A new modality for fractional CO2 laser resurfacing for acne scars in Asians

Since fractional photothermolysis was first introduced in 2004, it has become a very popular procedure, especially with more and more ablative fractional laser systems and treatments. Fractional ablative laser has been shown to be very effective; however, it does not reach the efficacy of conventional ablative laser treatments in most instances. In an attempt order to make the fractional CO₂ laser treatment more efficacious and safe, we combined both the conventional CO₂ laser and the fractional CO₂ laser to treat acne scars. We report our experience with this new modality. A total of 44 Chinese patients with facial acne scars and skin type IV were included in this study. Each patient received a minimum of two treatment sessions. For each laser session, both the conventional CO₂ laser treatment and the DeepFX laser treatment were focused on treating the scar areas only. Following this technique, the more superficialf ActiveFX fractional CO₂ laser was performed to the entire face. The efficacy of the procedure was evaluated 3 months after the final laser treatment. The improvement in acne scars and the overall skin texture change were assessed by photographic evaluation using the following scales: ≤25 % (mild), 26–50 % (moderate), 51–75 % (marked), and >75 % (excellent). Side effects from this therapy were mild to moderate. Two cases of HSV outbreak were noted; they were treated and resolved without adverse sequelae. Post-laser erythema was resolved within 1 month in one half of the patients. Prolonged erythema (≤3 months) was noted in 12(27 %) cases. Temporary post-inflammatory hyperpigmentation (PIH; ≤1 month) was seen in approximately 50 % of the patients. PIH (≤3 months) was noted in four cases (9 %). Sixty-four percent of the patients (28/44) had an improvement of between 51 and 75 % after more than two sessions of the combination of laser treatments. The average overall improvement was 52.50 % (±12.25 %). Three patients achieved improvement of >75 %. This new modality of ablative conventional CO₂ laser therapy with fractional CO₂ laser resurfacing was shown to be safe and efficacious in the treatment of acne scars in Asian patients. It did not increase the risk of PIH compared to other reports of laser therapy and PIH. It is the hope that future study with combination therapy will further enhance the clinical results and thus lessen potential adverse events.     

Random fractional ultrapulsed CO2 resurfacing of photodamaged facial skin: long-term evaluation

Although numerous papers have recently been published on ablative fractional resurfacing, there is a lack of information in literature on very long-term results. The aim of this retrospective study is to evaluate the efficacy, adverse side effects, and long-term results of a random fractional ultrapulsed CO₂ laser on a large population with photodamaged facial skin. Three hundred twelve patients with facial photodamaged skin were enrolled and underwent a single full-face treatment. Six aspects of photodamaged skin were recorded using a 5 point scale at 3, 6, and 24 months after the treatment. The results were compared with a non-parametric statistical test, the Wilcoxon’s exact test. Three hundred one patients completed the study. All analyzed features showed a significant statistical improvement 3 months after the procedure. Three months later all features, except for pigmentations, once again showed a significant statistical improvement. Results after 24 months were similar to those assessed 18 months before. No long-term or other serious complications were observed. From the significant number of patients analyzed, long-term results demonstrate not only how fractional ultrapulsed CO₂ resurfacing can achieve good results on photodamaged facial skin but also how these results can be considered stable 2 years after the procedure.     

Novel approach with fractional ultrapulse CO2 laser for the treatment of upper eyelid dermatochalasis and periorbital rejuvenation

Fractional ultrapulse CO₂ laser resurfacing improves photodamage, wrinkles, and acne scarring by ablation of damaged tissue with subsequent regeneration and remodeling of collagen. In this study, the authors examined the efficacy and safety of fractional CO₂ laser and introduce a novel approach to the treatment of upper eyelid dermatochalasis. We treated 20 patients with low and moderate upper eyelid dermatochalasis. We did photographic analysis of results by measuring distance of upper eyelid fold and lateral eyebrow in vertical axis from a horizontal line joining medial and lateral canthi. All patients underwent UltraPulse CO₂ laser (Microxel MX 7000) resurfacing at upper eyelid, superior to eyebrow, and in periorbital area. Measurements were taken before and at 3 and 6 months after the laser treatment. We evaluated results at 3 and 6 months after laser treatment and found that the UltraPulse CO₂ laser induced elevation of eyelid crease and brow position (1.62?±?0.69 and 2.110?±?0.66 mm at 3 months; 1.63?±?0.68 and 2.300?±?0.67 mm at 6 months, respectively) as compared to before the treatment. Side effects were mild, patients reported minor crusting and oozing that resolved within 48 to 72 h, edema (1–2 days), and moderate postoperative erythema resolved within 4 days. These data illustrate the safety and efficacy of fractional ultrapulse CO₂ laser in the treatment of low and moderate upper eyelid dermatochalasis with added advantage of nonsurgical brow lift.     

Ultrapulsed fractional ablative carbon dioxide laser treatment of hypertrophic burn scars: evaluation of an in-patient controlled,standardized treatment approach

In this study, we aimed to quantify the effects of fractional ablative carbon dioxide laser therapy in the treatment of widespread hypertrophic burn scars. While many different pilot studies have described the potential of the technology and expert groups and current guidelines, alike, recommend its use, the level of evidence for the efficacy of fractional CO₂-laser treatment for burn scars is currently very low. Ten patients (three male, seven female) with hypertrophic burn scars were treated with a single course of fractional CO₂-laser therapy in an in-patient controlled setup, using a standardized treatment paradigm. Documentation was based on modern scar scales and questionnaires, like the Vancouver Scar Scale (VSS), Patient and Observer Scar Assessment Scale (POSAS), and Dermatology Life Quality Index (DLQI), as well as state of the art clinical measurements (PRIMOS, Cutometer). Over the course of 6 months after treatment, VSS and POSAS scores showed significant improvement in the rating of scar parameters, as did the quality of life rating according to the DLQI. In the treated scars, surface relief improved significantly, as S _max decreased by 1893 μm (?36.92%) (p = 0.0273) and S _z by 1615 μm (?36.37%) (p = 0.0488). Scar firmness in treated scars could be reduced by 30% after one treatment session, as R ₀ improved by 0.0797 mm (+30.38%) (p = 0.0212). Fractional ablative CO₂-laser treatment is a safe and efficacious option for the treatment of hypertrophic burn scars. While more treatment sessions are required for satisfying results, significant improvement is already apparent after a single course of treatment.     

Treatment of post-burn and post-traumatic atrophic scars with fractional CO<Subscript>2</Subscript> laser: experience at a tertiary care centre

Scars are abnormal wound responses in predisposed individuals. They occur after any kind of wound and skin inflammation in predisposed individuals. Despite their benign nature, they can be aesthetically disabling. Although several approaches have been tried in their management, most of them have produced poor results. This study aims to assess the efficacy and safety of fractional CO₂ laser treatment in the management of post-burn and post-traumatic scars. One hundred consecutive patients (77 females and 23 males) affected by post-burn scars as well as post-traumatic atrophic scars were treated with monthly sessions of fractional CO₂ laser treatment. Patient’s response to treatment was assessed clinically as well as improvement of scars by comparing the photographs taken before treatment with those taken 6 months after the last treatment session. Changes in skin texture, surface irregularity and pigmentation were assessed on a quartile grading scale and scored individually from 0 to 4. A mean of the three individual scores was calculated and the response was labelled as ‘excellent’ if the mean score achieved was >?3. A score of 2–3 was labelled as good response while a score below 1 was labelled as ‘poor’ response. A mean of six treatments per scar were required and all patients, followed up for 1 year after the last treatment, had optimum results and no recurrence. Response to treatment was excellent in 53.75%, good in 16.25% patients, and poor in 30% patients. Fractional CO₂ laser gives a very good result in the management of patients with post-burn scars as well as post-traumatic scars with minimal adverse effects.     

Efficacy of fractional CO<Subscript>2</Subscript> laser in treatment of atrophic scar of cutaneous leishmaniasis

Cutaneous leishmaniasis is an endemic disease in Iran. Unfortunately, it can lead to unsightly atrophic scars with limited treatment options. Fractional CO₂ laser is accepted for treatment of atrophic acne scars and recently has been used to treat cutaneous leishmaniasis, so we planned to use fractional CO₂ laser on leishmaniasis scar. We conducted this study on 60 leishmaniasis scars on the face of 40 patients. The lesions were treated by a fractional CO₂ laser with beam size of 120 μm, with energy of 50–90 mJ, and 50–100 spots/cm² density with two passes in three monthly sessions. Evaluation was done in the first and second months after the first treatment and 3 and 6 months after the last treatment. Digital photography was performed at each visit. Assessment of improvement rate by patient and physician was rated separately as follows: no improvement (0 %), mild (<25 %), moderate (25–50 %), good (51–75 %), and excellent (76–100 %). Based on patients’ opinion, in the first and second follow-up, 48.3 and 90 % of them reported moderate to excellent healing, respectively (p?<?0.001). In 3 and 6 months follow-up after the end of the experiment, most of the patients (88.3 and 95 %, respectively) reported moderate to excellent healing of scars. Based on two observers’ opinion, healing in the first follow-up in most of the patients (65 %) was mild to moderate and 33 % were reported as having no healing. In the second follow-up, only 5 % of the patients were reported with no healing and 60 % were reported as having moderate healing (p?<?0.001). In 3 and 6 months follow-up, most of the patients (95 and 96.6 %) were reported as having moderate to excellent healing (p?=?<0.001). Our results underlined the high efficacy of fractional CO₂ laser for leishmaniasis scar. No significant adverse effects were noted.     

Efficacy and safety of fractional CO<Subscript>2</Subscript> laser versus fractional Er:YAG laser in the treatment of facial skin wrinkles

Ablative fractional lasers were introduced for treating facial rhytides. Few studies have compared fractional CO₂ and Er:YAG lasers on cutaneous photodamages by a split trial. The aim of the present study was to compare these modalities in a randomized controlled double-blind split-face design with multiple sessions and larger sample size compared to previous studies done before. Forty patients with facial wrinkles were enrolled. Patients were randomly assigned to receive three monthly treatments on each side of the face, one with a fractional CO₂ and one with a fractional Er:YAG laser. The evaluations included investigating clinical outcome determined by two independent dermatologists not enrolled in the treatment along with measuring skin biomechanical property of cheeks using a sensitive biometrologic device with the assessment of cutaneous resonance running time (CRRT). Moreover, possible side effects and patients’ satisfaction have been recorded at baseline, 1 month after each treatment, and 3 months after the last treatment session. Clinical assessment showed both modalities significantly reduce facial wrinkles (p value?<?0.05), with no appreciable difference between two lasers. Mean CRRT values also decreased significantly after the laser treatment compared to the baseline in both laser groups. There was no serious long-standing adverse effect after both laser treatments, but the discomfort was more pronounced by the participants after CO₂ laser treatment. According to the present study, both fractional CO₂ and fractional Er:YAG lasers show considerable clinical improvement of facial skin wrinkles with no serious adverse effects, but post-treatment discomfort seems to be lower with Er:YAG laser.     

Ablative non-fractional lasers for atrophic facial acne scars: a new modality of erbium:YAG laser resurfacing in Asians

Atrophic facial scars which commonly occur after inflammatory acne vulgaris can be extremely disturbing to patients both physically and psychologically. Treatment with fractional laser devices has become increasingly popular, but there has been disappointment in terms of effectiveness. The objective of this study was to assess the safety and efficacy of ablative full-face resurfacing on atrophic acne scars in the Korean population. A total of 22 patients, aged 25–44 years, underwent a new modality of resurfacing combining both short-pulsed and dual-mode erbium:yttrium–aluminum garnet (Er:YAG) laser. The patients had Fitzpatrick skin types ranging from III to V. Photographs were taken before and up to 6 months after treatment. Results were evaluated for the degree of clinical improvement and any adverse events. Degree of improvement was graded using a four-point scale: poor (1)?=?<25 %, fair (2)?=?25–50 %, good (3)?=?51–75 %, and excellent (4)?=?>75 %. Based on the blinded photo assessments by two independent reviewers, clinically and statistically significant mean improvement of 3.41 was observed (one-sample Wilcoxon signed rank test, P?<?0.001). Complete wound healing occurred between 6 and 9 days. Erythema occurred in all patients and lasted longer than 3 months in two patients (9.1 %). Postinflammatory hyperpigmentation occurred in ten patients (45.5 %) and lasted longer than 3 months in one patient (4.5 %). One patient experienced mild hypopigmentation (4.5 %). Mild to moderate acne flare-up occurred in five patients (22.7 %). No other adverse effects were observed. A new modality of Er:YAG laser resurfacing combining short-pulsed and dual-mode Er:YAG laser is a safe and very effective treatment modality for atrophic facial acne scars in Asians with darker skin tones.     

Laser Punch-Out for Acne Scars

Patients with acne scars want smooth facial skin. However, achieving this is difficult with dermabrasion or chemical peeling. Nor can acne scars be covered with cosmetics, due to their ice-picked or cobblestone appearance. Laser resurfacing is more effective and safer than other conventional methods due to its precision with depth control and variable methods of surface cutting. Even depth resurfacing with a laser shows unsatisfactory results, therefore, for the deep-sited acne scar the cutting methods have to be changed according to the depth and pattern of the scar. For 2 years, starting in January 1996, we treated 71 patients with a high-powered CO₂ laser (Ultrapulse). Different resurfacing methods were applied according to the depth and pattern of the scars. For mild depressed scars, even depth resurfacing was done. For moderate-depth acne scars, the shoulder technique was also used. For the deepest and ice-picked scars, the laser punch-out was combined. Laser resurfacing was carried out at 300–500 mJ, with two to five passes. Laser punch-out was done at 500 mJ, with three to seven continuous passes on the ice-picked scar. From the pathologic findings of acne scars showing that there was thick intradermal scar, we knew that laser punch-out was necessary for improvement of acne scars. Depth-wide, the ice-picked scars improved by over 80% and the sharp demarcated margin of the acne scar faded out. Most of the patients with acne scars were satisfied with laser resurfacing. Only six patients had a second laser treatment, with an interval of 12 months. There were no hypertrophic scars after laser resurfacing, but erythema lasted for 3–12 months. Patients taking oral retinoic acid were not contraindicated for laser resurfacing but required special caution because they had atrophic skin and delayed wound healing. Laser resurfacing is the most versatile method for acne scars, with a high-powered CO₂ laser. The laser punch-out method is better than even depth resurfacing for improving deep acne scars and can be combined with the shoulder technique or even depth resurfacing according to the type of acne scar.     

Vascular patterns in mature hypertrophic burn scars treated with fractional CO2 laser

Background and Objective

Fractional CO₂ laser has recently emerged as a promising therapeutic modality to improve the texture and appearance of burn scars. An issue in many burn scars is persistent erythema, which traditionally has been treated with vascular lasers. Interestingly, fractional CO₂ lasers have been shown to improve the appearance of burn scars, including erythema, but no mechanism has been proposed for this change. Our objective is to evaluate the histopathologic changes in vasculature in burn scars treated with fractionated CO₂ laser, and to attempt to describe the mechanism behind reduced erythema following treatment.

Study Design/Materials and Methods

Uncontrolled, prospective study of ten patients with mature burn scars, from a clinical and histological perspective. Biopsy specimens were obtained before and 2 months after 3 treatment sessions. Anti‐CD31 immunostaining was performed to highlight vascular patterns in biopsy specimens.

Results

In histological analysis, an increase in vascular density, particularly of small caliber vessels, was seen following treatment, with an 82.6% average increase in vasculature (P = 0.028). This increase in vascularity correlated with a decrease in clinical erythema and vascularity scores, measured using the Vancouver Scar Scale.

Conclusion

Mature hypertrophic burn scars treated with a fractional CO₂ laser showed a statistically significant increase in vascular density in the superficial dermis. A non‐statistical decrease in clinically perceived erythema and improvement of overall appearance was seen. To our knowledge, this is the first report of increased vascular density in burn scars treated with fractional CO₂ laser and suggests our prior assumptions on causes of erythema in mature hypertrophic scars may need to be challenged. Lasers Surg. Med. 46:597–600, 2014. © 2014 Wiley Periodicals, Inc.     

Early postoperative single treatment ablative fractional lasing of Mohs micrographic surgery facial scars: A split‐scar,evaluator‐blinded study

Background/Objectives

Despite precise surgical technique, some postoperative facial scars will depress and widen over time, likely due to weakened or inadequately replaced collagen fibers in the underlying dermis. The purpose of this study is to evaluate whether a 10,600 nm ablative carbon dioxide (CO₂) fractional laser used early in the post‐surgical setting results in improved postoperative facial scars after a single treatment session.

Study Design

A prospective randomized, comparative split‐scar study was conducted on 20 subjects between the ages of 20–90. Subjects underwent Mohs surgery for nonmelanoma skin cancer of the face. Subsequent to tumor removal, subjects with a linear scar of 4 cm or greater were enrolled. On the day of suture removal, all subjects had one‐half of their scar randomly selected and treated with a 10,600 nm CO₂ fractional laser (energy = 10 mJ; density = 10%; spot size = 7 mm; pulse = 1). The untreated scar half served as a control. Scars were re‐evaluated 12 weeks later. An independent blinded observer graded the scar halves with the Vancouver scar scale (VSS) immediately prior to treatment and 12 weeks after treatment. Subjects completed a visual analog scale (VAS) at the same time points.

Results

Three months after laser treatment, a significant decrease in VSS and 3 of the 4 of its individual parameters were detected in both control and treated halves of the scar. When comparing the laser group versus the control group, a statistically significant difference was not noted in VSS (P = 0.31) but a statistically significant difference in patient VAS was detected (P = 0.002). No side effects of the laser treatment were noted.

Conclusion

Facial wounds sutured in a layered manner heal well. Patients prefer early fractional CO₂ lasing of surgical scars, though use of the VSS failed to detect an objective difference between laser and control halves of scars. Conservative laser settings, a single session treatment, and VSS insensitivity for surgical scars may influence these findings. Lasers Surg. Med. 47:1–5, 2015. © 2015 Wiley Periodicals, Inc.     

The Efficacy and Safety of Epidermal Growth Factor Combined with Fractional Carbon Dioxide Laser for Acne Scar Treatment: A Split-Face Trial

BackgroundEpidermal growth factor (EGF) stimulates collagen production and supports the wound healing process. However, there are no studies on fractional carbon dioxide (CO₂) laser combined with EGF for acne scar treatment.ObjectiveWe sought to evaluate the efficacy and safety of fractional CO₂ laser combined with topical EGF versus fractional CO₂ laser alone in the treatment of acne scars.MethodsTwenty-three patients with atrophic acne scars underwent three monthly sessions of randomized split-face application of fractional CO₂ laser combined with topical EGF or placebo twice daily for seven days following each laser session. Scar improvement was evaluated at one month and three months posttreatment by two blinded dermatologists and the Antera 3D^® skin analysis system. Wound healing response and adverse events were also evaluated.ResultsTwenty-one patients completed the trial. According to dermatologist grading and skin analysis system, EGF showed significant superiority at three months posttreatment compared to placebo. The wound healing response did not differ between the groups. Surprisingly, the melanin index on the EGF side showed a significant decrease at three months posttreatment, compared to placebo. There was no allergic reaction to the topical EGF.ConclusionTreatment with topical EGF after ablative fractional CO₂ laser improves the clinical appearance of atrophic acne scars, and EGF may help decrease skin pigmentation after laser treatment. The use of topical EGF is safe when applied to post-laser ablation.     

Laser skin rejuvenation: epidermal changes and collagen remodeling evaluated by in vivo confocal microscopy

Fractionated carbon dioxide (CO₂) laser resurfacing is an effective treatment of skin aging. Several studies investigated the morphologic changes due to this laser treatment by using skin biopsies or animal model. Recently, reflectance confocal microscopy (RCM) has emerged as a new tool that can “optically” scan the skin in vivo with a nearly histologic resolution and in a totally noninvasive modality. Our study aims to analyze the skin changes following the ablative fractional CO₂ laser sessions by using RCM. Ten patients were subjected to ablative fractional CO₂ laser sessions for skin aging. Confocal microscopic images were acquired at baseline (w0), 3 weeks (w3), 6 weeks (w6), and 12 weeks (w12) after laser session. Previously identified confocal parameters were used to assess the skin aging at baseline and after treatment. At w3, the epidermis showed a complete disappearance of the mottled pigmentation upon RCM along with the presence of few Langherans’ cells. The collagen type as seen upon RCM observed at baseline was replaced by a newly formed collagen type of long, bright and straight fibers (collagen remodeling). These fibers were parallel arranged and observed throughout the entire RCM mosaic. At w6 and w12 the confocal aspects of the skin was unchanged compared to w3. RCM confirmed the presence of an intense collagen remodeling following laser resurfacing. In line with previous studies, this collagen showed a peculiar arrangement and distribution. The collagen remodeling was still present after 3 months and confirms the long-term effect of the treatment. This is the first time that the skin can be analyzed in vivo at patient’s bedside. In the near future, RCM can be an essential adjunct for Clinicians to measure the effects of laser treatment and possibly to gain new insights into the development of side effects.     

Safe and Effective One-Session Fractional Skin Resurfacing Using a Carbon Dioxide Laser Device in Super-Pulse Mode: A Clinical and Histologic Study

Carbon dioxide (CO₂) laser ablative fractional resurfacing produces skin damage, with removal of the epidermis and variable portions of the dermis as well as associated residual heating, resulting in new collagen formation and skin tightening. The nonresurfaced epidermis helps tissue to heal rapidly, with short-term postoperative erythema. The results for 40 patients (8 men and 32 women) after a single session of a fractional CO₂ resurfacing mode were studied. The treatments included resurfacing of the full face, periocular upper lip, and residual acne scars. The patients had skin prototypes 2 to 4 and wrinkle degrees 1 to 3. The histologic effects, efficacy, and treatment safety in various clinical conditions and for different phototypes are discussed. The CO₂ laser for fractional treatment is used in super-pulse mode. The beam is split by a lens into several microbeams, and super-pulse repetition is limited by the pulse width. The laser needs a power adaptation to meet the set fluence per microbeam. Laser pulsing can operate repeatedly on the same spot or be moved randomly over the skin, using several passes to achieve a desired residual thermal effect. Low, medium, and high settings are preprogrammed in the device, and they indicate the strength of resurfacing. A single treatment was given with the patient under topical anesthesia. However, the anesthesia was injected on areas of scar tissue. Medium settings (2 Hz, 30 W, 60 mJ) were used, and two passes were made for dark skins and degree 1 wrinkles. High settings (2 Hz, 60 W, 120 mJ) were used, and three passes were made for degree 3 wrinkles and scar tissue. Postoperatively, resurfaced areas were treated with an ointment of gentamycin, Retinol Palmitate, and DL-methionine (Novartis; Farmaceutics, S.A., Barcelona, Spain). Once epithelialization was achieved, antipigment and sun protection agents were recommended. Evaluations were performed 15 days and 2 months after treatment by both patients and clinicians. Treatment improved wrinkle aspect and scar condition, and no patient reported adverse effects or complications, irrespective of skin type, except for plaques of erythema in areas that received extra laser passes, which were not seen at the 2-month assessment. The results evaluated by clinicians were very much in correlation with those of patients. Immediately after treatment, vaporization was produced by stacked pulses, with clear ablation and collateral heat coagulation. An increased number of random pulses removed more epidermis, and with denser pulses per area, a thermal deposit was noted histologically. At 2 months, a thicker, multicelluar epidermis and an evident increase in collagen were observed. Fractional CO₂ laser permits a variety of resurfacing settings that obtain safe, effective skin rejuvenation and correct scar tissue in a single treatment.     

Improving the outcome of fractional CO2 laser resurfacing using a probiotic skin cream: Preliminary clinical evaluation

As known, fractional CO₂ resurfacing treatments are more effective than non-ablative ones against aging signs, but post-operative redness and swelling prolong the overall downtime requiring up to steroid administration in order to reduce these local systems. In the last years, an increasing interest has been focused on the possible use of probiotics for treating inflammatory and allergic conditions suggesting that they can exert profound beneficial effects on skin homeostasis. In this work, the Authors report their experience on fractional CO₂ laser resurfacing and provide the results of a new post-operative topical treatment with an experimental cream containing probiotic-derived active principles potentially able to modulate the inflammatory reaction associated to laser-treatment. The cream containing DermaACB (CERABEST?) was administered post-operatively to 42 consecutive patients who were treated with fractional CO₂ laser. All patients adopted the cream twice a day for 2 weeks. Grades were given according to outcome scale. The efficacy of the cream containing DermaACB was evaluated comparing the rate of post-operative signs vanishing with a control group of 20 patients topically treated with an antibiotic cream and a hyaluronic acid based cream. Results registered with the experimental treatment were good in 22 patients, moderate in 17, and poor in 3 cases. Patients using the study cream took an average time of 14.3 days for erythema resolution and 9.3 days for swelling vanishing. The post-operative administration of the cream containing DermaACB induces a quicker reduction of post-operative erythema and swelling when compared to a standard treatment.     

Fractional nonablative 1,540-nm laser resurfacing of atrophic acne scars. A randomized controlled trial with blinded response evaluation

The efficacy of nonablative fractional laser resurfacing of acne scars has been described in case reports and uncontrolled trials. The present study is the first randomized controlled trial in this field. The aim of this study was to examine the efficacy and adverse effects of 1,540-nm nonablative fractional laser treatment of acne scars. Ten patients with acne scars were included. Two intraindividual areas of similar size and appearance within contralateral anatomical regions were randomized to (1) 3-monthly laser treatments with a StarLux 1,540-nm fractional handpiece, and (2) no treatment. Blinded on-site clinical evaluations were performed before treatment, and at 4 and 12 weeks after the final treatment. End-points were overall change in scar texture (from score 0, even texture, to 10, worst possible scarring), adverse effects, change in skin colour (from score 0, absent, to 10, worst possible), and patient satisfaction (from score 0, no satisfaction, to 10, best imaginable satisfaction). Before treatment, scars were moderately atrophic and uneven in texture on both treated and untreated sides (median score 6.5, interquartile range 4.5–8; P=1). After treatment, laser-treated scars appeared more even and smooth than untreated control areas (4.5, 2–6.5, versus 6.5, 4.5–8, P=0.0156, at 4 weeks; 4.5, 2.5–6.5, versus 6.5, 4.5–8, at 12 weeks; P=0.0313). Patients were satisfied with the treatment (5.5, 1–7, after 12  weeks) and five of the ten patients evaluated their acne scars as moderately or significantly improved. No differences were found in skin redness or pigmentation between before and after treatment. Patients experienced moderate pain, erythema, oedema, bullae, and crusts. No adverse effects were seen in untreated control areas. The nonablative 1,540-nm fractional laser improves acne scars with a minimum of adverse effects.     

A comparative study of combined treatment with fractional carbon dioxide and targeted ultraviolet B phototherapy for facial vitiligo

Facial vitiligo is associated with considerable psychological impact. The management is challenging and requires multidisciplinary treatment. Adding fractional carbon dioxide (CO₂) to the conventional treatment has been reported as an effective modality. This study aimed to evaluate the efficacy of combined fractional CO₂ laser, targeted ultraviolet B (UVB) phototherapy, and topical steroid on facial vitiligo. A prospective, randomized, split face study was conducted on 14 patients with symmetrical non-segmental facial vitiligo. Ten sessions of fractional CO₂ laser was performed on the lesions on one side of face with 2-week interval. Immediately after laser, the lesions on both side of face were treated with 10 sessions of 2-week interval targeted UVB phototherapy and twice daily application of topical 0.05 % clobetasol propionate cream. The patients were followed up for 12 weeks after the last treatment. Clinical improvement was graded by blinded dermatologists and patients using a quartile grading scale. Twelve out of 14 patients completed the study. The degree of improvement was not different between both sides in nine patients. One patient showed more improvement on the combined laser side, and two patients showed inferior results on the combined laser side. Two patients with lesser improvement on the laser-treated side had positive Koebner phenomenon on the non-facial area. The combined treatment with laser, targeted UVB, and topical steroids are not superior to targeted UVB and topical steroids in facial vitiligo. Furthermore, laser may retard the response to the standard treatment in patients with Koebner phenomenon on non-treated areas.     

点阵铒激光治疗面部各种瘢痕的疗效及影响因素分析

目的:观察应用点阵铒激光治疗面部各种瘢痕的疗效,并对影响疗效的各种因素进行分析。方法:应用点阵铒激光对132例面部瘢痕患者皮损进行磨削、大范围平扫,分析对比依据不同影响因素分组后各组显效率差异,探索对治疗效果有影响的相关因素。结果:所有患者治疗后随访6个月,有效率97.8%,显效率85.7%,无严重不良反应。患者病史长短、皮损的临床分型、病损程度各组显效率差异有统计学意义(P<0.05),性别等其他因素对疗效无影响。结论:点阵铒激光治疗面部瘢痕疗效好,不良反应小,皮损稳定后及早治疗预后较好,皮损程度轻者预后较好,不同临床分型治疗效果不同。