Famciclovir Prophylaxis of Herpes Simplex Virus Reactivation After Laser Skin Resurfacing

BACKGROUND: Cutaneous laser resurfacing with carbon dioxide and erbium:YAG lasers has achieved remarkable clinical results with a relatively low risk of morbidity and complications. The incidence of herpes simplex virus (HSV) reactivation after resurfacing can be decreased by prophylaxis with antiviral agents. Famciclovir is effective in the suppression and treatment of HSV infections; however, no studies have examined the optimum dosing regimen for HSV prophylaxis in laser resurfacing. OBJECTIVE: The objective of this study was to determine the efficacy of 2 doses of famciclovir as prophylactic anti-HSV therapy during cutaneous laser resurfacing. METHODS: Ninety-nine consecutive patients undergoing full-face laser or perioral resurfacing received either 500-mg or 250-mg famciclovir twice daily, beginning 24 hours prior to laser resurfacing and continuing for 10 days. RESULTS: No HSV recurrences were seen in 90% of patients receiving famciclovir at either dose. Approximately one-third of patients in each group with a positive history of oral herpes labialis experienced HSV recurrence compared to 5% of those without a known HSV history. CONCLUSIONS: Famciclovir 250-mg or 500-mg twice daily is effective in the prevention of HSV recurrence in patients undergoing cutaneous laser resurfacing. Based on our clinical experience, a 500-mg dose is suggested for patients with a strong history of HSV, while 250-mg should be sufficient for those without prior HSV.     

Laser Resurfacing of the Neck: A Review of 48 Cases

With the advent of the new sophisticated carbon dioxide (CO₂) laser, effective treatment of facial rhytides and pigmented lesions of the photodamaged skin has been gaining popularity. Partial and full facial skin resurfacings have been reported. However, resurfacing of the neck has been ignored or discouraged. The objective of this study is to assess the feasibility, benefits, and risks of laser resurfacing of the neck, combined with the additional resurfacing of the whole face. A total of 48 patients underwent the procedure with a high-power and short-exposure time CO₂ laser (ultrapulse). Patients were evaluated and classified preoperatively. The great majority of patients had local anesthesia (topical and infiltrative) with minimal sedation. A computer pattern generator was used in all cases but one. In this paper, preoperative preparation, postoperative care, laser resurfacing techniques, and depth guidelines are discussed. Incorporating the neck with the facial resurfacing has given very satisfactory results, with minimal drawbacks.     

Prolonged Erythema After Facial Laser Resurfacing or Phenol Peel Secondary to Corticosteroid Addiction

Background. Prolonged persistent erythema postprocedure using phenol or carbon dioxide (CO₂) lasers occurs frequently and the reasons have not been fully ascertained.
Objective. To describe patients whose postoperative care consisted of prolonged use of topical corticosteroids and to assess the outcome of cessation of this medicine.
Methods. Twelve patients who underwent CO₂ laser resurfacing or phenol peels to their face are presented. All patients were seen between 3 and 30 months after the procedures were performed. All dressings, wound care, and other medicaments had been stopped prior to being seen. Most were patch tested to a wide variety of chemicals including corticosteroids, topical medications, and preservatives. They were observed during the poststeroid cessation period and the clinical response is described.
Results. All patch testing showed insignificant results. All postpeel patients cleared within 6 months of steroid cessation, experiencing several flares of erythema before the end result. Three of the six laser resurfacing patients cleared fully within 12 months and three are still being followed. The erythema and severe burning in the patients that cleared stayed clear during long-term follow-up. No scars or atrophy were seen.
Conclusion. The use of topical corticosteroid preparations postoperatively in peel and resurfacing patients is believed to be a major cause of prolonged erythema, dermatitis, burning, and telangiectasias in these patients. The mechanism is believed to be one of vasoconstriction/vasodilatation secondary to the corticosteroids through a nonintact barrier.     

Evaluation of the Role of Exogenous Estrogen in Postoperative Progress After Laser Skin Resurfacing

BACKGROUND: Recent studies indicate that exogenous estrogens may promote wound healing. Many laser skin resurfacing (LSR) patients use hormone replacement therapy (HRT) or oral contraceptive pills (OCPs). OBJECTIVE: To evaluate the effect of exogenous estrogen on LSR postoperative healing. METHODS: This is a retrospective case control study of 44 female patients who underwent combination CO2/Er:YAG full-face LSR. Sixteen postmenopausal patients using oral HRT during procedure and follow-up were compared with 16 controls. Six premenopausal patients on estrogen-containing OCPs during the procedure and follow-up were compared with six controls. Case and control groups were matched by age, skin type, and treatment technique. Premenopausal and postmenopausal groups were compared. The variables evaluated included erythema, swelling, crusting, purpura, pain, pruritus, reepithelialization, complications, and patient assessment of outcome. RESULTS: For premenopausal and postmenopausal women, there were no significant differences in outcome measures of postoperative morbidity between groups receiving and not receiving estrogen. The incidence of complications, time until re-epithelialization, and patient assessment of outcome were similar between groups. CONCLUSION: Our findings suggest that exogenous estrogen in the form of HRT or OCPs does not clinically alter postoperative progress in combination CO2/Er:YAG LSR patients. Premenopausal women heal comparably to postmenopausal women after LSR.     

Full-Face Laser Resurfacing and Rhytidectomy

The Ultrapulse CO₂ laser (Coherent Inc., Palo Alto, CA, USA) was used in 239 patients, from March 1996 to July 1998, for full-face laser resurfacing. In 106 (43%) of these patients rhytidectomy was performed in the same procedure. All patients submitted to laser resurfacing were prepared for 1 to 2 months beforehand with retinoic acid and hydroquinone. The procedures were done under local anesthesia controlled by an anesthesiologist. A clear film dressing impregnated with silicone gel (Silon TSR; Bio-Med Sciences, Bethlehem, PA, USA) was used for 6 to 7 days and complete healing was observed in 7 to 10 days. Complications were exclusively dermatologic, without relation to surgery. No necrosis of the cutaneous flap was observed. Skin biopsies of 10 consecutive patients undergoing the combined procedures revealed no vascular impairment to the dermis. The patients were able to resume their activities 2 weeks after the procedure.     

Wound Care Following CO2 Laser Resurfacing Using Kaltostat, Duoderm, and Telfa for Dressings

BACKGROUND: There are a variety of dressings available for wound care following CO2 laser resurfacing. OBJECTIVE: To share the experience of using Kaltostat and Duoderm for wound care following laser resurfacing. METHODS: A total of 27 patients underwent laser resurfacing, including 12 for wrinkles and 15 for acne scars. Kaltostat pads and Duoderm sheets were cut into appropriate shapes to cover the laser-treated areas. The patients' families changed the dressings when the exudate accumulating under Duoderm began to leak. Kaltostat pads were used only for the first 2-3 days when the amount of discharge was profuse. Telfa pads were used rather than Kaltostat in two cases. Duoderm alone was used thereafter to the day of complete reepithelialization. Patients returned to the hospital on days 4, 7, and 10. RESULTS: Complete reepithelialization occurred by day 7 in patients with wrinkles and day 10 in patients with acne scars. The degree of postoperative erythema was mild to moderate. CONCLUSIONS: Duoderm worked well for postresurfacing wound healing. Kaltostat fibers were difficult to remove totally. Telfa pads can be used instead of Kaltostat.     

高能量脉冲CO2激光磨削修复面部痤疮瘢痕病人的护理

采用高能量脉冲CO2激光磨削治疗面部痤疮瘢痕38例,结果总有效率84.2%.提示术前做好心理护理和皮肤准备,术中支持和保护病人,术后做好创面护理、并发症防护及饮食指导对手术成功起重要作用.     

Human Cell-Conditioned Media Produced Under Embryonic-Like Conditions Result in Improved Healing Time After Laser Resurfacing

Background

Laser resurfacing procedures are continuing to grow in popularity as patients select less invasive procedures for rejuvenation of photo-damaged and aging skin. However, although physicians have begun exploring options to aid in postlaser healing, currently available treatments have little clinical evidence to support their use for wounded skin.

Methods

When grown under conditions of very low oxygen and suspension, a simulation of the embryonic environment, neonatal cells have been found to produce proteins and growth factors in types and quantities similar to those of fetal cells. The human cell-conditioned media (hCCM) produced by the cells was extracted and formulated into a gel to evaluate its efficacy in the healing of postlaser wounds.

Results

A split-face clinical evaluation of the material was performed, with 42 subjects undergoing combination ablative and nonablative laser procedures. Three concentrations of the hCCM were tested (×?0.1,?×?1.0,?×?10.0), and a dose?Cresponse trend was seen in the blinded physician evaluation, particularly in the assessment of crusting. In addition, transepidermal water loss readings showed a significant difference (p????0.05), indicating a more rapid return to normal skin barrier function with the active treatment. Histopathologic evaluation of subject biopsies showed reduced inflammation and a more normal epidermal appearance in the active treatment sites.

Conclusions

The results of this clinical evaluation support the use of the soluble hCCM produced under embryonic-like conditions to accelerate wound healing after laser resurfacing procedures. The utility of the?×?10 concentration appears to promote more rapid, scarless wound healing after resurfacing procedures and more normal skin recovery.     

Skin Resurfacing with Laser in Asians

The carbon dioxide laser has been a popular dermatological tool, but for the cosmetic surgeon. The laser's usefulness has been limited due to the risk associated with hyperpigmentation and scarring, when attempting superficial aesthetic surgery. The new Tru-Pulse CO₂ Laser (Tissue Technology, Inc.) overcomes this limitation by providing a unique pulse duration of 60 μsec designed to reduce thermal damage and designed to promote rapid healing. Laser resurfacing with the Tru-Pulse Laser provides many potential benefits.     

Development of Multiple Warts After Skin Resurfacing with CO2 Laser

BACKGROUND: Skin resurfacing with CO2 laser is a common surgical procedure to improve photodamaged skin. Many complications may occur after this procedure, however, common warts is relatively rare. OBJECTIVE: To report a case of multiple warts after CO2 laser resurfacing and discuss the complete involution of these lesions. METHODS: A 78-year-old woman with multiple warts after CO2 laser resurfacing is described. RESULTS: The patient developed multiple common warts on the face after resurfacing with CO2 laser. Retinoic acid was introduced and complete involution of the lesions was observed after 5 days with no scars. CONCLUSION: Although emphasis is placed on the hazards of the laser plume to the medical staff, one should be aware of this complication. We believe that the regression of the lesions was spontaneous rather than induced by the retinoic acid.     

The Treatment of Hypopigmentation After Skin Resurfacing

BACKGROUND: Hypopigmentation has plagued all methods of skin resurfacing. Whether the physician uses chemical peels, dermabrasion or laser resurfacing hypopigmentation can develop. OBJECTIVE: To examine the pathogenesis and treatment of hypopigmentation after resurfacing. METHODS: Areas of hypopigmentation after skin resurfacing were blended in with laser-assisted chemabrasion (LACA). The process begins with preconditioning of the skin with vitamin A/glycolic skin conditioning lotions. Then the area is resurfaced with the LACA. This resurfacing usually requires three to four freeze-sand cycles to remove the areas of hypopigmentation associated with dermal fibrosis. The resurfaced skin is then occluded with a combination of polyethylene/silicone sheeting during the acute phase of wound healing. Ultraviolet photography and histologic examination were used to demonstrate the improvement in dermal fibrosis and hypopigmentation. RESULTS: The LACA improved areas of hypopigmentation in the 22 cases studied. Under occlusive wound dressings, the melanocytes migrated into the areas of hypopigmentation, and the wounds healed without extensive fibrosis. This produced a blending of skin color. CONCLUSION: It is possible with skin preconditioning, LACA, and occlusive wound healing to provide for a wound healing environment that blends in areas of hypopigmentation that have developed after previous skin resurfacing.     

Internal Fixation After Subtrochanteric Femoral Fracture After Hip Resurfacing Arthroplasty

Periprosthetic fractures around total hip arthroplasty create surgical challenges with many described techniques of either fixation or revision. The increasing popularity of hip resurfacing arthroplasty poses different problems especially if there is a desire to retain the prosthesis rather than converting to a total hip arthroplasty. We describe a previously unreported technique of fixation for a comminuted, proximal femoral fracture, beneath a hip resurfacing.     

Laser Resurfacing: Usual and Unusual Complications

The use of the carbon dioxide laser for skin resurfacing was initially described in 1989. ¹ Since that time, several reports have shown it to be highly effective in the treatment of photodamaged skin and acne scarring. ^2,3,4,5 Advances in laser technology have simplified the procedure and minimized adverse sequelae. Laser skin resurfacing has become a very popular technique, and recently several patient series have been published on the use of different resurfacing lasers to treat photodamaged skin. ^3,4 However, very little has been written about its complications. Adequate patient selection, sound medical judgement, proper training with experience and knowledge of skin physiology and wound care are important factors for successful outcomes. Interested physicians across a broad range of subspecialties have expressed concern about the rate of adverse outcomes and management of complications. We report seven representative cases of complications referred to our dermatology clinics from outside physicians, in the hope of educating clinicians regarding the usual and unusual side effects of this procedure.