Ablative Fractional Carbon Dioxide Laser Research Articles

The Effectiveness of Laser Therapy for Hypertrophic Burn Scars in Pediatric Patients: A Prospective Investigation

Abstract Laser therapy has become a valuable treatment option for hypertrophic burn scars. Improvements in scar symptoms have been achieved using the ablative fractional carbon dioxide laser as well as the pulsed dye laser. However, research regarding the use of laser therapy among pediatric patients remains limited. Thus, the aim of this study was to investigate the effectiveness of using laser therapy to improve hypertrophic burn scars in a pediatric population using a comprehensive scar assessment protocol. A pragmatic, single-center, prospective observational study was conducted at a tertiary pediatric hospital. Twenty participants with hypertrophic burn scars were included. Laser procedures were administered at approximately two month intervals and scars were evaluated at five time points over one year using the Vancouver Scar Scale, the Patient and Observer Scar Assessment Scale, conventional ultrasound, ultrasound elastography, and a multi-probe skin analysis device. Seventy-one laser procedures were performed with most participants receiving treatment with both the ablative fractional carbon dioxide laser and the pulsed dye laser at the same session (83%). From baseline to study completion, significant improvements in all scar measures were observed (p < .05). In particular, improvements in overall scarring and in specific scar properties including thickness, stiffness, and color were found (p < .05). To the best our knowledge, this is the most comprehensive study to date to evaluate the effect of laser treatment on hypertrophic burn scars in a pediatric population. Our findings suggest that laser therapy is a beneficial treatment for burn-injured children as evidenced by the improvements in subjective and objective scar assessment measures.

Snail Soothing and Repairing Cream Improves Skin Hydration after Ablative Fractional CO2 Laser: A Split-Face Randomized Double-Blinded Placebo-Controlled Trial

Background: Ablative fractional carbon dioxide laser (AFCO2) resurfacing causes transient skin barrier disruption characterized by decreased skin hydration and increased transepidermal water loss (TEWL). Snail Soothing and Repairing (SSR) cream, containing several glycoproteins with potential antimicrobial and antioxidant effects, may benefit skin hydration promotion after the laser treatment. Objective: To evaluate the efficacy and safety of SSR cream in skin hydration promotion after AFCO2 resurfacing. Method: The study was a double-blinded, split-face, placebo-controlled trial in participants aged 18–50 years with atrophic acne scars on both cheeks. After AFCO2 resurfacing, participants applied the product or placebo on either cheek twice daily for 14 days. Corneometry, TEWL, colorimetry, and clinical assessments (edema, erythema, crusting, pruritus, and tightness score) were evaluated at baseline, day 7, and day 14 after AFCO2 resurfacing. Results: From 22 participants in the study, the SSR cream-treated sides showed significantly higher corneometry levels than placebo-treated sides at day 14 (p = 0.033), while TEWL and colorimetry levels were not different at any study visits. Pruritus and tightness scores of the SSR side were lower, but not significant, than the placebo. Other clinical assessments (edema, erythema, and crusting) showed similar results. No significant adverse events took place. Conclusion: The SSR cream significantly improved skin hydration, highlighting skin barrier restoration after AFCO2 resurfacing, with a good safety profile.

A split-face study of moisturizer containing Centella asiatica extract after ablative fractional carbon dioxide laser resurfacing

A split-face study of moisturizer containing Centella asiatica extract after ablative fractional carbon dioxide laser resurfacing

29 The Effectiveness of Laser Therapy for Hypertrophic Burn Scars in Pediatric Patients: A Prospective Investigation

Abstract Introduction Laser therapy has emerged as a valuable treatment option for hypertrophic burn scars over the past decade. Improvements in scar symptoms have been found using the ablative fractional carbon dioxide laser (AFCL) as well as the pulsed dye laser (PDL). However, research regarding the use of laser therapy among pediatric burn patients remains limited. Thus, the aim of this study was to investigate the effectiveness of using laser therapy to improve hypertrophic burn scars in a pediatric population using a comprehensive set of subjective and objective scar assessment tools. Methods A single-center, prospective observational study was carried out at a tertiary pediatric hospital. Twenty participants with hypertrophic burn scars that had not received previous laser treatment were included. Laser procedures were administered at approximately two-month intervals and each participant attended five study visits over the course of one year. A comprehensive set of scar assessment tools including the Vancouver Scar Scale, the Patient and Observer Scar Assessment Scale, conventional ultrasound, ultrasound elastography, and a multi-parameter skin analysis device were used to evaluate scar properties at each study visit. Results Seventy-one laser procedures were carried out with most participants receiving treatment with both the AFCL and the PDL at the same session (83%). All participants underwent at least three laser procedures with no complications noted. From baseline to study completion, statistically significant improvements in all scar measures, both subjective and objective, were observed (p < 0.05). More specifically, improvements in overall scarring and in specific scar properties including thickness (p < 0.05), stiffness (p < 0.05), and color (p < 0.05) were found. Conclusions To our knowledge, this is the most comprehensive study to date to evaluate the effect of laser treatment on hypertrophic burn scars in a pediatric population. Our findings suggest that laser therapy is a highly beneficial treatment for burn-injured children that should be integrated into current scar treatment practices. In addition to obtaining strong evidence to support the use of laser therapy, we utilized rigorous scar assessment and laser treatment protocols that can be easily adopted by other clinicians.

The Rise and Fall of the Pale Puffy Lower Eyelid Pillow.

This case series demonstrates an exaggerated form of the clinical presentation of a known distressing late complication of retained hyaluronic acid filler – the “pale puffy pillow.” This presentation is often, unfortunately for the patient, misdiagnosed as festoons. However, the correction with liberal hyaluronidase is simple. Additionally, we have demonstrated that ablative fractional carbon dioxide laser resurfacing is an excellent tool that may be utilized after hyaluronidase to correct the residual skin laxity.J Drugs Dermatol. 20(4):475-476. doi:10.36849/JDD.5509.

Pretreatment with ablative fractional carbon dioxide laser improves treatment efficacy in a synergistic PDT protocol for actinic keratoses on the head.

A recently proposed synergistic photodynamic therapy protocol (s-PDT) combining advantages of both conventional- and daylight-PDT proved to be an effective and almost painless treatment for patients with actinic keratoses (AKs). This study investigated the safety and efficacy of an additional ablative fractional CO2-laser (AFXL) pretreatment. 28 patients with AKs on the head received s-PDT using 5-aminolevulinic acid. AFXL pretreatment was conducted using the following parameters: pulse energy 8 mJ, spot density 50 spots/cm2, power 30 W, beam size 4-18 mm. Outcome was assessed by AK area and severity index (AKASI) and lesion count (LC) before and 3 months after treatment. Safety was monitored by blood pressure and pulse measurements. Intensity of pain was determined by use of a visual analog scale (VAS). Most patients (96.4 %) showed a significant AKASI reduction (P < 0.0001) 3 months after PDT (median AKASI 1.6 [0-2.4]) compared to baseline (5.3 [4-7.75]). Median reduction rate was 75.5 % (61.3 %-100 %). Eleven patients (39.3 %) achieved AKASI 100, three (10.7 %) AKASI 75 and ten (35.7 %) AKASI 50. Blood pressure and pulse did not change significantly throughout treatment. Median VAS for pain during irradiation was 0 (0-0), 0 (0-2) and 0 (0-2) at the beginning, in the meantime and at the end, respectively. Compared to data without AFXL pretreatment, this study showed significantly higher AKASI and LC reduction rates (75.5 % vs. 63.7 % [P = 0.023] and 91.3 % vs. 80.4 % [P = 0.043]). S-PDT with AFXL pretreatment represents a safe and almost painless treatment for patients with AKs on the head and improves treatment efficacy.

The Rise and Fall of the Pale Puffy Lower Eyelid Pillow

This case series demonstrates an exaggerated form of the clinical presentation of a known distressing late complication of retained hyaluronic acid filler – the “pale puffy pillow.” This presentation is often, unfortunately for the patient, misdiagnosed as festoons. However, the correction with liberal hyaluronidase is simple. Additionally, we have demonstrated that ablative fractional carbon dioxide laser resurfacing is an excellent tool that may be utilized after hyaluronidase to correct the residual skin laxity.J Drugs Dermatol. 20(4):475-476. doi:10.36849/JDD.5509

Patient Satisfaction and Management of Postoperative Complications Following Ablative Carbon Dioxide Laser Resurfacing of the Lower Eyelids.

To describe postoperative management following ablative carbon dioxide laser resurfacing of the lower eyelids. A retrospective review of patients who consecutively underwent bilateral lower eyelid ablative carbon dioxide laser resurfacing by a single experienced oculoplastic surgeon over a 6-year period was conducted. Patient satisfaction, aesthetic outcomes, and postoperative complications were evaluated as adjunctive or monotherapy. Among 424 patients included in the study, most were female (n = 356, 84.0%) and Caucasian (n = 404, 95.3%), with Fitzpatrick skin types II-III (n = 381, 89.9%). Mean age was 62.8 years (standard deviation: 9.7 years). Most (n = 324, 76.4%) underwent fractional ablative carbon dioxide laser resurfacing of the lower eyelids, whereas 91 (21.5%) received traditional laser resurfacing and 9 (2.1%) had both fractional and traditional laser resurfacing during the same session. At the time of lower eyelid laser resurfacing, most patients also underwent concurrent procedures, including upper (n = 321, 75.7%) and lower blepharoplasty (n = 348, 82.1%); a small proportion of patients (n = 39, 9.2%) did not undergo any concurrent surgical procedure. In addition to ablative laser resurfacing of the lower eyelids, 25 (5.9%) had upper eyelid laser resurfacing, 60 (14.2%) had full-face laser resurfacing, 55 (13.0%) had neck laser resurfacing, and 42 (9.9%) had additional treatment of solar lentigines or dyschromias on the face. Median follow-up duration was 3.9 months (interquartile range: 2.0-11.0 months). In the immediate postoperative period, 22 patients (5.2%) developed contact dermatitis from topical antibiotic eye drops and/or ointment prescribed postblepharoplasty. Postinflammatory hyperpigmentation was observed in 40 patients (9.4%) despite topical prophylaxis; all were eventually successfully treated with a combination of topical nonprescription and prescription creams and/or oral tranexamic acid. A localized herpetic outbreak occurred in 3 (0.7%) who underwent full-face laser resurfacing and 1 (0.2%) who underwent periocular laser resurfacing only; all were successfully treated with oral antiviral therapy. Two (0.5%) developed culture-proven atypical mycobacterial infection of the resurfaced lower eyelid skin and were treated with combination antibiotic therapy for several months until resolution. A small scar was noted in 4 patients (0.9%), which resolved after local corticosteroid injections. No patient developed persistent scarring or ectropion. Patient satisfaction was overall high, with 363 (85.6%) very satisfied and 48 (11.3%) satisfied with the aesthetic outcome of lower eyelid laser resurfacing. Ablative carbon dioxide laser resurfacing of the lower eyelids can be a useful tool in the armamentarium of the experienced oculoplastic surgeon, with excellent aesthetic results, high patient satisfaction, and low complication rates as adjunctive or monotherapy. Proper and timely management of postoperative complications is essential to maximizing successful cosmetic outcomes.

Facilitated delivery of topical steroids after fractional ablative carbon dioxide laser failed to prevent the postthyroidectomy hypertrophic scar

Background: The ablative fractional laser can destroy the epidermal barrier and enhance the infiltration and distribution of drugs into the dermis. Objectives: This study was designed to investigate whether steroid delivery followed by the fractional ablative laser can prevent the formation of postthyroidectomy scar. Methods: This prospective split-scar design study recruited 12 adult female patients who underwent thyroidectomy between March 2018 and December 2018. The whole scar was treated with a fractional ablative carbon dioxide laser with topical 0.05% clobetasol propionate ointment only applied on the treatment side. The Patient and Observer Scar Assessment Scale (POSAS) questionnaire was used for outcome assessment at 1 year following the first treatment. The follow-up assessment by scar esthetic scale using digital photographs at 6 months and 1 year after first treatment was also done by three blinded plastic surgeons. Results: The POSAS revealed the improvement was not significant on vascularity, pigmentation, thickness, relief, pliability, surface area, and overall opinion on the improvement (all P > 0.05). The digital photographs evaluation also did not reveal a significant difference between the treatment side and control side. The overall esthetic score in the assessment of digital photographs was 4.4 ± 1.5, 4.2 ± 1.9, and 3.4 ± 1.9 at 6 months, and 2.8 ± 1.9, 3.1 ± 1.9, and 2.4 ± 2.1 at 1 year, with 0–10 indicating totally identical to significantly different comparing the whole scar with surrounding normal skin. Conclusion: This prospective scar-split study revealed that the application of topical steroid after fractional ablative carbon dioxide laser has no significant effect to prevent the formation of postthyroidectomy scar.

Combination of ablative fractional carbon dioxide laser and platelet-rich plasma treatment to improve hypertrophic scars: a retrospective clinical observational study.

BackgroundHypertrophic scars are one of the main complications that affect the quality of life of patients after burns. Many methods have been shown to be effective in the treatment of hypertrophic scars, such as ablative fractional CO2 laser (AFCL) and platelet-rich plasma (PRP). However, there are few studies on the effect of the combined application of these measures. The purpose of this study was to explore the therapeutic effect of AFCL combined with PRP on hypertrophic burn scars.MethodsA retrospective clinical observation study was conducted on 50 patients with hypertrophic burn scars. The AFCL+PRP group included 31 patients who received AFCL combined with PRP treatment; the AFCL group included 19 patients who received AFCL treatment only. The University of North Carolina 4P Scar Scale (UNC4P) and the Vancouver Scar Scale (VSS) scores that were collected before each treatment were used as indicators of the effectiveness of the previous treatment. The scores recorded at the second, fourth and seventh months were analysed.ResultsThe demographic data of the 2 groups were not significantly different. Before treatment, there was no difference in the UNC4P and VSS scores between the 2 groups. There was a significant decline in the UNC4P and VSS total scores over 6 months in both groups (p < 0.05) and scores in the 2 groups were comparable after 3 and 6 months (p < 0.05). UNC4P scores in the AFCL+PRP group decreased from a mean of 8.26 to 2.61 (p < 0.05) with a concomitant drop in VSS scores from a mean of 11.74 to 6.06 (p < 0.01). In the AFCL group UNC4P and VSS scores decreased from 7.68 to 4.63 (p < 0.05) and from 10.89 to 8.16 (p < 0.05), respectively. The sub-items of these 2 assessments were analysed and the results suggest that AFCL combined with PRP can comprehensively improve scarring.ConclusionsThis study shows that PRP is an effective adjunct for AFCL in the treatment of hypertrophic burn scars and that the combination of PRP and AFCL proved to be more useful than AFCL alone. This combination may be a new and effective clinical practice for the treatment of scars. However, larger and higher-level clinical studies are still needed to determine its efficacy and possible mechanisms.

Laser therapy in the treatment of post-burn scars in children

Burns are one of the most common injuries in the paediatric population. Despite improved medical care, many burn patients develop permanent scars, which are a serious cosmetic, functional and psychological burden. We present the possible use of a pulsed dye laser (PDL) and an ablative fractional CO2 laser (AFCL) in the treatment of post-burn scars, with particular emphasis on the paediatric population. PDL is intended to reduce scar redness through selective photothermolysis of blood vessels to reduce local hypervascularity. This type of laser can be also used to reduce pruritus, most likely by modifying local cytochemical reactions. Ablative fractional carbon dioxide laser therapy (AFCL) may be optionally used to improve scar texture and reduce its thickness. AFCL can also restore normal function of the scarred area. It causes vaporisation of scar tissue fragments, thereby stimulating collagen reconstruction. The fact that PDL and AFCL can be safely combined during the same procedure is an important advantage of using laser therapy in the treatment of hypertrophic scars. Combined therapy allows to reduce the overall number of sessions. The use of two lasers during one session also allows to reduce the amount of anaesthesia. The combined use of PDL and AFCL is safe. No serious complications were reported during combined therapy. Doctors treating patients with burn scars should consider the use of laser therapy as a modern standard for the treatment of hypertrophic scars. Scars that cause contractures and significantly impair motor functions may require multi-stage surgical treatment, supported by laser therapy, rehabilitation and conservative treatment.

Fractional ablative carbon dioxide laser treatment of facial scars: Improvement of patients' quality of life, scar quality, and cosmesis.

Disfiguring facial scars can be a massive burden on patients' psychosocial health and severely impact patients' self-esteem. The aim of this study was to analyze whether ablative fractional carbon dioxide laser (CO2-AFL) treatment can positively influence facial scarring and quality of life (QoL) while improving the aesthetic appearance. Patients with facial scars who had received CO2-AFL treatment between May 2019 and May 2020 were included in a retrospective study. The post-interventional course and patient and/or observer reported outcomes were inquired before and three months after treatment. Primary outcomes were changes in the Patient and Observer Scar Scale (POSAS) and QoL (Short Form (SF) 36). In addition, two independent examiners evaluated the aesthetic outcome by comparing initial scarring with the post-intervention results using photographs. A total of 16 patients with facial scars were included. Most of the scars were caused by burns (43.8%) or trauma (31.3%). The post-interventional course was uneventful. Overall POSAS scores improved decisively for both observers (n=2) and patients (n=16) (p<0.001 and p<0.001). Also, there was an improvement in QoL with an increase in emotional well-being (p=0.043) and social functioning (p=0.01). Furthermore, the aesthetic outcome was significantly enhanced (p=0.001) after treatment. The CO2-AFL offers a safe and effective treatment for disfiguring facial scars. We have shown that improvement of scar appearance and scar quality was meaningful to the patient, with a significant impact on a patient's life quality. Based on these findings we suggest including the CO2-AFL in the facial scar treatment concept.

14141 Efficacy of bleomycin application on periungual warts after treatment with ablative carbon dioxide fractional laser: A pilot study

Background: Treating periungual warts is a therapeutic challenge. Treatments are often ineffective and may cause complications including permanent nail changes, pain, and scarring. Translesional bleomycin delivery via the multipuncture technique is now reported.

Topical 0.5% Timolol Maleate Significantly Enhances Skin-Barrier Restoration After Fractional Carbon Dioxide Laser Treatment for Acne Scars.

Skin barrier is often compromised following ablative fractional carbon dioxide laser (AFCO2 ) therapy for acne scarring. The resultant downtime, even of a few days' duration, can be of significant concern to patients. We evaluated the efficacy and safety of topical 0.5% timolol maleate (TM) for its role in short-term restoration of the skin's biophysical properties after laser treatments. This double-blind, placebo-controlled trial included participants aged 18-50 years with atrophic acne scars for at least 3 months. After undergoing laser therapy, they applied 0.5% TM to one cheek and normal saline to the contralateral cheek (control) for 7 days. Corneometry, transepidermal water loss (TEWL) measurement, colorimetry, and clinical outcome parameters (erythema, edema, crusting, pruritus, and tightness scores) were evaluated at baseline and 48, 96, and 168 hours after AFCO2 treatment. Twenty-five healthy participants completed the study. Most participants had Fitzpatrick skin phototype IV. The TM-treated side showed statistically higher corneometry values and lower TEWL than the control side at every follow-up visit (P < 0.001). The crusting score at 96 hours post-AFCO2 treatment was also significantly better on the TM side. No adverse events occurred during the follow-up period. Application of topical 0.5% TM twice daily improves the skin-barrier function and might promote re-epithelialization after laser procedures. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Before-after cohort study to assess the efficacy of fractional ablative carbon dioxide laser treatment of pediatric hand scars.

The purpose of this study is to investigate the efficacy of fractional ablative carbon dioxide laser (AFXL) surgery in patients with pediatric hand scars. This study enrolled hand scar patients who received treatment in our hospital between May 2018 and April 2019. Patients were assigned to undergo AFXL surgery based on their personal intents and condition, whereas the fractional laser was used for stiffness and abnormal texture. Outcomes were as follows: hand function was evaluated using the Michigan hand outcomes questionnaire; scar condition was evaluated using the Vancouver scar scale and UNC4P scar scale. Total 30 pediatric patients (mean age, 11.4 years) were eligible for the study and laser-treated scars were significantly improved in Michigan hand outcomes questionnaire from 52.30 ± 6.14 to 66.91 ± 6.43 (p < 0.001). Provider-rated Vancouver scar scale dropped from 8.80 ± 2.75 to 6.73 ± 2.52 (p < 0.001). Patient-reported UNC4P scar scale declined from7.07 ± 2.02 to 4.73 ± 1.31 (p < 0.001). AFXL surgery can significantly improve hand function and appearance of pediatric hand scars, suggesting its advantages over traditional methods of operative intervention.

Treatment of Benign Adnexal Tumors in Birt–Hogg–Dubé Syndrome With Surgical Debulking in Combination With Fractional and Fully Ablative Carbon Dioxide Laser Resurfacing

Treatment of Benign Adnexal Tumors in Birt–Hogg–Dubé Syndrome With Surgical Debulking in Combination With Fractional and Fully Ablative Carbon Dioxide Laser Resurfacing

A meta-analysis of fractional CO2 laser combined with PRP in the treatment of acne scar.

This study aimed to analyze the effectiveness and safety of ablative fractional carbon dioxide laser systems (CO2 AFL) combined with autologous platelet-rich plasma (PRP) in the treatment of acne scars through the retrieval and collection of related literature to further guide the treatment of acne scars. We searched Web of Science, PubMed, Embase, Wanfang Data, Chinese National Knowledge Infrastructure, and VIP Database. All randomized and nonrandomized controlled trials on CO2 AFL combined with PRP in the treatment of acne scars were included, and Revman5.3 systematic review software was used in the meta-analysis. Nine studies were included in this meta-analysis. The data analysis results showed that the CO2 AFL combined with PRP treatment group showed significantly better results than the pure CO2 AFL control group in terms of clinical improvement score, clinical improvement rate, patient satisfaction, and crusting period. The results of this meta-analysis showed that CO2 AFL combined with PRP in the treatment of acne scars is more effective and safer than CO2 AFL alone.

Ablative Fractional Carbon Dioxide Laser and Autologous Platelet-Rich Plasma in the Treatment of Atrophic Acne Scars: A Comparative Clinico-Immuno-Histopathological Study.

To compare the efficacy of autologous platelet-rich plasma (PRP), ablative fractional carbon dioxide (FCO2 ) laser, and their combination in the treatment of atrophic acne scars, both clinically and immuno-histopathologically. Sixty patients were randomly divided into three equal groups. Group 1 received intradermal PRP injection sessions. Group 2 received FCO2 laser sessions. Group 3 received FCO2 laser followed by intradermal PRP injection sessions. Each group received three sessions at monthly intervals. The final assessment took place 3 months after the last session. Skin biopsies were obtained before and 1 month after treatment sessions with pathological evaluation. Combined PRP and FCO2 laser-treated patients had a better clinical response, fewer side effects, and shorter downtime than FCO2 laser alone. PRP-treated patients had some improvement but significantly lower than the other two groups. The current study concluded that a combination of PRP and FCO2 laser is an effective and safe modality in the treatment of atrophic acne scars with better results than PRP or FCO2 laser alone. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Hypertrophic Scar Improvement by Early Intervention With Ablative Fractional Carbon Dioxide Laser Treatment.

Ablative fractional laser treatment has been used to improve the color and texture of hypertrophic scars with safe and effective results. However, no consensus on the optimal time to initiate fractional laser treatment is available. The effect on early-stage scars remains controversial. This study was designed to assess the efficacy and safety of ablative fractional carbon dioxide (CO2 ) laser treatments for hypertrophic burn scars and to analyze the efficacy and safety in the early period within 3 months after injury. We performed a retrospective study of 221 hypertrophic scar patients. According to the time of the first laser treatment after injury, patients were divided into five subgroups, including less than 1 month, 1-3 months, 3-6 months, 6-12 months, and more than 12 months postinjury. One month after the last laser treatment, the scars were assessed by photography, the Vancouver Scar Scale (VSS), durometry, and spectrocolorimetry. The patients included 118 males and 103 females. The average age was 33.6 years. Fire/flame was the primary injury source. Thirty-six percent of the patients underwent at least one fractional CO2 laser treatment. All the included patients, including those treated within 1 month after injury, had significantly decreased VSS scores after laser treatment. We also noted that hardness and redness scores were decreased after treatment for both scars treated within 3 months and those treated more than 12 months after injury. Seepage (17.6%), bleeding (22.2%), and swelling (9.0%) were the main adverse events after laser treatment. This study demonstrated the safety and efficacy of ablative fractional CO2 laser treatment applied to early-stage burn scars. The optimal time for laser application for burn patients can be within 1 month after injury. Durometry and spectrocolorimetry were effective for assessing scars as objective modalities. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Daylight photodynamic therapy with ablative carbon dioxide fractional laser for treating actinic keratosis in Asians: A case series.

Photodynamic Therapy (PDT) is one of the standard treatment modalities for actinic keratoses (AKs). Daylight PDT (DL-PDT) with MAL cream, using daylight as light source, is one of recent treatment for AKs with less pain. Herein, we report cases of AKs successfully treated with DL-PDT in Asian patients. Four patients presented erythematous scaly patches and were diagnosed with AK by skin biopsy. The lesions were pretreated by fractional carbon dioxide laser first and then MAL creams were applied immediately. They went outdoors and exposed daylight for 2 h. They reported little pain of visual analogue scale 0. Clinically cleared lesions were observed with 1 month and 2 month follow-up. No complication such as oozing or scar was reported.