Evaluation of a non-ablative, fractional 1565 nm laser for the improvement of striae distensae albae

The efficacy and safety of the innovative cold atmospheric-pressure plasma technology in the treatment of striae distensae: A randomized controlled trial

BACKGROUND

Available current therapeutics modalities for striae distensae (SD) provide inconsistently effective outcomes. There is ongoing research on innovative treatment modalities to find better treatment solutions.

OBJECTIVES

To evaluate the efficacy and safety of innovative cold atmospheric plasma (CAP) technology in the treatment of striae distensae.

METHODS

This study includes twenty-three patients with striae distensae. The body was divided into two halves. One side was randomly treated with CAP biweekly on the same treated side for five sessions with 30 days follow-up after the last session. Another half was left untreated. Efficacy assessment was done using patient and observer scar assessment scale (POSAS), patient satisfaction scales, and Antera 3D® skin imaging system. Safety assessment was evaluated using the visual analog scale (VAS) and adverse effects monitoring.

RESULTS

Patient and observer scar assessment scale, patient and observer overall opinion score, and patient and observer total score in a summary of all rated characteristics, comparing treated and untreated areas, showed a statistically significant reduction in all parameters after one treatment (*p-value <0.05). Patients rated satisfaction as a great improvement in 52.3%, moderate improvement in 39.1%, extreme improvement in 4.3%, and slight improvement in 4.3%. Adverse effects included small scabs, shallow wounds, and rash.

CONCLUSION

Cold atmospheric plasma is a safe and effective, innovative treatment modality for striae distensae with minimal side effects.

Improving the outcome of treating striae gravidarum by combined therapies using topical β-glucan and 1565-nm non-ablative fractional laser: A prospective randomized vehicle-controlled parallel group study

Striae gravidarum (SG) is a kind of dermal scar associated with psychosocial and therapeutic challenge. Topical reagents and non-invasive laser are more preferred than invasive procedures for less pain and shorter downtime. However, there are few studies on comparing and combining these two modalities. The aim of the present study was to evaluate the efficacy and tolerance of a topical regimen containing β-glucan, 1565-nm non-ablative fractional laser (NAFL; ResurFX), and combination of them for SG. A total of 128 unilateral abdomens from 64 subjects were randomly divided into four strategies and were followed up for 12 weeks: topical vehicle (Veh); topical β-glucan (B); 1565-nm NAFL combined topical vehicle (NAFL); 1565-nm NAFL combined topical β-glucan (B + NAFL). NAFL was applied three times with a 4-week interval. Topical reagent was applied b.i.d. for 12 weeks. Global Aesthetic Improvement Scale (GAIS) scores were assessed by blinded physician according to standard photograph, and by subjects at 12th week. The degree of SG atrophy was assessed by blinded physician before treatment and at the 12th week according to a standard 5-point scale. Collagen remodeling was evaluated by histological analysis and all adverse effects were recorded. A total of 56 women (112 unilateral abdomens) completed all study. The GAIS scores by blinded physician showed greater improvement in NAFL as compared with β-glucan, and by subjects showed greater improvement in β-glucan as compared with vehicle. In terms of striae atrophy scale, the improvement of SG atrophy was more prominent in NAFL compared to β-glucan, and in β-glucan + NAFL compared to Veh + NAFL. All treatments were well tolerated. Topical β-glucan regimen can mildly improve SG. NAFL showed better results than topical β-glucan regimen. The combined strategy may further improve the SG atrophy compared with single treatment strategy.

Clinical Evaluation on the Performance and Safety of a Non-Ablative Fractional 1340 nm Laser for the Treatment of Stretch Marks in Adolescents and Young Adults: A Case Series

A large part of the world’s population suffers from Striae distensae (SD) or stretch marks, which create physical and psychological discomfort in people. We evaluate the SD clinical improvement by using a non-ablative fractional Nd:YAP 1340 nm laser. The research was performed on 25 patients of both sexes, with a mean age of 31 ± 13.09 years. Each patient underwent from a minimum of 3 to a maximum of 4 treatments, with an Nd:YAP (1340 nm) medical device, every four weeks, with 3- and 6-month follow-up, in these areas: back, abdomen, breast, flanks, lower limbs, buttocks, and thighs. Manchester Scar Scale assessed stretch marks improvement. Side effects, patient pain, and SD overall appearance improvement were also recorded for all patients. Digital photographs measured the aesthetic results. Treatment was well-tolerated (pain score 1.08 ± 0.76) by all patients. There were no long-term side effects, and 88% of patients revealed an SD excellent improvement showing good aesthetic results achieved by the treatment. The total mean pretreatment Manchester Scar Scale score decreased from 13.80 (±1.58) to 10.36 (±1.70) after 3 months (p < 0.01) and to 8.36 (±1.07) after 6 months (p < 0.01). An Nd:YAP (1340 nm) laser seems to be a safe and effective treatment, showing a higher security profile with no side effects.

Glass-laser in skin resurfacing

Following our survey, we can appreciate that a variety of laser platforms exist to rejuvenate the skin by resurfacing the outer layer of the skin as well as heating the lower layers of the dermis. Based on reliable clinical effectiveness and a limited side effect profile, we can confirm that non-ablative fractionated technologies greatly improve the appearance of lentigines, rhytids, eliminate sun damage, attenuate scarring due to acne and other causes and treat hyper-pigmentation. The Fraxel® (Solta Medical) laser system delivers pulses across a wide range of density and energy levels. We determined that when increasing the pulse energy this led to an increase in thermolysis micro zone (MTZ) depth and width without damaging the surrounding tissue. Due to its performance and various clinical applications, Fraxel® Laser can be optimally considered to be the gold-standard for skin rejuvenation.

A randomized, split-face controlled trial on the safety and effects of microneedle fractional radiofrequency and fractional erbium-doped glass 1,565-nm laser therapies for baggy lower eyelids

The non-ablative fractional erbium-doped glass 1,565-nm laser (NAFL) and the microneedle fractional radiofrequency (MFR) procedures are effective treatments that enable periorbital skin rejuvenation. To compare the clinical effectiveness and side effects of MFR and the NAFL for baggy lower eyelids (BLEs) in the Chinese population. Fifteen Chinese subjects with BLEs received three split-face treatments on a monthly basis randomly. Objective and subjective assessments were performed at baseline, as well as 1 month and 3 months after the third treatment. The results were evaluated using Antera-3D and CineScan systems. Blinded investigator assessments were performed by two plastic surgeons using a 0 to 4 score in six anatomic categories of BLEs. The patients also reported their level of satisfaction based on a four-point score. Most of the patients reported a greater than 47% satisfaction rate with both treatments. The cumulative contribution scores of prolapse of orbital fat, hollow tear trough, and skin laxity for each category variable declined with time. Using Antera 3D, the volume of elevation (mm³) decreased from 0.6 ± 0.4 to 0.4 ± 0.3 and from 0.6 ± 0.3 to 0.3 ± 0.3, the elevation area (mm²) decreased from 17.0 ± 8.4 to 13.0 ± 7.1 and from 17.0 ± 7.8 to 10.0 ± 5.6, and the maximum peak height (mm) also decreased from 0.10 ± 0.04 to 0.06 ± 0.04 and from 0.10 ± 0.03 to 0.06 ± 0.02 in the MFR and NAFL groups, respectively. Using CineScan, the depth of middle orbital fat (mm) decreased significantly from 10.2 ± 2.2 to 8.0 ± 0.7 and from 9.8 ± 1.1 to 8.0 ± 0.9 and the length of orbital fat significantly decreased from 9.2 ± 1.2 to 7.7 ± 0.7 and from 9.7 ± 1.4 to 7.8 ± 0.6 in the MFR and NAFL groups, respectively. MFR and NAFL therapies were effective for the treatment of BLEs, especially in BLE patients with skin elasticity in addition to tear trough deformity and orbital fat prolapse. Trial registration number: NCT04237324. Trial register: ClinicalTrials.gov. Level of Evidence: Level I, therapeutic study.

Objective evaluation of an occlusive overnight intensive patch containing onion extract and allantoin for hypertrophic scars

BACKGROUND

Patients suffering from hypertrophic scars often describe esthetic, functional, and psychological impairments. While current guidelines for the treatment of pathologic scarring recommend the use of onion extract containing gels and sheets, hard evidence for its efficacy remains scarce due to inconsistent data. Onion extract and allantoin containing occlusive overnight intensive patches (OIP) were introduced as a recent option for noninvasive scar management. However, objective data demonstrating their efficacy are missing.

AIMS

This study is the first to objectively evaluate the benefit and safety of an OIP for hypertrophic scars using a three-dimensional imaging device and a standardized scar scale.

METHODS

Twelve patients with untreated, three to twelve months old hypertrophic scars received an OIP for 3 months. The assessment was performed using PRIMOS^®pico , a three-dimensional imaging device and POSAS, a standardized scar questionnaire at baseline, one and 3 months after the last treatment.

RESULTS

Objective evaluation at three months follow-up (FU) showed a significant decrease in scar height of 28.8% (baseline mean: 2.08 ± 0.68 mm, three months FU mean: 1.48 ± 0.52 mm) and a reduction in scar volume of 31.9% (baseline mean: 454.33 ± 265.53 mm3, 3 months FU mean: 309.58 ± 224.28 mm3). Pain and pruritus subsided under treatment. There were no negative side effects.

CONCLUSION

Overnight intensive patches is a convenient, painless, safe, affordable and effective prevention and treatment option for hypertrophic scars. Treatment should be performed at least for 3 months for visible effects.

Treatment of keloids using 5-fluorouracil in combination with crystalline triamcinolone acetonide suspension: evaluating therapeutic effects by using non-invasive objective measures

BACKGROUND

Intralesional 5-fluorouracil (5-FU) in combination with triamcinolone acetonide (TAC) has been recommended as a promising alternative for keloids not responding to silicone-based products, cryotherapy or intralesional corticosteroids alone. Although numerous studies support the efficacy of this regime, there is a lack of objective data.

OBJECTIVES

In this study, we evaluate the therapeutic effect of four courses of intralesional 5-FU in combination with TAC (3 : 1) utilizing 3D analysis (PRIMOS^®pico ), ultrasound and scar scales such as the Patient and Observer Scar Assessment Scales (POSAS) and the Dermatology Life Quality Index (DLQI).

METHODS

Twenty-five patients with keloids were treated using 5-FU and TAC every 4 weeks. Objective assessments were performed and the scar scales administered at baseline, as well as during consecutive visits at 1- and 12-month follow-up (FU). Routine laboratory tests were performed at baseline and at 1-month FU.

RESULTS

3D PRIMOS and ultrasound measurements revealed highly significant and stable reductions in height (baseline mean score: 4.0 ± 1.7 mm, 1-month FU mean score: 1.5 ± 0.8 mm, 12-month FU mean score: 1.8 ± 0.9 mm, P = <0.0001), volume (baseline mean score: 1,105 ± 911.5 mm³ , 1-month FU mean score: 416.1 ± 218.1 mm³ , 12-month FU mean sore: 431.2 ± 253.6 mm³ , P = <0.0001, respectively) and penetration depth of keloids (relative reduction between baseline and 12-month FU of 74.4%, P = <0.0001). The POSAS and DLQI scales confirmed significant objective and subjective improvements in scar appearance in all categories. The life quality associated with keloid appearance improved from a 'moderate effect' to a 'small effect' throughout the course of the study.

CONCLUSIONS

Results of this study confirm the efficacy and safety of the combination of 5-FU and TAC in keloids. Treatments were well tolerated and demonstrated stable results at 12-month FU.

Dermoscopy and VISIA imager evaluations of non-insulated microneedle radiofrequency versus fractional CO2 laser treatments of striae distensae

BACKGROUNDS

Striae distensae (SD) has a known psychological impact due to the resulting cosmetic disfigurement. Many treatment modalities have been used over the years, but no standard interventions or evaluation methods have been proposed to date.

OBJECTIVE

We compared the efficacy and safety of non-insulated microneedle radiofrequency (NIMRF) and fractional CO₂ laser treatments of SD by objective measurements with dermoscopy and VISIA.

METHODS

Fourteen females with severe SD were enrolled. These subjects had been treated three sessions of NIMRF and fractional CO₂ laser for the right and left abdomen, respectively. Dermoscopy and VISIA imaging data, and photographs were collected at baseline and 2 months after the last treatment session. The global aesthetic improvement scale (GIAS) was scored by patients, and blinded investigators, pain score and satisfaction score were also documented. Any side effects were recorded.

RESULTS

Ten patients completed the study. The GIAS from investigators and patients showed an overall improvement but without a significant difference (P = 0.18, P = 0.17, respectively). The decreased width measured by dermoscopy was between 5% and 32% (right side) and 6-31% (left side). There was no significant difference between both sides in either the per-protocol or intention to treat analyses (P = 0.149, P = 0.161, respectively). The mean pain score was 5.35 and 2.35 on the right side and left side, respectively, which was significant (P = 0.0016). Post-inflammatory hyperpigmentation (PIH) manifested in six patients on their left sides and four patients on their right sides. In most cases, this had resolved by the 3-month follow-up.

CONCLUSION

Non-insulated microneedle radiofrequency and fractional CO₂ laser are both effective and safe treatment options for SD. PIH is a possible side effect but is more likely with fractional CO₂ laser treatment. However, it clears up in most cases. Dermoscopy and VISIA are both convenient, digitalized methods of tracking subtle changes and monitoring the efficacy of SD treatments.

Clinical benefit of using a multifractional Er:YAG laser combined with a spatially modulated ablative (SMA) module for the treatment of striae distensae: A prospective pilot study in 20 patients

BACKGROUND AND OBJECTIVE

Striae distensae (SD) are cutaneous lesions that often occur on the breasts, abdomen, hips, and thighs. The aim of this study is to evaluate the effectiveness of a new technique using a non-invasive Er:YAG laser combined with Spatially Modulated Ablation (SMA) module for the treatment of SD.

STUDY DESIGN/MATERIALS AND METHODS

This prospective pilot clinical study included 20 patients with skin phototypes I to IV who are affected by SD. The Er:YAG 2940 nm laser with SMA module was used in scanning mode with fluences of 2.3 J/cm² , frequency of 3 Hz, and pulse duration of 0.3 milliseconds. The laser beam is split into several microspots and penetrates only by 50 μm in the epidermis thickness. This technology induces also the generation of acoustic waves to stimulate tissue regeneration. Each patient underwent six laser sessions. An objective and subjective assessment of SD were used. All adverse events were reported.

RESULTS

Most patients reported good improvement and expressed their satisfaction with the treatment. Cutometric analysis showed significant improvement in skin elasticity at the end of study. Moreover, ultrasound analysis revealed an increase in dermal thickness (P < 0.01). POSAS scores decreased significantly at 3 and 6 months, reflecting improved skin quality. The average recovery time was 5 days, with no adverse effects reported.

CONCLUSION

Using Er:YAG laser (2,940 nm) with SMA technology to treat SD resulted in improved volume and textural appearance without side effects. The elasticity and thickness of the dermis also improved. The Er:YAG laser with SMA module may be considered as a novel and effective technique to treat SD lesions with minimal time recovery. Lasers Surg. Med. 51:230-238, 2019. © 2018 Wiley Periodicals, Inc.