Ablative Fractional CO2 Laser Research Articles

Topical delivery of PD‐1 inhibitors with laser‐assisted passive diffusion and active intradermal injection: Investigation of cutaneous pharmacokinetics and biodistribution patterns

Current cancer immunotherapeutic treatment with PD-1 inhibitors is administered systemically. However, a local treatment strategy may be advantageous as it could provide targeted drug delivery as well as attenuate side effects seen with systemic treatments. For keratinocyte cancers, where surgical excision is not always applicable, an alternate local treatment approach would be beneficial. This study aims to examine cutaneous pharmacokinetics and biodistribution of the PD-1 inhibitor nivolumab, locally delivered either by ablative fractional laser (AFL)-assisted passive diffusion or active intradermal injection, in vivo. In vivo pig skin was either exposed to CO2 AFL (80 mJ/mb by two stacked pulses of 40 mJ/mb) at 5% or 15% density followed by topical application of nivolumab (1 mg/ml, 100 µl/10 × 10 mm) or intradermally injected with nivolumab (1 mg/ml, 100 µl). Cutaneous nivolumab delivery was evaluated at different timepoints (0, 1, 2, 4 hours and 2 days) at two tissue depths (100-800 and 900-1600 µm) by ELISA. Visualization of cutaneous biodistribution was shown in vertical tissue sections using HiLyte FluorTM 488 SE labeled nivolumab for fluorescence microscopy whereas nivolumab was DOTA-tagged with Dysprosium before the laser ablation-inductively coupled plasma-mass spectrometry analysis (LA-ICP-MS). Our in vivo study revealed different pharmacokinetic and biodistribution patterns for the AFL- and injection techniques. A superficial horizontal band-like uptake of nivolumab was provided with AFL-assisted passive diffusion whereas a deep focal deposition was seen with active intradermal injection, compared with controls showing remnant deposition on the skin surface. AFL-assisted nivolumab uptake in upper dermis peaked after 4 hours (p < 0.01). The cutaneous concentration of nivolumab achieved by intradermal injection was markedly higher than with AFL, the highest deposition with intradermal injection was detected at time 0 hours in both upper and deep dermis (p < 0.01) and decreased throughout the study period, although the concentration remained higher compared with saline control injections at all time points (0 hours -2 d) (p < 0.01). Local cutaneous delivery of nivolumab with either AFL or intradermal injection revealed two different pharmacokinetic and biodistribution patterns. Passive AFL-assisted diffusion of nivolumab resulted in enhanced uptake after 4 hours, while intradermal actively injected nivolumab showed immediate enhanced cutaneous deposition with retention up to 2 days after injection. The two local delivery techniques show potential for development of individualized treatment strategies depending on the clinical tumor appearance.

Clinical and histological evaluation of a dual sequential application of fractional 10,600\xa0nm and 1570\xa0nm lasers, compared to single applications in a porcine model

The sequential application of fractional ablative/10,600 nm/CO2 followed by 1570 nm non-ablative laser treatment might produce better results than applying either laser treatment alone. However, histological data regarding the safety of this combination is lacking. This study aimed to assess and compare clinical effects, histological tissue damage, and wound healing after monochromatic and sequential fractional laser treatments. In this prospective porcine model study, three adult female pigs were each irradiated using three different wavelengths: (a) monochromatic fractional ablative CO2 laser; (b) monochromatic fractional non-ablative 1570 nm laser; (c) sequential fractional 10,600 nm/CO2 followed by 1570 nm laser treatment. There were six power levels in the monochromatic 1570 nm laser, five in the 10,600 nm/CO2, and five in the sequential treatment. The immediate skin reaction (ISR), crusting and adverse effects, was evaluated across different time points throughout the healing process. Wound biopsies were taken at immediately after (0) and at 3, 7, and 14 days after irradiation. Depth and width of craters, and width of coagulation zone were measured and compared. Similar ISR and crusting score values were obtained following the monochromatic and sequential irradiation in a similar dose–response manner. During 14 days of follow-up, the skin looked intact and non-infected with no signs of necrosis. The mean depth and width of craters were comparable only at the maximal energy level (240 mJ) of CO2 laser, with the coagulation size greater after the sequential treatment. In histology, a similar wound healing was evident. On day 3, crusts were observed above all lesions as was epithelial regeneration. The sequential irradiation with 10,600 nm/CO2 and 1570 nm lasers did not pose any additional risk compared to the risk of each laser alone.

Multinucleate Cell Angiohistiocytoma: A Case Report and Unique Treatment Consideration

Introduction: Multinucleate cell angiohistiocytoma (MCAH) is a benign, yet exceedingly rare vascular and firbiohistiocytic proliferation. The lesions are typically asymptomatic and are commonly cosmetically displeasing to patients. 1 Previous reports have demonstrated success in treating MCAH with fractional ablative CO2 laser, argon laser, pulsed dye laser, and KTP lasers. 3 The scarcity of reported cases may suggest that the lesion is commonly misdiagnosed, and we report this case to highlight the characteristic features of MCAH with successful treatment with Neodymium YAG laser.&#x0D; Case Presentation: A 64-year- old female presented to our clinic with a 1- month history of multiple erythematous to violaceous lesions on her bilateral hands. The lesions were asymptomatic, but cosmetically displeasing for the patient. Past medical history and family history was noncontributory. Examination revealed several 2-6 mm well- circumscribed, erythematous, indurated smooth papules on the bilateral dorsal and in the second web space of the left hand. Shave biopsy of the lesions were consistent with MCAH. She was initially treated with topical steroids twice daily for 2 weeks, with no improvement. The patient received 3 treatments with Neodymium YAG, 4 weeks apart. This treatment was discontinued after 3 sessions due to the dramatic visible improvements in regards to induration and discoloration of the lesions.&#x0D; Discussion: MCAH is an extremely uncommon lesion, diagnosis is made on the basis of clinical examination, histopathologic and immunohistochemical analysis of the lesions. This case illustrates diagnosis and successful treatment of MCAH with Neodymium YAG and offers a unique treatment consideration for patients.

Efficacy and safety of Resveratrol combined with Ablative Fractional CO2 laser system in the treatment of skin photoaging

AbstractObjectiveTo evaluate the efficacy and safety of resveratrol combined with ablative fractional CO2 laser system (AFL) treating skin photoaging.MethodsThirty‐two subjects were assigned to the treatment group (TG) or the control group (CG), respectively, applied test product (resveratrol essence) or control product twice daily for 6 months. Each subject was given an AFL treatment or no laser treatment on left or right side of the face randomly. Subjective evaluations by investigators and subjects themselves were conducted after treatment. Melanin index, erythema index, and cuticle moisture content were conducted at baseline and after treatments. Adverse events (AEs) were evaluated during the study period.ResultsAll subjects in TG achieved improvements of their photoaging signs compared to pre‐treatment both the laser side and the non‐laser side at 6 months (p &lt; 0.05). On the laser side, TG produced a better improvement than CG at 6 months (p &lt; 0.05). On the laser side, the difference values of MI in TG at the 2 months after enrollment (M2), M3, and M4 were more obvious than those in CG (p &lt; 0.05). On the non‐laser side, the difference values of MI in TG at M3, M4, M5, and M6 were more obvious than those of CG (p &lt; 0.05). Subjects in TG were more likely to have tingling and had a faster subsidence of erythema mild edema, and pigmentation induced by AFL compared to CG.ConclusionThe resveratrol can improve photoaging alone and add an efficacy to the AFL treatment and subside the AEs induced by AFL.

Evaluation of Device-Based Cutaneous Channels Using Optical Coherence Tomography: Impact for Topical Drug Delivery.

Topical medications play a large role in the management of cutaneous diseases, but penetration is limited. Device-assisted drug delivery using mechanical destruction, lasers, and other energy-based modalities can increase penetration and absorption through creation of transcutaneous channels. To examine real-time, in vivo cutaneous changes in response to various devices used to improve topical drug delivery through optical coherence tomography (OCT) imaging. Treatment was performed with 8 medical devices, including mechanical destruction, lasers, and other energy-based modalities. Optical coherence tomography was used for real-time, noninvasive, in vivo imaging. Using OCT, microneedling and radiofrequency microneedling demonstrated no cutaneous channels. Both low-energy, low-density, fractional nonablative lasers produced transient channels, which closed within hours. The fractional nonablative 1,927-nm thulium fiber and 1,550-nm erbium fiber lasers created channels with epidermal debris within, which were still closing at 24 hours. The fractional thermomechanical ablative device and the fractional ablative CO2 laser produced channels that were still open at 24 hours. CO2 laser channels had thick rims of coagulated tissue and remained open for longer. Demonstrable differences among the devices were seen, and only some can produce observable channels, the characteristics of which vary with each technology.

The use of CO2 ablative fractional laser, non-ablative picosecond fractional lasers 1064 nm and 755 nm and needle mesotherapy in combined therapy to reduce stretch marks and skin laxity. A clinical case

Stretch marks are a common problem and a challenge for cosmetologists and aesthetic medicine doctors. Due to the complex etiopathogenesis and difficulties in their reduction, specialists use various therapeutic methods. In this study, the described case confirms the effectiveness of selected combined therapy in reducing stretch marks and skin laxity. Impressive surgical results were obtained with the implementation of combined therapy consisting of the use of non-ablative Nd:YAG fractional laser and alexandrite laser in picosecond technology, CO2 fractional ablative laser and needle mesotherapy treatments.

A COMPARATIVE STUDY BETWEEN THE FRACTIONAL CO2 LASER AND CARBOXYTHERAPY IN TREATMENT OF STRIAE DISTENSAE: A CLINICAL AND HISTOPATHOLOGICAL STUDY

Striae distensae (SD), commonly known as stretch marks, represent linear dermal scars associated with epidermal atrophy. It is prevalent in all races. Objective: The aim of this study was to compare the efficacy and the safety of use of ablative fractional CO2 laser therapy and carbon dioxide gas intradermal injection in treatment of striae distensae. Methods: The present study included 20 patients diagnosed with striae distensae who had never received any previous treatment for SD. There were three groups; each group composed of 10 patients: The first group was treated with ablative fractional CO2 laser resurfacing 10,600 nm The treatment parameters in this study were: energy (30-40 mJ), pulse duration (1.4-1.8 ms), scanning area (20 mm x 5 mm), depth level (1-2) and density level (8-16) according to each patient condition and skin type. Stria of the second group was treated with intradermal injection of carbon dioxide gas. 4-mm bunch biopsies were taken from patients before and after treatment by and results showed high percentage of excellent improvement with fractional CO2 laser.Results: Carbon dioxide laser showed significant higher percentage of excellent improvement after last session of treatment of SD, when compared with carbon dioxide injection.Conclusion: Treatment with CO2 laser showed significant higher frequency of striae with excellent improvement, with good improvement, when compared to treatment with CO2 injection (carboxytherapy). Fractional CO2 laser is promising tool in dermatology and in treatment of SD (safe and effective).

Comparative study between fractional carbon dioxide laser versus retinoic acid chemical peel in the treatment of acanthosis nigricans.

Acanthosis nigricans (AN) is a common dermatological issue with several therapeutic modalities to treat. Despite retinoid is the first drug of choice in the treatment, the fractional-ablative carbon dioxide (CO2 ) laser has revealed as a promising procedure for the management of neck-AN, outstanding to its ability for superficial ablation of the skin surface, with trans-epidermal melanin elimination. To decide whether fractional-ablative CO2 laser or retinoic acid (5%) peel is the more effective and safe choice for AN treatment. In this study, twenty Egyptian cases with neck-AN were enrolled, where each case was exposed to four sessions with 2weeks apart of both fractional CO2 laser on the right half of the neck and retinoic acid peel on the left half of the neck. Cases were assessed by a scoring system: Acanthosis Nigricans Area and Severity Index (ANASI) score, two blinded dermatologists, and dermoscopically before and one month after treatment. We found a highly statistically significant improvement among both treated groups regarding (ANASI) score and dermatologist's assessments. Bedside, the degree of sulci cutis, cristae cutis, brown-to-dark brown dots, and milia-like cysts, dermoscopic sign improvement was evident in both treated groups. However, fractional CO2 laser shows the superior result to retinoic acid peel in the treatment. Fractional CO2 laser and retinoic acid peel are considered effective modalities for neck-AN treatment. However, fractional CO2 laser was more effective.

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.

Pulsed dye laser versus ablative fractional CO2 laser in treatment of old hypertrophic scars: Clinicopathological study.

There is a continuous need to find out the best treatment for old hypertrophic scars (OHSs). Thirty patients with OHSs were included. Each scar was divided into right half treated with PDL (handpiece with a 7-mm spot, pulse duration of 1.5 ms and fluence of 6 J/cm2 ) and left half treated with FrCo2 laser (15 W, spacing 800 μm, dwelling time 600 μs and stack 3) once every month for three sessions. Scars were assessed before and after treatment clinically by Vancouver Scar Scale (VSS) and histologically using hematoxylin and eosin (H&E), Masson trichrome and orcein stains. Both halves showed statistically significant improvement after treatment. However, there was no statistically significant difference in VSS between them (P = 0.176). FrCo2 laser showed more significant improvement in pliability and height (Pp = 0.017, Ph = 0,011), while, PDL showed more significant improvement in vascularity (P = 0.039) of OHSs. Both PDL and ablative FrCo2 laser were effective in the treatment of OHSs, however, FrCo2 laser was more effective in improving OHSs pliability, and height which are the main concern in OHSs.

Pulse-Dye Laser Followed by Betamethasone-Calcipotriol and Fractional Ablative CO2-Laser-Assisted Delivery for Nail Psoriasis.

Nail psoriasis is a common and potentially debilitating condition for which no effective and safe nonsystemic therapy is currently available. Recently, laser-assisted drug delivery (LADD) is being increasingly used to facilitate transcutaneous penetration of topical treatments. We set to assess the efficacy and safety of combined pulse-dye laser and fractional CO2 laser-assisted betamethasonecalcipotriol gel delivery for the treatment of nail psoriasis. We conducted a prospective, intrapatient comparative study in a series of 22 patients with bilateral fingernail psoriasis. Nails on the randomized hand were treated with 3 monthly sessions of pulse-dye laser to the proximal and lateral nail folds followed by fractional ablative CO2 laser to the nail plate. Between treatments and one month following the last treatment, the participants applied betamethasone propionate-calcipotriol gel once daily to the nail plate. Clinical outcome was ascertained using nails photography, the Nail Psoriasis Severity Index (NAPSI) and patient satisfaction. Seventeen completed the study. Three participants withdrew from the study because of treatment-associated pain. Treatment was associated with a statistically significant improvement of the NAPSI scale (p < .002). Patient satisfaction was high. Combined PDL and fractional ablative CO2-LADD of betamethasone-calcipotriol gel should be considered for the treatment of nail psoriasis.

Fractionated carbon dioxide (CO2) laser treatment contributes to trans-nail penetration of rhodamine B and changes of cytokine microenvironment.

This study is to determine the role of the fractional CO2 laser in topical drug delivery and the impact of local immune responses. Experimental rabbit nails were treated with fractionated CO2 laser at varied fluencies of 20mJ, 25mJ, and 30mJ and half of which were coated with rhodamine B (RhB). Histological examination was performed by hematoxylin and eosin staining; the penetration of RhB was assessed by the use of confocal laser scanning microscopy; and the expressions of IFN-γ and IL-4 mRNA in situ were detected by means of qPCR at 12h, 24h, 3days, and 7days post-laser irritation. The fractional CO2 laser could generate microscopic treatment zones in nail plates, and the depths of these micropores as well as the permeation of RhB in nails increased significantly in an energy-dependent manner. Importantly, the laser irritation led an upregulation of local IFN-γ mRNA expression accompanied by a downregulation of IL-4 mRNA expression. The ultrapulsed ablative fractionated CO2 laser may assist topical drug delivery, and may drive stronger local Th1 responses due to an imbalance of IFN-γ/IL-4 expressions, suggesting that the combination of ablative fractionated CO2 laser with topical agents would be an effective option for the treatment of onychomycosis.

Fractional Carbon Dioxide Laser versus Combined Fractional Carbon Dioxide Laser with Platelet-rich Plasma in the Treatment of Atrophic Post-acne Scars: A Split-face Comparative Study.

Context:Though many treatment options are available for treating post-acne scars, optimized treatment still does not exist. Till date, comparative split-face studies, analyzing the efficacy of combined treatment modalities for acne scars with adequate sample size and with statistically significant results, are still lacking.Aim:The aim of this study was to compare the effectiveness of the combined use of platelet-rich plasma (PRP) and fractional ablative CO2 laser (FACL) versus FACL in the management of acne scars and to study the safety of autologous PRP and FACL in the treatment of post-acne scars.Settings and Design:This was a randomized split-face trial study.Materials and Methods:This study was conducted in 30 patients having Goodman and Baron’s grade 3 and 4 acne scars. The efficacy of PRP in combination with FACL was compared to FACL alone in the treatment of post-acne scars. Right half of the patient’s face was taken as the study side where FACL was performed followed by PRP injections. The left half of the same patient’s face was taken as the control side where FACL was performed followed by normal saline injections.Statistical Analysis:Results were analyzed using Statistical Package for the Social Sciences (SPSS, Chicago).Results:At the time of enrollment, mean Goodman and Baron Acne Qualitative Grading Scale on study and control side was 3.80 with standard deviation (SD) of 0.40 at baseline. After completion of four treatment sessions, it was reduced to 2.43 (SD = 0.76) and 2.76 (SD = 0.49) on the study and control side, respectively. Improvement on both sides was statistically significant (P = 0.000).Conclusion:There is no single proven modality for the effective treatment of post-acne scars. Combination of FACL with newer adjuvants such as PRP has definitive role in managing post-acne scars with better safety profile than FACL alone.

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.

Fractional carbon dioxide laser-assisted topical steroid delivery versus intralesional steroid in the treatment of alopecia areata

Background Alopecia areata is a common disease that affects the psychological well-being of the affected individuals. No single treatment option is proved to be effective and safe in its management. Laser-assisted drug delivery is a new method for the management of different dermatological diseases. Objective To evaluate the effectiveness of fractional carbon dioxide laser-assisted topical steroid delivery in the management of alopecia areata. Patients and methods A total of 30 patients with alopecia areata with two or more nonadjacent patches were included. Patients were randomized and given two separate treatment modalities in two different patches in the same individual. One patch was treated with fractional carbon dioxide laser followed by topical triamcinolone acetonide (group I), and the other was treated with intralesional triamcinolone acetonide (group II). Follow-ups by MacDonald Hull and Norris grading were done every 3 weeks for 3 months. Results The mean grading score in group I patches treated with ablative fractional CO2 laser followed by the topical steroid application at fourth follow-up was 3.37±0.76, and the mean grading score in group II patches treated with intralesional steroid at fourth follow-up was 3.73±0.58. There was significant improvement in the MacDonald Hull and Norris grading score every follow-up in both groups. However, group II patches showed significantly higher mean grading score as compared with group I patches. The mean pain score in group II patches was significantly higher than that in group I patches. Conclusion The use of fractional carbon dioxide laser to assist topical steroid delivery is a promising, safe, and effective method for the treatment of alopecia areata. Although intralesional steroid treatment showed more significant results, we thought that the low pain score in patients treated with laser-assisted drug delivery is more advantage, which increases their compliance to treatment.

Ablative fractional CO2 laser surgery improving sleep quality, pain and pruritus in adult hypertrophic scar patients: a prospective cohort study.

BackgroundPoor sleep quality is associated with a decrease in quality of life in patients with major burn scars, combined with pruritus and pain. Few interventions have been reported to improve the sleep quality of patients with scars. In the current prospective cohort study, we investigated the efficacy of CO2-ablative fractional laser (AFL) surgery vs conventional surgery in post-burn patients with hypertrophic scars with sleep quality as the primary study outcome.MethodsIn total 68 consecutive patients undergoing scar surgical treatment were recruited, including a CO2-AFL surgery cohort (n = 35) and a conventional surgery cohort (n = 33). A subgroup from the AFL cohort was selected. Sleep quality, pain and pruritus were evaluated. Multiple linear regression analyses were performed to reveal the effect of CO2-AFL surgery.ResultsThe CO2-AFL surgery cohort had significantly lower Pittsburgh sleep quality index (PSQI) global scores than the conventional surgery cohort after the last surgical treatment. In the subgroup of patients receiving hardware sleep monitoring, CO2-AFL markedly increased deep sleep time, deep sleep efficiency and reduced initial sleep latency. Compared to the conventional surgery cohort, the CO2-AFL cohort presented significantly lower pain and pruritus scores. Correlation analysis showed pain and pruritus were significantly associated with PSQI scores, and there were also significant correlations between pain and pruritus scores. Multiple linear regression analysis showed that surgery method was negatively linearly correlated with visual analog scale (VAS) pain score, brief pain inventory (BPI) total, VAS pruritus score, 5-D itch scale total, four-item itch questionnaire (FIIQ) total and PSQI total.ConclusionsCO2-AFL surgery significantly improved sleep quality and reduced pain and pruritus of hypertrophic scar patients. The alleviation of sleep disorder was associated with improvement of deep sleep quality including deep sleep time and deep sleep deficiency.Trial registrationThe Chinese Clinical Trial Registry (ChiCTR200035268) approved retrospectively registration on 5 Aug 2020.

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.

Effects of combined Pulsed Dye Laser and Fractional CO2 Laser treatment of burn scars and correlation with plasma levels of collagen type I, MMP-2 and TIMP-1

Hypertrophic burn scars remain a significant burden for patients and a challenge for clinicians. The aimAssessement of the efficacy of combined Pulsed Dye Laser and Ablative Fractional CO2 Laser therapy on hyperthophic scars and correlation with plasma levels of MMP-2, TIMP-1 and alpha-1 type I collagen. Patients and methodsTwenty five pediatric subjects were enrolled into the study. Control group consisted of age-matched subjects admitted for surgical repair of inguinal hernia. For the assessment of the results of laser treatment we used the Vancouver scar scale (VSS), and Patient-Observer Scar Assessment Scale (POSAS). We also correlated clinical results with plasma levels of MMP-2, TIMP-1 and alpha-1 type I collagen. ResultsAll subjects reported the laser treatment resulted in improvement and were somewhat satisfied or very satisfied with their experience. No adverse events were reported. The levels of MMP-2, TIMP-1 and alpha-1 type I collagen in our patients with scars before laser threatment were higher in comparison to controls. We also found statistically significant decrease in the levels of MMP-2, TIMP-1 and alpha-1 type I collagen after laser treatment of burn scars ConclusionsOur study clearly shows that combined CO2-AFL treatment for burn scars improve texture, colour, function and alleviate pruritus. We believe that decrease in the levels of MMP-2, TIMP-1 and alpha-1 type I collagen after laser treatment of burn scars, reflects reduced dynamic of scar.

13270 Evaluation of the effects of a cosmetic treatment based on the secretion of Cryptomphalus aspersa 40% after the use of ablative fractionated CO2 laser in cutaneous aging

Background: Among the different treatments that seek to reverse the signs of skin aging, ablative fractionated laser induces a controlled skin damage that results in the improvement of these signs. The main objective of this study was to determine whether the application of a cosmetic treatment based on the secretion of Cryptomphalus aspersa (40% SCA) improves tolerance and skin recovery after the laser treatment.

Combination treatment utilizing fractional ablative and continuous wave CO2 lasers for hypertrophic burn scars

BackgroundHypertrophic scars are devastating outcomes of severe burn injuries, producing physical and mental burdens. Adequate treatment is of benefit to relieve these burdens. Laser therapy has shown scar reducing effects. In this study, we compared outcomes after combination of two different lasers or single laser treatment to treat severe hypertrophic burn scars. MethodsForty patients with hypertrophic burn scars were included in one of two therapeutic groups: continuous wave CO2 laser and fractional ablative CO2 laser group (group 1, n = 20) or fractional ablative CO2 laser alone group (group 2, n = 20). Hypertrophic scars were evaluated by the observer-rated Vancouver Scar Scale (VSS) before and after treatment and by patient-completed questionnaires after treatment. Comparative analyses were performed before and after treatment, and time-dependent improvement was also analyzed. ResultsForty patients (54 hypertrophic scars) completed the laser treatment protocols. Group 1 exhibited significantly more improvement in VSS vascularity, pliability, and height indices than group 2 (p < 0.05). Time-dependent analysis of total VSS scores suggested that group 1 experienced more improvement during a shorter treatment period (p < 0.05). For patient-reported outcomes, group 1 noted better grades than group 2 in four indices, namely scar appearance, scar thickness, pain, and pruritus (p < 0.05). ConclusionEffective scar reduction was achieved using combination laser treatment, with significant improvement in multiple observer- and patient-reported outcomes. The shorter treatment period of the combination method can be a merit, as prolonged hypertrophic scars may increase morbidity. Nonetheless, cautious treatment protocols are necessary to avoid undesirable sequelae related to laser application.