Effect of combination of fractional CO<Subscript>2</Subscript> laser and narrow-band ultraviolet B versus narrow-band ultraviolet B in the treatment of non-segmental vitiligo

The present study was designed to evaluate the effect of combining fractional CO₂ laser with narrow-band ultraviolet B (NB-UVB) versus NB-UVB in the treatment of non-segmental vitiligo. The study included 20 patients with non-segmental stable vitiligo. They were divided into two groups. Group I received a single session of fractional CO₂ laser therapy on the right side of the body followed by NB-UVB phototherapy twice per week for 8 weeks. Group II received a second session of fractional CO₂ laser therapy after 4 weeks from starting treatment with NB-UVB. The vitiligo lesions were assessed before treatment and after 8 weeks of treatment by VASI. At the end of the study period, the vitiligo area score index (VASI) in group I decreased insignificantly on both the right (?2.6%) and left (?16.4%) sides. In group II, VASI increased insignificantly on the right (+14.4%) and left (+2.5%) sides. Using Adobe Photoshop CS6 extended program to measure the area of vitiligo lesions, group I showed a decrease of ?1.02 and ?6.12% in the mean area percentage change of vitiligo lesions on the right and left sides, respectively. In group II the change was +9.84 and +9.13% on the right and left sides, respectively. In conclusion, combining fractional CO₂ laser with NB-UVB for the treatment of non-segmental vitiligo did not show any significant advantage over treatment with NB-UVB alone. Further study of this combination for longer durations in the treatment of vitiligo is recommended.     

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.     

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.     

Effectiveness of a 308-nm excimer laser in treatment of vitiligo: a review

Vitiligo is a relatively common acquired disorder, characterized by progressive loss of melanocytes from the epidermis and the epidermal appendages. The disease is associated with considerable morbidity because of a major impact on the quality of life. The treatment for vitiligo is generally unsatisfactory and challenging. There are a variety of therapeutic possibilities including topical corticosteroids, topical calcineurin inhibitors, as well as phototherapy with Psoralen plus UVA (PUVA), narrow-band UVB, and a 308-nm excimer laser and/or lamps. Furthermore, surgical methods encompass grafting and transplantation while depigmentation treatments and psychological support may also be considered. The objective is to assess the effect of the 380-nm excimer laser in the treatment of vitiligo based on the available studies and case series. We searched the relevant literature about vitiligo and excimer laser published between 1990 and 2012 using the MEDLINE database. We reviewed all relevant articles about 308-nm excimer laser and light sources assessing their efficacy in the management of vitiligo as well as their side effects. The value of combination treatment methods was also analyzed. The available studies provide strong evidence that the excimer laser represents the most effective approach to treat vitiligo compared to ordinary phototherapy. Excimer laser is relatively safe and effective for localized disease. UV-sensitive areas respond best as well as a short duration of the disease. More frequent treatments achieve better results. Compared to other treatment modalities, the excimer laser most likely constitutes the treatment of choice for localized vitiligo. Its efficacy can be further improved in combination with other therapies such as corticosteroids, pimecrolimus, or tacrolimus.     

Fractional Er:YAG laser assisting topical betamethasone solution in combination with NB-UVB for resistant non-segmental vitiligo

Resistant non-segmental vitiligo is difficult to be treated. Ablative erbium-YAG (Er:YAG) laser has been used in the treatment of vitiligo, but the ablation of entire epidermis frustrated the compliance of patients. The purpose of this study is to investigate the effects of fractional Er:YAG laser followed by topical betamethasone and narrow band ultraviolet B (NB-UVB) therapy in the treatment of resistant non-segmental vitiligo. The vitiligo lesions of each enrolled patient were divided into four treatment parts, which were all irradiated with NB-UVB. Three parts were, respectively, treated with low, medium, or high energy of Er:YAG laser, followed by topical betamethasone solution application. A control part was spared with laser treatment and topical betamethasone. The treatment period lasted 6 months. The efficacy was assessed by two blinded dermatologists. Treatment protocol with high energy of 1800 mJ/P of fractional Er:YAG laser followed by topical betamethasone solution and in combination with NB-UVB made 60% patients achieve marked to excellent improvement in white patches. The protocol with medium energy of 1200 mJ/P of laser assisted approximate 36% patients achieve such improvement. The two protocols, respectively, showed better efficacies than NB-UVB only protocol. However, fractional Er:YAG laser at low energy of 600 mJ/P did not provide such contributions to the treatment of vitiligo. The fractional Er:YAG laser in combination with topical betamethasone solution and NB-UVB was suitable for resistant non-segmental vitiligo. The energy of laser was preferred to be set at relatively high level.     

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.     

他克莫司软膏联合308nm准分子激光治疗儿童局限性白癜风

目的:本研究旨在评价0.03%他克莫司软膏和308 nm准分子激光治疗儿童局限性白癜风的安全性和有效性。同时研究308nm准分子激光联合外用0.03%他克莫司软膏对疗效的影响。方法:76个患者入组研究,研究采用随机单盲自身对照试验共15周。入组患者均具有两侧对称病变,进行左/右面部、躯干、手足的比较。按患者2至4个靶病变随机分为两组:A组患者外用0.03%他克莫司软膏,每天两次;B组患者外用0.03%他克莫司软膏每日两次,联合308nm准分子激光治疗,每周两次。研究期间对疗效和安全性因素进行评价。结果:76个患者完成了研究,A组91.3%和B组97.4%的皮损观察到复色。与治疗前相比,A组和B组皮损均明显改善。B组72.3%的皮损获得4级复色,与A组比较有显着性差异(P<0.05)。面颈部的复色率(复色75%以上)明显高于躯干、四肢、手足的复色率(P<0.05)。两组患者未见明显的副作用,两组之间的副作用发生率没有显著差异。结论:0.03%的他克莫司软膏和308 nm准分子激光对于治疗儿童局限性白癜风是安全、有效的,且耐受性良好。联合使用他克莫司软膏和308nm准分子激光显著提高疗效。     

A Retrospective Study of 3,000 Indian Patients with Vitiligo Treated with Phototherapy or Topical Monotherapy

BACKGROUND: Vitiligo-affected individuals, especially patients with darker skin tones, can suffer from negative psychosocial impacts due to unpredictable development of the condition and perceived cosmetic concerns. However, given that spontaneous repigmentation can be gained in vitiligo, many patients ask for treatment due to these cosmetic concerns. In the literature, only a few studies have been documented focusing on the outcome of various treatment modalities for vitiligo. OBJECTIVE: This article highlights the retrospective response of various treatment modalities in Indian patients with vitiligo. METHODS: A retrospective chart review was performed from July 2017 to August 2018 at our private dermatology clinic. A total of 3,000 patients were enrolled in this observational study. Patient characteristics and details of phototherapy (psoralen and ultraviolet A, narrow-band ultraviolet B, excimer laser) were noted as per a predefined format. The clinical response was evaluated as a marked response, defined as repigmentation in more than 75% of the initial lesional area. RESULTS: Of those included in this retrospective analysis, 1,996 patients received phototherapy and 1,004 patients were treated with topical monotherapy. Patients treated with phototherapy only and those treated with a combination of phototherapy and topical agents showed significantly higher clinical response rates relative to patients treated with topical monotherapy only (marked response rate: 47.8% vs. 8.7%; P<0.001 and 23.4% vs. 8.7%; P<0.001). Disease subtype predominately affected the treatment response. CONCLUSION: In Indian patients with vitiligo, phototherapy appears to be an effective treatment option for both focal and vitiligo vulgaris. Due to its reliability and minimal side effects, it can be considered a preferable treatment modality for vitiligo.     

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.     

Comparative study using fractional carbon dioxide laser versus glycolic acid peel in treatment of pseudo-acanthosis nigricans

Pseudo-acanthosis nigricans is a common dermatological disorder that is usually difficult to treat secondary to maceration of the skin from excessive sweating, obesity, or associated with endocrine disorders. Fractional photothermolysis and chemical peeling have been reported to improve the condition. To determine whether fractional CO₂ laser resurfacing or glycolic acid peel is more effective and safe option for therapy. Twenty Egyptian patients were included in the study where each patient was subjected to three sessions of both fractional CO₂ on the right side of the neck and glycolic acid peel 70% on the left side of the neck. All patients were evaluated by a scoring system Acanthosis Nigricans Area and Severity Index (ANASI) score and three blinded dermatologists before and after treatment. Clinical improvement on the side treated by glycolic acid peel showed 43% improvement while the side treated by fractional CO₂ showed 19% improvement. Glycolic acid peel shows superior results to fractional CO₂ due to accelerated induced exfoliation, yet still fractional CO₂ results are promising due to a presumably long-term improvement of skin texture.     

中波高能紫外光治疗白癜风疗效与影响因素分析

目的：评价中波高能紫外光治疗白癜风的临床疗效及其影响因素.方法：采用美国DuaLightTMUV120-2型高能紫外光治疗仪治疗85例白癜风患者,共211处皮损.治疗前判定皮肤类型,测定最小红斑量.照射起始剂量为最小红斑量的2倍,逐渐增加照射剂量,每周照射1～2次,规律治疗3个月后判定疗效.结果：皮损的有效率为93.36％,痊愈率为52.61％.疗效影响因素分析显示年龄、不同部位、病程以及照射频率对治疗效果有显著影响.结论：中波高能紫外光治疗白癜风疗效高、副作用少.     

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.     

Fractional CO<Subscript>2</Subscript> laser contributes to the treatment of non-segmental vitiligo as an adjunct therapy: a systemic review and meta-analysis

The treatment of stable non-segmental vitiligo is often challenging, which new therapies are being searched. Multiple clinical trials have proposed the benefits and safety of using fractional carbon dioxide (CO₂) laser as an adjunct therapy to conventional treatments. This study aimed to evaluate the safety and efficacy of fractional carbon dioxide laser as a combination therapy to conventional treatments in patients with stable non-segmental vitiligo. A literature search using PubMed, EMBASE, and the Cochrane Library was performed for comparative studies among vitiligo patients treated with additional fractional CO₂ laser. Clinical outcomes in the selected studies were compared, and a meta-analysis was performed via Review Manager version 5.3, according to the PRISMA guidelines. Six studies with a total of 184 patches/patients were included in the present meta-analysis. The combination therapy group had significantly superior results than that of the control group (≥?75% re-pigmentation, risk ratio [RR] 2.80, 95% confidence interval [CI] 1.29–6.07; ≥?50% re-pigmentation, RR 2.26, 95% CI 1.23–5.9; <?25% re-pigmentation, RR 0.57, 95% CI 0.43–0.75). Limitations of the study included the small number of studies and sample size, inadequate blinding of participants, and variation between therapy protocols. Meta-analysis revealed that using fractional CO₂ laser in combination with conventional treatments is efficient and safe, and may be considered as an adjunct therapeutic option for patients with refractive non-segmental vitiligo.     

Fractional CO2 laser in the treatment of facial scars in children

Facial scars in children have a profound psychosocial impact and require early and aggressive treatment. In this age group in particular, however, attention must be placed on the methodology so as not to trigger additional trauma—whether physical or emotional—as a sequela to the treatment. We assess the safety and efficacy of fractional CO₂ in a prospective study of pediatric facial scars from various etiologies. Twenty four children, age 2–16 years, underwent fractional CO₂ laser resurfacing. Recovery, clinical response, and adverse events were monitored at 3 days, 1 week, 1 month, 2 months, and 6 months. Photographs taken before treatment and 2 months after final treatment were independently evaluated and scored by two physicians. All patients tolerated treatment well, with minimal erythema an edema. The clinical improvement was scored as excellent in 14 patients (58 %), good in 7 (29 %), and fair in 3 (13 %). No cases were graded as poor or worse. No adverse events were noted. The study supports the use of fractional CO₂ resurfacing of pediatric facial scars as well tolerated and effective. Given the particularly rapid healing and clinical improvement of pediatric skin, fractional CO₂ treatment should be offered early to mitigate both the physical and psychosocial stigmata of scars as early as possible.     

Combined Treatment with Electrocauterization,Carbon Dioxide Laser,and Microneedle Fractional Radiofrequency for Facial Angiofibromas in Tuberous Sclerosis Complex: A Case Report and Literature Review

Tuberous sclerosis complex is a type of genetic multisystem disease that causes hamartomas in various organs.Facial angiofibromas commonly occur in 80%of patients and are prominently distributed over the cheek,chin,and nasolabial folds with severe disfigurement and emotional distress.Recently,photoelectric devices have been identified for the treatment of angiofibromas with great efficacy and fewer side effects.We report a case of a 42-year-old man with facial angiofibromas,who was treated with a combination of high-frequency electrocauterization,Ultrapulse CO₂ laser,and microneedle fractional radiofrequency with 7 sessions and a 6-month follow-up.The patient showed great improvement in relation to the elevated lesions and nodules.A low recurrence rate was observed.This is the first study to investigate the efficacy of high-frequency electrocauterization and microneedle fractional radiofrequency in angiofibromas.It may provide an optimal approach for clinicians wherein a combined treatment of various lasers and electric devices is effective for complicated,protuberant,and firm angiofibromas of specific patients.     

308nm准分子激光联合他卡西醇软膏治疗儿童面部白癜风疗效观察

目的:探讨308nm准分子激光联合他卡西醇软膏治疗儿童面部白癜风的疗效。方法:治疗组儿童面部白癜风患者采用Xt rac颠峰准分子激光联合他卡西醇软膏治疗,对照组仅用Xt rac颠峰准分子激光,为期3月,治疗结束后3天进行疗效评价。结果:治疗组显效率77.3%,对照组显效率52.5%,两组差异有统计学意义(χ2=5.69,P<0.05)。结论:308nm准分子激光联合他卡西醇软膏治疗儿童面部白癜风疗效好、副作用小。     

308nm准分子激光联合0.1%糠酸莫米松乳膏治疗面部白癜风疗效观察

目的:探讨308nm准分子激光联合0.1%糠酸莫米松乳膏治疗面部白癜风的疗效及安全性。方法:选取门诊面部白癜风患者180例,随机平均分为三组,共有167例完成了试验观察,A组为治疗组57例,308nm准分子激光(2次/周)联合0.1%糠酸莫米松乳膏(1次/天)治疗;B组为对照1组56例,单用308nm准分子激光治疗(2次/周);C组为对照2组54例,单用0.1%糠酸莫米松乳膏外用治疗(1次/天),疗程均为12周或至皮损完全复色,观察三组治疗方法治疗面部白癜风的疗效及不良反应。结果:A组显效率为75.43%,B组为48.21%,C组为14.81%,A组和B组及C组比较,显效率差异有统计学意义(P<0.05)。三组患者均未出现严重不良反应。结论:308nm准分子激光联合0.1%糠酸莫米松乳膏治疗面部白癜风疗效好、副作用少,显效率明显高于单独治疗。     

Efficacy and safety of fractional carbon dioxide laser for treatment of unwanted facial freckles in phototypes II–IV: a pilot study

Facial freckles are a cosmetic concern to Egyptians, particularly young females. Several therapeutic lines exist with variable response rates and limitations. Fractional carbon dioxide (FCO₂) laser provides minimal ablation and therefore less down time and less side effects. The efficacy and safety of this laser technology have still not been studied in freckles. The aim of this study is to assess the efficacy and safety of FCO₂ laser in the treatment of unwanted facial freckles in Egyptians. Twenty patients undergone a single session of FCO₂ laser and then were followed up clinically a month later. Photographs were taken before treatment and at follow-up visit and were assessed by three blinded investigators. Percent of global improvement was measured on a 4-point grading scale. Patient’s satisfaction and adverse events were recorded. Two patients (10 %) showed grade 1 improvement, while eight patients (40 %) showed grade 2 improvement. Nine patients (45 %) showed grade 3 improvement, and only one patient (5 %) showed grade 4 improvement. FCO₂ laser resurfacing is effective and safe in treatment of facial freckles in skin phototypes II–IV. It can offer a more practical alternative to topical treatments, and a cheaper alternative to Q-switched lasers.     

果酸联合二氧化碳点阵激光治疗面部毛孔粗大的临床疗效

观察果酸联合二氧化碳点阵激光治疗面部毛孔粗大新方案的临床效果及安全性。方法 选取 2021年4月-2022年8月佛山市第二人民医院收治的60例面部毛孔粗大患者为研究对象，按随机数字表法分 为点阵组、果酸组及联合组三组，每组20例。点阵组给予二氧化碳点阵激光治疗，果酸组给予果酸活肤套 包治疗，联合组给予二氧化碳点阵激光联合果酸活肤套包治疗，分别比较治疗前、治疗后4周VISIA面部分 析仪的毛孔计数分值变化、毛孔标准照片评分，统计不良反应发生情况。结果 三组治疗后4周VISIA面部 分析仪检测毛孔计数分值及部毛孔标准照片评分低于治疗前，且联合组低于果酸组、点阵组，差异有统计 学意义（P ＜0.05）；果酸治组不良反应发生率低于联合组及点阵组，联合组不良反应发生率低于点阵组 （P ＜0.05）。结论 对面部毛孔粗大患者采用果酸联合二氧化碳点阵激光治疗效果确切，较单一使用二氧 化碳点阵治疗或果酸治疗更能改善毛孔，且安全性更高。