Carbon Dioxide Laser Ablation Research Articles

Light and laser therapies for the treatment of sebaceous gland hyperplasia a review of the literature.

Sebaceous gland hyperplasia (SGH) is a benign cutaneous condition that presents primarily on the face and increases with UVB exposure and ageing. These lesions are a common cosmetic concern but are difficult to treat, as the entire sebaceous gland needs to be destroyed to prevent recurrence. Traditional methods of treatment include: cryosurgery, electrodessication, curettage, shave excision and topical trichloroacetic acid. These methods have an increased risk of skin discoloration and scarring to the area of treatment that may lead to inferior cosmetic outcomes. Alternatively, oral isotretinoin can treat SGH, but is a known teratogen in pregnancy and has high relapse rates with discontinuation. A systematic review of the literature was performed to look at photodynamic therapy (PDT) and laser treatment for SGH. According to the results of this study, PDT, lasers and combinations of the two treatments were found to offer alternatives to the more conventional techniques with better outcomes. In particular, the use of wavelength-specific laser for the sebaceous gland of 1720nm were found to have better outcomes and provide minimal damage to surrounding tissues. Additionally, combination PDT with aminolevulinic acid and pre-treatment with carbon dioxide laser ablation or pulse-dyed laser offered higher cure rates over stand-alone laser or PDT treatments in a shorter number of sessions with similar transient side-effects. However, further large-scale prospective studies with adequate follow-up are required to confirm these findings and those for sebaceous gland-specific lasers.

Treatment of Neurofibromas with a Carbon Dioxide Laser: A Retrospective Cross-Sectional Study of 106 Patients

Background: Few studies have evaluated the efficacy of carbon dioxide (CO₂) laser ablation for treating neurofibromatosis type 1 (NF1). Objective: To evaluate laser treatment safety and patient satisfaction at the French National Referral Centre for Neurofibromatosis. Methods: Retrospective survey with a specific questionnaire. The principal outcome measures included pain evaluation and assessments of treatment safety. Results: We included 106 patients, 70% of whom had more than 50 neurofibromas. Laser treatment was performed mostly for aesthetic reasons, or due to pain, recurrent local trauma or familial influence, under a local anaesthetic, during outpatient visits. The mean pain score was 4.0 ± 2.7 during the administration of local anaesthesia, 2.4 ± 2.1 during laser treatment and <2 48 h after treatment in 56% of cases. The mean satisfaction score for the treatment was 4.6 ± 3.4 and was not associated with disease phenotype. Conclusions: CO₂ laser treatment for NF could be considered more frequently and might help to decrease the social impact of the disease.

Successful treatment of multiple cutaneous leiomyomas with carbon dioxide laser ablation.

Successful treatment of multiple cutaneous leiomyomas with carbon dioxide laser ablation.

Acquired lymphangiectasis following surgery and radiotherapy of breast cancer.

Acquired lymphangiectasia (AL) is a significant and rare complication of surgery and radiotherapy. We report lymphangiectasia in a 40-year-old woman who had undergone radical mastectomy and radiotherapy. After 4 years of combined therapy, she developed multiple vesicles and bullae. Skin biopsy confirmed the diagnosis of lymphangiectasia. The case is unique as it is not associated with lymphedema, which is a usual accompaniment of lymphangiectasia following surgery and radiotherapy. AL is usually asymptomatic, but trauma may cause recurrent cellulitis. Treatment modalities include electrodessication, surgical excision, sclerotherapy and carbon dioxide laser ablation.

Preliminary study of intralesional bleomycin injection for the treatment of genital warts.

Preliminary study of intralesional bleomycin injection for the treatment of genital warts.

Ultrapulse carbon dioxide laser ablation of xanthelasma palpebrarum: A case series

Context:Xanthelasma palpebrarum is the most common form of xanthomas. Albeit a benign entity, it is cosmetically disturbing and a frequently recurring dermatologic referral. Although the classical treatment option remains surgical excision, alternatively, chemical cauterization, cryosurgery and electrofulguration have all been tried in the past with mixed results. The use of laser systems such as carbon dioxide laser, Erb:YAG laser, Q-switched Nd:YAG laser, diode laser, pulsed dye laser and KTP laser have become popular in the treatment of these lesions. Recent literature suggests minimal pigmentary changes and scarring with the use of ultrapulse carbon dioxide laser treatment of these lesions.Aim:To study and evaluate the effectiveness of ultrapulse carbon dioxide laser ablation for treatment of xanthelasma palpebrarum.Materials and Methods:10 patients presenting with bilateral xanthelasma palpebrarum, new and with recurrence were studied for results after a single treatment with ultrapulse carbon dioxide laser (10,600 nm; 100-200 Hz; 200-400 μsec). The follow-up time was 9 months.Results:All lesions were treatable with a single-laser treatment session. Two patients (20%) developed recurrence during the follow-up period. Side effects included post inflammatory hyperpigmentation in two patients (20%), but no visible scarring was observed.Conclusions:The ultrapulse carbon dioxide laser is an effective and safe therapeutic alternative in treatment of xanthelasma palpebrarum.

The safe delivery of fractional ablative carbon dioxide laser treatment for acne scars in Asian patients receiving oral isotretinoin.

Because acne scarring is associated with substantially reduced quality of life, early initiation of effective treatment is desirable. In previous reports, isotretinoin treatment was associated with increased scarring after cosmetic procedures, such as laser treatment, dermabrasion, and chemical peeling. To evaluate wound healing after ablative carbon dioxide (CO2) fractional resurfacing for acne scarring conducted during and/or within 1 to 3 months of oral isotretinoin treatment. The records of 20 patients with facial acne scars were included in this retrospective study. All patients were receiving isotretinoin treatment or had completed it within the previous 1 to 3 months. All patients received full-face fractional ablative CO2 laser treatment. Follow-up was for at least 6 months to evaluate side effects. All patients showed normal reepithelialization and were satisfied with the results of the laser treatments. All adverse events were minor, and there were no hypertrophic scars or keloids. Ablative CO2 fractional laser treatment for acne scarring seems to be safe regardless of isotretinoin use (10-60 mg/d). The authors' findings contribute to the discussion of whether oral isotretinoin treatment impairs wound healing after ablative laser treatment.

Observation of In vivo Morphologic Changes after Carbon Dioxide Ablative Fractional Laser in a Mouse Model Using Noninvasive Imaging Modalities and Comparison with Histologic Examination

Ablative fractional carbon dioxide (CO2) lasers have been widely used for several types of cosmetic dermatosis. A number of previous studies have evaluated this technique in animals or human beings by observing morphologic changes using an invasive modality such as skin biopsy. In this study, we assessed in vivo skin changes after CO2 ablative fractional laser treatment in a mouse model using noninvasive imaging modalities (Folliscope(®) and Visioscan 98(®)), and each results was compared with data from histologic examination. An ablative fractional CO2 laser was applied with different pulse energy between 7 to 35 mJ/microspot. As results of above methods, we also confirmed that the CO2 ablative fractional laser generated injuries with increasing width and depth with increasing pulse energy. Although numerous papers have described application of this laser in vivo skin specimens, our study evaluated the feasibility of using relative noninvasive imaging modalities for assessing the outcome of laser ablation. Based on our data, we suggest that these technologies may be useful alternative modalities for assessing laser ablation that are easier to perform and less invasive than skin biopsy.

Subcutaneous metastases from melanoma: a discussion of clinical experience.

The majority of locoregional relapses of cutaneous melanoma occur as subcutaneous local recurrences/in-transit metastases; subcutaneous metastases (SMs) are also common in distant metastases. SM therapy is challenging and depends on the number, site, depth, size, clinical behavior and presence of other metastases. Isolated, resectable SMs should be treated surgically. In multiple/unresectable lesions, several local modalities are used: carbon dioxide laser ablation, radiotherapy, cryotherapy, intralesional injections and electrochemotherapy. Hyperthermic isolated limb perfusion is the preferred method of treating multiple, bulky in-transit metastases in extremities, allowing for high response rates and long-lasting remission. Electrochemotherapy is a simple method for the fast ablation of SMs that are not feasible for hyperthermic isolated limb perfusion. Recent advances in systemic therapy of melanoma, including immunotherapy (anti-CTLA4/anti-PD-1) and targeted therapy (BRAF/MEK inhibitors), have significantly impacted on SM treatment. We present our own SM cases treated with different modalities. The future of SM therapy will rely on a combination of different local, locoregional and systemic modalities, and we can expect major improvements in long-term outcomes.

Lesion-directed treatment for actinic keratoses.

ORIGINAL ARTICLE, p 1114 Actinic keratoses represent a significant and increasing burden on healthcare systems in many parts of the world. For such a common problem, significant uncertainties still exist over their management. It is generally accepted that a number of actinic keratoses may progress to squamous cell carcinoma,1 but incontrovertible evidence that their treatment reduces the risk is lacking. Nevertheless, there is a widely held belief among many clinicians that treatment of individual actinic keratoses is worthwhile for risk prevention or simply because many of these lesions are symptomatic or of cosmetic concern. Several treatment guidelines list both cryotherapy and the carbon dioxide laser among treatment options,2 3 although evidence of efficacy for the latter has been scarce to date.4 In this issue of BJD, Zane et al.5 provide us with a welcome addition to the comparative data on lesion‐directed treatments for actinic keratoses. In a randomized comparison of cryotherapy and carbon dioxide laser ablation, they demonstrated overall equivalent lesion clearance rates at 3 months of 78·2% and 72·4%, respectively, although thicker lesions responded significantly better to cryotherapy at this time point (cryotherapy 80·2%, laser treatment 59·8%). However, at 12 months, of the lesions apparently clear at 3 months, significantly fewer remained clear in the carbon dioxide laser arm (37%) than with cryotherapy (66·8%).

Cavernous Hemangioma of the Uterine Cervix Treated with Carbon Dioxide Laser Ablation

Abstract Background: Hemangiomas of the uterine cervix are extremely rare benign gynecologic tumors. Approximately 50 cases have been described worldwide. This article describes a unique case of a large cervical hemangioma treated surgically with carbon-dioxide laser ablation. Case: A 23-year-old, nulliparous Caucasian woman presented with complaints of postcoital bleeding and dyspareunia. On physical examination, a large expophytic purple mass extending from the anterior lip of the cervix to the posterior fornix was noted. The patient underwent an examination under anesthesia with cervical biopsies and laser ablation. Final pathology revealed a cervical cavernous hemangioma. Results: The patient's vaginal bleeding and dyspareunia were reduced postoperatively. Conclusions: Cervical hemangiomas may be asymptomatic or may present with postcoital or intermenstrual bleeding and should be considered as part of the differential diagnosis for abnormal uterine bleeding. Conservative management options include loc...

Design and Fabrication of Low-Cost 1536-Chamber Microfluidic Microarrays for Mood-Disorders-Related Serological Studies

Mood disorders are common mental diseases, but physiological diagnostic methods are still lacking. Since much evidence has implied a relationship between mood disorders and the protein composition of blood sera, it is conceivable to develop a serological criterion for assisting diagnosis of mood disorders, based on a correlative database with enough capacity and high quality. In this pilot study, a low-cost microfluidic microarray device for quantifying at most 384 serological biomarkers at the same time was designed for the data acquisition of the serological study. The 1,536-chamber microfluidic device was modeled on a 1,536-well microtiter plate in order to employ a common microplate reader as the detection module for measuring the chemiluminescent immunoassay tests on the chips. The microfluidic microarrays were rapidly fabricated on polymethylmethacrylate slides using carbon dioxide laser ablation, followed by effective surface treatment processing. Sixteen types of different capture antibodies were immobilized on the chips to test the corresponding hormones and cytokines. The preliminary tests indicated that the signal-to-noise ratio and the limit of detection of microfluidic microarrays have reached the level of standard ELISA tests, whereas the operation time of microfluidic microarrays was sharply reduced.

Fractionated ablative carbon dioxide laser for the treatment of rhinophyma

Rhinophyma is a progressive and disfiguring proliferative disorder of the nose, which is related to chronic rosacea. Many different treatment modalities have been utilized both alone and in combination including: loop cautery, CO2 laser, argon laser, dermabrasion, cryotherapy, radiotherapy, full-thickness excision, skin graft, flap reconstruction, and cold scalpel. CO2 resurfacing has been considered first line therapy but is often associated with a shiny, scarred appearance, with patulous pores, and with loss of pigmentation. We report a technique using aggressive parameters with the fractionated ablative CO2 laser, resulting in improvement of appearance with very few complications. Five patients who presented with rhinophyma of varying degrees were treated with a series of fractional ablative CO2 laser treatments (Fraxel re:Pair, Solta Medical, Hayward, CA). These patients were treated with settings of up to 70 mJ, 70% density and 16-18 passes. All patients received HSV prophylaxis using either acyclovir 400 mg TID or valacyclovir 500 mg BID. Patients were rendered anesthetic by 1% lidocaine and epinephrine regional perinasal nerve block. All of the patients tolerated the procedure well with reepithelialization at days 4-7 and self-limited edema and erythema. Patients with relatively early to moderate signs of rhinophyma proved optimal candidates for this treatment. There were no adverse events. Patients and physicians noted significant improvement and reduction in the rhinophyma without the typical scarring noted with most other treatments. Rhinophyma treated with fractionated ablative CO2 laser using relatively aggressive parameters achieved good cosmetic outcomes in this group of early to moderate cases of rhinophyma, while still retaining the benefits of a fractionated treatment such as faster healing times and fewer adverse events.

Photodynamic therapy combined with cryotherapy for the treatment of nodular basal cell carcinoma

Carbon dioxide (CO2) laser ablation in combination with photodynamic therapy (PDT) has previously been successfully used to treat superficial basal cell carcinoma (BCC). However, the efficacy of this treatment modality is limited in the treatment of deeper lesions and the more aggressive subtypes of BCC. In order to improve the outcome of PDT, 8 BCC lesions of variable depths (4 lesions ≤2 mm and 4 lesions >2 mm) and subtypes (1 superficial, 6 nodular and 1 infiltrative) were treated with CO2 laser ablation in combination with PDT, followed by modified cryotherapy. The mean number of treatment sessions was 1.5 and the follow-up period was 22 months. All of the patients demonstrated a complete response and no recurrence of disease, while the majority of patients were satisfied with the cosmetic results upon follow-up examination. The combination therapy of CO2 laser ablation with PDT followed by modified cryotherapy demonstrated a good efficacy and satisfactory cosmetic outcomes in the treatment of nodular BCC.

Treatment of Lymphangioma Circumscriptum Using Fractional Carbon Dioxide Laser Ablation

Lymphangioma circumscriptum remains a challenging entity to treat given anatomic considerations and a significant tendency for recurrence regardless of the modality selected. Surgical excision offers the greatest potential for definitive management but is often beset by procedural morbidity and suboptimal cosmetic outcomes. A range of palliative options have been reported for the treatment of lymphangioma circumscriptum, with varying degrees of associated efficacy and morbidity. This report describes the novel use of fractional carbon dioxide laser ablation for the treatment of lymphangioma circumscriptum, with promising cosmetic results and durable symptomatic relief.

In vivo study of necrosis on the liver tissue of Wistar rats: a combination of photodynamic therapy and carbon dioxide laser ablation

Photodynamic therapy (PDT) is known to be limited to applications in large volume tumors due to its limited penetration. Therefore, a combination of PDT and carbon dioxide (CO2) laser ablation may constitute a potential protocol to destroy bulk tumors because it involves an association of these two techniques allowing the removal of visible lesions with a high selectivity of destruction of remnant tumors. The main aim of this study is to investigate the most appropriate procedure to combine use of a CO2 laser and PDT on livers of healthy rats, and to analyze different techniques of this treatment using three types of photosensitizers (PSs). Forty eight animals were separated to form six groups: (1) only CO2 laser ablation, (2) drug and CO2 laser ablation, (3) only PDT, (4) drug and light (PDT) followed by CO2 laser ablation, (5) ablated with CO2 laser followed by PDT, and (6) drug followed by CO2 laser ablation and light. For each group, three types of photosensitization were used: topical 5-aminolevulinic acid (ALA), intravenous ALA and intravenous Photogem®. Thirty hours after the treatments, the animals were sacrificed and the livers removed. The depth of necrosis was analyzed and measured, considering microscopic and macroscopic aspects. The results show that the effects of the PDT were considerably enhanced when combined with CO2 laser ablation, especially when the PDT was performed before the CO2 laser ablation.

A Pilot Split-Face Study Comparing Conventional Methyl Aminolevulinate-Photodynamic Therapy (PDT) With Microneedling-Assisted PDT on Actinically Damaged Skin

Topical photodynamic therapy (PDT) is an approved treatment for superficial nonmelanoma skin cancers. To enhance photosensitizer penetration into the epidermis, microneedling (MN) devices or ablative carbon dioxide lasers are combined with PDT. To compare the efficacy and safety of MN-assisted PDT with that of conventional PDT in human skin field cancerization. Ten patients with multiple actinic keratoses (AKs) and photodamage were randomized to receive conventional methyl aminolevulinate (MAL) with previous gentle curettage on one side of the face and MAL-PDT combined with 1.5-mm-length MN on the other side after MAL application. After a 90-minute incubation, patients were illuminated with a red light-emitting diode and evaluated for improvement of photodamage, clearance of AKs, and side effects before and after 30 and 90days. At day 30, global scores for photodamage, mottled pigmentation, roughness, and sallowness improved on both sides (p<.05), but fine lines improved only on the MN-PDT side (p=.004). At day 90, facial erythema (p=.04) and coarse wrinkles (p=.002) also improved on the MN-PDT side, in addition to fine lines for conventional MAL-PDT (p=.01). Erythema (p=.009), edema (p=.01), crusting (p=.01), and pain (p=.004) were more common and intense on the MN-PDT side. One patient developed a secondary bacterial infection at day 7 on the MN-PDT side. Average AK clearance was 88.3%, with no difference between the sides. Microneedling-assisted PDT is a safe and effective method and can produce superior cosmetic results to conventional MAL-PDT for improving photodamaged skin. Further larger prospective studies are needed to determine whether the addition of MN decreases actinic keratosis.

Laser Earlobe Revision

Earlobe tears and disfigurement often result from prolonged pierced earring use and trauma. They are a common cosmetic complaint for which surgical reconstruction has often been advocated. A series of 10 patients with earlobe tears or disfigurement treated using straight-line closure, carbon dioxide (CO2 ) laser ablation, or both are described. A succinct literature review of torn earlobe repair is provided. Successful repair with excellent cosmesis of torn and disfigured earlobes was obtained after straight-line surgical closure, CO2 laser ablation, or both. A minimally invasive earlobe repair technique that involves concomitant surgical closure and CO2 laser skin vaporization produces excellent cosmetic results for torn or disfigured earlobes.

Retrospective analysis of earlobe keloids treated with the carbon dioxide laser ablation or cold steel debulking surgery

Background: Treatment of keloids is a therapeutic challenge. Objectives: To determine the outcome and the risk of recurrence after debulking cold steel surgery or carbon dioxide (CO2) laser ablation of earlobe keloids. Material and methods: The case records of 16 patients with earlobe keloids managed at Changi General Hospital, Singapore, from 2003 to 2009 were reviewed retrospectively. Results: Fourteen patients were females, and the mean age at presentation was 20 years. Eight patients underwent CO2 laser ablation, six patients underwent cold steel surgery, one patient underwent both surgery and CO2 laser ablation, and one patient received only 40 mg/ml of intralesional triamcinolone acetonide. Fourteen patients were followed up for 1–24 months post procedure, and two patients defaulted. Both modalities were equally effective in debulking the earlobe keloids. All 13 patients who had either CO2 laser ablation or cold steel surgery had recurrence of keloid growth at 2–18 weeks post procedure. The patient who received intralesional triamcinolone acetonide therapy alone had only partial response to the therapy. Conclusions: Both the CO2 laser ablation and cold steel surgery were equally useful in reducing the size of the earlobe keloids, but were not effective in preventing regrowth of the keloids, even with adjunctive intralesional steroids. Patients should be clearly counselled regarding this.

Plasmoacanthomas at both angles of mouth treated with carbon dioxide laser ablation

The Journal of DermatologyVolume 40, Issue 3 p. 217-219 Letter to the Editor Plasmoacanthomas at both angles of mouth treated with carbon dioxide laser ablation Hyun Soo ROH, Hyun Soo ROH Department of Dermatology, College of Medicine, University of Hanyang, Seoul, KoreaSearch for more papers by this authorMyeong Gil JEONG, Myeong Gil JEONG Department of Dermatology, College of Medicine, University of Hanyang, Seoul, KoreaSearch for more papers by this authorWon Jun CHOI, Won Jun CHOI Department of Dermatology, College of Medicine, University of Hanyang, Seoul, KoreaSearch for more papers by this authorMihn Sook JUE, Mihn Sook JUE Department of Dermatology, College of Medicine, University of Hanyang, Seoul, KoreaSearch for more papers by this authorJoo Yeon KO, Joo Yeon KO Department of Dermatology, College of Medicine, University of Hanyang, Seoul, KoreaSearch for more papers by this authorYoung Suck RO, Corresponding Author Young Suck RO Department of Dermatology, College of Medicine, University of Hanyang, Seoul, KoreaCorrespondence: Young Suck Ro, M.D., Ph.D., Department of Dermatology, Hanyang University Hospital, 17 Heangdang-dong, Sungdong-gu, Seoul 133-792, Korea. Email: [email protected]Search for more papers by this author Hyun Soo ROH, Hyun Soo ROH Department of Dermatology, College of Medicine, University of Hanyang, Seoul, KoreaSearch for more papers by this authorMyeong Gil JEONG, Myeong Gil JEONG Department of Dermatology, College of Medicine, University of Hanyang, Seoul, KoreaSearch for more papers by this authorWon Jun CHOI, Won Jun CHOI Department of Dermatology, College of Medicine, University of Hanyang, Seoul, KoreaSearch for more papers by this authorMihn Sook JUE, Mihn Sook JUE Department of Dermatology, College of Medicine, University of Hanyang, Seoul, KoreaSearch for more papers by this authorJoo Yeon KO, Joo Yeon KO Department of Dermatology, College of Medicine, University of Hanyang, Seoul, KoreaSearch for more papers by this authorYoung Suck RO, Corresponding Author Young Suck RO Department of Dermatology, College of Medicine, University of Hanyang, Seoul, KoreaCorrespondence: Young Suck Ro, M.D., Ph.D., Department of Dermatology, Hanyang University Hospital, 17 Heangdang-dong, Sungdong-gu, Seoul 133-792, Korea. Email: [email protected]Search for more papers by this author First published: 07 January 2013 https://doi.org/10.1111/1346-8138.12054Citations: 1 Funding source: none. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume40, Issue3March 2013Pages 217-219 RelatedInformation