Carbon Dioxide Laser Therapy Research Articles

Safety of Cosmetic Dermatologic Procedures During Pregnancy

Safety of cosmetic procedures in pregnant women has not been extensively studied. Maternal and fetal health risks are important to consider in any procedure performed. With the increasing popularity of cosmetic procedures, dermatologic surgeons will be faced with scenarios necessitating knowledge regarding the safety of such procedures during pregnancy. Furthermore, dermatologic surgeons may inadvertently perform cosmetic procedures during the first trimester, before the patient is aware of the pregnancy. To investigate the safety of cosmetic procedures during pregnancy and the postpartum period. A literature search of PubMed and Google Scholar was conducted of all English-language articles published from 1960 through 2012. Definitive recommendations on the safety of procedures such as chemical peels, injectables, fillers, and most laser therapies during pregnancy cannot be made. The safety of onabotulinum toxin usage is well documented in the neurology literature, although isolated events of miscarriage have been reported with high doses of toxin in women with a previous history of miscarriage. Carbon dioxide laser therapy for genital condylomas has considerable evidence supporting its safety during pregnancy. There is a lack of controlled trials addressing the safety of cosmetic procedures during pregnancy and postpartum periods. It is advisable to delay elective cosmetic procedures until after the baby is born.

Confocal laser scanning microscopy and optical coherence tomography for the evaluation of the kinetics and quantification of wound healing after fractional laser therapy

Information on the course of wound healing after fractional carbon-dioxide laser therapy has so far been gathered by histopathology. Confocal laser scanning microscopy (CLSM) and optical coherence tomography (OCT) allow the visualization of the upper layers of the skin invivo over time. The aim of this study was to determine whether CLSM and OCT can be used to quantify the kinetics of the dynamic wound-healing process. Twenty healthy probands were treated with fractional carbon-dioxide laser with 8- and 16-W laser power, respectively. Optical follow-ups using CLSM and OCT were performed right after laser application and during the next 3 weeks. Although wound healing seems to be completed after day 7 to 14 clinically, on day 21 in 89.5% of the 8 W-treated areas and in 100% of the 16 W-treated areas subepidermal skin damage was still visible using CLSM and OCT imaging. The maximal penetration depth of CLSM is limited to the papillary dermis, whereas OCT can visualize deeper but with lower resolution. Invivo CLSM and OCT are able to visualize changes after fractional laser treatment noninvasively. They allow especially the detection and quantification of substance defects and thereby help to elucidate the therapeutic effects.

Carbon Dioxide Laser Treatment in Hailey-Hailey Disease: A Series of 8 Patients

BackgroundHailey-Hailey disease (HHD), or benign familial pemphigus, is a rare autosomal dominant genodermatosis characterized by the formation of blisters. Eruptions are usually located in large skin folds, and when blisters become infected the condition can be very painful and disabling. HHD is difficult to treat. Many topical and systemic treatments have been used to bring exacerbations under control, but none have achieved medium- to long-term remission. Patients and methodsRetrospective study of 8 patients with HHD treated with carbon dioxide laser therapy in our hospital between 1999 and 2011. The patients’ mean age was 50.7 years. The 4 men and 4 women were followed for between 1 and 12 years. ResultsSatisfactory outcomes were achieved for 6 of the patients. Clinical improvement was observed in more than 75% of the affected area in 4 patients and in 50% to 75% of the area in 2 patients. The effect of treatments was maintained over time. The poorest outcomes were observed in patients treated at lower potencies. When blistering recurred after treatment, a second laser session achieved a good response. We observed no adverse events other than slight changes in skin texture and pigmentation. ConclusionsCarbon dioxide laser therapy was safe and effective in producing medium- to long-term improvement in HHD symptoms that were refractory to conventional treatments.

Tratamiento de la enfermedad de Hailey-Hailey con láser de dióxido de carbono: tratamiento en 8 pacientes

Introduction and objectivesHailey-Hailey disease (HHD), or benign familial pemphigus, is a rare autosomal dominant genodermatosis characterized by the formation of blisters. Eruptions are usually located in large skin folds, and when blisters become infected the condition can be very painful and disabling. HHD is difficult to treat. Many topical and systemic treatments have been used to bring exacerbations under control, but none have achieved medium- to long-term remission. Patients and methodsRetrospective study of 8 patients with HHD treated with carbon dioxide laser therapy in our hospital between 1999 and 2011. The patients’ mean age was 50.7 years. The 4 men and 4 women were followed for between 1 and 12 years. ResultsSatisfactory outcomes were achieved for 6 of the patients. Clinical improvement was observed in more than 75% of the affected area in 4 patients and in 50% to 75% of the area in 2 patients. The effect of treatments was maintained over time. The poorest outcomes were observed in patients treated at lower potencies. When blistering recurred after treatment, a second laser session achieved a good response. We observed no adverse events other than slight changes in skin texture and pigmentation. ConclusionsCarbon dioxide laser therapy was safe and effective in producing medium- to long-term improvement in HHD symptoms that were refractory to conventional treatments.

Carbon Dioxide Laser Treatment of Epidermal Nevi: Response and Long-Term Follow-Up

Background and objectivesEpidermal nevi, which are benign skin growths, have been treated using a range of approaches, with varying results. Topical treatments are ineffective and, while surgical excision is a more definitive treatment, it causes scar formation. In recent decades, epidermal nevi have been treated with various types of laser therapy. We describe our experience with the use of carbon dioxide (CO2) laser therapy to treat epidermal nevi and inflammatory linear verrucous epidermal nevi (ILVEN). Patients and methodsTwenty patients (15 with epidermal nevi and 5 with ILVEN) underwent CO2 laser treatment at our hospital between 2002 and 2010. ResultsResponse was good (>50% reduction in lesion size) in 50% of cases and excellent (>75% reduction) in 30%. A greater resistance to treatment was observed in patients with ILVEN (only 40% had a good response). Long-term follow-up (at least 18 months) showed a recurrence rate of 30%. The side effects were hypopigmentation (25% of patients) and scarring (20%). ConclusionsWe consider CO2 laser therapy to be the treatment of choice for epidermal nevi as it is well tolerated and has proven to be safe and effective in the long term. While the response in patients with ILVEN was limited, CO2 laser therapy might be a good option for selected cases or for palliative treatment since no other treatments have yet proven effective in this setting.

A split-face comparison of a fractional microneedle radiofrequency device and fractional carbon dioxide laser therapy in acne patients

Background: A number of lasers and light-based devices have been reported as promising treatment options for acne vulgaris. Objective: To evaluate the efficacy and safety of fractional microneedle radiofrequency (MRF) device treatment compared to CO2 fractional laser system (FS) for the treatment of acne vulgaris. Methods: Twenty healthy subjects underwent full-face treatment for acne vulgaris with CO2 FS and MRF device. For each subject, two passes of CO2 FS with a pulse energy setting of 80 mJ and a density of 100 spots/cm2 were used on one side, and two passes of MRF device with a intensity of 8, density of 25 MTZ/cm2, and a depth of 1.5–2.5 mm were used on the other. Patients were evaluated 3 months postoperatively and were also photographed. Results: Most of the patients improved based on clinical and photographic assessments 3 months after the treatment. No significant differences in physician-measured parameters, patient ratings, or intraoperative pain ratings were found, although downtime was significantly longer for the CO2 FS treated side. Conclusions: MRF device and CO2 FS can be used for acne vulgaris patients and MRF device is more convenient than CO2 FS because of its short downtime.

Effective Treatment of Nodular Amyloidosis with Carbon Dioxide Laser

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. 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. 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. 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.

Nevos epidérmicos tratados con láser de CO2: respuesta y seguimiento a largo plazo

Background and objectivesEpidermal nevi, which are benign skin growths, have been treated using a range of approaches, with varying results. Topical treatments are ineffective and, while surgical excision is a more definitive treatment, it causes scar formation. In recent decades, epidermal nevi have been treated with various types of laser therapy. We describe our experience with the use of carbon dioxide (CO2) laser therapy to treat epidermal nevi and inflammatory linear verrucous epidermal nevi (ILVEN). Patients and methodsTwenty patients (15 with epidermal nevi and 5 with ILVEN) underwent CO2 laser treatment at our hospital between 2002 and 2010. ResultsResponse was good (>50% reduction in lesion size) in 50% of cases and excellent (>75% reduction) in 30%. A greater resistance to treatment was observed in patients with ILVEN (only 40% had a good response). Long-term follow-up (at least 18 months) showed a recurrence rate of 30%. The side effects were hypopigmentation (25% of patients) and scarring (20%). ConclusionsWe consider CO2 laser therapy to be the treatment of choice for epidermal nevi as it is well tolerated and has proven to be safe and effective in the long term. While the response in patients with ILVEN was limited, CO2 laser therapy might be a good option for selected cases or for palliative treatment since no other treatments have yet proven effective in this setting.

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Combination treatment by 10 600 nm ablative fractional carbon dioxide laser and narrowband ultraviolet B in refractory nonsegmental vitiligo: a prospective, randomized half-body comparative study

Vitiligo is a common acquired depigmentation disorder caused by the loss of melanocytes. Despite the numerous treatment modalities available for vitiligo, responses to treatment are still unsatisfactory. For this reason, new treatment modalities and approaches are needed. To investigate the effects of fractional carbon dioxide (CO(2) ) laser therapy followed by systemic narrowband ultraviolet B (NB-UVB) phototherapy on nonsegmental vitiligo (NSV) as a prospective and randomized left-right comparative study. Ten patients with NSV who presented symmetrical vitiligo lesions with no further improvement despite more than 1 year of conventional treatment were enrolled. Two sessions of half-body fractional CO(2) laser therapy were performed at a 2-month interval. NB-UVB phototherapy was then administered to the entire body 5 days after each fractional laser treatment twice a week, increasing the dose incrementally by 15% at each session. Objective clinical assessments were made by two blinded dermatologists using a quartile grading scale, and the patients' overall satisfaction was evaluated using a 10-point visual analogue scale. Two months after the last treatment, mean improvement scores, assessed by physicians, were significantly higher for those treated with half-body fractional CO(2) laser therapy followed by NB-UVB phototherapy, compared with those treated with NB-UVB alone (P=0·034). In addition, according to subjective assessment, the half-body laser treatment followed by NB-UVB showed significantly higher improvements compared with NB-UVB treatment alone (P=0·023). Noticeable adverse events, such as infection, scarring and Koebner phenomenon, were not found in any patient. This study suggests that fractional CO(2) laser therapy followed by NB-UVB phototherapy could be used effectively and safely as an alternative modality for the treatment of refractory vitiligo.

Induction of De Novo Hair Regeneration in Scars After Fractionated Carbon Dioxide Laser Therapy in Three Patients

Induction of De Novo Hair Regeneration in Scars After Fractionated Carbon Dioxide Laser Therapy in Three Patients

Carbon Dioxide Laser Therapy Using Various Irradiation Methods for the Treatment of Cutaneous Disorders

Carbon Dioxide Laser Therapy Using Various Irradiation Methods for the Treatment of Cutaneous Disorders

Combination of Carbon Dioxide Laser Therapy and Artificial Dermis Application in Plantar Warts: Human Papillomavirus DNA Analysis after Treatment

Various laser therapies have been used to treat viral warts, and numerous successful results have been reported, but plantar warts are notoriously difficult to treat and eradicate. This study included 35 lesions in 31 patients (17 female, 14 male) with plantar warts. We used a carbon dioxide (CO₂) laser for incisions, and the defect was covered with artificial dermis. Follow-up periods ranged from 3 to 12 months. Overall, we examined the presence or absence of human papillomaviruses (HPVs) DNA in the lesional skin of all cases and at the excisional site after treatment in 20 cases. Thirty-one of 35 lesions (88.6%) achieved complete clearance after one treatment session. We observed local recurrence in four lesions (11.4%). The application of salicylic acid was effective in treating minor recurrent cases. After complete remission, HPV DNA was not detected in the upper epidermis of the postoperative site. No significant scars or severe pain were seen in any patients. A combination of CO₂ laser therapy and artificial dermis application effectively treated the majority of plantar warts after one treatment, with complete and rapid clearance and no persistent pain. The authors have indicated no significant interest with commercial supporters.

Microcystic Lymphatic Malformations of the Tongue

To describe a classification of microcystic lymphatic malformations of the tongue and to investigate different treatment methods. Retrospective review of patients treated for microcystic lymphatic malformations of the tongue. Lymphatic malformations were classified into the following 4 groups according to their extent: isolated superficial microcystic lymphatic malformations of the tongue (stage I); isolated lymphatic malformations of the tongue with muscle involvement (stage II; stage IIA, involving a part of the tongue; stage IIB, involving the entire tongue); microcystic lymphatic malformations of the tongue and the floor of mouth (stage III); and extensive microcystic lymphatic malformations involving the tongue, floor of mouth, and further cervical structures (stage IV). Twenty patients with microcystic lymphatic malformation of the tongue. Medical records were reviewed for demographic data and extent and treatment of the lymphatic malformations. Three patients had stage I disease; 5 patients, stage II; 3 patients, stage III; and 9 patients, stage IV. In 6 patients, the lymphatic malformations could be completely removed by carbon dioxide laser surgery; the remaining 13 patients had persistent disease. The initial stage seems to predict outcome. Carbon dioxide laser therapy provides good results primarily in stages I and IIA lymphatic malformations. In advanced lymphatic malformations (stages IIB, III, and IV), an interdisciplinary approach is necessary, because complete surgical excision is often impossible owing to the diffuse growth behavior, and therefore recurrence and persistence are common.

The effective treatment of basal cell carcinoma

Basal cell carcinoma (BCC) accounts for 75% of all skin cancers and its incidence is rising by between 3-8% each year (Szeimies and Karrer, 2006). As a result, the development of new therapeutic strategies and treatment methods for the removal of BCC is crucial in combating what is a growing problem. Surgical techniques, such as Mohs micrographic surgery, cryotherapy/cryosurgery, curettage and carbon dioxide laser therapy, as well as non-surgical techniques, such as radiotherapy, are recognized as potential options. The aim of this article is to critically review some of the current literature in order to substantiate the efficacy of destructive and non-surgical techniques as reliable alternatives to surgery for the management/removal of BCCs. The success rate, cosmetic outcome, pain and discomfort, recurrence rates, and the cost associated with each method are explored and discussed. Results of the review indicate that no one treatment is completely superior. According to the research, simple excision and Mohs micrographic surgery provide the lowest recurrence rates. However, in relation to success rates, patients tolerance of the treatment and cosmetic outcomes, and depending on the type of BCC involved, other treatment methods do offer reliable alternatives.

Obstructive sleep apnea syndrome in an adolescent girl with hypertrophic lingual thyroid

We present a 14-year-old girl whose initial diagnosis was obstructive sleep apnea syndrome (OSAS) with symptoms of habitual snore, sleep breath holding, shortness of breath, and lump in throat. Lingual thyroid was diagnosed by thyroid scan and histology, and was treated by radioactive iodine therapy and endoscopic carbon dioxide laser therapy. Her OSAS completely subsided after lingual thyroid surgery. Physicians should be aware of rare causes of OSAS in children, such as lingual thyroid and certainly if accompanied by difficulties in swallowing and speech problems.

Microdebrider resection of bilateral subglottic cysts in a pre-term infant: A novel approach

Acquired subglottic cysts are a rare cause of stridor in infants. The two major risk factors for development of these cysts are prematurity and history of intubation. Microlaryngeal decompression and carbon dioxide laser resection of these cysts have been the most common treatment methods with recurrence rates as high as 43% [J. Lim, W. Hellier, J. Harcourt, S. Leighton, D. Albert, Subglottic cysts: the Great Ormond Street experience, Int. J. Pediatr. Otorhinolaryngol. 67 (2003) 461-465]. Carbon dioxide laser therapy also carries the risk of airway fire, injury to adjacent structures, and possible delayed scarring. We present a case of bilateral subglottic cysts in a premature infant with progressive stridor, treated using a microdebrider, and review the literature regarding the treatment of these lesions.

Defocused CO2laser therapy in traumatic arthritis of the metacarpophalangeal joint: A randomized clinical study

AbstractA prospective, blinded, randomized and controlled study was conducted in horses with traumatic arthritis of the metacarpophalangeal joint in order to evaluate the efficacy of defocused carbon dioxide (CO2) laser therapy. Sixteen horses were randomly assigned to two groups: active laser (an output power of 16 W, scanned over 42 cm2, an average dose of 91 J cm− 2) and sham laser (the laser beam directed at the non-reflecting floor). All the horses received a total of five treatments during 1 week. The horses were evaluated with respect to the degree of initial lameness by conventional lameness examination and an objective accelerometer technique before the onset of treatment, and at 1 and 3 weeks. The concentrations of substance P (SP), prostaglandin E2(PGE2) and Met-enkephalin-Arg-Phe (MEAP) in synovial fluid were also assessed. Our study demonstrates that there was no significant difference in lameness score between the laser- and the sham-treated group before the treatment and at 1 and 3 weeks after the initial examination. Moreover, no significant difference in the concentrations of SP, PGE2and MEAP in synovial fluid in the active laser group compared with the sham-treated group was observed. In conclusion, this study suggests that treatment with defocused CO2laser in the management of traumatic arthritis of the metacarpophalangeal joint is not statistically better than sham treatment at reducing the grade of lameness as evaluated by conventional lameness examination and accelerometer technique.

A review of the surgical treatment of vulval lymphangioma and lymphangiectasia: four case reviews

To evaluate whether surgical management of vulval lymphoedema and/or lymphangiectasia conveys any longstanding patient benefit. A qualitative analysis of signs and symptoms that occurred before and after surgical treatment for vulval lymphoedema and/or lymphangiectasia was performed. This was done by analysis of patient notes and telephone conducted interview. From a hospital database search, four patients were found to have had surgical treatment--three for lymphangioma and one for lymphangiectasia. Overall there was a clear improvement in the signs and symptoms associated with these conditions. In particular, all patients reported an improvement (i.e. a reduction or elimination) in the amount of oedema following surgery. Carbon dioxide laser therapy and superficial radiotherapy have been previously described for the management of vulval lymphangioma and lymphangiectasia with limited success, whereas our data suggests surgery offers a more permanent solution. In particular, labial reduction seems to be more successful than methods such as lymphovenous anastomoses and lymphangioplasties. A single operation may provide benefit for up to ten years. This approach has the potential to allow patients to be rehabilitated to normal life and activity.

Antiangiogenic Therapy With Pioglitazone, Rofecoxib, and Trofosfamide in a Patient With Endemic Kaposi Sarcoma

Kaposi sarcoma (KS) in patients who are seronegative and seropositive for human immunodeficiency virus is currently the most common malignant tumor in central Africa. It accounts for 50% of all tumors reported in central African countries. Owing to the rising number of patients and the limitations of current therapies, there is an urgent demand for new strategies to treat KS. We describe a 42-year-old dark-skinned patient from Mozambique with endemic KS. The tumor was first diagnosed 8 years earlier when an ulcerated nodule appeared at his right ankle joint. Subsequently, multiple reddish brown nodules appeared on both feet and the left thigh. Results of dermatohistopathological analysis confirmed the diagnosis of KS. Topical therapies including cryotherapy, carbon-dioxide laser, and photodynamic therapy could not prevent new recurrences and further cutaneous dissemination. Therefore, a novel antiangiogenic systemic therapy was started that was previously shown to be effective in angiosarcomas other than KS. The regimen consists of the biomodulators pioglitazone hydrochloride and rofecoxib combined with a metronomic (daily) low-dose chemotherapy with trofosfamide. We observed a partial remission, which has been stable for 18 months. No significant toxic effects were observed. The suggested antiangiogenic strategy has the potential to become a cheap, practical, feasible alternative treatment for endemic KS, particularly suitable for the outpatient setting.