Low-fluence CO2 laser irradiation: selective epidermal damage to human skin

The interaction of normal human skin with low-fluence CO2 laser irradiation was studied using a three-phase approach. In phase one, freshly excised skin was observed immediately after impact. In phase two, skin irradiated 2 h prior to excision was studied. In phase three, human volunteers were irradiated and biopsied at time zero, 24 h and 48 h. Seventy-five sites were exposed and 60 biopsies were performed. The earliest histologic changes were observed in the 6-10 J/cm2 fluence (radiant exposure) range and these changes included spindle and vacuolar changes in the basal layer of the epidermis. Papillary dermal coagulation was present to a maximum of 0.03 mm. At fluences of 10-25 J/cm2, superficial dermal necrosis (0.06-0.08 mm) was observed. At fluences above 25 J/cm2, transepidermal necrosis was present with increasing papillary dermal necrosis that was in proportion to the energy density delivered. At 2h, basal vacuolar changes were accompanied by diffuse keratinocytic cell death where contact was maintained between the epidermis and dermis, while where separation occurred limited keratinocytic death was observed. The earliest changes occurred at lower threshold fluences (4-6 J/cm2). After 24 h, these doses resulted in extensive epidermal necrosis with focal acute inflammatory infiltrates. At 48 h, the degree of epidermal "slough" was proportional to the energy density delivered and was maximal with a fluence of 5.7 J/cm2 delivered whereas with a fluence of 3.8 J/cm2 thin slough (0.02 mm) was observed. These findings suggest that low-dose CO2 laser irradiation may provide a new approach to selectively damage the epidermis with minimal dermal damage.     

Ingrowing nails and carbon dioxide laser surgery

BACKGROUND: Ingrown nails are common in young people, surgery is often required and recurrence rates are high. OBJECTIVE: To evaluate the efficacy of CO2 laser surgery. METHODS: Three hundred and two patients were operated with the CO2 laser under local anaesthesia. RESULTS: They were evaluated one year later: nine cases (3%) recurred and we observed 15 cases (5%) of spicules. CONCLUSION: Ingrown nails are easily operated with the CO2 laser; bleeding is minimal, post-operative pain is low, infection is rare, the wounds heal without exhudative drainage and cosmetic results are good.     

Multistage tattoo removal using carbon dioxide laser

The carbon dioxide laser is an effective and convenient method for tattoo removal, but when this is undertaken in a single stage as previously recommended by Bailin et al. , and Beacon (1980), severe scarring may follow. Multistage removal with the instrument in perfect focus was tried, therefore, and found to be advantageous, with excellent results in 25 of 28 patients.
Hypertrophic scars may occur and are treated by vaporization to a point just below the level of the surrounding epidermis with the subsequent daily use of clobetasol ointment until the wound has healed.
The number of laser treatments required is given in the table.  

  TABLE. Number of treatments     

7.

Oral verrucous carcinoma treated with carbon dioxide laser     

D Galimberti  G Galimberti  A Pontón Montaño  LR Jácome  R Galimberti 《Journal of the European Academy of Dermatology and Venereology》2010,24(8):976-977

     

8.

Acne rosacea occurring after carbon dioxide laser treatment     

Silver EA  Silver AH  Silver DS 《Journal of the American Academy of Dermatology》2001,44(5):877-878

     

9.

Continuous-wave carbon dioxide laser therapy in pseudoacanthosis nigricans     

Bredlich  KRÄhn  Kunzi-Rapp  Wortmann  & Peter 《The British journal of dermatology》1998,139(5):937-938

     

10.

Effective treatment of nodular amyloidosis with carbon dioxide laser     

Lesiak A  Rakowski A  Brzezinska A  Rogowski-Tylman M  Kolano P  Sysa-Jedrzejowska A  Narbutt J 《Journal of cutaneous medicine and surgery》2012,16(5):372-374

Background:Nodular amyloidosis is a rare form of localized cutaneous amyloidosis that is characterized by nodules located on the extremities, trunk, genitalia, or face. In treatment regimens, many approaches have been described, including carbon dioxide (CO2) laser therapy.Objective:We present a case of a 60-year-old white male with a 20-year history of disseminated waxy, purpuric, yellowish, and bullous skin lesions on the trunk and extremities. The skin changes were accompanied by pain during palpation and were temporarily pruritic.Method:Based on histologic and direct immunofluorescence test findings, the diagnosis of cutaneous nodular amyloidosis was established. Skin lesions were treated with a CO2 laser. During surgery, treated tissue was found to be slightly friable, and there was a little problem with hemostasis that correlated with amyloid infiltration of the dermis and blood vessels. However, after 8 weeks, we observed clinical improvement of all treated areas with the presence of atrophic scars. In the regions of laser therapy, no recurrence of the disease was observed during a 12-month follow-up.Conclusion:Based on these results, we conclude that CO2 laser has a beneficial effect in the treatment of nodular amyloidosis; however, surgery procedures may be associated sometimes with tissue friability and poor hemostasis.     

11.

Fractionated ablative carbon dioxide laser treatment of steatocystoma multiplex     

Sama Kassira  Dorota Z. Korta  Sebastien de Feraudy 《Journal of cosmetic and laser therapy》2016,18(7):364-366

Steatocystoma multiplex is a well-recognized condition in which subjects develop dermal cysts generally inherited in an autosomal dominant fashion, though these can occur sporadically. This case report describes the successful treatment of a 51-year-old woman with steatocystomata limited to the face, who after two treatments with a fractionated ablative carbon dioxide laser remained free of cysts for three years. We conclude that this treatment should be considered as an efficient and effective treatment option for patients with steatocystoma multiplex.     

12.

Treatment of Hailey-Hailey disease with carbon dioxide laser vaporization     

Collet Villette AM  Richard MA  Fourquet F  Monestier S  Gaudy C  Bonerandi JJ  Grob JJ 《Annales de dermatologie et de vénéréologie》2005,132(8-9 PT 1):637-640

     

13.

Treatment of lichen sclerosus with carbon dioxide laser vaporization     

M. KARTAMAA  S. REITAMO 《The British journal of dermatology》1997,136(3):356-359

We have treated 10 patients (five women and five men) with lichen sclerosus (LS), verified by histopathological studies from skin biopsies, with CO₂ laser vaporization. All men studied had LS of the penile skin, of the women, three had extragenital lesions and two LS of the perineal skin. The mean follow-up time was 32 months (range 3-79 months). One man had both penile and urethral LS. All penile lesions of the five men were clinically cured by laser treatment: however, urethral lesions of one patient recurred despite three separate treatments. The two women with perineal LS improved after laser treatment. However, LS recurred on the treated area in one and on the margins of the treated area in another. Two women with LS on the skin of the breast became asymptomatic after treatment. One woman had several lesions on the skin of the trunk that improved after treatment but were not cured completely. The present study suggests that carbon dioxide vaporization may be an effective treatment of skin lesions in LS.     

14.

Treatment of fibroelastolytic papulosis with fractionated carbon dioxide laser     

Summer P. Chong  David T. Woodley  Gene H. Kim 《Journal of cosmetic and laser therapy》2015,17(2):90-92

Fibroelastolytic papulosis (FEP) is an acquired elastic tissue disorder that presents as white-to-yellow papules and plaques usually occurring on the neck. Although the lesions are often asymptomatic, their appearance may be distressing to patients. FEP has been treated with topical tretinoin in one case report (1 Wang AR, Lewis K, Lewis M, Robinson-Bosom L. Papillary dermal elastosis: a unique elastic tissue disorder or an unusual manifestation of pseudoxanthoma elasticum- like papillary dermal elastolysis? J Cutan Pathol. 2009;36: 1010–1013.[Crossref] , [Google Scholar]). Other reports have not mentioned treatment for this rare disorder (1–6 Wang AR, Lewis K, Lewis M, Robinson-Bosom L. Papillary dermal elastosis: a unique elastic tissue disorder or an unusual manifestation of pseudoxanthoma elasticum- like papillary dermal elastolysis? J Cutan Pathol. 2009;36: 1010–1013. Rongioletti F, Rebora A. Fibroelastolytic patterns of intrinsic skin aging: pseuodoxanthoma-elasticum-like papillary dermal elastolysis and white fibrous papulosis of the neck. Dermatology. 1995;191:19–24. Shimuzu H, Kimura S, Harada T, Nishikawa T. White fibrous papulosis of the neck: a new clinicopathologic entity? J Am Acad Dermatol. 1989;20:1073–1077. Balus L, Amantea A, Donati P, Fazio M, Giuliano MC, Bellocci M. Fibroelastolytic papulosis of the neck: a report of 20 cases. Br J Dermatol. 1997;137:461–466. Jagdeo J, Ng C, Ronchetti IP, Wilkel C, Bercovitch L, Robinson-Bostom L. Fibroelastolytic papulosis. J Am Acad Dermatol. 2004;51:958–964. Ohnishi Y, Tajima S, Ishibasi A, Inazumi T, Saski T, Sakaoto T. Pseudoxanthoma elasticum-like papillary dermal elastolysis: reposrt of four Japanese cases and an immunohistochemical study of elastin and fibrillin-1. Br J Dermatol. 1998;139:141. ). We present a case of FEP successfully treated with a fractionated carbon dioxide (CO₂) laser.     

15.

Treatment of venous-lake angiomas with a carbon dioxide laser     

H Majamaa  †‡  M Hjerppe† 《Journal of the European Academy of Dermatology and Venereology》2003,17(3):352-353

     

16.

Fractional carbon dioxide laser in recalcitrant vulval lichen sclerosus          下载免费PDF全文

Andrew Lee  Adrian Lim  Gayle Fischer 《The Australasian journal of dermatology》2016,57(1):39-43

Vulval lichen sclerosus is an uncommon skin condition that can usually be managed with topical corticosteroids to maintain remission. However, there is a subset of patients in whom it remains recalcitrant despite treatment with super‐potent topical corticosteroids. We report a case series of four patients undergoing fractional carbon dioxide laser resurfacing and one with ablative carbon dioxide laser for severe, hyperkeratotic vulval lichen sclerosus not responding to super‐potent topical corticosteroids. In these patients, carbon dioxide laser was successful in achieving remission. Their vulval lichen sclerosus was subsequently able to be maintained with topical corticosteroid treatment.     

17.

Epidermal and sebaceous nevi treated with carbon dioxide laser     

Verma KK  Ovung EM 《Indian journal of dermatology, venereology and leprology》2002,68(1):23-24

Eight patients, 2 males and 6 females, between 10-21 years in age with epidermal (4) and sebaceous nevi (4) were taken up for this study. The lesions in all the patients were vaporized with the indigenously developed carbon dioxide laser. All the patients were evaluated at 1, 2, 4, 8 and 12 weekly visits. The final evaluation was done at the 12 weekly visit to assess the overall response to the treatment and side effects. The patients were then followed up every month for 6 months to look for any recurrence. All the patients responded to the treatment. Three patients each with epidermal and sebaceous nevi had 8090% improvement while I patient each with above disorders had % and 60% improvement respectively. Transient hypopigmentation was seen in all the patients. There were no other significant side effects.     

18.

Preoperative and postoperative considerations for carbon dioxide laser resurfacing     

Horton S  Alster TS 《Cutis; cutaneous medicine for the practitioner》1999,64(6):399-406

Cutaneous laser resurfacing is a tremendous advance in the treatment of photoaged skin. With the recent developments in laser technology, the procedure has become widely utilized among many physician subspecialists. The latest laser systems permit controlled vaporization of skin so that most novice operators feel comfortable with the technique in a short period of time. Nevertheless, there are many issues that need to be addressed before performing the procedure. First, not every person is an appropriate candidate for laser resurfacing. Second, both the physician and the patient must be aware of the preoperative preparation and prolonged postoperative care involved with the procedure. Finally, the physician must be able to identify and treat, and the patient must be educated about, the side effects and potential complications associated with the procedure. It is only by addressing these issues that the clinical results obtained by CO2 laser resurfacing can be maximized.     

19.

Multiple dermatofibromas on face treated with carbon dioxide laser     

Krupa Shankar DS  Kushalappa AA  Suma KS  Pai SA 《Indian journal of dermatology, venereology and leprology》2007,73(3):194-195

     

20.

Targeted laser reconstruction of skin scars using 10600-nm carbon dioxide fractional laser     

Lee SJ  Choi MJ  Chung WS  Cho SB 《Journal of cosmetic and laser therapy》2012,14(2):87-88

     

Effective treatment of nodular amyloidosis with carbon dioxide laser

Background:Nodular amyloidosis is a rare form of localized cutaneous amyloidosis that is characterized by nodules located on the extremities, trunk, genitalia, or face. In treatment regimens, many approaches have been described, including carbon dioxide (CO2) laser therapy.Objective:We present a case of a 60-year-old white male with a 20-year history of disseminated waxy, purpuric, yellowish, and bullous skin lesions on the trunk and extremities. The skin changes were accompanied by pain during palpation and were temporarily pruritic.Method:Based on histologic and direct immunofluorescence test findings, the diagnosis of cutaneous nodular amyloidosis was established. Skin lesions were treated with a CO2 laser. During surgery, treated tissue was found to be slightly friable, and there was a little problem with hemostasis that correlated with amyloid infiltration of the dermis and blood vessels. However, after 8 weeks, we observed clinical improvement of all treated areas with the presence of atrophic scars. In the regions of laser therapy, no recurrence of the disease was observed during a 12-month follow-up.Conclusion:Based on these results, we conclude that CO2 laser has a beneficial effect in the treatment of nodular amyloidosis; however, surgery procedures may be associated sometimes with tissue friability and poor hemostasis.     

Fractionated ablative carbon dioxide laser treatment of steatocystoma multiplex

Steatocystoma multiplex is a well-recognized condition in which subjects develop dermal cysts generally inherited in an autosomal dominant fashion, though these can occur sporadically. This case report describes the successful treatment of a 51-year-old woman with steatocystomata limited to the face, who after two treatments with a fractionated ablative carbon dioxide laser remained free of cysts for three years. We conclude that this treatment should be considered as an efficient and effective treatment option for patients with steatocystoma multiplex.     

Treatment of lichen sclerosus with carbon dioxide laser vaporization

We have treated 10 patients (five women and five men) with lichen sclerosus (LS), verified by histopathological studies from skin biopsies, with CO₂ laser vaporization. All men studied had LS of the penile skin, of the women, three had extragenital lesions and two LS of the perineal skin. The mean follow-up time was 32 months (range 3-79 months). One man had both penile and urethral LS. All penile lesions of the five men were clinically cured by laser treatment: however, urethral lesions of one patient recurred despite three separate treatments. The two women with perineal LS improved after laser treatment. However, LS recurred on the treated area in one and on the margins of the treated area in another. Two women with LS on the skin of the breast became asymptomatic after treatment. One woman had several lesions on the skin of the trunk that improved after treatment but were not cured completely. The present study suggests that carbon dioxide vaporization may be an effective treatment of skin lesions in LS.     

Treatment of fibroelastolytic papulosis with fractionated carbon dioxide laser

Fibroelastolytic papulosis (FEP) is an acquired elastic tissue disorder that presents as white-to-yellow papules and plaques usually occurring on the neck. Although the lesions are often asymptomatic, their appearance may be distressing to patients. FEP has been treated with topical tretinoin in one case report (1 Wang AR, Lewis K, Lewis M, Robinson-Bosom L. Papillary dermal elastosis: a unique elastic tissue disorder or an unusual manifestation of pseudoxanthoma elasticum- like papillary dermal elastolysis? J Cutan Pathol. 2009;36: 1010–1013.[Crossref] , [Google Scholar]). Other reports have not mentioned treatment for this rare disorder (1–6 Wang AR, Lewis K, Lewis M, Robinson-Bosom L. Papillary dermal elastosis: a unique elastic tissue disorder or an unusual manifestation of pseudoxanthoma elasticum- like papillary dermal elastolysis? J Cutan Pathol. 2009;36: 1010–1013. Rongioletti F, Rebora A. Fibroelastolytic patterns of intrinsic skin aging: pseuodoxanthoma-elasticum-like papillary dermal elastolysis and white fibrous papulosis of the neck. Dermatology. 1995;191:19–24. Shimuzu H, Kimura S, Harada T, Nishikawa T. White fibrous papulosis of the neck: a new clinicopathologic entity? J Am Acad Dermatol. 1989;20:1073–1077. Balus L, Amantea A, Donati P, Fazio M, Giuliano MC, Bellocci M. Fibroelastolytic papulosis of the neck: a report of 20 cases. Br J Dermatol. 1997;137:461–466. Jagdeo J, Ng C, Ronchetti IP, Wilkel C, Bercovitch L, Robinson-Bostom L. Fibroelastolytic papulosis. J Am Acad Dermatol. 2004;51:958–964. Ohnishi Y, Tajima S, Ishibasi A, Inazumi T, Saski T, Sakaoto T. Pseudoxanthoma elasticum-like papillary dermal elastolysis: reposrt of four Japanese cases and an immunohistochemical study of elastin and fibrillin-1. Br J Dermatol. 1998;139:141. ). We present a case of FEP successfully treated with a fractionated carbon dioxide (CO₂) laser.     

Fractional carbon dioxide laser in recalcitrant vulval lichen sclerosus

Vulval lichen sclerosus is an uncommon skin condition that can usually be managed with topical corticosteroids to maintain remission. However, there is a subset of patients in whom it remains recalcitrant despite treatment with super‐potent topical corticosteroids. We report a case series of four patients undergoing fractional carbon dioxide laser resurfacing and one with ablative carbon dioxide laser for severe, hyperkeratotic vulval lichen sclerosus not responding to super‐potent topical corticosteroids. In these patients, carbon dioxide laser was successful in achieving remission. Their vulval lichen sclerosus was subsequently able to be maintained with topical corticosteroid treatment.     

Epidermal and sebaceous nevi treated with carbon dioxide laser

Eight patients, 2 males and 6 females, between 10-21 years in age with epidermal (4) and sebaceous nevi (4) were taken up for this study. The lesions in all the patients were vaporized with the indigenously developed carbon dioxide laser. All the patients were evaluated at 1, 2, 4, 8 and 12 weekly visits. The final evaluation was done at the 12 weekly visit to assess the overall response to the treatment and side effects. The patients were then followed up every month for 6 months to look for any recurrence. All the patients responded to the treatment. Three patients each with epidermal and sebaceous nevi had 8090% improvement while I patient each with above disorders had % and 60% improvement respectively. Transient hypopigmentation was seen in all the patients. There were no other significant side effects.     

Preoperative and postoperative considerations for carbon dioxide laser resurfacing

Cutaneous laser resurfacing is a tremendous advance in the treatment of photoaged skin. With the recent developments in laser technology, the procedure has become widely utilized among many physician subspecialists. The latest laser systems permit controlled vaporization of skin so that most novice operators feel comfortable with the technique in a short period of time. Nevertheless, there are many issues that need to be addressed before performing the procedure. First, not every person is an appropriate candidate for laser resurfacing. Second, both the physician and the patient must be aware of the preoperative preparation and prolonged postoperative care involved with the procedure. Finally, the physician must be able to identify and treat, and the patient must be educated about, the side effects and potential complications associated with the procedure. It is only by addressing these issues that the clinical results obtained by CO2 laser resurfacing can be maximized.