Laser treatment of scars and keloids – How we do it

The existence of scars may present considerable problems for patients. As well as being sometimes disfiguring and having an influence on a person's perception of him or herself, hypertrophic scars and keloids can often also cause pruritus, dysesthesia and pain, and can form strictures.

Since the first attempts to influence hypertrophic scars and keloids with lasers, many refinements in the technology and improved laser treatment techniques have taken place. Flashlamp-pumped dye lasers and near infrared (NIR) lasers are the most frequently used lasers for hypertrophic scar treatment, whereas CO₂ and Er:YAG lasers are preferred to diminish atrophic scars. Non-ablative skin remodeling may be used for minor changes.

Lasers and other intensive light sources can also play a role in prevention of scars, and new strategies for acne treatment are on the horizon.     

聚氨酯泡沫敷料在点阵激光治疗面颈部增生性瘢痕辅助治疗中的疗效观察

目的 探讨聚氨酯泡沫敷料在点阵激光治疗面部增生性瘢痕术后辅助治疗中的疗效.方法 回顾我科2018年9月至2020年12月面部烧伤后增生性瘢痕在烧伤创面愈合后3个月内采用二氧化碳点阵激光+压力治疗和二氧化碳点阵激光+聚氨酯泡沫敷料+压力治疗的86例患者,采用温哥华瘢痕量表(vancouver scar scale,vss...     

Microcirculation in hypertrophic scars after burn injury

Hypertrophic scar formation is a common complication after burn injury. Early active scars show hyperemic appearances that change as the scar matures. This is a report on microcirculation in hypertrophic scars after burn injury among 50 Chinese patients with a laser Doppler flowmeter. The average period of follow-up for the patients was 20 months. The microcirculatory response in scars to vasodilation (heat) stimulus was studied. Significant differences (p less than 0.0001) were demonstrated between scars of different clinical grades of maturity when compared with normal skin. The qualitative and quantitative differences in microcirculatory blood flow were correlated with site variations and different physiologic demands from different grades of scars. The study showed that laser Doppler flowmetry was useful in the clinical grading assessment of or for scar maturity.     

Laser Doppler flowmetry for the early detection of hypertrophic burn scars

In this preliminary study it was hypothesized that patients with hypertrophic scars have increased microcirculatory perfusion in the areas of scarring. Sixteen former patients whose burn injuries involved less than 30% TBSA and who required autologous skin grafting were evaluated using laser Doppler flowmetry. Data grouped at three-week intervals showed higher flow values in patients with hypertrophic scarring than in those with non-hypertrophic scars. These initial data suggest that hypertrophic scars may be associated with increased microcirculatory blood flow. These values are elevated early and could possibly serve as an early indicator for the occurrence of hypertrophic scarring.     

2940nm点阵激光联合倍他米松在增生性瘢痕的中的应用

目的探讨点阵激光联合倍他米松局部封闭治疗增生性瘢痕的疗效,评价其应用效果及价值。方法选取2018年5月至2019年2月我院接收的72例增生性瘢痕患者作为本次研究对象,将其按照随机数表法原则分为对照组(36例)与观察组(36例)。对照组采用倍他米松局部封闭治疗,观察组在对照组基础上联合点阵激光治疗。比较分析两组疗效、瘢痕长轴长度及不良反应发生情况。结果观察组临床疗效明显比对照组高,差异具有统计学意义(P<0.05);治疗后1-5月,相比对照组,观察组瘢痕长轴长度均较短,且差异具有统计学意义(P<0.05);观察组不良反应比对照组低,但差异无统计学意义(P>0.05)。结论对增生性瘢痕采用点阵激光联合倍他米松局部封闭治疗,临床效果显著,可有效抑制瘢痕增生,降低不良反应发生,值得借鉴。     

神经纤维瘤病的CT、MRI表现

目的探讨神经纤维瘤病的CT、MRI表现。方法回顾性分析24例经临床或手术病理证实的神经纤维瘤病患者的CT、MRI表现。结果根据美国国立卫生研究所标准,24例患者,Ⅰ型22例,Ⅱ型2例,其中有4例和2例分别系同一家族成员,分别为母亲和3个儿子及父亲和女儿,且均为Ⅰ型患者,合并皮肤牛奶咖啡斑的12例,皮下多发纤维瘤结节的10例,其中19例行手术确诊。结论神经纤维瘤病的CT、MRI表现有一定特征性,NF1型占大部分,NF2型较少,结合典型临床表现、     

CO2点阵激光联合伊可尔治疗难治性掌跖疣疗效观察

目的观察CO₂点阵激光联合伊可尔治疗难治性掌跖疣的临床疗效及安全性。方法:选取掌跖部多发,经其他疗法治疗后复发的难治性掌跖疣患者58例,患者平均分为两组,对照组29例先选择激光功率0.5-2W将皮损磨削薄直至焦痂或点状出血,之后采用CO₂点阵模式10-20mJ/cm2治疗,每周治疗一次,连续治疗4周。观察组29例观察组:CO₂点阵激光治疗仪器及治疗方法与对照组相同。激光治疗完毕,使用伊可尔药水棉片湿敷患处2小时,激光治疗后连续湿敷伊可尔棉片5天,停药2天至下一次激光治疗后继续湿敷,连续治疗4周。2组均随访观察6个月。结果:58例患者均完成治疗,治疗4周后,观察组总有效率93.10%,病损清除率为77.82%,均高于对照组的72.41%、60.81%,组间差异均有统计学意义(P<0.05)。6个月后,观察组复发率10.34%,对照组复发率37.93%,组间差异有统计学意义(P<0.05),两组不良反应差异无统计学差异。结论:CO₂点阵激光联合伊可尔治疗难治性掌跖疣疗效优于单用CO₂点阵激光。联用伊可尔降低了难治性掌跖疣的复发率,并且操作简便,安全性高。     

Long-pulsed Nd:YAG 1064 nm in the treatment of leg veins: Check up of results at 6 months in 100 patients

This study assessed at 6 months, subjectively and objectively, the efficacy of a long-pulsed Nd:YAG laser system in clearing leg veins.

A hundred female patients (25–60 y.o., skin types II–IV) with leg vein varicosities were treated with single pulse shots by a long-pulsed 1064 nm Nd:YAG laser, with 3, 5, 7 and 10 mm spot size diameters with related energies at 130, 120, 110 and 100 J/cm², and pulse lengths of 20, 30, 40 and 50 ms, respectively.

One or two treatments were given at 2-month intervals, with post-treatment assessments at 6 months. Patients subjectively assessed the treatment and their results were used to identify a satisfaction index (SI). Objective assessment was based on clinical photography and computer-generated data from a vein clearance detection program.

The overall patient satisfaction rate was 57% and objective assessments based on the clinical photography and computer assessment were 64% and 71%, respectively.

The Nd:YAG 1064 nm long-pulsed laser offered efficient treatment of leg veins irrespective of skin phototypes and results were better on blue and thick vessels. Side effects were minimal and transient.     

单核细胞趋化蛋白1和骨形成蛋白7在病理性瘢痕中的表达

背景：单核细胞趋化蛋白1是新近明确的对单核/巨噬细胞有趋化和激活双重作用的趋化因子,骨形成蛋白7作为一种新发现的纤维化负性调节因子逐渐成为抗组织纤维化治疗的研究热点,但两者对病理性瘢痕形成中组织纤维化作用的研究至今鲜有报道。目的：研究单核细胞趋化蛋白1,骨形成蛋白7在病理性瘢痕中的表达水平。方法：采用免疫组织化学方法检测单核细胞趋化蛋白1、骨形成蛋白7在25例瘢痕疙瘩、30例增生性瘢痕、24例非病理瘢痕和20例正常皮肤组织中的表达水平。所有标本均来自2008-07/2010-01郑州大学第一附属医院整形外科住院患者,且均无皮肤疾病、结缔组织病、传染病、恶性肿瘤和其他重要脏器疾病,术前无射线治疗、激光治疗及免疫治疗史,其中所取瘢痕组织来自于临床诊断明确的瘢痕患者。结果与结论：单核细胞趋化蛋白1在瘢痕疙瘩、增生性瘢痕中的阳性表达率均高于非病理性瘢痕与正常皮肤组织（P〈0.05）,骨形成蛋白7阳性表达率均降低（P〈0.05）,两者阳性表达率在病理性瘢痕（瘢痕疙瘩和增生性瘢痕）中呈明显负相关（r=-0.639,P〈0.01）。结果显示,在病理性瘢痕的形成过程中单核细胞趋化蛋白1表达上调,而骨形成蛋白7表达下调。     

CO2激光加按摩整脊法治疗颈椎病临床疗效研究

目的 探讨CO2激光加按摩整脊法综合治疗颈椎病的临床疗效.方法 将300例颈椎病患者随机分为两组,CO2激光加按摩整脊治疗组（综合治疗组）150例,采用CO2激光加按摩整脊法治疗;传统按摩整脊治疗组（对照组）150例,采用传统按摩整脊法治疗.结果 综合治疗组疗效明显优于对照组,经SPSS 16.0软件包统计学分析,差异有高度统计学意义（P＜0.01）.结论 CO2激光加按摩整脊综合治疗颈椎病可明显提高临床疗效且疗效稳定.     

Lumbar coupling during lateral translations of the thoracic cage relative to a fixed pelvis

Objective. To determine lumbar coupling during lateral postural translations (lumbosacral list) of the thoracic cage relative to a fixed pelvis.

Design. Digitized measurements from anteroposterior lumbar radiographs of 17 volunteers were obtained in neutral, maximal left lateral translation and maximal right lateral translation posture of the thoracic cage compared to a fixed pelvis. Subjects were constrained with two sets of clamps at the lateral borders of the pelvis and lower ribs.

Background Data. Clinically, lumbosacral list is a common posture. Range of motion and spinal coupling results have not been reported for the lumbosacral list movement.

Methods. Four vertebral body corners, mid narrow-waisted body margins, superior and inferior pedicle margins, and spinous-lamina junction of T12–L5 were digitized on 51 anterior–posterior lumbar radiographs. Using the orthogonal axes of positive x-direction to the left, vertical as positive y, and anterior as positive z, digitized points were used to measure projected segmental z-axis rotation, y-axis rotation, and segmental lateral translations of each vertebra.

Results. Using the displacement of T12, subjects could translate 35–70 mm left or right along the x-axis with an average of 53.2 mm to the left and 52.1 mm to the right. Using superior endplates to superior sacral base, lateral flexion was largest at L1 and decreased from L1 to L5, but the segmental rotation angles for lateral flexion were largest at L2–L3 (3.9°), L3–L4 (6.2°) and L4–L5 (5.7°) and were in the same direction as the main motion translation. The relative z-axis rotation of T12 was opposite to the direction of L1–L5. The coupled y-axis rotations were less than 1° and coupled segmental lateral translations were averaging less than 1 mm.

Conclusions. Thoracic cage x-axis translations compared to a fixed pelvis are significant, between 35 and 70 mm. The z-axis lumbar coupled rotation was largest at L2–L3, L3–L4 and L4–L5 and to the same side of the main motion translation in L1–L5, but opposite the main motion direction for T12. All other movements were small, averaging less than 1° or 1 mm.

Relevance

The clinically common posture of lateral translation of the thoracic cage (lumbosacral list) is often associated with disc herniation. Yet normal lumbar coupling patterns and total range of motion of this movement have not been established in the literature. Normal values for lumbar segmental coupling on anterior–posterior lumbo-pelvic radiographs during trunk list might be important for an analysis of segmental instability since segmental translations were determined to be 1 mm or less.     

Immunochemiluminometric assays (ICMA) specific for growth hormone releasing hormone 1-44 NH2 and 1-40 OH.

We describe specific two-site immunochemiluminometric assays able to directly measure human growth hormone-releasing hormone 1–44 NH₂ and 1–40 OH concentrations in unextracted plasma. A common N-terminal antibody was purified from polyclonal rabbit antisera to growth hormone-releasing hormone 1–44 NH₂ on a growth hormone-releasing hormone 1–29 NH₂ linked affinity column and labelled with chemiluminescent acridinium ester. C-terminal specific monoclonal antibodies to growth hormone-releasing hormone 1–44 NH₂ and 1–40 OH were raised in Balb/C mice and used as solid phase antibodies. Assay of fasting specimens from normal individuals gave medians (and ranges) of 23 pg/ml (2–200) and 30 pg/ml (3–134) for growth hormone-releasing hormone 1–44 NH₂ and 1–40 OH, respectively. Samples from a series of acromegalics showed that most have values in the normal range though median values were higher, 56 pg/ml for growth hormonereleasing hormone 1–44 NH₂ (P < 0.001) and 52 pg/ml for 1–40 OH (P < 0.001). Using these assays it will be possible for the first time to directly study the physiology and pathophysiology of these two peptides.     

From the Editors

Only seven years after the construction of the first laser by Maiman in 1960, the dermatologist Professor Leon Goldman/USA reported about the first therapeutic laser application in patients with vascular lesions and tattoos in his book Biomedical Aspects of the Laser. In the seventies and early eighties, mainly the argon and carbon dioxide laser were used because of their thermal destructive effects. Most important indications were port-wine stains, telyangiectasias, and the removal of tattoos.

A mile stone in laser therapy was the principle of selective photo thermolysis published by Anderson and Parish in Science in 1983. The use of a wave length with high absorption in the target structure and a very short exposure time shorter than thermal relaxation time of the target structure and a sufficiently high energy density allowed the destruction of the target within the skin without damage to the surrounding tissue. Target structures were, for example, ectatic vessels of port-wine stains, tattoo pigment, or melanin-pigmented cells.

Nowadays, lasers are an indispensable therapeutic tool in dermatology. They can be used for the treatment of vascular lesions such as port-wine stains, childhood hemangiomas and telyangiectasias, epidermal and organoid nevi, melanin pigmented lesions, tattoos, or benign tumors, inflammatory lesions, virus papillomas, sun-damaged skin, wrinkles, and for epilation.

Analogous to the many indications for laser therapy, the number of applied lasers is also very high. Lasers used for selective photo thermolysis are pigmented lesion dye lasers (PLDL,510 nm), flash-lamp pumped pulsed dye lasers (FPDL, 585 nm), long-pulsed tuneable dye lasers (LPDL, 585–600 nm), Q-switched ruby lasers (694 nm), Q-switched Nd:YAG lasers (1064 nm), frequency doubled Q-switched Nd:YAG lasers (532 nm), Alexandrite lasers (755 nm), and diode lasers (800 nm). Apart from these laser units, argon lasers (488 and 514 nm), copper vapour lasers (515 and 578 nm), Krypton lasers (589 nm), and frequency doubled Nd:YAG lasers (532 nm) are also routinely used. Cw-Nd:YAG lasers (1064 nm) are mainly applied if unspecific coagulation of the tissue is warranted. Lasers for vaporisation and ablation include cw-CO₂ lasers, pulsed CO₂ lasers, CO₂ lasers with scanner, and Erbium:YAG lasers.

Since not every indication and laser can be covered in one single issue of the journal, topics and authors were selected according to areas of interest. This issue includes articles on ablative therapy with the Erbium:YAG laser, treatment of vascular lesions, analysis of different cooling devices, a study on laser epilation, and the therapy of neurofibromatosis.

Two non-dermatological papers on “Indocyanine Green Therapy for Hypopigmented Choroidal Melanoma” and on “Optical Tomography for the Imaging of Rheumatoid Arthritis” describe techniques which are also important in dermatology.

In summary, I believe that this issue of Medical Laser Application will be of interest to readers since the articles emphasise laser therapy with regard to the scientific point of view instead of more commercially orientated cosmetic aspects. This issue will help to define the important role of lasers in dermatotherapy.     

The effect of auto-positive end-expiratory pressure on the arterial-end-tidal carbon dioxide pressure gradient and expired carbon dioxide slope in critically ill patients during total ventilatory support

To examine the effect of auto-positive end-expiratory pressure (autoPEEP) on the estimation of arterial carbon dioxide pressure (PaCO₂) from end-tidal carbon dioxide pressure (PetCO₂) during changes in minute ventilation (MV), we studied 24 consecutive sedated and paralyzed patients under controlled mechanical ventilation for acute respiratory failure. The patients were grouped according to whether they had autoPEEP: group I (n = 11) comprised non-autoPEEP patients and group II (n = 13) comprised autoPEEP patients. Patients were randomly ventilated at three different levels of MV: normal MV (basal tidal volume), high MV (tidal volume 2.5 mL/kg above basal), and low MV (tidal volume 2.5 mL/ kg below basal). Respiratory rate and inspiration to expiration ratio were kept constant during the study. In each condition, we measured arterial blood gases, expiratory capnograms, airway pressure, and autoPEEP. We determined PaCO₂-PetCO₂ gradient, predicted PaCo₂ (Pa'CO₂) [Pa'CO₂ = PetCO₂ for each condition + (PaCO₂ PetCO₂ gradient at normal MV)], and expired CO₂ slope. The PaCO₂-PetCO₂ gradient only remained stable in group I (mean values for low, normal, and high MV were 3.3, 3.3, and 3.5 mm Hg, respectively), while group II showed a significant difference during low MV (12.2 mm Hg) when compared with normal MV (8.4 mm Hg; P < .01) and high MV (8.9 mm Hg; P < .05). PaCO₂ and PetCO₂ showed significant correlations in both groups (r = .92 in group I and .79 in group II). However, Pa'CO₂ could only be safely estimated in patients without autoPEEP when the difference between PaCO₂ and Pa'CO₂, ranged between 1.6 and −1.9 mm Hg. Slopes of expired CO₂ greater than 3 mm Hg/s identified patients with autoPEEP of 89% sensitivity, 93% specificity, 94% positive predictive power, and 95% accuracy. A significant correlation was found between autoPEEP and expired CO₂ slope (r = .70; P < .001), between autoPEEP and PaCO₂-PetCO₂ gradient (r = .46; P < .001), and between CO₂ expired slope and PaCO₂ PetCO₂ gradient (r = .74; P < .001). These results indicate that in patients with acute respiratory failure under controlled mechanical ventilation, the presence of autoPEEP is associated with inaccuracy in the calculation of predicted PacoZ from PetcoZ after changes in MV at fixed respiratory rates.     

Differences of 25-hydroxyvitamin D3 concentrations in children and adults with neurofibromatosis type 1

ObjectivesNeurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder, frequently associated with reduced bone mineral density. Serum 25-hydroxyvitamin D3 concentrations in NF1 adults are lower than in healthy controls in autumn respectively winter and are inversely correlated with the number of dermal neurofibromas. We investigated 25-hydroxyvitamin D3 levels in children and adults with neurofibromatosis type 1 in winter and summer and compared them to healthy controls to get more pathogenic insights in vitamin D3 metabolism in NF1 patients.Design and methodsNF1 patients were clinically examined and serum 25-hydroxyvitamin D3 concentrations were measured in 58 NF1 adults and 46 children in winter as well as in summer and compared to sex-, age- and month-matched controls.Results52 adults suffered from 10 to 5000 dermal neurofibromas, whereas none of the children presented neurofibromas. 25-Hydroxyvitamin D3 increased from winter to summer (mean: 21.0 to 46.5 nmol/l) in NF1 adults. This increase was even larger (p = 0.0001) than in healthy controls (mean: 50.5 to 60.5 nmol/l). However, there were no differences of 25-hydroxyvitamin D3 concentrations in NF1 children and healthy controls both in winter and in summer.ConclusionsOnly adults with NF1 showed lower 25-hydroxyvitamin D3 levels in winter and summer, which are unlikely due to impaired UV-dependent dermal synthesis, but rather might be caused by an accelerated catabolism.     

细胞外信号调节激酶1/2传导通路对增生性瘢痕的影响

目的观察细胞外信号调节激酶1/2(ERK1/2)传导通路对增生性瘢痕的影响。方法用免疫组化方法和常规病理技术检测Ras、磷酸化ERK1/2和C-fos在14例增生性瘢痕和14例正常皮肤中的表达变化规律。结果在正常皮肤中,Ras、磷酸化ERK1/2和C-fos蛋白表达较低,随着增生性瘢痕不断成熟,这3种蛋白表达逐渐增强。在成熟期瘢痕中,这3种蛋白阳性细胞率明显高于正常皮肤(P<0.01)。结论增生性瘢痕的发生和成熟可能与激活ERK1/2信号传导通路,促进C-fos转录因子表达有关。     

Smad3和转化生长因子β1在瘢痕疙瘩、增生性瘢痕及正常皮肤中的表达:48∶40∶40例标本病理检测

目的:与病理性瘢痕发生机制相关的Smad3/转化生长因子β1信号传递通路研究多集中在体外成纤维细胞的培养上,在瘢痕疙瘩中的表达少见报道.检测病理性瘢痕中Smad3和转化生长因子β1蛋白的表达,探讨其在病理性瘢痕发生及发展中的作用.方法:实验标本均来自2004-06/2008-0 6河北医科大学附属唐山工人医院烧伤整形科手术患者,瘢痕疙瘩48例,年龄16～52岁;增生性瘢痕40例,年龄18～56岁;选取同期因其他手术切除的正常皮肤组织40例作为对照组.应用流式细胞术检测48例瘢痕疙瘩、40例增生性瘢痕及40例正常皮肤组织Smad3和转化生长因子β1的表达.结果:Smad3和转化生长因子β1在瘢痕疙瘩和增生性瘢痕中的表达明显高于正常皮肤组织中的表达(P＜0.05),Smad3和转化生长因子β1在瘢痕疙瘩和增生瘢痕中的表达差异无显著性意义(P＞0.05).瘢痕疙瘩和增生性瘢痕中Smad3和转化生长因子β1表达呈正相关(r=0.489 2,P=0.000 4;r=0.471 0,P=0.002 2),Smad3和转化生长因子β1在正常皮肤组织中的表达未见明显相关性(P=0.4714).结论:Smad3和转化生长因子β1在病理性瘢痕中高表达,Smad3和转化生长因子β1的协同作用可能参与病理性瘢痕的发生发展.     

Characterization of plasma acylcarnitines in patients under valproate monotherapy using ESI-MS/MS

Objectives: The effect of administration of the antiepileptic drug valproate (VPA), on the composition of the plasma acylcarnitine profile (including free carnitine) was investigated.

Design and methods: Plasma samples were obtained from 18 individuals (13♂:5♀; 15–65y) on long-term treatment with VPA (resulting in plasma levels of 14.6–135.0 mg/L; therapeutic conc.: 40–100 mg/L). Acylcarnitines (AC) in plasma were quantified by electrospray tandem mass spectrometry (ESI-MS/MS).

Results: VPA was found to increase the levels (mean ± SD, μM) of 3-hydroxy-isovalerylcarnitine (0.10 ± 0.04; controls: 0.02–0.06), C14:2 acylcarnitine (0.11 ± 0.05; controls: 0.02–0.08), propylglutarylcarnitine (0.06 ± 0.05; controls: 0.00–0.04), and C18-0H-acylcarnitine (0.09 ± 0.05; controls: 0.00−0.04). The free carnitine (C) (42.2 ± 9.0; controls: 22.3–54.9) and the total carnitine (52.3 ± 10.1; controls: 26.5–73.6) were not significantly altered by VPA. Other AC (C2-C18, monounsaturated and hydroxylated) were all within the control range and especially no increase of C8 (valproyl) carnitine was observed. A positive correlation was found between the ratios [AC] / [C] (p < 0.05) or [long-chain AC (C10-C18)] / [C] (p < 0.09) with the plasma VPA concentration.

Conclusions: The unequivocal increase in 3-hydroxy-isovalerylcarnitine is consistent with the increase of 3-hydroxy-isovaleric acid observed in urine of VPA treated patients. This finding suggests an interaction mechanism of VPA with specific enzymes, namely involved in leucine metabolism. Adult patients under VPA monotherapy do not suffer from carnitine deficiency; the effect of the accumulating acylcarnitines is ill-defined.     

增生性瘢痕中细胞外信号调节激酶及其激酶基因表达的变化

目的：探讨细胞外信号调节激酶1/2（extracellular-signal regulated protein kinase，ERK1/2）及其上游信号分子MEK1/2在增生性瘢痕和正常皮肤中基因表达的变化。方法：提取8例增生性瘢痕和8例正常皮肤组织的总RNA后，分离mRNA，用逆转录聚合酶链反应（RT-PCR）法检测这4种基因在不同组织中的表达变化规律。结果：在正常皮肤组织中，MEK1、MEK2、ERK1和ERK2基因表达较弱；而在增生性瘢痕中，这4种基因表达明显增强，其mRNA量的灰度比分别为正常皮肤的1.1倍、1.2倍、2.2倍和2.5倍。结论：增生性瘢痕的发生可能与MEK1/2和ERK1/2基因表达升高有关。