Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA-compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms "ablative laser" and "skin resurfacing" from March 2002 until July 2020. Studies included meta-analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self-resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.

Concomitant use of isotretinoin and lasers with implications for future guidelines: An updated systematic review

It is generally believed that intervention on skin while on isotretinoin or within 6 to 12 months after treatment can lead to prolonged healing and abnormal scarring. The objective of this systematic review is to evaluate the body of evidence on concomitant use of isotretinoin and lasers for adverse events as a consequence of treatment. A PRISMA-compliant systematic review (Systematic Review Registration Number: CRD42017056492) of 12 electronic databases was conducted for the terms "laser" and "isotretinoin" or associated brand names from inception until June 2020. Subsequent reference search of studies meeting predefined inclusion criteria were conducted, and all articles were evaluated for bias and assigned levels of evidence to facilitate data synthesis. The search strategy produced 29 studies. Of 871 patients included in the studies of interest, 12 experienced transient adverse effects that resolved spontaneously, and only two presented with keloid formation, both from case reports. This systematic review suggests the risk associated with concomitant isotretinoin and laser use is small to absent. Further studies are needed, but these results suggest that current contraindications may be overly cautious.

The use of lasers in the treatment of skin cancer: A review

BACKGROUND

In considering skin cancer, a number of factors-including effectiveness, simplicity of treatment, cost, and esthetic outcomes-are important to ensure patient's satisfaction. There are several existing interventions, such as electrodessication and curettage, excision, Mohs surgery, radiation therapy, cryotherapy, and topical/oral treatments. Laser therapy has emerged as a new promising alternative that should be explored.

OBJECTIVE

To review the literature on the dermatological use of laser therapy in the treatment of skin cancer.

RESULTS

A review of articles available on the MEDLINE and Web of Science databases until May 2017 yielded 24 and 6 studies, respectively, on laser therapy in the treatment of skin cancers, particularly melanoma, basal cell carcinoma, and squamous cell carcinoma. The four laser subtypes included solid-state, diode, dye, and gas lasers.

CONCLUSION

Review of the literature demonstrates the progress of dermatological understanding of the clinical implications of laser therapy in the treatment of premalignant and malignant neoplasms of the skin, and suggests that this treatment modality might be a viable option for some patients.

Reduction in thigh circumference and improvement in the appearance of cellulite with dual-wavelength, low-level laser energy and massage

OBJECTIVES

This study evaluated the efficacy and safety of a low-level, dual-wavelength laser energy and massage device for improving the appearance of cellulite and reducing thigh circumference.

METHODS

Subjects (n = 83) with mild to moderate cellulite enrolled in this IRB-approved, open-label, multicenter study. Their right or left thighs received eight treatments with a low-level, dual-wavelength laser and massage device. The untreated contralateral thigh served as a control. Circumferences of the upper, middle, and lower thighs (treated and untreated) were measured before the fifth and eighth treatments and 1 month after the final treatment.

RESULTS

Reduction in thigh circumference of the treated areas exceeded those of the control areas for the upper, middle, and lower thigh in most subjects. The maximum reduction (-0.82 cm) occurred in the upper thigh at 1 month. The mean reduction of the upper, middle, and lower thigh circumferences was -0.64 cm for the treated thighs compared to -0.20 cm for untreated thighs. The difference was significant (p < 0.0001). Fifty-nine (71.1%) treatment thighs lost circumference compared to 44 (53.0%) control thighs. Resolution of adverse effects including erythema, swelling, and increased urination was seen within 30 minutes after treatment. All were resolved without sequelae and within the expected duration.

CONCLUSION

The low-level, dual-wavelength laser energy and massage device safely improves the appearance of cellulite while reducing thigh circumference.

Treatment of cutaneous lesions with a novel erbium-doped yttrium aluminum garnet laser with micron tips

BACKGROUND AND OBJECTIVE

The water content of epidermis below the stratum corneum is more than 70%. The 2,940-nm wavelength is at the peak of water absorption, making it an ideal wavelength for ablation of skin. The purpose of this study was to determine the effectiveness and safety of a novel erbium-doped yttrium aluminum garnet (Er:YAG) laser with micron tips in the removal of cutaneous lesions.

METHODS

Fourteen subjects with various cutaneous lesions received a single treatment with an Er:YAG laser, using an average fluence of 104.7 J/cm² (range 99-314 J/cm²), a mean repetition rate of 11.7 Hz, and straight and curved tips with a 400- to 600-μm spot size. One subject received two treatments with a 1-month interval. The majority of subjects (80%, n = 12) did not require anesthesia.

RESULTS

Clearance of 76% to 100% was obtained in 33% (n = 5) of subjects 1 month after treatment, 67% (n = 10) of subjects at 3 months, and 100% (n = 15) of subjects at 6 months. Investigators noted complete lesion clearance in all subjects 6 months after treatment. Ninety-three percent of subjects (n = 14) reported satisfaction with the procedure and its outcome.

CONCLUSION

The 2,940-nm wavelength combined with small micron spot size tips provides safe and effective clearance of cutaneous lesions, even in hard-to-reach locations. HOYA-Con Bio supported study-related expenses.

Laser peel: facial rejuvenation with a superficial erbium:YAG laser treatment

BACKGROUND

Facial rejuvenation is a popular procedure to temporarily mask the effects of aging. Most patients desiring this treatment are younger and want improvement without any down time. This study was conducted to evaluate the use of Er:YAG laser as a facial rejuvenation tool.

METHODS

The full faces of 18 volunteers were treated with an Er:YAG laser using a fluence of either 5 or 10 J/cm2. All volunteers applied EMLA cream (lidocaine 2.5% and prilocaine 2.5%) two hours before the procedure and were treated with a single pass using a pulse duration of about 300 microseconds. Follow-up visits were made in order to evaluate the degree of discomfort, erythema, swelling and improvement in skin aging. Skin biopsy was performed in one volunteer before and two hours after EMLA application, although preceding laser treatment.

RESULTS

Most volunteers experienced moderate discomfort during the treatment. There was mild to moderate erythema and mild swelling. The improvement in general skin appearance, actinic bronzing and photo-damage was mild to moderate. The microscopic evaluation of pre-laser treated skin two hours after EMLA application was suggestive of increased water content in the dermis.

CONCLUSION

The Er:YAG laser is an effective and safe tool for facial rejuvenation. With a superficial treatment, resolution of intense erythema is fairly rapid, averaging two to three days. The improvement, however, is mild compared to full laser skin resurfacing (LSR).

Ablation of cutaneous lesions using an erbium:YAG laser

BACKGROUND AND OBJECTIVE

This study was performed to evaluate the effectiveness and safety of erbium:YAG laser in removal of cutaneous lesions.

STUDY DESIGN

Data were collected after removing 363 benign, pre-malignant and malignant lesions in 27 patients at a dermatology and cosmetic laser surgery center.

RESULTS

All lesions were completely removed. Eight of 363 lesions recurred and the histological analysis showed complete removal of one malignant lesion with erbium:YAG laser ablation. There were no long term or permanent complications.

CONCLUSION

Erbium:YAG laser is safe and effective in removal of cutaneous lesions.

Comparison of two wound dressings after laser skin resurfacing

BACKGROUND

It has been reported that the final outcome of laser resurfacing still depends to a large degree on the efficiency of the post laser resurfacing wound care in promoting wound healing and preventing early and late complications.

OBJECTIVE

The objective of this study was to evaluate and compare a new hydrocolloid dressing, H2460, with Flexzan(TM) for healing of an acute wound after laser skin resurfacing (LSR).

METHODS

Ten volunteers received LSR of the peri-orbital area with an erbium:YAG laser. Identical parameters were used on both sides: 2 J, 5 mm spot, 8 Hz, 300 micros pulse, two passes on the upper eyelids, four passes on the lower eyelids and six passes on the crow's feet area. Soon after the LSR, one side was covered with Flexzan dressing and the other side was covered with a new hydrocolloid dressing -- H2460. The side of the dressing was randomized by alternating both dressings. All volunteers were evaluated and digitally photographed every day for a week and at 1 month after LSR. The degree of erythema, swelling, bleeding, oozing, crusting, pigmentary changes, scarring, discomfort, itching, burning, ease of application of dressings, initial adhesion, overall adhesion, leakage of fluid, maceration of surrounding skin, ease of removal and adhesive residue upon removal were documented.

RESULTS

In all volunteer and investigator's evaluations, the new dressing, H2460, achieved far better results than Flexzan in each category. After a 1-week follow-up all volunteers and the investigator evaluated the H2460 side as: healed better, simple to use, and caused less discomfort in 10 out of 10 volunteers. The blinded observer's assessment showed that the Flexzan side healed better in one volunteer.

CONCLUSION

The new dressing, H2460, is a better and suitable alternative to Flexzan as a post LSR dressing.

Derm diagnoses you can't afford to miss

Management of hereditary angioedema should include fresh frozen plasma containing C1 inhibitor (C1-INH), whenever possible; if C1-INH-containing plasma is unavailable, fresh frozen plasma can be used instead. Do not give neomycin to patients with suspected cellulitis; the drug may promote antibiotic resistance in Staphylococcus aureus, a pathogen often associated with this condition. Whenever a patient presents with erythematous skin lesions and a recent history of receiving penicillin or a cephalosporin antibiotic, a sulfa derivative, or an anticonvulsant, the suspected medication should be stopped until Stevens-Johnson syndrome is ruled out.

Bilateral aberrant axillary breast tissue mimicking lipomas: report of a case and review of the literature

A 31 year old Indian woman presented with bilateral axillary masses that became noticeable with the onset of puberty. The masses exhibited similar consistency to the adjacent normal breast tissue but lacked an associated nipple complex. The clinical impression was lipoma; however, mammography, ultrasonography and skin biopsy revealed ectopic breast tissue. These findings were consistent with the diagnosis of aberrant breast tissue. A subset of ectopic mammary tissue, aberrant breast tissue may constitute a diagnostic challenge and is often misdiagnosed as lipoma, hidradenitis, follicular cyst, or lymphadenopathy. In addition, some studies have suggested that aberrant breast tissue may be at higher risk of malignant degeneration. Therefore, it's important that physicians be familiar with this condition as this may contribute to the early detection of ectopic breast cancer.

Comparison of the open technique with a new wound dressing, H2460, in the healing of an acute wound after laser skin resurfacing

BACKGROUND

Applying various dressings or leaving the treated area open are two techniques in use after laser skin resurfacing (LSR).

OBJECTIVE

This study was conducted to compare healing of an acute wound using a new hydrocolloid dressing, H2460, with the open technique.

METHODS

Immediately after LSR, one side was covered with the new hydrocolloid dressing H2460 and the other side was left open. Participants were instructed to clean the open side four times a day and replace the H2460 dressing if it was dislodged.

RESULTS

In the volunteers' and investigator's evaluations, the new dressing H2460 generally outperformed the 'open' technique. At the 1-month follow-up, eight of 10 volunteers reported that the H2460 side resulted in better healing; two of 10 volunteers felt there was no difference between the two sides for final outcome and none believed that the open side had better healing. Overall, the H2460 side healed better in the majority of participants as graded by the blinded observer (60%) and participant themselves (80%).

CONCLUSION

The new hydrocolloid dressing H2460 is a better and suitable alternative to the open technique to manage an acute wound after LSR.

Erbium:YAG Laser Resurfacing Using a Novel Portable Device

Laser resurfacing of facial rhytids has become a popular treatment for many patients who have wrinkles, photodamage, and acne scarring. Erbium:YAG laser resurfacing has emerged as one of the safer, more effective methods of facial rejuvenation and its increasing popularity has led to its widespread use for resurfacing. However, size and high initial and maintenance cost are among the problems with currently available laser devices. The LightPod portable Erbium:YAG laser from Aerolase offers a new paradigm for more cost effective means of performing ablative resurfacing with reduced initial and maintenance cost and the ease of portability with significantly reduced size and weight. The objective of this pilot study was to analyze the efficacy of The LightPod Erbium:YAG laser in different skin types for various indications.

Laser skin resurfacing with a novel portable erbium:YAG laser

BACKGROUND AND OBJECTIVE

The erbium:YAG laser is a popular modality for laser skin resurfacing (LSR). This study was performed to evaluate the safety and efficacy of a new portable Er:YAG laser in the treatment of photo-damaged skin.

METHODS

Nine patients with skin types I-III were treated for rhytides, large pores, pigmented lesions, lentigines and photo-damage. Small facial areas such as the periorbital area, nose, cheeks, and upper lip were treated with one to six passes at 5-6 J/cm2 with a new portable Er:YAG laser. Topical and local anesthesia was used.

RESULTS

All treated areas showed improvement and, depending upon the number of passes, re-epithelialization was complete within 2-7 days. The intense erythema resolved within 7 days and there was blending of treated and untreated areas within 2 weeks.

CONCLUSION

The technique of applying a tailored number of 5-6 J/cm2, 300 micros pulses of a new portable Er:YAG laser to small areas appears to be safe and effective. There was minimal discomfort and a high level of patient satisfaction after a relatively short recovery time.

Diode Laser Hair Removal in Patients Undergoing Isotretinoin Therapy

BACKGROUND

It is generally believed that any intervention in skin while on isotretinoin or within 6 months after the treatment can lead to prolonged healing and scarring.

OBJECTIVE

The objective was to evaluate the side effects of laser hair removal in patients undergoing isotretinoin treatment.

METHODS

Seven female patients undergoing isotretinoin therapy for acne were treated with a diode laser with a wavelength of 810 nm, a contact-cooling device, and a variable pulse width of 50 to 1000 ms. All volunteers received first treatment in the axillary or bikini area at 21 J/cm(2) (80 W) and the second treatment was done in the same area at 24 J/cm(2) (90 W). Six volunteers received additional treatments of chin area with a fluence of 21 or 24 J/cm(2). All volunteers were evaluated and photographed 1 week and 1 month after each treatment and degree of erythema, pigmentary change, vesiculation, swelling, and scarring was documented.

RESULTS

There was no erythema, pigmentary change, swelling, or scarring at any follow up visits. One volunteer presented with a bulla 1 week after second treatment, which was resolved at 1-month follow-up. All volunteers were satisfied with the degree of hair removal with two treatments.

CONCLUSION

This limited study suggests that diode laser hair removal is safe in patients undergoing isotretinoin therapy.

Erbium:YAG laser skin resurfacing: a Pakistani experience

BACKGROUND AND OBJECTIVES

To evaluate the use of the erbium:YAG laser for resurfacing in type IV skin patients in Pakistan.

STUDY DESIGN/MATERIALS AND METHODS

Ten patients with skin type IV underwent laser skin resurfacing with an erbium:YAG laser to treat wrinkles, acne/chickenpox scars and hyperpigmentation. An evaluation was done by the treating physician and a photographic evaluation and grading was done by a blinded observer.

RESULTS

The treating physician's records show no erythema, pigmentary alteration, infection or scarring at the 3-month follow-up. The blinded observer's evaluation of the 3-month photographs showed moderate to excellent improvement in 80% of patients in their respective underlying condition.

CONCLUSION

The erbium:YAG laser is safe and effective in treating wrinkles, acne/chickenpox scars and hyperpigmentation in skin type IV patients.

The effects of variable pulse width of Er:YAG laser on facial skin

BACKGROUND

The use of CO2 and Er:YAG lasers for resurfacing has increased significantly in the past few years. Er:YAG laser causes pinpoint bleeding during and after treatment with a typical pulse width of 250 microsec. A longer pulse of Er:YAG laser can potentially coagulate dermal blood vessels and increase the residual thermal damage (RTD).

OBJECTIVE

To evaluate the effects of various pulse durations of Er:YAG laser on the depth of RTD and bleeding.

METHODS

The preauricular skin of a volunteer was exposed to Er:YAG laser at 250-, 350-, and 700-microsec pulse durations, with a fluence of 5 J/cm2. The number of passes varied between 6 and 16. The treated skin was excised and a histologic evaluation was done.

RESULTS

The maximum depth of RTD was 50 microm and there was decreased bleeding with a 700-microsec pulse duration.

CONCLUSION

The increased pulse duration of Er:YAG laser of 700 micros does not increase the maximum reported RTD and therefore would not change the recovery time and may have a beneficial effect on hemostasis.

Comparison of erbium:YAG and carbon dioxide lasers in resurfacing of facial rhytides

OBJECTIVE

To compare the efficacy, adverse effects, and histological findings of erbium:YAG (Er:YAG) and carbon dioxide (CO2) laser treatment in removing facial rhytides.

DESIGN

An intervention study of 21 subjects with facial rhytides. All participants were followed up for 6 months. The end points of the study were wrinkle improvement and duration of adverse effects.

SETTING

Academic referral center.

SUBJECTS

Nineteen female and 2 male volunteers with skin type I to III and wrinkle class I to III participated in the study.

INTERVENTION

In all subjects, 1 side of the face was treated with a CO2 laser and other side with an Er:YAG laser. Skin biopsies were performed in 6 subjects before treatment and immediately, 1 day, 2 days, and 6 months after treatment. Observations were recorded by subjects, investigators, and a blinded panel of experts.

MAIN OUTCOME MEASURES

Improvement in wrinkles and severity and duration of adverse effects.

RESULTS

The CO2 laser-treated side had relatively better wrinkle improvement when evaluating all subjects (P<.03). However, in subjects receiving more than 5 passes of Er:YAG laser, improvement scores were not significantly different from those for 2 to 3 passes of CO2 laser treatment. Posttreatment erythema was noted at 2 weeks in 14 subjects (67%) on the Er:YAG laser-treated side and 20 subjects (95%) on the CO2 laser-treated side. The frequency of erythema was significantly less after Er:YAG laser treatment at 2 (P=.001) and 8 (P=.03) weeks. Hypopigmentation was seen in 1 Er:YAG-treated (5%) and 9 CO2-treated (43%) sides (chi2, P<.05). Histological evaluation showed residual thermal damage of up to 50 microm on the Er:YAG-treated side and up to 200 microm on the CO2-treated side.

CONCLUSIONS

Erbium:YAG laser is safe and effective in removing facial rhytides. Subjects treated with Er:YAG laser recover more quickly from the procedure than those receiving CO2 laser treatment.