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Chen A, Choi J, Balazic E, Zhu TR, Kobets K. Review of laser and energy-based devices to treat rosacea in skin of color. J COSMET LASER THER 2024; 26:43-53. [PMID: 39171934 DOI: 10.1080/14764172.2024.2376701] [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: 04/28/2023] [Revised: 09/06/2023] [Accepted: 07/02/2024] [Indexed: 08/23/2024]
Abstract
The prevalence of rosacea in skin of color (SOC) populations is estimated to be as high as 10% in some countries. Traditionally, intense pulsed light (IPL) and pulsed dye laser (PDL) have been the laser and energy-based devices (EBDs) used to treat rosacea. However, not all laser and EBDs are safe for SOC (Fitzpatrick skin types IV-VI) due to increased absorption of energy in pigmented skin and increased risk of post-inflammatory hyperpigmentation and scarring. This review summarizes the use of the top seven laser and EBDs for treating rosacea in SOC.
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Affiliation(s)
- Anna Chen
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Janet Choi
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Tian Ran Zhu
- Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Medical Center, Department of Medicine, Division of Dermatology, Bronx, NY, USA
| | - Kseniya Kobets
- Montefiore Medical Center, Department of Medicine, Division of Dermatology, Bronx, NY, USA
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Teymour S, Kania B, Lal K, Goldberg D. Energy-based devices in the treatment of acne scars in skin of color. J Cosmet Dermatol 2023; 22:1177-1184. [PMID: 36575886 DOI: 10.1111/jocd.15572] [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: 06/14/2022] [Revised: 11/15/2022] [Accepted: 12/05/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Acne scarring is disfiguring and psychologically taxing on patients. Many energy-based modalities have emerged and been studied for the treatment of acne scarring; however, there is a paucity of these studies in skin phototypes IV-VI. OBJECTIVE To review the medical literature and discuss the most significant studies regarding safety and efficacy of energy-based devices (ablative lasers, non-ablative lasers, and radiofrequency microneedling) in the treatment of ethnic skin (skin phototypes IV-VI). METHODS A literature search was conducted using the PubMed database and bibliographies of relevant articles. RESULTS Ablative and non-ablative lasers have proven to be effective for treatment of acne scars in ethnic skin. The risk of developing adverse effects such as post-inflammatory hyperpigmentation is contingent upon several factors including skin phototype, laser device, fluence, and moreso density settings. Non-ablative fractional lasers have been considered first line for the treatment of acne scars in skin of color due to their better safety profile; however, they are less efficacious and require more treatments compared to ablative lasers. Studies regarding efficacy and safety of radiofrequency microneedling for treatment of acne scarring in skin of color are limited, but are promising. CONCLUSION Ablative lasers, non-ablative lasers, and radiofrequency microneedling are all useful treatments for acne scarring in ethnic skin when appropriate settings are used. Further head-to-head studies are needed to evaluate their efficacy and safety in darker skin phototypes V-VI.
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Affiliation(s)
- Shereen Teymour
- Department of Dermatology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Barbara Kania
- Skin Laser & Surgery Specialists of NY and NJ, Hackensack, New Jersey, USA
| | - Karan Lal
- Skin Laser & Surgery Specialists of NY and NJ, Hackensack, New Jersey, USA
| | - David Goldberg
- Skin Laser & Surgery Specialists of NY and NJ, Hackensack, New Jersey, USA
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Nunez JH, Strong AL, Comish P, Hespe GE, Harvey J, Sorkin M, Levi B. A Review of Laser Therapies for the Treatment of Scarring and Vascular Anomalies. Adv Wound Care (New Rochelle) 2023; 12:68-84. [PMID: 35951024 DOI: 10.1089/wound.2021.0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Significance: Laser use has become part of the gold standard of treatment as an effective adjuvant in multimodal therapy for pathologic scarring caused by burns, trauma, acne, and surgery, as well as vascular anomalies. Understanding indications and applications for laser therapy is essential for physicians to improve patient outcomes. Recent Advances: Since the 1980s, the medical use of lasers has continuously evolved with improvements in technology. Novel lasers and fractionated technologies are currently being studied in the hopes to improve treatment efficacy, while reducing complications. Recent advancements include acne treatment with novel picosecond lasers, new hypertrophic scar therapies with simultaneous laser and intense pulsed light use, and novel systems such as lasers with intralesional optical fiber delivery devices. In addition, optimizing the timing of laser therapy and its use in multimodal treatments continue to advance the field of photothermolysis. Critical Issues: Selecting the correct laser for a given indication is the fundamental decision when choosing a laser balancing effective treatment with minimal complications. This article covers the principles of laser therapy, the preferred lasers used for the treatment of scarring and vascular anomalies, and discusses the current evidence behind these laser choices. Future Directions: To optimize laser therapy, larger randomized control trials and split scar studies are needed. Continued advancement through better randomized controlled studies will help to improve patient outcomes on a broader scale.
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Affiliation(s)
- Johanna H Nunez
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Amy L Strong
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul Comish
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Geoffrey E Hespe
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jalen Harvey
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael Sorkin
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Benjamin Levi
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Chilicka K, Rusztowicz M, Szyguła R, Nowicka D. Methods for the Improvement of Acne Scars Used in Dermatology and Cosmetology: A Review. J Clin Med 2022; 11:jcm11102744. [PMID: 35628870 PMCID: PMC9147527 DOI: 10.3390/jcm11102744] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 02/07/2023] Open
Abstract
Acne vulgaris is a chronic skin disease that, depending on its course, is characterized by the occurrence of various skin eruptions such as open and closed comedones, pustules, papules, and cysts. Incorrectly selected treatment or the presence of severe acne vulgaris can lead to the formation of atrophic scars. In this review, we summarize current knowledge on acne scars and methods for their improvement. There are three types of atrophic scars: icepick, rolling, and boxcar. They are of different depths and widths and have different cross-sections. Scars can combine to form clusters. If acne scars are located on the face, they can reduce the patient’s quality of life, leading to isolation and depression. There are multiple effective modalities to treat acne scars. Ablative lasers, radiofrequency, micro-needling, and pilings with trichloroacetic acid have very good treatment results. Contemporary dermatology and cosmetology use treatments that cause minimal side effects, so the patient can return to daily functioning shortly after treatment. Proper dermatological treatment and skincare, as well as the rapid implementation of cosmetological treatments, will certainly achieve satisfactory results in reducing atrophic scars.
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Affiliation(s)
- Karolina Chilicka
- Department of Health Sciences, Institute of Health Sciences, University of Opole, 45-040 Opole, Poland; (M.R.); (R.S.)
- Correspondence: ; Tel.: +48-665-43-94-43
| | - Monika Rusztowicz
- Department of Health Sciences, Institute of Health Sciences, University of Opole, 45-040 Opole, Poland; (M.R.); (R.S.)
| | - Renata Szyguła
- Department of Health Sciences, Institute of Health Sciences, University of Opole, 45-040 Opole, Poland; (M.R.); (R.S.)
| | - Danuta Nowicka
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, 50-368 Wrocław, Poland;
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Cenk H, Sarac G. Efficacy of 2940 nm Multifractional Er: YAG Lasers in Self-inflicted Razor Blade Incision Scars. J Cosmet Dermatol 2021; 21:1013-1017. [PMID: 34918442 DOI: 10.1111/jocd.14678] [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: 09/17/2021] [Revised: 10/08/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Deliberate self-harm (DSH) can be defined as self-inflicted injury without an intention to suicide, and it may result in scar formation with a particular shape. AIMS There is no treatment algorithm for DSH scars, nor is there a gold standard for the treatment of hypertrophic scars. Therefore, we aimed to share our experience with Er: YAG laser treatment of self-inflicted razor blade incision scars. PATIENTS/METHODS The study involved 18 patients with DSH scars treated with fractional ablative Er: YAG laser (MCL 31 Asclepion laser Technologies) between 2017 and 2020, with the parameters of 40 J/cm2 , 300 µs, and 4 Hz. The sessions were repeated by increasing 10 joules in every session with 4-week intervals until reaching a maximum of 80 joules. The patients were evaluated retrospectively by two different dermatologists in terms of scar improvement over digital photographs taken before and 4 weeks after the treatment. Evaluations have been made based on a 4-point score (0:no change, 1:1%-25% mild, 2:26%-50% moderate, 3:51%-75% well, and 4:76%-100% excellent improvement). RESULTS After the third session, 90.9% of the patients showed a moderate improvement. After the fourth session, only 27.2% of the patients had a good, and 63.2% of the patients had a moderate improvement rate. CONCLUSIONS Er: YAG laser is a safe and effective treatment method for the hypertrophic scars induced by razor blades. Also, we believe that combined treatments with other treatment modalities will provide better results in DSH scars.
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Affiliation(s)
- Hulya Cenk
- Department of Dermatology, Pamukkale University, Denizli, Turkey
| | - Gulbahar Sarac
- Department of Dermatology, Inonu University, Malatya, Turkey
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Lu K, Cai S. Efficacy and safety comparison between 1927 nm thulium laser and 2940 nm Er:YAG laser in the treatment of facial atrophic acne scarring: a prospective, simultaneous spilt-face clinical trial. Lasers Med Sci 2021; 37:2025-2031. [PMID: 34826022 PMCID: PMC8971160 DOI: 10.1007/s10103-021-03465-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/08/2021] [Indexed: 11/02/2022]
Abstract
Acne scarring is a common disfiguring complication of acne, and fractional lasers are widely applied in improving it. This study is to compare the efficacy and safety of fractional non-ablative 1927 nm thulium laser (FTL) and fractional ablative 2940 nm Er:YAG laser (FEL) in the treatment of acne scarring. Subjects with moderate or severe atrophic facial acne scarring received 3 sessions of FTL on the left side of face and FEL on the right side of face at an average interval of 4-6 weeks. Major assessments included Goodman&Baron quantitative global scarring grading system (GBS), self-rated improvement and satisfaction score. Twenty-seven subjects completed the study; for FTL side, average GBS decreased from 11.15 ± 5.04 at baseline to 7.07 ± 4.87 with an improvement percent of 36.54%; for FEL side, average GBS decreased from 10.81 ± 4.46 to 7.00 ± 4.07 with an improvement percent of 35.27%. Adverse effects include transient pain, erythema, edema, and increase of acne. No significant difference was found between two lasers. Both FTL and FEL improved atrophic acne scarring and were well-tolerated. Increase of acne during laser treatment may have a negative impact on efficacy. Trial registration number was NCT04813419 and date of registration was 19th, March, 2021, retrospectively registered.
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Affiliation(s)
- Kune Lu
- Department of Dermatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Suiqing Cai
- Department of Dermatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
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Mani N, Zorman A. Acne scar treatment using high-energy fractional nanosecond Q-switched 1064 nm laser. J Cosmet Dermatol 2021; 20:3907-3912. [PMID: 34648683 PMCID: PMC9291920 DOI: 10.1111/jocd.14534] [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: 07/26/2021] [Revised: 09/13/2021] [Accepted: 10/04/2021] [Indexed: 01/05/2023]
Abstract
Aims The objective of this study was to evaluate the effectiveness and safety of high‐energy ablative fractional nanosecond Q‐switched 1064 nm laser therapy for acne scars. Material and methods Forty‐six patients aged from 16 to 69 years and of Fitzpatrick skin type from 2 to 4 were included in this retrospective study. Multiple passes were delivered with a fractional 1064‐nm handpiece at high energy. Results were evaluated using blinded analysis of patient before and after photographs and also by evaluating patient satisfaction. Results Most patients (75%) were improved or very improved according to blinded evaluation. Patient satisfaction was high. No hypo/hyperpigmentation, scarring, or any other side effects were reported by any of the patients. Conclusions The study demonstrated good clinical outcomes in facial acne scar management with a high patient satisfaction rate and no adverse side effects.
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Affiliation(s)
- Nasrin Mani
- La Jolla Cosmetic Laser Clinic, La Jolla, CA, USA
| | - Anže Zorman
- Medilase Ljubljana Slovenia, Ljubljana, Slovenia
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