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1.
BackgroundTopical photodynamic therapy (PDT) has been increasingly used to treat malignant skin tumors including the Bowen disease. However, patients could be displeased with the long incubation time required for conventional PDT. ObjectiveWe evaluated the efficacy and safety of PDT with a short incubation time of ablative CO 2 fractional laser pretreatment for treating Bowen disease. MethodsTen patients were included. Just before applying the topical photosensitizer, all lesions were treated with ablative CO 2 fractional laser, following the application of methyl aminolevulinate and irradiation with red light (Aktilite CL 128). Histological confirmation, rebiopsy, and clinical assessments were performed. Adverse events were also recorded. ResultsFive of the ten (50%) lesions showed a complete response (CR) within three PDT sessions. After four treatment sessions, all lesions except one penile shaft lesion (90%) achieved clinical and histological CR or clinical CR only. The average number of treatments to CR was 3.70±1.70. The treatments showed favorable cosmetic outcomes and no serious adverse events. ConclusionThe results suggest that pretreatment with an ablative fractional CO 2 laser before PDT has similar treatment efficacy and requires a shorter photosensitizer incubation time compared with the conventional PDT method. 相似文献
2.
BackgroundRecently, photodynamic therapy (PDT) has been shown to be an effective first-line treatment for actinic keratosis (AK). However, a major limitation of PDT is the long incubation time required to allow penetration of the photosensitizer. ObjectiveThe aim of this study was to assess if pretreatment with an ablative carbon dioxide (CO 2) fractional laser can reduce the incubation time of the photosensitizer. MethodsInitially, 29 patients with a total of 34 AK lesions were treated with an ablative CO 2 fractional laser at Ajou University Hospital between January and December 2010. Immediately after the laser treatment, topical 20% 5-aminolevulinic acid or methyl-aminolevulinate was applied to the AK lesions and incubated for 70 to 90 minutes. Then, the treated areas were illuminated with a red light source. Improvement was clinically or histologically assessed eight weeks after the treatment. ResultsIn spite of the short incubation time, 24 lesions (70.6%) showed a complete response (CR) within three sessions of PDT (10 lesions a clinical CR and 14 lesions a clinical/histological CR). There were no significant side effects associated with the combination of ablative CO 2 fractional laser and PDT. ConclusionAblative CO 2 fractional laser may be considered an additional treatment option for reducing the incubation time of the photosensitizer in PDT. 相似文献
3.
BackgroundAlthough ablative fractional resurfacing is known to be effective against photoaging and acne scars, studies on its efficacy, safety and changes in the skin characteristics of Asians are limited. ObjectiveThe aim of this study is to assess the efficacy and safety of carbon dioxide fractional laser (CO 2FL) in Koreans treated for wrinkles and acne scars, and to define the changes in skin characteristics during recovery period. MethodsWe administered one session of CO 2FL on 10 acne scar patients and 14 wrinkles patients with skin types IV and V. The surveillance of efficacy and side effects along with the measurement of biophysical properties was carried out before 1 day, 1 week, 1 month and 3 months after treatment. ResultsUsing a non-invasive method, skin barrier damage, erythema and bronzing of skin during the recovery period were assessed, and all of the items eventually returned to the pre-treatment level. Skin elasticity was measured in the wrinkle group, and the statistically significant effect was sustained throughout the next three months. The outcome of treatment was found to be better than ''moderate improvement'' in both the acne scar and wrinkle groups. Further, there were no serious side effects three months post-procedure. ConclusionCO 2 FL is thought to be an effective and safe method for treating moderate to severe acne scars and wrinkles in Asians. 相似文献
4.
BackgroundThe anterior neck is the site of open thyroidectomy and where postoperative scarring can cause distress to patients. Both fractional and pulsed-dye lasers are effective and safe methods for preventing and improving surgical scars. ObjectiveThis study evaluated the improvement in scar appearance with laser intervention during the wound healing process. We evaluated the effect of nonablative fractional and pulsed-dye lasers on fresh thyroidectomy scars. MethodsPatients were treated 3 times at 4-week interval with a follow-up visit at the 6 th month. Scars were divided into 2 halves for each optional treatment. At every visit, a questionnaire evaluating the scar and patient satisfaction was completed. ResultsThirty patients completed the 6-month process. The mean Vancouver Scar Scale scores improved significantly from 8.0 to 4.6 and 8.2 to 4.7 with nonablative fractional and pulsed-dye lasers, respectively ( p<0.001). However, there was no significant difference between the 2 methods ( p=0.840). ConclusionThere remains no consensus on the optimal treatment of scars. The present study indicates nonablative fractional and pulsed-dye lasers significantly improve scars. Nonablative fractional lasers are non-inferior to pulsed-dye lasers. Further studies are required to corroborate this finding. 相似文献
5.
Background:A number of treatments for reducing the appearance of acne scars are available, but general guidelines for optimizing acne scar treatment do not exist. The aim of this study was to compare the clinical effectiveness and side effects of fractional carbon dioxide (CO 2) laser resurfacing combined with punch elevation with fractional CO 2 laser resurfacing alone in the treatment of atrophic acne scars. Materials and Methods:Forty-two Iranian subjects (age range 18–55) with Fitzpatrick skin types III to IV and moderate to severe atrophic acne scars on both cheeks received randomized split-face treatments: One side received fractional CO 2 laser treatment and the other received one session of punch elevation combined with two sessions of laser fractional CO 2 laser treatment, separated by an interval of 1 month. Two dermatologists independently evaluated improvement in acne scars 4 and 16 weeks after the last treatment. Side effects were also recorded after each treatment. Results:The mean ± SD age of patients was 23.4 ± 2.6 years. Clinical improvement of facial acne scarring was assessed by two dermatologists blinded to treatment conditions. No significant difference in evaluation was observed 1 month after treatment ( P = 0.56). Their evaluation found that fractional CO 2 laser treatment combined with punch elevation had greater efficacy than that with fractional CO 2 laser treatment alone, assessed 4 months after treatment ( P = 0.02). Among all side effects, coagulated crust formation and pruritus at day 3 after fractional CO 2 laser treatment was significant on both treatment sides ( P < 0.05). Conclusion:Concurrent use of fractional laser skin resurfacing with punch elevation offers a safe and effective approach for the treatment of acne scarring. 相似文献
6.
In this study were described the results, by tridimensional imaging evaluation, of the new “Combined Fractional Resurfacing” technique with the first fractional laser that overtakes the limits of traditional ablative, nonablative fractional resurfacing by combining CO 2 ablative and GaAs nonablative lasers. These two wavelengths can work separately or in a mixed modality to give the best treatment choice to all the patients. In this study, it is demonstrated that the simultaneous combination of the CO 2 wavelength (10600 nm) and GaAs wavelength (1540 nm) reduced the downtime, reduced pain during the treatment, and produced better results on fine wrinkles reduction and almost the same results on pigmentation as seen with 3D analysis by Antera (Miravex). 相似文献
7.
Context:Striae distensae are linear atrophic dermal scars covered with flat atrophic epidermis. They may cause disfigurement, especially in females. Many factors may cause striae distensae such as steroids, obesity, and pregnancy. Although there is no standard treatment for striae; many topical applications, peeling, and light and laser systems have been tried. Aims:To evaluate and compare the efficacy of fractional CO 2 laser with intense pulse light in treating striae distensae. Results:Both groups showed significant improvement after treatments ( P < 0.05). Patients treated with fractional CO 2 laser showed significant improvement after the fifth session compared with those treated with ten sessions of intense pulsed light ( P < 0.05) in all parameters except in the length of striae ( P > 0.05). Conclusions:The current study has provided supportive evidence to the effectiveness of both fractional CO 2 laser and intense pulse light as treatments for striae distensae. Fractional CO 2 laser was found to be more effective in the treatment of striae distensae compared with intense pulse light. 相似文献
8.
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 CO 2 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 CO 2 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 CO 2 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. 相似文献
9.
BackgroundStable non-segmental vitiligo is often resistant to conventional therapies.ObjectivesThe purpose of this study was to investigate the effect of three types of fractional lasers in the treatment of stable nonsegmental vitiligo.Materials & methodsTwenty patients were enrolled in the study. The vitiligo lesions of each patient were divided into four treatment parts, and all parts were treated with narrowband ultraviolet-B (NB-UVB). Three of the four parts were respectively treated with three types of fractional lasers (two ablative 10,600-nm CO2 lasers and one non-ablative 1,565-nm laser), followed by topical betamethasone solution application. The treatment period lasted six months. Efficacy and satisfaction were respectively assessed by dermatologists and patients.ResultsThe ablative CO2 lasers, in combination with topical betamethasone solution and NB-UVB, achieved marked to excellent improvement on white patches assessed by dermatologists. Patients showed high satisfaction scores for the treatments. The non-ablative 1,565-nm fractional laser did not provide any further benefit in the treatment of vitiligo. No severe adverse events developed for any of the treatments.ConclusionThe treatment protocol with ablative CO2 lasers, in combination with topical betamethasone solution and NB-UVB, was suitable for stable non-segmental vitiligo. For vitiligo, the ablative fractional CO2 laser is more effective than the non-ablative fractional laser. 相似文献
10.
BackgroundFractional laser resurfacing treatment has been extensively investigated and is widely used. However, the mechanism underlying its effects is poorly understood because of the ethical and cosmetic problems of obtaining skin biopsies required to study the changes after laser treatment. ObjectiveTo evaluate the usefulness of human skin explants for the investigation of fractional photothermolysis. MethodsFull-thickness discarded skin was treated in 4 ways: no treatment (control), fractional carbon dioxide laser, fractional Er:YAG laser, and fractional 1,550-nm erbium-doped fiber laser. Both treated and non-treated skin samples were cultured ex vivo at the air-medium interface for 7 days. Frozen tissue was sectioned and stained with hematoxylin & eosin for histologic examination and nitro blue tetrazolium chloride for viability testing. ResultsSkin explants cultured for up to 3 days exhibited histologic changes similar to those observed in in vivo studies, including microscopic treatment zones surrounded by a thermal coagulation zone, re-epithelialization, and formation of microscopic epidermal necrotic debris. However, the explant structure lost its original form within 7 days of culture. The viability of skin explants was maintained for 3 days of culture but was also lost within 7 days. ConclusionThe skin explant model may be a useful tool for investigating the immediate or early changes following fractional photothermolysis, but further improvements are required to evaluate the long-term and dermal changes. 相似文献
11.
Background: Fractional photothermolysis is creation of microscopic thermal zones of controlled depth, width and density. Microneedling is a simple treatment modality to reduce striae distensae. Objective: Evaluate and compare the efficacy of fractional carbon dioxide laser and microneedling as a treatment of striae distensae. Methods: Individuals with striae distensae received three split-body treatments at four-week intervals. The right side of the body was treated with fractional CO2 laser, while the other side with microneedling. Assessment was done by comparing photographs before and after treatments by two blinded physicians using a quartile grading scale. Evaluation also included patient satisfaction score and histopathological examination. Results: In total 33 subjects were enrolled and 30 completed the study. By quartile grading score, we recorded 55% moderate-excellent improvement of striae in the dermaroller-treated side but with fractional CO2 laser-treated side, we recorded 76% of patients had moderate-excellent improvement. Patients were more satisfied with fractional CO2 laser than the microneedling. Post-inflammatory hyperpigmentation, as a complication of fractional CO2 laser, appeared in 11 patients. Conclusion: Fractional CO2 laser is more effective in treating striae with acceptable side effects but still microneedling can be afforded as an effective, safe and cheap method. 相似文献
12.
BackgroundLentigines solares (LS) on the dorsum of hands are often esthetically disturbing. Q-switched ruby laser treatment is highly effective in the treatment of these lesions. Ablative fractional photothermolysis may be a suitable alternative.We compared the Q-switched ruby laser with ablative CO2 fractional photothermolysis for the treatment of solar lentigines.ObjectiveTo evaluate the efficacy and side-effects of 694nm Q-switched ruby laser (Sinon) with the ablative 10,600nm CO2 fractional laser (Quantel Excel O2) in an intra-individual side-to-side comparison in the treatment of LS on the dorsum of hands.Material and methodsEleven patients were included in the study. The hands of each patient were randomized for treatment with the two laser systems. Three treatment sessions were scheduled at weeks 0, 4 and 8. Evaluations by patients, treating physician and blinded experts were scheduled at weeks 0, 4, 8, 16 and 24.ResultsThe Q-switched ruby laser was significantly more efficacious than the ablative CO2 fractional laser for removing LS on the dorsum of hands (p = 0.01).ConclusionIn this first study on this topic, the Q-switched ruby laser was superior to the ablative CO2 fractional laser in the treatment of lentigines solares on the dorsum of hands. 相似文献
13.
Background:Fractionated carbon dioxide (CO 2) can treat hypopigmented scars. Latanoprost is a prostaglandin analog used to treat glaucoma. It can cause adverse effects, such as periocular hyperpigmentation. The aim of this study was to assess the efficacy and safety of latanoprost plus CO 2 laser on the repigmentation of hypopigmented scars. Patients and Methods:28 patients with hypopigmented scars were divided randomly into two groups. The patients in group A were treated in six sessions (1-month intervals) with 10600-nm fractional CO 2 laser plus latanoprost 0.005% and those of group B fractionated CO 2 laser plus placebo (distilled water). Digital photographs were taken at baseline and 3 months after the last treatment session. The blinded dermatologist compared the photographs and evaluated the efficacy of treatment in the hypopigmented scars using a 4-scale point (grade 1-4). Patient satisfaction was scored from 0 to 10 on a visual analog scale. Results:Follow-up results 12 weeks after the last treatment session demonstrated that 11 of the 14 patients in group A had more than 50% improvement in hypopigmentation The difference in improvement of the two groups was statistically significant ( P = 0.027). The mean of the VAS scores of patients in group A was 6.50 ± 1.45 and in group B 4.57 ± 1.6. The difference in mean satisfaction of the two groups was statistically significant ( P = 0.003). Side effects were mild and resolved within 1 to 5 days. Conclusion:The fractional CO 2 laser resurfacing plus topical latanoprost can be used as a safe and efficacious method to treat hypopigmented scars. 相似文献
14.
BACKGROUNDOnychomycosis is a fungal infection of the nails caused in most cases by
dermatophytes Trichophyton rubrum and Trichophyton
mentagrophytes. Despite numerous available antifungal drugs for therapy of this
infection, the cure rate is low, with high rates of relapse after treatment and
side effects. OBJECTIVESTo present a new option for the treatment of onychomycosis, in search of a more
effective and rapid method than conventional ones. METHODSPatients underwent two sessions of CO 2 fractional laser 10.600nm
associated with photodynamic therapy. Mycological and digital photography were
performed before and after the treatment. RESULTSMcNemar test with continuity correction and degrees of freedom = 1: for clinical
cure rate, 13.06, with p=0.00005; for mycological cure, 17.05, with p=0.00005; 72%
felt fully satisfied with the procedure. CONCLUSIONSThe use of fractional CO 2 laser 10.600nm associated with photodynamic
therapy can be effective in the treatment of onychomycosis, decreasing the risk of
systemic lesions that may be triggered with prolonged use of oral antifungals. 相似文献
15.
BackgroundUntil recently, the removal of melanocytic nevi has been performed with a CO 2 laser or Er:YAG laser. These lasers have been useful for removing affected spots. However, enlargement of spots or some sequelae, including depressed or hypertrophic scars, could develop as unwanted results. The Q-switched Nd:YAG laser has been used to remove deep-seated melanocytes, such as Ota nevus or tattoos. However, there have been no previous experiments performed to test the efficacy and safety of this laser treatment for melanocytic nevi. ObjectiveThe objective of this study was to investigate the efficacy and safety of the 1,064 nm Q-switched Nd:YAG laser for removing melanocytic nevi, including congenital nevomelanocytic and acquired nevomelanocytic nevi. MethodsTwo thousand and sixty four Korean patients with small melanocytic nevi were treated with a Q-switched Nd:YAG laser from 2005 to 2009. High-resolution photographs were taken in identical lighting and positions before and after the six weeks of treatment to observe the procedural efficacy. ResultsAbout 70% of the nevi treated using a 1,064 nm Q-switched Nd:YAG laser were completely removed after one session. The other 30% were completely treated within three sessions. The appearance of sequelae such as hollow scars noticeably decreased compared to the results seen in CO 2 or Er:YAG laser treatments. ConclusionUse of the 1,064 nm Q-switched Nd:YAG laser is a safe and effective treatment modality for melanocytic nevi. 相似文献
16.
ABSTRACT: Skin resurfacing can be divided into nonablative, nonablative fractional, ablative fractional, and traditional ablative categories. Nonablative technologies have yielded inconsistent and unimpressive results, whereas ablative technologies, although generally clinically effective, are losing momentum as a result of prolonged recovery times, risks for hypopigmentation, limitation in lighter skin types, and the production of unnatural sheen and texture to the skin. Fractional resurfacing can produce the safety of nonablative technologies and the efficacy of traditional ablative resurfacing. Nonablative fractional resurfacing is the most widely studied of fractional technologies allowing for nonablative tissue coagulation, creation of microthermal zones, and resurfacing with extrusion and replacement of damaged tissue with rapid re-epithelialization. This article will review nonablative fractional resurfacing with 1550-nm laser in the male patient. 相似文献
17.
BackgroundFractional photothermolysis makes thousands of minute areas called microthermal treatment zones on the skin surface and transmits thermal injury to facilitate heat shock protein formation around the dermis. Potential side effects include acneiform eruption, herpes simplex virus outbreak, erythema, and post-inflammatory hyperpigmentation. ObjectiveTo investigate and compare the changes in the skin of Asian patients after two different fractional photothermolysis systems (FPS) on a split face. MethodsA half-split face study was performed with 10,600 nm carbon dioxide FPS on the left and 1,550 nm erbium-doped FPS on the right side of the face. Only one session of laser irradiation and several biophysical measurements were done. ResultsAlthough both FPS proved to be effective in treating acne scar and wrinkle patients, a slightly higher satisfaction rating was seen with the 10,600 nm FPS treatment. Both types of FPS showed a significant increase in transepidermal water loss which decreased gradually after treatment and returned to pre-treatment level after 1 week. A decreased reviscometer score was sustained for a longer period in wrinkle areas treated with 10,600 nm FPS. ConclusionEven though the changes in skin varied according to different FPS wave-length, adverse outcomes, such as increased erythema and TEWL were entirely subdued within 3 months of treatment. 相似文献
18.
Skin grafts are widely used in reconstructive and plastic surgery, leaving an inevitable scar appearance on the body, affecting the quality of life of the patients. Fractional ablative lasers have become a leading procedure for the treatment of acne and burn scars. We report a case of a skin graft showing excellent improvement in overall appearance after three sessions of fractional CO 2 laser. The undamaged tissue left between the microthermal treatment zones is responsible of collagen formation and reepithelialization. Remodeling and collagen formation are observed even 6 months after a fractional CO 2 laser session. 相似文献
20.
Modern treatment of chronically photodamaged skin provides new, minimally invasive methods for laser intervention, using fractional, non‐ablative thermal energy for an induction of dermal remodeling. The clinical efficacy coupled with a minimum "down time" for the patient has directed the development of fractional ablative laser systems. Recently introduced systems are based on C0 2 and heated Er:YAG laser systems. The clinical efficacy has been tested on one prototype each and verified their effects at a microscopic level. Initial reports suggest the results are comparable to those achieved with fractional ablative systems. We review the current possibilities incorporating our personal experience. Systematic investigations of clinical outcomes with various system settings are still needed. The possible combination of ablative and non‐ablative fractional technology may also lead to increased efficacy and safety of the procedure. 相似文献
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