Treatment of striae distensae using fractional ablative CO2 laser in skin types II-IV: a retrospective case series study

Striae distensae (SD) are atrophic dermal scars often found on abdomen, breasts, thighs, and hips of pregnant women. The strias’ self-healing without any intervention is a poor possibility. Till now, several lasers and light sources have been used for treatment of SD. However, there are no integrated therapeutic approaches determined for treatment of SD yet. So, in this study, the therapeutic effect of fractional ablative CO₂ laser in women with pregnancy was assessed. Twenty-four ethic Iranian women aged between 20 and 42 years with various severity of pregnancy SD enrolled in retrospective case series study. Participants with skin types II-IV were treated in four sessions with a one-month interval by fractional ablative CO₂ laser. The severity of striae was determined by Daveys scoring. Clinical improvement was assessed by comparing pretreatment and posttreatment clinical photographs based on global improvement scoring. The evaluation of clinical results showed that fractional ablative CO₂ laser was an effective treatment. Twenty of 24 (83.3%) patients showed improvement. Clinical improvement was affected by striae severity (P = 0.03). Also, there were no statistical differences between clinical improvements with skin types, striae scar severity, number of pregnancy, and striae location.     

Successful treatment of lichen amyloidosis accompanied by atopic dermatitis by fractional CO2 laser

Lichen amyloidosis (LA) is a subtype of primary cutaneous amyloidosis that is presented as persistent, multiple-grouped hyperkeratotic papules usually located on the shins, back, forearms or thighs. The treatment of LA has been considered to be difficult, and of the various methods available, recent studies have reported the efficacy of fractional CO₂ lasers. LA may be accompanied by atopic dermatitis (AD) in which the treatment options may be more limited. Herein, we report three cases of LA accompanied by AD treated by a fractional CO₂ laser.     

Successful treatment of lichen amyloidosis using a CO2 surgical laser

Lichen amyloidosis (LA) is a type of primary localized cutaneous amyloidosis characterized by multiple pruritic discrete hyperkeratotic papules with amyloid deposition in the papillary dermis. Two patients with LA had been treated with topical corticosteroids, but with no effect on the eruptions. The present authors then started treating the affected area by superficial ablation using a CO₂ surgical laser (LASER 30C, Lumenis Inc., Yokneum, Israel) at a setting of 10–15 watts with a 0.12‐second pulse duration, 0.36‐second rest duration, and 5‐mm laser spot size. The present authors treated the patients twice a month with the CO₂ laser. The papules on the legs had flattened in both patients, with a great improvement in the severe itching after 6 months in Case 1 and after 10 months in Case 2. These cases indicate that the CO₂ laser led to a good response in terms of the clinical manifestations, and may be useful for the treatment of LA.     

Skin tightening induced by fractional CO(2) laser treatment: Quantified assessment of variations in mechanical properties of the skin

Background Certain authors have reported the efficacy of fractional resurfacing laser treatment in patients with photodamaged skin resulting in skin tightening of treated area. Objective To assess skin tightening after CO₂ fractional resurfacing laser treatment by measuring variations in mechanical properties in treated areas. Dermal elasticity was measured using suction applied with an in vivo skin elasticity meter (Cutometer^®). Methods A prospective observational study was undertaken from January 2007 to August 2009. Laser treatment was performed with the SmartXide Dot^® (Deka^®, Firenze, Italy) CO₂ fractional resurfacing device. Patients were offered quantified analysis using the Cutometer^® before and after treatment. Results Seventeen patients (61 areas treated) were included in the study. Median delay between before and after cutometric evaluations was 80 days. We found significant improvement in elastic (R2 +5.9%), viscoelastic (R8 ?9.4%), fatigue (R3 and R9 ?16.2% and ?19.7%, respectively), and thickness (R0 ?14.9%) parameters. These results are consistent with significant tightening and also elastic tissue improvement. Conclusions It was possible to quantify skin tightening because of CO₂ fractional laser treatment using a noninvasive technique.     

Inflammatory linear verrucous epidermal nevus: why a combined laser therapy

Abstract

Inflammatory linear verrucous epidermal nevus (ILVEN) is a benign cutaneous hamartoma, and more precisely an uncommon variant of the verrucous epidermal nevus. In our case report we describe an ILVEN female patient, resistant to previous treatments but responsive to a combined laser therapy, 10,600-nm CO₂ laser and Fractional CO₂ laser, with good and longstanding results. A complete resolution of the lesion was observed at the 9-month follow-up. The application of lasers has been reported in literature over recent years for resolving ILVEN lesions. Based on our clinical experience, 10,600-nm CO₂ pulsed laser therapy seems to be the best treatment and Fractional CO₂ laser treatment can be regarded as a very promising technique to combine with CO₂ laser for reducing pigment modifications and endowing a more youthful appearance to the treated areas.     

Treatment of Striae Distensae with Nonablative Fractional Laser versus Ablative CO2 Fractional Laser: A Randomized Controlled Trial

Background

Striae distensae are atrophic dermal scars with overlying epidermal atrophy causing significant cosmetic concern. Although a variety of laser and light sources have been used for the treatment of striae distensae, to date no definite ''gold standard'' treatment modality has been determined.

Objective

To assess and compare the efficacy and safety of nonablative fractional photothermolysis and ablative CO₂ fractional laser resurfacing in the treatment of striae distensae.

Methods

Twenty-four ethnic South Korean patients with varying degrees of atrophic striae alba in the abdomen were enrolled in a randomized blind split study. The patients were treated with 1,550 nm fractional Er:Glass laser and ablative fractional CO₂ laser resurfacing. Each half of the abdominal lesion was randomly selected and treated three times at intervals of 4-weeks using the same parameters. Digital photography was conducted and skin elasticity and the width of the widest striae in each subject were measured at the baseline and 4 weeks after the final treatment. Clinical improvement was assessed by comparing pre- and post-treatment clinical photographs by two blinded physicians and participant satisfaction rates were evaluated. Skin biopsies were taken from three participants. All adverse effects were reported during the study.

Results

Although they do not statistically differ, both treatments with nonablative fractional laser and ablative CO₂ fractional laser showed a significant clinical and histopathologic improvement of striae distensae over pretreatment sites.

Conclusion

These results support the use of nonablative fractional laser and ablative CO₂ fractional laser as effective and safe treatment modalities for striae distensae of Asian skin. However, neither treatment showed any greater clinical improvement than the other treatment.     

Combination of CO2 and Q-switched Nd:YAG lasers is more effective than Q-switched Nd:YAG laser alone for eyebrow tattoo removal

Background: The eyebrow tattoo removal using Q-switched lasers is usually prolonged. Other modalities may be required to enhance the efficacy and shorten the treatment course. Objective: To compare the efficacy of Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser alone versus combination of Q-switched Nd:YAG and Ultrapulse CO₂ lasers for eyebrow tattoo removal after a single session. Patients and methods: After local anesthesia, the right eyebrow of 20 patients was treated with Ultrapulse CO₂ laser with the parameters of 4 J/cm² and 3.2 J/cm² for the first and the second passes. Both eyebrows were then treated with 1064-nm and 532-nm Q-switched Nd:YAG laser. The spot size and pulse duration were 3 mm and 5 nanoseconds for both wavelengths, and the fluence was 7 J/cm² for 1064 nm and 3 J/cm ² for 532 nm. Results: The side treated with combination of Q-switched Nd:YAG and CO₂ lasers improved 75–100% in 6 of 20 patients versus only 1 of 20 in the side treated with Q-switched Nd:YAG alone. Similarly, the right side in 13 of 20 patients showed more than 50% improvement with combination therapy versus the left side (the monotherapy side), where only 6 of 20 cases showed more than 50% improvement. The Mann–Whitney test was 2.85 for the right side and 1.95 for the left side (P value = 0.007). Conclusion: Using Ultra pulse CO₂ laser enhances the efficacy of Q-switched Nd:YAG laser in eyebrow tattoo removal.     

A preliminary study of fractional CO2 laser added to topical tacrolimus combined with 308 nm excimer lamp for refractory vitiligo

Fractional CO₂ laser has been proposed recently to be effective and well tolerated in patients with refractory vitiligo. In this preliminary, prospective study, 21 patients with multiple, localized, refractory, non‐segmental vitiligo lesions were randomized to receive either tacrolimus ointment plus 308 nm excimer lamp (control), with or without the addition of fractional CO₂ laser. There was no statistically significant improvement in the repigmentation on the laser side compared to the control side. Treatment was generally well‐tolerated; only localized adverse effects were noted. Overall the triple combination therapy was not superior to tacrolimus ointment plus 308 nm excimer lamp. Treatment failure may reflect insufficient penetration of tacrolimus ointment through the holes created by fractional CO₂ laser on the skin.     

The clinical effectiveness and cost-effectiveness of fractional CO2 laser in acne scars and skin rejuvenation: A meta-analysis and economic evaluation

Introduction: Fractional CO₂ has many indications in medicine including in treatment of acne scars and rejuvenation. The aim of this study was to evaluate the safety, efficacy, and cost-effectiveness of Fractional CO₂ Laser in comparison with other methods of rejuvenation and acne scar treatment. Materials and Methods: Several databases including Medline, OVID, EMBASE, CINHAL, SCOPUS, Web of science, CRD, and Cochrane were searched. After conducting the search and evaluation of selected publications, critical appraisal was done and eligible studies were accepted for inclusion in the systematic review. Results and Discussion: From 2667 identified publications two of the trials were eligible. The effectiveness and complications of Fractional CO₂ laser were comparable with Er:YAG but Fractional CO₂ laser was 14.7% (p = 0.01) more effective than Q-Switched ND:YAG laser. Cost affectivity of this method was the same as other alternative lasers. In conclusion Fractional CO₂ laser is an effective and safe method for curing of several kinds of skin diseases. Nevertheless there was not sufficient evidence to support its advantage. This device has equal or lower price in comparison to competent technologies except for the non- fractional ablative CO₂ laser that has the same or lower price and comparable effects.     

Our experience of carbon dioxide laser ablation of angiofibromas: Case series and literature review

Angiofibromas are one of the dermatological hallmarks of tuberous sclerosis. Various ablative treatments have been trialled and more recently topical rapamycin has been proposed. We present our experience of treatment of angiofibromas using carbon dioxide (CO₂) laser ablation and provide a timely literature review. Nine patients were retrospectively identified as being treated with CO₂ laser between 2009 and 2015. Three patients were male, six were female, median age at first treatment was 28 (range 15–49) years and the median number of treatments was two (range 1–17). Four of these patients could be contacted for a post-treatment telephone interview. All reported an improvement in appearance of angiofibromas following treatment and that they would recommend CO₂ laser ablation to others. Three of the four reported recurrence of some lesions following treatment. The only side effect reported by one patient was transient hyperpigmentation. CO₂ laser ablation appears to be a well-tolerated, efficacious treatment for angiofibromas with few long-term side effects.     

Early treatment using fractional CO2 laser before skin suture during scar revision surgery in Asians

Fractional CO₂ laser is one of the most effective treatment options used to resurface scars. However, most previous studies have been performed on mature scars at least 2 months after surgery. Recent studies have emphasized the importance of early treatment to reduce scar formation. In the present study, we described our experience with fractional CO₂ laser intervention before skin suture during scar revision surgery in Asians, and found the treatment was safe and effective.     

Treatment of striae distensae with needling therapy versus CO2 fractional laser

Background and objectives: Striae are atrophic dermal scars with overlying epidermal atrophy causing cosmetic concern. This study assesses and compares the efficacy and safety of needling therapy versus CO2 fractional laser in treatment of striae. Methods: Twenty Egyptian female patients with striae in the abdomen and lower limbs were involved in the study. The patients were treated with needling therapy and CO₂ laser every 1 month for 3 sessions. Follow-up by digital photography and skin biopsy was conducted at baseline and 6 months after treatment. Clinical improvement was assessed by comparing photographs and patient's satisfaction before and after treatment. Results: Nine of 10 (90%) needle-treated patients showed improvement. Among them, 3 (30%) had good, 4 (40%) had fair, and 2 (20%) had poor improvements; however, 1 (10%) did not show any improvement after the treatment. In CO₂-laser treated patients, 5 of 10 (50%) of the patients showed clinical improvement; 1 (10%) were good, 3 (30%) were fair, and 1 (10%) were poor; however, 5 (50%) did not show improvement. Conclusion: The results support the use of microneedle therapy over CO₂ lasers for striae treatment.     

Effectiveness of CO2 laser with subcision in patients with acne scars

Background: Post-acne facial scarring has always been a challenge to treat. It requires multiple therapeutic modalities as single modality is not hundred percent effective. Therefore, we have combined CO₂ laser resurfacing with subcision in patients with acne scars for better results. Objectives: The aim is to study the effectiveness and side effects of CO₂ laser with subcision in patients with atrophic acne scars. Methods: Fifty patients were selected for the study. Baseline grading was done with Goodman and Baron grading system. Twenty-five patients were randomly selected for subcision followed by CO₂ laser and the remaining patients were selected for CO₂ laser alone. The treatment was done for four sessions at 4-week interval. Clinical photographs were obtained for evaluation. Results: CO₂ laser with subcision showed excellent response in grade-2 and -3 acne scars. Statistically there is a significant difference between CO₂ laser following subcision and CO₂ laser alone at 5% level (p < 0.05). Both procedures were well tolerated with minimal side effects. Conclusion: The highly versatile CO₂ laser is useful for treating acne scars. Subcision prior to the CO₂ laser procedure showed better improvement when compared to CO₂ laser alone. Thus, in acne scars, multiple therapeutic modalities achieve better results.     

Comparison of Q-switched Nd:YAG laser alone versus its combination with ultrapulse CO2 laser for the treatment of black tattoo

Background: Q-switched lasers are conventionally used for the treatment of black tattoo. However, they require multiple sittings, and the response may be slow due to competing epidermal pigment in dark skin. Objective: To compare the efficacy of Q-switched Nd:YAG laser alone with its combination with ultrapulse CO₂ for the removal of black tattoo. Materials and methods: Sixty patients with black tattoo were randomized into two groups viz., group A and group B. Group A was treated with QS Nd:YAG laser (1064 nm) alone, and group B received combination of ablative ultrapulse CO₂ followed by fixed-dose QS Nd:YAG laser (1064 nm), at 6-week interval for a maximum of 6 sittings. After each sitting, 3 independent physicians noted percentage of improvement that was evaluated using visual analogue scale (VAS) and grading system for tattoo ink lightening (TIL). Results: Combination laser (group B) showed statistically significant improvement in mean VAS score in the last 2 noted visits as compared to 1st session (p < 0.007, p < 0.001) and TIL mean score in last three noted visits as compared to 1st session (p < 0.008, p < 0.020, and p < 0.004). There was no statistically significant difference in the side effect profile of both the groups. Conclusion: For refractory professional tattoos, combination of ultrapulse CO₂ laser and QS Nd:YAG laser is superior to QS Nd:YAG laser alone.     

Successful treatment of malar dermal melasma with a fractional ablative CO2 laser in a patient with type V skin

Abstract

Background/Objective: Melasma is a common disorder of hypermelanosis, and although numerous treatment modalities have been employed, many cases are refractory to treatment or the improvement after therapy is temporary. Methods: The clinical files, treatment parameters, and photographs of a 59-year-old female with black skin with refractory malar dermal melasma treated using a fractionally ablative CO₂ laser (Affirm 10 600 nm) for seven sessions were carefully reviewed. Results: After treatment, clinical improvement was achieved. Conclusion: The fractional ablative CO₂ laser is a potentially safe and effective modality for the treatment of dermal melasma in Fitzpatrick type V skin.     

Evaluation of autologous platelet-rich plasma plus ablative carbon dioxide fractional laser in the treatment of acne scars

Introduction: Acne scar is a common distressing complication of acne vulgaris. CO₂ laser resurfacing proved effective for the treatment of this problem, but the associated complications may limit its use. Platelet-rich plasma (PRP) may increase the chance of favorable outcome. Aim of the work: To evaluate the synergistic effects of autologous PRP with fractional CO₂ laser resurfacing in the treatment of acne scars among Egyptian patients. Patients and method: This study included 30 patients suffering from post-acne scars. CO₂ laser treatment was applied to both sides of the face followed by PRP injection for the right side. Evaluation was carried out through operating physicians, two blinded physicians as well as through patient’s satisfaction. Result: The right side of the face (PRP-treated side) achieved excellent improvement in 13.3% of the patients, while there was no excellent improvement on the left side. Conclusion: Combination of fractional CO₂ laser resurfacing and intradermal PRP was superior to CO₂ laser alone for acne scar treatment.     

A systematic review of comparative studies of CO2 and erbium:YAG lasers in resurfacing facial rhytides (wrinkles)

Background: Laser resurfacing is used to minimize wrinkles, solar scars and sequelae of acne. Objective: Purpose of the systematic review was to compare resurfacing outcomes of CO₂ laser and erbium: yttrium aluminium garnet (erb:YAG) laser therapies. Materials and methods: Medline, Cochrane Library, EMBASE and Google Scholar databases were searched until 9 April 2015 using the following terms: laser, carbon dioxide/CO₂, facial wrinkles, rhytides and erbium-doped yttrium aluminium garnet/erbium:YAG/Er:YAG. Two-armed controlled split faced studies that compared CO₂ laser and erbium:YAG laser in patients with mild-to-moderate facial wrinkles or rhytides were included. Results: The pooled data in this study and findings of other studies support the greater efficacy with the CO₂ laser in improving facial wrinkles, but the erb:YAG laser was associated with a better complication profile compared with the CO₂ laser. Except one case of hypopigmentation, other complications (i.e., erythema, hyperpigmentation and crusting) and their rates were reported by studies examining both lasers. Conclusion: In general, the CO₂ laser appeared to be more efficacious then the erb:YAG laser in treating facial wrinkles. Both lasers treatments were well tolerated.     

Non‐ablative 1550‐nm erbium‐glass and ablative 10 600‐nm carbon dioxide fractional lasers for acne scars: a randomized split‐face study with blinded response evaluation

Background Non‐ablative 1550‐nm erbium‐doped fractional photothermolysis systems (FPS) and 10 600‐nm carbon dioxide fractional laser systems (CO₂ FS) have been effectively used to treat scars. Objective We compared the efficacy and safety of single‐session treatments of FPS and CO₂ FS for acne scars through a randomized, split‐face, evaluator‐blinded study. Methods Eight patients with acne scars were enrolled in this study. Half of each subject’s face was treated with FPS and the other half was treated with CO₂ FS. We used a quartile grading scale for evaluations. Results At 3 months after the treatment, the mean grade of improvement based on clinical assessment was 2.0 ± 0.5 for FPS and 2.5 ± 0.8 for CO₂ FS. On each side treated by FPS and CO₂ FS, the mean duration of post‐therapy crusting and scaling was 2.3 and 7.4 days respectively and that of post‐therapy erythema was 7.5 and 11.5 days respectively. The mean VAS pain score was 3.9 ± 2.0 with the FPS and 7.0 ± 2.0 with the CO₂ FS. Conclusion We demonstrated the efficacy and safety of single‐session acne scar treatment using FPS and CO₂ FS in East Asian patients. We believe that our study could be used as an essential reference when choosing laser modalities for scar treatment.     

A Chinese experience of fractional Ultrapulsed CO2 laser for skin rejuvenation

Abstract

Background and objectives: The ablative fractional CO₂ laser has been successfully used in treating photoaged skin in the Caucasian population. However, its application in Asian skin has not been widely reported. The purpose of this study is to observe the efficacy and safety of the protocol ‘ActiveFX’ for photodamaged facial skin in Chinese patients. Methods: A non-sequential fractional ultrapulsed CO₂ laser with specific settings is used in addition to a new computer pattern generator (CPG). Twenty patients received a single-session, single-pass, ablative fractional treatment on a split face. The patients were evaluated at baseline, and 1 and 3 months (M1, M3) after the treatment using a quartile grading scale. They were also asked to assess their overall satisfaction using a 4-point scale. The improvement of the coarse wrinkles was also quantitatively analyzed with a 3D in vivo imaging system. Results: At M1 and M3, the blinded investigator rated global improvement as 2.8 ± 0.95 and 3.00 ± 0.73, which was consistent with the patients' assessment (2.55 ± 0.83 at M1 and 3.15 ± 0.88 at M3). The roughness analysis (Rz) demonstrated a significant decrease in periorbital wrinkles (p < 0.0001). Minimal and reversible adverse side effects and rapid healing were noted. Conclusions: Non-sequential fractional ultrapulsed CO₂ laser resurfacing (ActiveFX) is considered an excellent treatment modality for photodamaged Chinese facial skin.     

Verruca plana as a complication of CO2 laser treatment: A case report

Carbon dioxide (CO₂) laser treatment is a common therapeutic modality for many dermatologic conditions. It uses a high energy, infrared beam of light, which selectively targets water-containing tissue resulting in controlled ablative resurfacing. This modality, however, can manifest significant cosmetic side effects. Here we report a case of verruca plana manifesting as a response to CO₂ laser treatment. A 74-year-old female with recent Mohs surgery for a basal cell carcinoma, presented for full-face-fractionated CO₂ treatment to address her surgical scars in addition to treating her mild diffuse actinic damage. Six weeks post treatment, the patient developed erythematous thin plaques over the areas that had been treated. Histology was consistent with verruca plana. Lesions showed mild improvement with topical tretinoin. Verruca plana are benign and typically self-limited; however, they can present a significant cosmetic burden to patients and are an important complication to consider when performing elective cosmetic procedures.