmed, Embase) to assess the efficacy of single MFU treatments for facial skin tightening. Eligible studies included randomised controlled trials, controlled trials, cohort studies and case series (n ≥ 10). Objective and subjective outcomes were assessed. Results: A total of 693 studies were identified of which 16 studies were eligible. All the studies involved female patients. MFU is capable of tightening the skin, as observed in studies measuring the results of brow lifts (0.47−1.7 mm) and submental lifts (measured as a 26−45 mm2 reduction in the submental area on lateral photographs). Data from the Global Aesthetic Improvement Scale (GAIS) were pooled, and the day 90 pooled subjective investigator reported scores (IGAIS) (n = 337) showed that 92% of the patients demonstrated an improvement in skin tightening and/or in wrinkle reduction which continued up to one year. Longer-term follow-up data are not available. The patient-reported pooled scores (SGAIS) (n = 81) showed that the skin improvements were mild and continued to increase from 42% (90 days) to 53% (360 days) post-treatment. The MFU treatment was moderately painful and caused transient erythema with or without oedema. Other adverse effects were rare (2%), including dysesthesia (numbness or hypersensitivity), bruising and stinging, mandibular burns, striations and contact dermatitis. Various device settings, treatment protocols and energies were applied. Excessive skin laxity and a BMI > 30 were posed as relative contraindications for MFU treatment because positive results declined with an increase in laxity and BMI. Conclusions: MFU treatment is effective in tightening female patients’ mildly to moderately lax facial skin. Future studies should focus on objective treatment outcomes, optimising treatment regimens and male patients.
Collapse
Affiliation(s)
- Mark Contini
- JC Kliniek, Boermarkeweg 44C, 7824 AA Emmen, The Netherlands
| | - Marijke H. J. Hollander
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen (UMCG), 9700 RB Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen (UMCG), 9700 RB Groningen, The Netherlands
| | - Rutger H. Schepers
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen (UMCG), 9700 RB Groningen, The Netherlands
| | - Johan Jansma
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen (UMCG), 9700 RB Groningen, The Netherlands
| | | |
Collapse
|
15
|
Magni G, Piccolo D, Bonan P, Conforti C, Crisman G, Pieri L, Fusco I, Rossi F. 1540-nm fractional laser treatment modulates proliferation and neocollagenesis in cultured human dermal fibroblasts. Front Med (Lausanne) 2022; 9:1010878. [PMID: 36330058 PMCID: PMC9623312 DOI: 10.3389/fmed.2022.1010878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Giada Magni
- Istituto di Fisica Applicata “Nello Carrara”, Consiglio Nazionale delle Ricerche (IFAC-CNR), Florence, Italy
| | | | - Paolo Bonan
- Laser Cutaneous Cosmetic and Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
| | - Claudio Conforti
- Department of Dermatology and Venereology, Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | | | | | - Irene Fusco
- El.En Group, Calenzano, Italy
- *Correspondence: Irene Fusco
| | - Francesca Rossi
- Istituto di Fisica Applicata “Nello Carrara”, Consiglio Nazionale delle Ricerche (IFAC-CNR), Florence, Italy
| |
Collapse
|
16
|
Tawfic SO, Hassan AS, El-Zahraa Sh Aly F, Elbendary A, Shaker OG, AlOrbani AM. Fractional microneedle radiofrequency versus fractional carbon dioxide laser in the treatment of postburn hypertrophic scars. Lasers Surg Med 2022; 54:1089-1098. [PMID: 35900305 DOI: 10.1002/lsm.23589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/01/2022] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE New and improved treatment modalities, including lasers and energy-based devices, are promising treatment options for hypertrophic scars. This study aimed to assess the efficacy and safety of fractional microneedle radiofrequency (FMR) compared with fractional carbon dioxide (CO2 ) laser in the treatment of postburn hypertrophic scars. PATIENTS AND METHODS Twenty patients with hypertrophic scars were enrolled in the study. Two areas in each patient were randomly assigned to fractional CO2 laser or FMR. Four sessions, 6-8 weeks apart were performed. The Patient and Observer Scar Assessment Scale (POSAS) was used for clinical evaluation, H & E and orcein-stained samples were examined for histopathological assessment, and tissue transforming growth factor beta 1 (TGFβ1 ) levels were measured for biochemical evaluation. RESULTS Both fractional CO2 and FMR-treated areas showed significant improvement in all parameters 1 month after treatment. Fractional CO2-treated areas showed a higher degree of improvement compared with FMR in OSAS (p = 0.025), elastin grading (p = 0.004), and TGFβ1 levels (p = 0.000). Patients reported less downtime and showed less postinflammatory hyperpigmentation with FMR compared with fractional CO2, but this did not reach statistical significance (p = 0.327, p = 0.231; respectively). CONCLUSION Our results demonstrate the value of FMR as an effective alternative to fractional CO2 in the treatment of hypertrophic scars, with a potentially favorable safety profile.
Collapse
Affiliation(s)
- Shereen O Tawfic
- Dermatology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Akmal S Hassan
- Dermatology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | | | - Amira Elbendary
- Dermatology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Olfat G Shaker
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Aya M AlOrbani
- Dermatology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| |
Collapse
|
17
|
Klimek P, Placek W, Owczarczyk-Saczonek A. Fractional Ablative Carbon Dioxide Lasers for the Treatment of Morphea: A Case Series and Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138133. [PMID: 35805793 PMCID: PMC9266234 DOI: 10.3390/ijerph19138133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/17/2022] [Accepted: 06/30/2022] [Indexed: 02/01/2023]
Abstract
Morphea is an inflammatory, immune-mediated disease of unknown aetiology. It is characterised by excessive collagen deposition, which leads to the hardening of the dermis and subcutaneous tissues. The disease is associated with cosmetic and functional impairment, which can affect the patients’ quality of life. Fractional ablative lasers (FALs) are currently used for the treatment of many skin diseases that are connected to tissue fibrosis due to the low risk of side effects and their great effectiveness. This study aimed to improve the aesthetic defects that are caused by morphea lesions and assess the efficacy and safety of FAL use in this indication. We also reviewed the literature on the subject. We present four women with biopsy-proven morphea, manifesting as hyperpigmented plaques and patches. One of the patients additionally had morphea-related knee joint contracture. Four fractional CO2 laser sessions, separated by one-month intervals, were performed and produced significant improvements in dyspigmentation and induration. An improved elasticity and a decrease in dermal thickness were also obtained, as proven by measurements using DermaLab Combo. No severe adverse effects occurred. Based on these cases presented by the authors, fractional CO2 lasers appear to be an effective, well-tolerated, and safe therapeutic option for patients suffering from morphea.
Collapse
|
18
|
Kim J, Jongudomsombat T, Lee Y, Kim J, Oh SH, Hong JW, Lee JH. Combined use of energy-based interventions with low-dose isotretinoin for the treatment of inflammatory acne: An retrospective cohort analysis. J Cosmet Dermatol 2022; 21:4383-4391. [PMID: 35723897 DOI: 10.1111/jocd.15171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/22/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The combined use of oral isotretinoin with energy-based interventions including fractional microneedle radiofrequency, pulsed dye laser, and ablative fractional laser is an effective way to treat moderate-to-severe inflammatory acne lesions. However, studies regarding its efficacy and safety are limited. AIMS This study aimed to assess the efficacy and safety of a treatment using low-dose isotretinoin with energy-based interventions for inflammatory acne. PATIENTS AND METHODS This retrospective cohort study included 126 patients who were diagnosed with inflammatory acne and were treated with systemic isotretinoin for at least 3 months. Patients were divided into EBD (energy-based intervention) (n=82) and non-EBD groups (n=44). Clinical outcomes of both groups were assessed using medical records and digital photographs. RESULTS After treatment, the modified Global Acne Grading Score of the EBD and non-EBD groups decreased by 35.1±17.2 and 25.6±10.1, respectively. The improvement in acne severity was significantly greater in the EBD group than in the non-EBD group. Cumulated isotretinoin dose and frequency of drug-related side effects were significantly higher in the non-EBD group than in the EBD group. CONCLUSION Combined treatment with low-dose isotretinoin and energy-based intervention is well tolerated and associated with positive responses in patients with inflammatory acne.
Collapse
Affiliation(s)
- Jemin Kim
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine.,Scar Laser and Plastic Surgery Center, Yonsei Cancer Hospital, Yonsei University College of Medicine
| | - Tunyaporn Jongudomsombat
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine
| | - YoungIn Lee
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine.,Scar Laser and Plastic Surgery Center, Yonsei Cancer Hospital, Yonsei University College of Medicine
| | - Jihee Kim
- Scar Laser and Plastic Surgery Center, Yonsei Cancer Hospital, Yonsei University College of Medicine.,Department of Dermatology, Yongin Severance Hospital, Yonsei University College of Medicine
| | - Sang Ho Oh
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine
| | - Jong Won Hong
- Scar Laser and Plastic Surgery Center, Yonsei Cancer Hospital, Yonsei University College of Medicine.,Department of Plastic and Reconstructive Surgery Institute for Human Tissue Restoration, Yonsei University College of Medicine
| | - Ju Hee Lee
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine.,Scar Laser and Plastic Surgery Center, Yonsei Cancer Hospital, Yonsei University College of Medicine
| |
Collapse
|
19
|
Scarcella G, Pieri L, Fusco I. Skin Fractional Scar Treatment with a New Carbon Dioxide Scanner: Histological and Clinical Evaluation. Photobiomodul Photomed Laser Surg 2022; 40:424-432. [DOI: 10.1089/photob.2021.0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Giuseppe Scarcella
- General Secretary and National Head of Laser Department of ISPLAD, International-Italian Society of Plastic-Regenerative and Oncologic Dermatology, Verona, Italy
| | | | - Irene Fusco
- Department of Pharmacology, University of Florence, Florence, Italy
| |
Collapse
|
20
|
Chen SX, Cheng J, Watchmaker J, Dover JS, Chung HJ. Review of Lasers and Energy-Based Devices for Skin Rejuvenation and Scar Treatment With Histologic Correlations. Dermatol Surg 2022; 48:441-448. [PMID: 35165220 DOI: 10.1097/dss.0000000000003397] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lasers and energy-based devices (EBD) are popular treatments for skin rejuvenation and resurfacing. Achieving desired outcomes and avoiding complications require understanding the effects of these devices at a histologic level. Currently, no comprehensive review summarizing the histologic effects of laser and energy-based treatments exists. OBJECTIVE To describe how lasers and EBD alter skin histology and improve the overall understanding of these devices. MATERIALS AND METHODS A PubMed search was conducted for studies with histologic analysis of fractional picosecond laser, fractional radiofrequency microneedling, nonablative lasers, and ablative lasers. RESULTS Fractional picosecond lasers induce intraepidermal and/or dermal vacuoles from laser-induced optical breakdown. Fractional radiofrequency microneedling delivers thermal energy to the dermis while sparing the epidermis, making it safer for patients with darker skin phototypes. Fractional nonablative lasers induce conical zones of coagulation of the epidermis and upper dermis. Ablative lasers vaporize the stratum corneum down to the dermis. Traditional ablative lasers cause diffuse vaporization while fractional ablative lasers generate columns of tissue ablation. CONCLUSION Lasers and EBD are effective for skin resurfacing and rejuvenation and have different mechanisms with disparate targets in the skin. Safe and effective use of devices requires understanding the histologic laser-tissue interaction.
Collapse
Affiliation(s)
- Stella X Chen
- Harvard Combined Dermatology Residency Program, Boston, Massachusetts
| | - Judy Cheng
- Department of Dermatology, Northwestern Medical Group, Chicago, Illinois
| | | | - Jeffrey S Dover
- SkinCare Physicians, Chestnut Hill, Massachusetts
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Hye Jin Chung
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| |
Collapse
|
21
|
Schaffrick L, Ding J, Kwan P, Tredget EE. Molecular Features of Hypertrophic Scars After Thermal Injury: Is There a Biologic Basis for Laser Therapy? Adv Wound Care (New Rochelle) 2022; 11:163-178. [PMID: 34663086 DOI: 10.1089/wound.2021.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Significance: Hypertrophic scars (HTS) and keloids are common after thermal injuries and other trauma to deep regions of dermis of the skin. These abnormal scars can cause contractures and the thick masses of scar tissue that result in functional and cosmetic impairment. Management of these dermal fibrotic conditions includes a wide range of medical and surgical treatments, which can be time consuming, only partially effective, and often uncomfortable for patients. Recent Advances: The molecular pathophysiology of HTS has become more understood over the past two decades, where thermal injury to the reticular dermis results in an inflammatory response, fibrogenic growth factor release, and the formation of a dermal scar with increased collagen and proteoglycan composition in an abnormal morphology. Lasers are becoming a widely used form of treatment for these types of scars; however, the evidence for the beneficial effects of laser treatments and the understanding of their mechanism of action are still evolving. Critical Issues: Paradoxically, laser delivery of thermal energy to the skin is suggested to improve scar remodeling and wound healing, yet HTS is a well-recognized complication of excessive thermal energy delivered by laser treatments. This review aims to examine the current evidence for the use of lasers for HTS, and to investigate the molecular mechanisms where re-injury of a burn scar from laser treatment could result in overall improvements in scar quality. Future Directions: Improved design of clinical trials for the treatment of scarring in the future will evolve from new methodology and models of HTS in animals and humans.
Collapse
Affiliation(s)
- Lindy Schaffrick
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Jie Ding
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Peter Kwan
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Edward E. Tredget
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
- Department of Surgery, Division of Critical Care, University of Alberta, Edmonton, Canada
| |
Collapse
|
22
|
de Filippi Sartori J, Osaki TH, Osaki MH, de Souza RB, Allemann N. "Split-Face" Evaluation of Collagen Changes Induced by Periorbital Fractional CO2 Laser Resurfacing. Aesthet Surg J 2022; 42:239-248. [PMID: 34618888 DOI: 10.1093/asj/sjab357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Periorbital fractional CO2 laser resurfacing has been employed for facial rejuvenation purposes. However, to the best of our knowledge, no study has objectively assessed periorbital neoformation and remodeling of local cutaneous collagen, in a split-face model, from skin samples obtained during upper blepharoplasty. OBJECTIVES The authors sought to objectively evaluate neoformation and remodeling of local cutaneous collagen after periorbital skin fractional CO2 laser resurfacing. METHODS Sixteen female patients presenting with dermatochalasis and periorbital rhytids were evaluated in a prospective and comparative study. All patients underwent unilateral periorbital fractional CO2 laser resurfacing 30 days before upper blepharoplasty. Quantification of types I and III collagen from laser-treated and untreated eyelid skin samples obtained during upper blepharoplasty was assessed with histochemical analysis (Picrosirius Red staining). Laser resurfacing treatment was applied to the untreated side immediately after the upper blepharoplasty. Two blinded, independent physicians evaluated clinical improvement in pretreatment and 1- and 6-month posttreatment digital images. RESULTS Histochemical analysis showed significantly higher intensity in collagen types I (treated: 158.7 ± 5.3, untreated: 139.2 ± 5.0; P < 0.0001) and III (treated: 105.1 ± 7.7, untreated: 104.1 ± 7.1; P < 0.0001) in the fractional CO2 laser treatment samples; a greater difference was detected in collagen type I. A significant improvement in periorbital rhytidosis was observed 1 month after laser resurfacing (23%); a greater improvement in the periorbital region was observed 6 months after laser resurfacing and upper blepharoplasty (43.67%). CONCLUSIONS Periorbital fractional CO2 laser resurfacing was an effective method to improve palpebral skin, with histochemical evidence of increase in collagen types I and III. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- Juliana de Filippi Sartori
- Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo (EPM/ UNIFESP), São Paulo, SP, Brazil
| | - Tammy Hentona Osaki
- Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo (EPM/ UNIFESP), São Paulo, SP, Brazil
| | - Midori Hentona Osaki
- Periorbital Aesthetics Sector, Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil
| | - Rodrigo Barbosa de Souza
- Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of São Paulo, São Paulo, SP, Brazil
| | - Norma Allemann
- Division of Ocular Imaging, Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo (UNIFESP/ EPM), São Paulo, SP, Brazil
| |
Collapse
|
23
|
Abstract
ABSTRACT Skin changes that accompany aging lead many to seek treatments that restore a more youthful appearance. Common issues of concern include skin tone, wrinkles, skin thinning, sagging, laxity and decreased elasticity, and hollowing of the face. This work discusses these concerns and their anatomic bases and highlights evidence for a causal role played by menopause-associated hormonal changes where such evidence exists. In addition, treatment options are discussed, with an emphasis on minimally invasive approaches. A variety of modalities are discussed, including botulinum toxins, fillers, multiple types of lasers, radiofrequency devices, focused ultrasound, chemical peels, and thread lifts. These interventions, often in combination, can achieve goals of patients seeking aesthetic rejuvenation.
Collapse
Affiliation(s)
- Yakir S Levin
- Harvard Medical School, Department of Dermatology and Wellman Center for Photomedicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114
| |
Collapse
|
24
|
Kim H, Lee S, Cho M, Han Y, Woo Y, Cho S, Lee J. Laser-induced mottled hypopigmentation successfully treated with a combined regimen of topical calcineurin inhibitors and fractional CO 2 laser. DERMATOL SIN 2022. [DOI: 10.4103/ds.ds_2_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
25
|
Alhamzawi NK. Efficacy of Fractional Carbon Dioxide Laser (FCO 2) with Intralesional 5-Fluorouracil (5-FU) in the Treatment of Keloids. J Cutan Aesthet Surg 2021; 14:323-329. [PMID: 34908775 PMCID: PMC8611703 DOI: 10.4103/jcas.jcas_153_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Context: Managing keloids remains a challenge in clinical practice. Many therapeutic options are available, but none is universally accepted or without recurrence. Therefore, an effort is required to choose the treatment with maximal outcomes. Aims: To evaluate the effectiveness of combining fractional carbon dioxide (FCO2) laser and intralesional 5-fluorouracil (5-FU) for the treatment of keloids. Materials and Methods: In this prospective open-label study, 24 patients received FCO2 laser treatment, started at baseline, for a total of six sittings. The patients also received 1 mL/cm2/keloid of 5-FU (50 mg/mL) intralesionally, following irradiation, at identical time points. The primary outcome evaluated was the clinical response concerning height, pliability, vascularity, and pigmentation, using the Vancouver Score Scale (VSS). Adverse reactions and recurrences were recorded as secondary outcomes. Results: A significant reduction was observed in the VSS in terms of pliability and height after three treatment sessions. The mean VSS reduction was 65%, from 8.45 ± SD 0.93 at baseline to 3 ± SD 1.8 one month after the last treatment (P < 0.05). Most patients (79.1%; n = 19) showed a satisfactory response to treatment, with 57.8% (n = 11) achieving an excellent result. Adverse reactions included post-inflammatory hyperpigmentation in four patients and ulceration in two. Recurrences were reported in 21% of the patients who responded well. Conclusions: Combination therapy with FCO2 laser and intralesional 5-FU showed a promising effect in the treatment of resistant keloids, with an acceptable safety profile and low recurrence rate.
Collapse
|
26
|
Transcriptomic analysis of human skin wound healing and rejuvenation following ablative fractional laser treatment. PLoS One 2021; 16:e0260095. [PMID: 34843523 PMCID: PMC8629261 DOI: 10.1371/journal.pone.0260095] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/02/2021] [Indexed: 11/19/2022] Open
Abstract
Ablative fractional laser treatment is considered the gold standard for skin rejuvenation. In order to understand how fractional laser works to rejuvenate skin, we performed microarray profiling on skin biopsies to identify temporal and dose-response changes in gene expression following fractional laser treatment. The backs of 14 women were treated with ablative fractional laser (Fraxel®) and 4 mm punch biopsies were collected from an untreated site and at the treated sites 1, 3, 7, 14, 21 and 28 days after the single treatment. In addition, in order to understand the effect that multiple fractional laser treatments have on skin rejuvenation, several sites were treated sequentially with either 1, 2, 3, or 4 treatments (with 28 days between treatments) followed by the collection of 4 mm punch biopsies. RNA was extracted from the biopsies, analyzed using Affymetrix U219 chips and gene expression was compared between untreated and treated sites. We observed dramatic changes in gene expression as early as 1 day after fractional laser treatment with changes remaining elevated even after 1 month. Analysis of individual genes demonstrated significant and time related changes in inflammatory, epidermal, and dermal genes, with dermal genes linked to extracellular matrix formation changing at later time points following fractional laser treatment. When comparing the age-related changes in skin gene expression to those induced by fractional laser, it was observed that fractional laser treatment reverses many of the changes in the aging gene expression. Finally, multiple fractional laser treatments, which cover different regions of a treatment area, resulted in a sustained or increased dermal remodeling response, with many genes either differentially regulated or continuously upregulated, supporting previous observations that maximal skin rejuvenation requires multiple fractional laser treatments. In conclusion, fractional laser treatment of human skin activates a number of biological processes involved in wound healing and tissue regeneration.
Collapse
|
27
|
Li FG, Maheux-Lacroix S, Deans R, Nesbitt-Hawes E, Budden A, Nguyen K, Lim CY, Song S, McCormack L, Lyons SD, Segelov E, Abbott JA. Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Symptom Severity in Women With Postmenopausal Vaginal Symptoms: A Randomized Clinical Trial. JAMA 2021; 326:1381-1389. [PMID: 34636862 PMCID: PMC8511979 DOI: 10.1001/jama.2021.14892] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Postmenopausal vaginal symptoms are common and frequently detrimental to a woman's quality of life. Fractional carbon dioxide vaginal laser is increasingly offered as a treatment, but the efficacy remains unproven. OBJECTIVE To determine the efficacy of fractional carbon dioxide laser for treatment of vaginal symptoms associated with menopause. DESIGN, SETTING, AND PARTICIPANTS A double-blind, randomized, sham-controlled trial with 12-month follow-up was undertaken at a single tertiary referral hospital in Sydney, Australia. Enrollment commenced on September 19, 2016, with final follow-up on June 30, 2020. Participants were postmenopausal women with vaginal symptoms substantive enough to seek medical treatment. Of 232 participants approached, 85 were randomized. INTERVENTIONS Three treatments using a fractional microablative carbon dioxide laser system performed 4 to 8 weeks apart, with 43 women randomized to the laser group and 42 to the sham group. MAIN OUTCOMES AND MEASURES The co-primary outcomes were symptom severity assessed using a visual analog scale (VAS; range, 0-100; 0 indicates no symptoms and 100 indicates the most severe symptoms) and the Vulvovaginal Symptom Questionnaire (VSQ; range, 0-20; 0 indicates no symptoms and 20 indicates the most severe symptoms) at 12 months. The minimal clinically important difference was specified as a 50% decrease in both VAS and VSQ severity scores. There were 5 prespecified secondary outcomes, including quality of life (range, 0-100; higher scores indicate better quality of life), the Vaginal Health Index Score (range, 5-25; higher scores indicate better health), and vaginal histology (premenopausal or postmenopausal status). RESULTS Of 85 randomized participants (mean [SD] age, 57 [8] years), 78 (91.7%) completed the 12-month follow-up. From baseline to 12 months, there was no significant difference between the carbon dioxide laser group and the sham group in change in symptom severity (VAS score for overall vaginal symptoms: -17.2 vs -26.6; difference, 9.4 [95% CI, -28.6 to 47.5]; VAS score for the most severe symptom: -24.5 vs -20.4; difference -4.1 [95% CI, -32.5 to 24.3]; VSQ score: -3.1 vs -1.6; difference, -1.5 [95% CI, -5.9 to 3.0]). There were no significant differences between the laser and sham group in the mean quality of life score (6.3 vs 1.4; difference, 4.8 [95% CI, -3.9 to 13.5]) and Vaginal Health Index Score (0.9 vs 1.3; difference, -0.4 [95% CI, -4.3 to 3.6]) or in histological comparisons between laser and sham treatment groups. There were 16 adverse events in the laser group and 17 in the sham group, including vaginal pain/discomfort (44% vs 68%), spotting, discharge, and lower urinary tract symptoms. No severe adverse events were reported in either group. CONCLUSIONS AND RELEVANCE Among women with postmenopausal vaginal symptoms, treatment with fractional carbon dioxide laser vs sham treatment did not significantly improve vaginal symptoms after 12 months. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN12616001403426.
Collapse
Affiliation(s)
- Fiona G. Li
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Sarah Maheux-Lacroix
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Rebecca Deans
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Aaron Budden
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Kimberly Nguyen
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Claire Y. Lim
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Sophia Song
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Lalla McCormack
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Stephen D. Lyons
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Eva Segelov
- School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Jason A. Abbott
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| |
Collapse
|
28
|
Ge X, Sun Y, Lin J, Zhou F, Yao G, Su X. Effects of multiple modes of UltraPulse fractional CO 2 laser treatment on extensive scarring: a retrospective study. Lasers Med Sci 2021; 37:1575-1582. [PMID: 34436696 PMCID: PMC8971167 DOI: 10.1007/s10103-021-03406-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/18/2021] [Indexed: 12/03/2022]
Abstract
The main therapeutic options for extensive scarring (e.g., > 20% of the total body surface area, or TBSA) after burns and trauma have focused on conservative treatments, such as compression, moisturization, and topical agent application. However, these treatments may not achieve optimal effects due to the large size and complexity of the scars. UltraPulse fractional CO2 laser treatment is a novel approach that is currently a subject of intense interest; this treatment is most widely used to improve texture, pliability, and pigmentation in all types of scars. However, no studies on the independent use of UltraPulse fractional CO2 laser treatment for extensive scars have been reported. This retrospective study evaluated a total of 21 patients, whose scars covered 20 to 65% TBSA. Scar thickness was measured by ultrasonography before treatment. Personalized treatment modalities and parameters were set according to the scar type and thickness. Scar formation and treatment effects were evaluated by photography, the Patient and Observer Scar Assessment Scale (POSAS), and patients’ judgment of effectiveness. Where the scars covered joints, joint function was assessed by measuring the maximum range of motion (ROM). With laser therapy, scars became flatter and lighter; furthermore, pruritus, pain, and discomfort decreased significantly. POSAS scores significantly decreased after laser therapy, including the item scores for pain and pruritus. There were no instances of joint contracture, ROM reduction, apparent functional impairment, serious adverse events, or comorbidities. This study demonstrates the safety and efficiency of UltraPulse fractional CO2 laser treatment for extensive scarring.
Collapse
Affiliation(s)
- Xiaojing Ge
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, Jiangsu Province, China
| | - Yute Sun
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, Jiangsu Province, China
| | - Jing Lin
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, Jiangsu Province, China
| | - Fang Zhou
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, Jiangsu Province, China
| | - Gang Yao
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, Jiangsu Province, China
| | - Xin Su
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, Jiangsu Province, China.
| |
Collapse
|
29
|
Laser Therapy for the Treatment of Morphea: A Systematic Review of Literature. J Clin Med 2021; 10:jcm10153409. [PMID: 34362192 PMCID: PMC8347526 DOI: 10.3390/jcm10153409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023] Open
Abstract
Morphea, also known as localized scleroderma (LoS), comprises a set of autoimmune sclerotic skin diseases. It is characterized by inflammation and limited thickening and induration of the skin; however, in some cases, deeper tissues might also be involved. Although morphea is not considered a life-threatening disease, the apparent cosmetic disfigurement, functional or psychosocial impairment affects multiple fields of patients’ quality of life. Therapy for LoS is often unsatisfactory with numerous treatments that have only limited effectiveness or considerable side effects. Due to the advances in the application of lasers and their possible beneficial effects, the aim of this study is to review the reported usage of laser in morphea. We present a systematic review of available literature, performed with MEDLINE, Cinahl, Central, Scopus, Web of Science, and Google Scholar databases. We identified a total of twenty relevant studies (MEDLINE n = 10, Cinahl n = 1, Central n = 0, Scopus n = 2, Web of Science n = 5, Google Scholar n = 2) using laser therapy for LoS. Eight studies were focused on the use of PDL, six on fractional lasers (CO2 and Er:YAG), four on excimer, and two on either alexandrite or Nd:YAG.
Collapse
|
30
|
Jordão JM, Stoliar MFF, Melo SS, de Campos GLM, de Forville Mesquita LA, Skare TL. Low-fluence and low-density CO2 laser: histological analysis of collagen fiber changes in skin and its clinical repercussions in photorejuvenation. Lasers Med Sci 2021; 37:905-911. [PMID: 34009520 DOI: 10.1007/s10103-021-03330-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
This study refers to clinical and histologic analysis of effects on photorejuvenation after one single treatment of fractional CO2 laser with low fluence and low density. To analyze histologically the quantitative variation of collagen fibers type I and III, elastic fibers, and epidermal thickness on D84, besides clinical evaluation of amount, length, thickness, and depth of periocular wrinkles during the same period. This is an open, prospective, interventional study. There were 40 healthy female with age between 35 and 65 years. Twenty-six participants were randomly selected for D0 and D84 biopsy. A single session of fractional CO2 laser was done in the hole face, using a 800-µm tip, 5% density, and 10 mJ fluence with a single pass. On D0, D42, and D84, a clinical comparative analysis of amount, length, depth, and thickness of periocular wrinkles has been done. On histological analysis, a comparative quantitative evaluation of collagen fibers type I and III, elastic fibers, and epidermal thickness has been done on D0 and D84. The results of this study denoted a significant clinical improvement of amount (- 32.17%; p < 0.0001), thickness (- 33%; p < 0.0001), lenght (- 35.84%; p < 0.0001), and depth of periocular wrinkles (- 32.46%; p < 0.0001). A significant increase in the amount of collagen fibers type III was observed on D84 (+ 60.67%; p = 0.0013). Collagen fibers type I and elastic fibers did not have the same result, with a nonsignificant increase (+ 8.31%; p = 0.3820) and a decrease (- 12.4%; p = 0.0585) respectively. Epidermal thickness has a tendency to significant variation (p = 0.05553). The results demonstrate that fractional CO2 laser with low fluence and low density is a safe and efficient option for photorejuvenation of the face.
Collapse
Affiliation(s)
- Juliana Merheb Jordão
- Head of Laser Therapy Dermatology Department, Hospital Universitário Evangélico Mackenzie, Curitiba, PR, Brazil.
| | | | - Sarah Sanches Melo
- Dermatology Department, Hospital Universitário Evangélico Mackenzie, Curitiba, PR, Brazil
| | | | | | - Thelma Larocca Skare
- Rheumatology Department, Hospital Universitário Evangélico Mackenzie, Curitiba, PR, Brazil
| |
Collapse
|
31
|
Motta MM, Stelini RF, Calderoni DR, Gilioli R, Damiani GV, César CL, Kharmandayan P. Effects of the lower energy and pulse stacking in carbon dioxide laser skin treatment: an objective analysis using second harmonic generation. Acta Cir Bras 2021; 36:e360304. [PMID: 33978061 PMCID: PMC8112111 DOI: 10.1590/acb360304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/11/2021] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To evaluate the effect of fractional carbon dioxide (CO2) laser treatment using lower power associated with pulse stacking within collagen fibers, using second harmonic generation microscopy and computerized image analysis. METHODS Twenty male Wistar rats aging eight weeks were used. Each treatment area received a single-pass CO2 fractional laser with different parameters. The 20 animals were divided into two groups and euthanized after 30 and 60 days. Second harmonic generation images were obtained and program ImageJ was utilized to evaluate the collagen organization within all areas. Collagen anisotropy, entropy and optical density were quantified. RESULTS Increased anisotropy over time was observed in all four areas, but only reached statistical significance (p = 0.0305) when the mildest parameters were used (area four). Entropy decreased over time in all areas, but without significance(p = 0.1779) in area four. Density showed an overtime increase only in area four, but no statistical significance was reached (p = 0.6534). CONCLUSIONS When combined, the results obtained in this study regarding anisotropy, entropy and density tend to demonstrate that it is possible to achieve collagen remodeling with the use of lower power levels associated with stacked pulses.
Collapse
|
32
|
Ou KL, Wen CC, Lan CY, Chen YA, Wang CH, Wang YW. The Optimal Application of Medium Potency Topical Corticosteroids in Preventing Laser-Induced Inflammatory Responses-An Animal Study. Life (Basel) 2021; 11:life11040350. [PMID: 33920511 PMCID: PMC8073345 DOI: 10.3390/life11040350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 01/07/2023] Open
Abstract
Background: During ablative fractional resurfacing (AFR) laser therapy, thermal damage to the skin is inevitable, resulting in inflammatory responses and small wounds. Corticosteroids are known for their anti-inflammatory effect. However, inappropriate application of corticosteroids carries the risk of delayed wound healing. Therefore, we aimed to find the optimal administration route, timing, and duration of medium potency corticosteroid treatment to prevent AFR laser-induced inflammatory responses and to minimize the risk of delayed wound healing. Methods: We determined the anti-inflammatory efficacy of corticosteroids by skin erythema and tissue biopsies on C57BL/6 mice. Wound healing was evaluated by crust area and epithelial gap. Finally, Masson’s trichrome stain and α-SMA immunohistochemistry stain were used to analyze scar contracture. Results: Our results demonstrated that one dose of medium-potency topical corticosteroid applied immediately after AFR laser treatment could prevent erythema effectively with minimal disruption to wound healing. Notably, when more than one dose was administered, wound healing was delayed and scar contracture was aggravated by the application of medium-potency topical corticosteroids in a dosage-dependent manner. Conclusion: Our findings suggested that single-dose medium-potency topical corticosteroids could potentially improve AFR laser-induced acute inflammatory responses in clinical applications.
Collapse
Affiliation(s)
- Kuang-Ling Ou
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
| | - Chia-Cheng Wen
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
| | - Ching-Ya Lan
- Department and Graduate Institute of Biology and Anatomy, National Defense Medical Center, Taipei 114, Taiwan;
| | - Yu-An Chen
- Department of Health and Leisure Management, Yuanpei University of Medical Technology, Hsinchu 300, Taiwan;
| | - Chih-Hsin Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
- Correspondence: (C.-H.W.); (Y.-W.W.)
| | - Yi-Wen Wang
- Department and Graduate Institute of Biology and Anatomy, National Defense Medical Center, Taipei 114, Taiwan;
- Correspondence: (C.-H.W.); (Y.-W.W.)
| |
Collapse
|
33
|
Holcomb JD. Helium plasma dermal resurfacing: VISIA CR assessment of facial spots, pores, and wrinkles-Preliminary findings. J Cosmet Dermatol 2021; 20:1668-1678. [PMID: 33773028 PMCID: PMC8251577 DOI: 10.1111/jocd.14106] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/01/2021] [Accepted: 03/19/2021] [Indexed: 12/18/2022]
Abstract
Objectives Effects of low energy, single‐pass helium plasma dermal resurfacing (PDR) treatment on brown spots, enlarged pores, and wrinkles—preliminary findings. Methods Twenty two subjects (64.6 ± 6.6 years) with Fitzpatrick Wrinkle and Elastosis Scale score (FWS) of ≤2 and seeking improvement of facial appearance were included in this subanalysis. All subjects received a single, one‐pass, full face, and low power helium PDR treatment. Standard digital images were collected using the VISIA‐CR (Canfield Scientific Inc.) at baseline and 3 months after treatment with images assessed for improvement in FWS and for improvements in brown spots, enlarged pores, and wrinkles by proprietary automated image processing algorithms. Results Nearly all subjects demonstrated ≥1‐point improvement in FWS and also reported improvement per modified Global Aesthetic Improvement Scale query. The numbers of brown spots and enlarged pores decreased by 45.1% and 28.3%, respectively. Stratification of brown spots data by presence or absence of post‐inflammatory hyperpigmentation revealed paradoxically conflicting data. The improvement detected in wrinkle area and mean wrinkle thickness was less pronounced with overall reductions of 13.4% and 4.8%, respectively. 37 Non‐serious adverse events (AEs) in 22 subjects were reported with most resolving within 14 days or less, and no serious AEs were observed. Conclusions While longer‐term follow‐up is needed, these early study results show that one single‐pass, low energy helium PDR treatment improves facial skin appearance both qualitatively and quantitatively. Studies evaluating higher energy levels and multiple treatment passes are ongoing.
Collapse
|
34
|
Benzaquen M, Fongue J, Pauly V, Collet-Villette AM. Laser-Assisted Hyaluronic Acid Delivery by Fractional Carbon Dioxide Laser in Facial Skin Remodeling: A Prospective Randomized Split-Face Study in France. Lasers Surg Med 2021; 53:1166-1172. [PMID: 33792961 DOI: 10.1002/lsm.23403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/06/2021] [Accepted: 03/15/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Combining the efficacy of ablative fractional carbon dioxide lasers (AFXL) to laser-assisted hyaluronic acid delivery (LAHAD) has not yet been studied. The objective of our study was to evaluate the safety and the efficacy of laser-assisted hyaluronic acid (HA) delivery with AFXL in facial skin remodeling. STUDY DESIGN/MATERIALS AND METHODS We conducted a prospective, double-blinded, randomized split-face study on 20 patients from 30 to 70 years old, with a skin phototype from I to IV. Each patient received full-face treatment with AFXL, immediately followed by the application in droplets into the fractional ablative tunnels of 1 ml of HA gel on one hemiface and 1 ml of physiological saline on the other hemiface. To evaluate postlaser aftermath, the intensity of erythema, edema, and crusts was graded. To assess facial skin remodeling, we scored the improvement of skin texture, firmness, fine lines, and skin radiance from baseline. Patients were evaluated on the 3rd and 7th day, 1st and 3rd month using clinical evaluations, photographs, and patient questionnaires. RESULTS We showed equivalence in postlaser aftermath between HA-treated and nontreated hemiface. Trend data analyses at the 3rd month suggested that immediate application of HA after AFXL resulted in a greater improvement in facial skin remodeling, especially for skin texture (mean score of 2.60 vs. 2.45) and skin firmness (mean score of 2.55 vs. 2.40). Skin radiance showed the best improvement, reaching almost a score of 5/10. CONCLUSIONS LAHAD with AFXL is a safe treatment showing promising results in facial skin remodeling. These findings need to be confirmed by a larger study to evaluate the value of LAHAD in daily clinical practice. Lasers Surg. Med. © 2021 Wiley Periodicals LLC.
Collapse
Affiliation(s)
- Michael Benzaquen
- Department of Dermatology, Inselspital-Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland
| | - Jessica Fongue
- Dermatologic Laser Center, Hôpital de la Conception, Aix-Marseille Univ., APHM, 13005, Marseille, France
| | - Vanessa Pauly
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille Univ., Marseille, 13005, France.,Department of Medical Information, APHM, Marseille, 13005, France
| | - Anne-Marie Collet-Villette
- Dermatologic Laser Center, Hôpital de la Conception, Aix-Marseille Univ., APHM, 13005, Marseille, France
| |
Collapse
|
35
|
Alexiades M, Munavalli GS. Single Treatment Protocol With Microneedle Fractional Radiofrequency for Treatment of Body Skin Laxity and Fat Deposits. Lasers Surg Med 2021; 53:1026-1031. [PMID: 33764552 PMCID: PMC8518615 DOI: 10.1002/lsm.23397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/10/2021] [Accepted: 02/22/2021] [Indexed: 11/12/2022]
Abstract
Background and Objectives Treatment modalities have been developed to address patient concerns with skin laxity and focal adipose excess. A previously published multicenter clinical trial reported improvement in cellulite severity after a single dermal and subcutaneous treatment on the upper thigh with a microneedle radiofrequency device. In the current study, this device was used to improve the esthetic appearance of body skin laxity and localized fat deposits above the knee, upper arms, and upper‐mid back/axillary region (“bra‐line”). Study Design/Materials and Methods Subjects with cellulite, skin laxity, and/or subcutaneous adipose excess in the suprapatellar region of the anterior thigh, upper arms, and bra‐line underwent a single dermal and/or subcutaneous treatment. Investigators and subjects assessed outcome at 1‐, 3‐, and 6‐month follow‐up, using 5‐point Likert scales for global esthetic improvement, skin laxity improvement, and satisfaction. Results In total, 31 females (mean age 51 ± 9 years) with Fitzpatrick skin types I–IV received a single treatment on 62 treatment areas: 22 upper arms, 34 suprapatellar, and 6 bra‐lines. Investigator assessments at 1, 3, and 6 months for global esthetic improvement and skin laxity for the upper arms and bra‐line demonstrated improvements in 100% of subjects at all timepoints; for the suprapatellar region, these values were 69%, 92%, 65%, and 85%, 92%, 65%, respectively. Investigator satisfaction at each timepoint was satisfied or very satisfied in 80%, 100%, 90% for upper arms; 80%, 80%, 80% for bra‐line; and 50%, 81%, 65% for suprapatellar region. Subject self‐assessments at 1, 3, and 6 months for global esthetic improvement and skin laxity for the upper arms demonstrated improvements in 100% of subjects at all timepoints; for the bra‐line, these values were 40%, 60%, 80%, and 60%, 60%, 80%, respectively; for the suprapatellar region, these values were 81%, 92%, 88%, and 69%, 85%, 88%, respectively. Subject satisfaction at each timepoint was satisfied or very satisfied in 80%, 100%, 100% for upper arms; 40%, 40%, 80% for bra‐line; and 50%, 77%, 65% for suprapatellar. Treatments were well tolerated with subjects reporting transient erythema and edema associated with 69% and 46% of treatments, respectively. Mild bruising, resolving within 5 days, was reported after 32% of the treatments. Conclusion Microneedle fractional radiofrequency provides a single treatment protocol to improve the esthetic appearance of body skin laxity and localized adipose excess to the upper arms, bra‐line, and suprapatellar regions. Further study is warranted to evaluate the degree of improvement and long‐term effect beyond 6 months post‐treatment. Lasers Surg. Med. © 2021 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC
Collapse
Affiliation(s)
- Macrene Alexiades
- School of Medicine, Yale University, New Haven, Connecticut, 06510.,Dermatology and Laser, Surgery Center, New York, New York, 10028
| | - Gilly S Munavalli
- Dermatology, Laser & Vein Specialists of the Carolinas, Charlotte, North Carolina, 28207
| |
Collapse
|
36
|
Liu D, Zhao S, Li J, Chen M, Wu L. The application of physical pretreatment in photodynamic therapy for skin diseases. Lasers Med Sci 2021; 36:1369-1377. [PMID: 33404884 DOI: 10.1007/s10103-020-03233-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 12/22/2020] [Indexed: 01/22/2023]
Abstract
Photodynamic therapy (PDT) is widely used in skin diseases; the response rate of PDT treatment varies widely. The limited penetration in the tissue of photosensitizers influenced the penetration depth of PDT, which obviously impacts the therapeutic effect. The studies have improved the efficacy of PDT through various pretreatment applications; especially, the physical pretreatment had achieved significant outcomes. We will review the physical pretreatment to optimize the efficacy of PDT in skin diseases by searching the literature on this topic. The types of physical pretreatment commonly used in the clinical practice are discussed: curettage, superficial shaving, laser, surgical resection, plum-blossom needles, and microneedles. Compared with PDT alone, the physical pretreatment before PDT application was generally improved the efficacy and reduced the recurrence, especially in actinic keratoses (AK), Bowen disease (BD), basal cell carcinoma (BCC), and viral warts. The application of the physical pretreatments before PDT may improve the efficacy of PDT in various skin diseases. However, each kind of physical pretreatment has the benefit and shortcoming, and the applicable situation is different.
Collapse
Affiliation(s)
- Dihui Liu
- Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.,Department of Dermatology, Guangzhou Integrated Traditional Chinese and Western Medicine Hospital, 87 Yingbin Avenue, Huadu District, Guangzhou, 510800, Guangdong, China
| | - Shuang Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Jinmao Li
- Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Mingliang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.
| | - Lisha Wu
- Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China. .,Institute of Medical Sciences, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
| |
Collapse
|
37
|
Safety of Combined Fractional Microneedle Radiofrequency and CO2 as an Early Intervention for Inflammatory Acne and Scarring Treated With Concomitant Isotretinoin. Dermatol Surg 2021; 46:e71-e77. [PMID: 32187040 DOI: 10.1097/dss.0000000000002364] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fractional microneedle radiofrequency (FMRF) systems are popular options for treating acne scars. However, treatment efficacy when used in combination with traditional ablative fractional laser (AFL) and the safety profile with concomitant use of isotretinoin remain unknown. OBJECTIVE The aim of this study was to assess the safety and efficacy of an early intervention combination treatment protocol for inflammatory acne and acne scars. MATERIALS AND METHODS The electronic records of 71 patients with inflammatory acne and acne scars were included in this retrospective observational study. Data were collected for all patients who received combination FMRF and AFL. Within the study group, 43 patients were receiving low-dose isotretinoin or had completed isotretinoin within the past 3 weeks. RESULTS The mean Scar Global Assessment score significantly decreased after 3 sessions of combination treatment (n = 71). Patients with inflammatory acne showed a significant decrease in the number of inflammatory lesions (n = 30). Patients with concomitant low-dose isotretinoin use reported a further decrease in Scar Global Assessment score (n = 43). There were no reported persistent side effects, including prolonged inflammatory reaction or scarring. CONCLUSION Combination treatment with FMRF and AFL is an effective and well-tolerated treatment modality for acne scars and inflammatory acne.
Collapse
|
38
|
Harrison LM, Shapiro R, Johnson RM. Tissue Modification in Nonsurgical Facelift Options. Facial Plast Surg 2020; 36:688-695. [PMID: 33368123 DOI: 10.1055/s-0040-1721115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Nonsurgical facelifts are a term for a heterogeneous group of procedures used by physicians to improve facial rejuvenation without the use of operative techniques. Patients demand these services due to the reduced recovery time and generally lower risk. However, nonsurgical techniques, to be effective, must induce conformational change in the cells and tissues of the face. Therefore, these techniques are significant procedures that have associated risks. Understanding the tissue modifications and mechanisms of action of these techniques is vital to their safe and effective use. The purpose of this article is to provide a background of tissue modification in nonsurgical facelift options.
Collapse
Affiliation(s)
- Lucas M Harrison
- Department of Plastic Surgery, Wright State University, Dayton, Ohio
| | - Ryan Shapiro
- Department of Plastic Surgery, Wright State University, Dayton, Ohio
| | - R Michael Johnson
- Department of Plastic Surgery, Wright State University, Dayton, Ohio
| |
Collapse
|
39
|
Badawi A, Osman M, Kassab A. Novel Management of Rhinophyma by Patterned Ablative 2940nm Erbium:YAG Laser. Clin Cosmet Investig Dermatol 2020; 13:949-955. [PMID: 33335414 PMCID: PMC7737936 DOI: 10.2147/ccid.s286847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/15/2020] [Indexed: 11/24/2022]
Abstract
Introduction Rhinophyma is a cosmetic disorder that causes emotional distress if the symptoms are extensive or obvious enough. Treatment options range from topical antibiotics or isotretinoin, surgical resection, cryosurgery, electrocautery, dermabrasion and more recently laser therapy. With the limitations of surgical techniques, lasers gained popularity for treating rhinophyma. However, laser ablation is invasive and can lead to side effects and prolonged downtime. Fractional photothermolysis (FP) was introduced to overcome the limitations posed by conventional ablative lasers. To the best of our knowledge, there are no previous studies to evaluate the use of Er:YAG in an ablative mode with a fractional handpiece for the treatment of rhinophyma. Aim of the Work The goal of this study was to evaluate the efficacy and safety of fractional ablative 2940 nm Er:YAG laser for the treatment of mild to moderate rhinophyma. Patients and Methods Sixteen patients having mild to moderate rhinophyma were treated with fractional ablative 2940 nm Er:YAG laser. All patients received 4 laser treatments and were followed up over the following 3 months. An additional follow-up appointment 6 months after the last session was arranged to detect any signs of recurrence. Outcome Measures Patient questionnaire was used to evaluate patient subjective satisfaction. Objective evaluation was performed by a blind assessment of clinical photographs that were taken before and 3 months after the final treatment by two independent blinded evaluators. Results Patient questionnaire taken 3 months after last treatment revealed that 8 patients (50%) were “very satisfied”, 4 patients (25%) were satisfied, and 4 patients (25%) were somewhat satisfied. None of the patients assessed their results as not satisfying. Conclusion In conclusion, the use of patterned ablative Er:YAG laser with a PS01 handpiece and parameters used in this study comprise an effective tool for treatment of mild to moderate rhinophyma with rapid postoperative recovery compared with conventional surgical procedures and other ablative lasers.
Collapse
Affiliation(s)
- Ashraf Badawi
- Department of Medical Laser Applications, National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt.,Department of Dermatology and Allergology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Mai Osman
- Department of Medical Laser Applications, National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt
| | - Ahmed Kassab
- Department of Medical Laser Applications, National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt
| |
Collapse
|
40
|
1550-nm Nonablative Fractional Laser Versus 10,600-nm Ablative Fractional Laser in the Treatment of Surgical and Traumatic Scars: A Comparison Study on Efficacy and Treatment Regimen. Dermatol Surg 2020; 46:780-788. [PMID: 31567609 DOI: 10.1097/dss.0000000000002152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The appearance and symptoms of scars can cause significant distress to patients. OBJECTIVE To assess and compare efficacy of the 1,500-nm nonablative fractional laser (NAFL) and 10,600-nm ablative fractional laser (AFL) in reducing symptoms and improving the appearance of traumatic or surgical scars. MATERIALS AND METHODS Single-center prospective, randomized, blinded, split-scar study was conducted on 100 patients with a scar obtained through trauma or surgery. Three treatments of NAFL or AFL were administered to each half of the scar at 4-week intervals. Scars were self-rated by the patient using the Patient and Observer Scar Assessment Scale and a satisfaction score and objectively evaluated by blinded dermatologists using the Manchester Scar Scale and visual analog scale. RESULTS Blinded observers found no statistically significant difference in scar appearance. Patient rating showed improvement of scar appearance (p < .0001). Pain was worse after treatment with AFL (p = .0492). Overall, there was no statistically significant evidence of one laser being superior or inferior to the other for patient and blinded observer scores (p = .3173 and p = .2513, respectively). CONCLUSION Scar treatment with AFL or NAFL is associated with high patient satisfaction. Objective evaluation of scars did not identify improvement in scar appearance.
Collapse
|
41
|
Rosenberg LK, Bagger C, Janfelt C, Haedersdal M, Olesen UH, Lerche CM. A Comparison of Human and Porcine Skin in Laser-Assisted Drug Delivery of Chemotherapeutics. Lasers Surg Med 2020; 53:162-170. [PMID: 33161610 DOI: 10.1002/lsm.23344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/08/2020] [Accepted: 10/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Porcine skin is a widely used model in diffusion studies, but its usefulness for laser-assisted drug delivery (LADD) has not been evaluated in comparison with human skin. This study compared porcine and human skin in ex vivo LADD diffusion studies. STUDY DESIGN/MATERIALS AND METHODS Ex vivo ablative fractional laser (AFL) treatments (5, 20, and 80 mJ/mb) were applied to skin samples from three sources: human, normal pig (Duroc × Landrace × Yorkshire breed), and a hyperkeratotic pig phenotype. Samples were stained using hematoxylin and eosin, photo-documented, and measured digitally. Samples (20 mJ/mb) were exposed to bleomycin or 5-fluorouracil (5-FU) for 19 hours in Franz diffusion cells. Drug uptake was quantified at three skin depths (100, 500, and 1,500 µm) by high-performance liquid chromatography-mass spectrometry. Drug biodistribution and endogenous lipids were visualized by matrix-assisted laser desorption/ionization-mass spectrometry imaging. RESULTS Epidermal and dermal thicknesses of human and normal pig skin were similar (76-87 µm and 1,668-1,886 µm, respectively; P = 0.082-0.494). Endogenous lipids were investigated, and 116 compounds were identified. Of these compounds, 100 were found in all three skin types, while six were present exclusively in human skin. Laser channel depths (20 mJ/mb) in human and normal pig skin were similar (1,081 vs. 1,126 µm; P = 0.588). Bleomycin uptake was similar in all skin types at all depths (101.4-175.6 µg/cm3 ; P = 0.132-0.699). 5-FU uptake in human and normal pig skin was similar at 100 and 500 µm (80.5 vs. 140.3 µg/cm3 and 131.2 vs. 208.1 µg/cm3 , respectively; P = 0.065-0.093). At 1500 µm, 5-FU concentrations in the porcine skin types differed from those in human skin (104.7 vs. 196.7-344.8 µg/cm3 ; P = 0.002-0.026). Drug biodistribution was similar among skin types, but differences between bleomycin and 5-FU biodistribution were observed. CONCLUSIONS Normal porcine and human skin showed similar morphology, the composition of endogenous lipids, and AFL-assisted cutaneous uptake, and biodistribution of chemotherapeutics. Therefore, normal porcine skin, but not hyperkeratotic pig phenotype skin, is a practical and reliable model for healthy human skin in ex vivo LADD diffusion studies. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
Collapse
Affiliation(s)
- Lukas K Rosenberg
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Charlotte Bagger
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Christian Janfelt
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Uffe H Olesen
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Catharina M Lerche
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.,Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
42
|
Ghandehari R, Robati RM, Niknezhad N, Hajizadeh N, Tehranchinia Z. Efficacy and safety of fractional CO 2 laser and tranexamic acid versus microneedling and tranexamic acid in the treatment of infraorbital hyperpigmentation. J DERMATOL TREAT 2020; 33:1391-1396. [PMID: 32893707 DOI: 10.1080/09546634.2020.1819527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of microneedling and fractional CO2 laser in combination with tranexamic acid (TA) in the treatment of infra-orbital hyperpigmentation. PATIENTS AND METHODS This split-face clinical trial performed on 30 volunteers. The patients were randomly assigned to treat with fractional CO2 laser and microneedling, both combined with TA topically. Three monthly treatment sessions were performed. Two blinded dermatologists evaluated the response after each treatment session and one and three months after the last session. We also asked patients to evaluate their overall satisfaction at the final follow up. Adverse effects have also been documented. RESULTS Both methods showed significant improvement in all sessions comparing with the baseline state (p value <.05). There were no significant differences between two methods on the days 30, 90, and 150. But the laser showed significantly higher improvement on day 60. The patients' satisfaction did not reveal any significant difference between the two sides. Adverse events were temporary with no significant difference between both sides except for erythema that lasts longer with microneedling. CONCLUSIONS Both fractional CO2 laser and microneedling in combination with topical TA seem to be effective modalities in the treatment of infraorbital hyperpigmentation with no significant side effects.
Collapse
Affiliation(s)
- Reza Ghandehari
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza M Robati
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasim Niknezhad
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nastaran Hajizadeh
- Department of Biostatistics, Faculty of Paramedical, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zohreh Tehranchinia
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
43
|
Pagano T, Travaglino A, Raffone A, Vallone R, Buonfantino C, De Rosa P, Locci M, Guadagno E, Insabato L, Salvatore S, De Placido G. Fractional Microablative CO 2 Laser-Related Histological Changes on Vulvar Tissue in Patients With Genitourinary Syndrome of Menopause. Lasers Surg Med 2020; 53:521-527. [PMID: 32797701 DOI: 10.1002/lsm.23311] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Fractional CO2 laser has been proposed as an effective treatment for the genitourinary syndrome of menopause (GSM). However, the effects of laser treatment on vulvar tissue have never been assessed. We aimed to assess histological changes related to fractional CO2 laser in vulvar tissue from GSM patients. STUDY DESIGN/MATERIALS AND METHODS A single-center observational prospective cohort study was performed enrolling all GSM patients from July 2017 to October 2018. Patients underwent three outpatient vulvovaginal applications of fractional CO2 laser and vulvar biopsy before and after treatment. Rates of histological changes in vulvar tissue, the difference in means of Vulva Health Index (VuHI), Vaginal Health Index (VHI), Visual Analogue Scale scores for GSM symptoms, and procedure-related pain, and rate of patient's overall satisfaction with treatment were assessed. Univariate comparisons between continuous variables were performed by using the paired t-test (α error = 0.05). RESULTS Of 20 enrolled patients, 18 underwent all laser applications, and 15 underwent both vulvar biopsies. 93.3% of patients showed remodeling of vulvar connective tissue; 80% showed improvement in vulvar epithelium trophism and 86.7% showed neovascularization. Differences in means between before and after treatment were significant for VuHI, VHI, and all GSM symptoms. Means ± standard deviation of the degree of pain at each laser application were 4.4 ± 0.9, 3.7 ± 1.6, and 2.9 ± 1.9. The rate of overall satisfaction with the treatment was 72.2%. CONCLUSIONS Fractional CO2 laser leads to a restoration of the normal architecture of vulvar tissue, with significant improvement in GSM-related signs and symptoms, and overall satisfaction with the treatment in most GSM patients. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
Collapse
Affiliation(s)
- Tiziana Pagano
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, 80131, Italy
| | - Antonio Travaglino
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, 80131, Italy
| | - Antonio Raffone
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, 80131, Italy
| | - Roberta Vallone
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, 80131, Italy
| | - Cira Buonfantino
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, 80131, Italy
| | - Pasquale De Rosa
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, 80131, Italy
| | - Mariavittoria Locci
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, 80131, Italy
| | - Elia Guadagno
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, 80131, Italy
| | - Luigi Insabato
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, 80131, Italy
| | - Stefano Salvatore
- Division of Obstetrics and Gynaecology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, 20132, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe De Placido
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, 80131, Italy
| |
Collapse
|
44
|
El-Hawary EE, Nassar S, Hodeib AA, Shareef MM, Fawzy MM. Ablative Fractional Carbon Dioxide Laser and Autologous Platelet-Rich Plasma in the Treatment of Atrophic Acne Scars: A Comparative Clinico-Immuno-Histopathological Study. Lasers Surg Med 2020; 53:458-467. [PMID: 32770685 DOI: 10.1002/lsm.23306] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES To compare the efficacy of autologous platelet-rich plasma (PRP), ablative fractional carbon dioxide (FCO2 ) laser, and their combination in the treatment of atrophic acne scars, both clinically and immuno-histopathologically. STUDY DESIGN/MATERIALS AND METHODS Sixty patients were randomly divided into three equal groups. Group 1 received intradermal PRP injection sessions. Group 2 received FCO2 laser sessions. Group 3 received FCO2 laser followed by intradermal PRP injection sessions. Each group received three sessions at monthly intervals. The final assessment took place 3 months after the last session. Skin biopsies were obtained before and 1 month after treatment sessions with pathological evaluation. RESULTS Combined PRP and FCO2 laser-treated patients had a better clinical response, fewer side effects, and shorter downtime than FCO2 laser alone. PRP-treated patients had some improvement but significantly lower than the other two groups. CONCLUSION The current study concluded that a combination of PRP and FCO2 laser is an effective and safe modality in the treatment of atrophic acne scars with better results than PRP or FCO2 laser alone. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
Collapse
Affiliation(s)
- Esraa E El-Hawary
- Department of Dermatology, Venereology, and Andrology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Samia Nassar
- Department of Dermatology, Venereology, and Andrology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Abeer A Hodeib
- Department of Dermatology, Venereology, and Andrology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed M Shareef
- Department of Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed M Fawzy
- Department of Dermatology, Venereology, and Andrology, Faculty of Medicine, Tanta University, Tanta, Egypt
| |
Collapse
|
45
|
Graves LL, Hoopman J, Finn R. Carbon Dioxide Laser Resurfacing for Rhinophyma: A Case Report and Discussion of the Literature. J Oral Maxillofac Surg 2020; 78:2296.e1-2296.e7. [PMID: 32640206 DOI: 10.1016/j.joms.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
Rhinophyma, an unsightly and obstructive skin lesion of the nasal area, can be difficult to treat. Numerous modalities have been tried, including medical, excision, and ablation, with various tools and results. In the present report, we have demonstrated the use of the carbon dioxide (CO2) laser on the nose of a 56-year-old man, with excellent cosmetic results even at 59 months after treatment. Discussion of the disease entity and the advantages and disadvantages of the different treatment options are presented. Given the results shown in our patient, we believe that CO2 laser ablation should be a standard treatment of rhinophyma, given its practicality, predictability, and excellent outcomes.
Collapse
Affiliation(s)
- Lindsay L Graves
- Resident, Parkland Memorial Hospital/UT Southwestern Medical Center, Dallas, TX.
| | - John Hoopman
- Laser Safety Officer, UT Southwestern Medical Center, Dallas, TX
| | - Richard Finn
- Professor, Division of Oral and Maxillofacial Surgery, Departments of Surgery and Cell Biology, UT Southwestern Medical Center; and Chief, Department of Oral and Maxillofacial Surgery, Veterans Administration North Texas Healthcare System, Dallas, TX
| |
Collapse
|
46
|
Xi W, Xie Y, Zhang Z, Li K, Wang J, Li J, Feng S, Hultman CS, Liu Y, Zhang Y. 3D Mesh Releasing Method: A Retrospective Analysis of Fractional CO 2 Treatment on Contracture Scars. Lasers Surg Med 2020; 53:227-235. [PMID: 32432374 DOI: 10.1002/lsm.23262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 05/08/2020] [Accepted: 05/09/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES There has been reports on fractional CO2 laser successfully improving contracture scars that impair the function of a joint. It seems that certain contracture problems could be solved by laser instead of surgery. However, the clinical application could be difficult when the efficacy of the method remains unknown. The purpose of this study is to report the releasing capacity of the fractional CO2 laser on contracture scars based on a defined treatment method. STUDY DESIGN/MATERIALS AND METHODS We conducted a retrospective study in patients with limited function in joints caused by contracture scars. Fractional CO2 laser and our "3D mesh releasing" protocol were applied. The primary outcome was the improvement measured in range of motion (ROM) of the relevant joint before all intervention and 6 months after the last treatment. RESULT From November 2016 to January 2018, 11 joints of 10 cases were treated by the fractional CO2 laser. Patients went through 2.27 (standard deviation [SD] 1.42, 1-5) sessions. The average progress of ROM before and 6 months after all treatments was 19.13° (SD 10.25, P < 0.02). In six cases, we recorded that there was an 8.53° (SD 5.81, P < 0.02) of increase in ROM immediately after the laser session, and the average improvement reached up to 13.58° (SD 8.15, P < 0.02) after 2-3 months during the next follow-up. CONCLUSION The fractional CO2 laser could achieve functional improvement in contracture scars and it maintained its effect for at least 6 months. The "3D Mesh Releasing" protocol would help to standardize the treatment procedure. This modality has minimal-invasiveness and potentially could become a supplement to the current treatment choices for mild contracture scars. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
Collapse
Affiliation(s)
- Wenjing Xi
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yixin Xie
- Department of Burns Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zheng Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Ke Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jingyan Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jie Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Shaoqing Feng
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - C Scott Hultman
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Ying Liu
- Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| |
Collapse
|
47
|
Paasch U, Said T. Stimulation of collagen and elastin production in-vivo using 1,540 nm Er:Glass laser: assessment of safety and efficacy. J COSMET LASER THER 2020; 22:77-83. [PMID: 32079432 DOI: 10.1080/14764172.2020.1728339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Induction of collagen and elastin remodeling in the human skin can be achieved by non-ablative fractional laser (NAFXL) and ablative fractional laser (AFXL). Our objective was to compare the safety, efficacy, tolerability, and ability to induce collagen and elastin remodeling of NAFXL versus AFXL in a series of treatments over time.Materials and Methods: In this prospective, proof of principle, single-case study, the safety, tolerability and efficacy of the laser systems were assessed via histopathology and clinical evaluations including photographs. Optical biopsies by means of multiphoton tomography (MPT) were used to evaluate the induction of collagen and elastin remodeling.Results: Treatments by both NAFXL and AFXL were well tolerated. The NAFXL system was found to be less painful and resulted in a shorter down- and healing times. MPT findings showed the superior capability of the AFXL procedure to induce collagen; on the other hand, elastin induction was more pronounced after NAFXL treatments.Conclusions: While NAFXL is as effective and safe as the traditional AFXL, it is better tolerated and has a shorter downtime. Serial optical biopsies over time over time can be a useful tool to assess the induction of collagen and elastin remodeling in the human skin.
Collapse
Affiliation(s)
- Uwe Paasch
- Department of Dermatology, Venereology and Allergology, University of Leipzig, 04103 Leipzig, Saxony, Germany
| | - Tamer Said
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| |
Collapse
|
48
|
Nieboer MJ, Meesters AA, Almasian M, Georgiou G, de Rie MA, Verdaasdonk RM, Wolkerstorfer A. Enhanced topical cutaneous delivery of indocyanine green after various pretreatment regimens: comparison of fractional CO 2 laser, fractional Er:YAG laser, microneedling, and radiofrequency. Lasers Med Sci 2020; 35:1357-1365. [PMID: 31984457 PMCID: PMC7351854 DOI: 10.1007/s10103-020-02950-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/02/2020] [Indexed: 11/24/2022]
Abstract
Different devices have been used to enhance topical drug delivery. Aim of this study was to compare the efficacy of different skin pretreatment regimens in topical drug delivery. In six ex vivo human abdominal skin samples, test regions were pretreated with fractional CO2 and Er:YAG laser (both 70 and 300 μm ablation depth, density of 5%), microneedling (500 μm needle length), fractional radiofrequency (ablation depth of ± 80–90 μm), and no pretreatment. The fluorescent agent indocyanine green (ICG) was applied. After 3 h, fluorescence intensity was measured at several depths using fluorescence photography. Significantly higher surface fluorescence intensities were found for pretreatment with fractional Er:YAG and CO2 laser and for microneedling vs. no pretreatment (p < 0.05), but not for radiofrequency vs. no pretreatment (p = 0.173). Fluorescence intensity was highest for the Er:YAG laser with 300 μm ablation depth (mean 38.89 arbitrary units; AU), followed by microneedling (33.02 AU) and CO2 laser with 300 μm ablation depth (26.25 AU). Pretreatment with both lasers with 300 μm ablation depth gave higher fluorescence intensity than with 70 μm ablation depth (Er:YAG laser, 21.65; CO2 laser, 18.50 AU). Mean fluorescence intensity for radiofrequency was 15.27 AU. Results were comparable at 200 and 400 μm depth in the skin. Pretreatment of the skin with fractional CO2 laser, fractional Er:YAG laser, and microneedling is effective for topical ICG delivery, while fractional radiofrequency is not. Deeper laser ablation results in improved ICG delivery. These findings may be relevant for the delivery of other drugs with comparable molecular properties.
Collapse
Affiliation(s)
- Marilin J Nieboer
- Netherlands Institute for Pigment Disorders, Department of Dermatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, NL-1105, Amsterdam, AZ, Netherlands
| | - Arne A Meesters
- Netherlands Institute for Pigment Disorders, Department of Dermatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, NL-1105, Amsterdam, AZ, Netherlands.
| | - Mitra Almasian
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, NL-1105, Amsterdam, AZ, Netherlands
| | - Giota Georgiou
- TechMed Center, BioMedical Photonics and Imaging group, University of Twente, Drienerlolaan 5, 7522, Enschede, NB, Netherlands
| | - Menno A de Rie
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, NL-1105, Amsterdam, AZ, Netherlands.,Department of Dermatology, VU Medical Center, De Boelelaan 1117, VU University, NL-1081, Amsterdam, HV, Netherlands
| | - Rudolf M Verdaasdonk
- TechMed Center, BioMedical Photonics and Imaging group, University of Twente, Drienerlolaan 5, 7522, Enschede, NB, Netherlands
| | - Albert Wolkerstorfer
- Netherlands Institute for Pigment Disorders, Department of Dermatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, NL-1105, Amsterdam, AZ, Netherlands
| |
Collapse
|
49
|
Klifto KM, Asif M, Hultman CS. Laser management of hypertrophic burn scars: a comprehensive review. BURNS & TRAUMA 2020; 8:tkz002. [PMID: 32346540 PMCID: PMC7175764 DOI: 10.1093/burnst/tkz002] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/28/2019] [Indexed: 12/15/2022]
Abstract
Hypertrophic scars often develop following burn-related injuries. These scars can be cosmetically unappealing, but associated symptoms of pruritus, pain and restricted range of motion can impair a person’s quality of life. Laser and light therapies offer a minimally invasive, low-risk approach to treatment, with a short postoperative recovery period. As laser technology developed, studies have shown decreased scar thickness, neuropathic pain and need for surgical excision, as well as improved scar pigmentation, erythema, pliability, texture, height and pruritus. In this review, we present the evolution of laser therapy for hypertrophic burn scars, how different types of lasers work, indications, perioperative considerations and guidelines for practice management.
Collapse
Affiliation(s)
- Kevin M Klifto
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, Maryland, USA, 21205.,Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, Maryland, USA, 21224
| | - Mohammed Asif
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, Maryland, USA, 21205.,Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, Maryland, USA, 21224
| | - C Scott Hultman
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, Maryland, USA, 21205.,Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, Maryland, USA, 21224
| |
Collapse
|
50
|
Fractional CO 2 laser micropatterning of cell-seeded electrospun collagen scaffolds enables rete ridge formation in 3D engineered skin. Acta Biomater 2020; 102:287-297. [PMID: 31805407 DOI: 10.1016/j.actbio.2019.11.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 12/12/2022]
Abstract
Rete ridges are interdigitations of the epidermis and dermis of the skin that play multiple roles in homeostasis, including enhancing adhesion via increased contact area and acting as niches for epidermal stem cells. These structures, however, are generally absent from engineered skin (ES). To develop ES with rete ridges, human fibroblast-seeded dermal templates were treated with a fractional CO2 laser, creating consistently spaced wells at the surface. Constructs with and without laser treatment were seeded with keratinocytes, cultured for 10 days, and grafted onto athymic mice for four weeks. Rete-ridge like structures were observed in the laser-patterned (ridged) samples at the time of grafting and were maintained in vivo. Ridged grafts displayed improved barrier function over non-lasered (flat) grafts at the time of grafting and 4 weeks post-grafting. Presence of ridges in vivo corresponded with increased keratinocyte proliferation, epidermal area, and basement membrane length. These results suggest that this method can be utilized to develop engineered skin grafts with rete ridges, that the ridge pattern is stable for at least 4 weeks post-grafting, and that the presence of these ridges enhances epidermal proliferation and establishment of barrier function. STATEMENT OF SIGNIFICANCE: Rete ridges play a role in epidermal homeostasis, enhance epidermal-dermal adhesion and act as niches for epidermal stem cells. Despite their role in skin function, these structures are not directly engineered into synthetic skin. A new method to rapidly and reproducibly generate rete ridges in engineered skin was developed using fractional CO2 laser ablation. The resulting engineered rete ridges aided in the establishment of epidermal barrier function, basement membrane protein deposition and epidermal regeneration. This new model of engineered skin with rete ridges could be utilized as an in vitro system to study epidermal stem cells, a testbed for pharmaceutical evaluation or translated for clinical use in full-thickness wound repair.
Collapse
|