Carbon Dioxide Laser Treatment Research Articles

Treatment of Facial Hypopigmented Scars by the Laser Hole Technique Using a Nonfractional Carbon Dioxide Laser in Asians.

Facial hypopigmented scars are usually characterized by white color and a glossy surface. To correct the two problems simultaneously, the authors attempted to induce persistent postinflammatory hyperpigmentation for color and to build multiple pitted scars like facial skin pores for texture. This study describes a laser hole method using a traditional nonfractional carbon dioxide laser for treatment of facial hypopigmented scars and evaluates the clinical results. Forty-three facial hypopigmented scars in 27 patients were treated, excluding protruding or thick scars. A carbon dioxide laser was set in the superpulse mode by continuous delivery. Multiple small holes were made in the scar at a distance of 1 to 3 mm. Each laser hole was produced by continuously repeated shots at one point until the deep dermis was involved. All lesions were exposed without protection. At 1 or 2 months after initial treatment, the remaining hypopigmentation was treated by the same procedure. Treatment sessions were performed once for nine scars, twice for 22 scars, and three times for 12 scars. In most cases, postinflammatory hyperpigmentation was slightly diminished but maintained until the last follow-up. The fine irregular surface with multiple pitted scars was similar to that of normal skin. Scar improvement evaluation showed marked or excellent in 39 scars (90.7 percent) and minimal or partial in four deep or thick scars. The laser hole technique using a nonfractional carbon dioxide laser may be an excellent option for simultaneously treating the color and texture of superficial or thin hypopigmented facial scars in Asians.

The effects of recombinant human epidermal growth factor containing ointment on wound healing and post inflammatory hyperpigmentation prevention after fractional ablative skin resurfacing: A split-face randomized controlled study.

Epidermal growth factor (EGF) is one of the important peptides in wound healing process. The effects of EGF have been increasingly studied in various types of ulcers. However, data on postablative laser resurfacing wound is still limited. To evaluate the effects of the topical EGF ointment on wound healing process and postinflammatory hyperpigmentation (PIH) prevention after fractional ablative laser resurfacing. This is a randomized split-face study. Nineteen healthy subjects were enrolled and completed follow up protocol. Patients received single treatment of fractional carbon dioxide laser on both cheeks. After randomization, each patient was assigned to apply one side of the face with topical EGF ointment and another side with petrolatum. Wound healing was evaluated by duration of scab shedding, duration of postlaser erythema, erythema index, and transepidermal water loss on the daily follow up period of seven days after treatment. PIH was evaluated at 2, 3weeks and 1, 2months follow up by photographs and melanin index. Most of patients were female with Fitzpatrick skin phototype III to V. Comparing with control (petrolatum), EGF treated side showed no significant difference in duration of scab shedding, duration of postlaser erythema, erythema index, and transepidermal water loss (P-value=.58, .22, .78, and .51, respectively). Incidence of PIH was 52.6% on EGF side and 57.9% on petrolatum side, however, it was not statistically different (P=.56). The melanin index was also not different as well (P=.96). Topical EGF might provide significant wound healing stimulation for chronic wound more than acute wound. Further studies, especially in post laser wound or other cosmetic purposes are needed.

Effectiveness of modified transsection and longitudinal suture in epicanthoplasty

To introduce a modified transsection and longitudinal suture in epicanthoplasty and summarize its effectiveness. The clinical data of 119 patients underwent epicanthoplasty with modified transsection and longitudinal suture and with a follow-up time over 6 months between February 2014 and December 2016 were retrospectively analyzed. There were 8 males and 111 females with an average age of 22.7 years (range, 18-38 years). The epicanthus was as eyebrow type in 12 cases, as eyelid type in 57 cases, as tarsalis type in 39 cases, and as backward type in 11 cases. The narrow degree of epicanthus included mild (the lacrimal caruncle covered size was less than 1/3) in 42 cases, moderate (the lacrimal caruncle covered size was between 1/3 and 2/3) in 58 cases, and severe (the lacrimal caruncle covered size was over 2/3) in 19 cases. One hundred and thirteen patients were treated by blepharoplasty at the same time. The new canthus was located on the basis of the inner canthus physiological aesthetics. Through a short transverse incision, dislocated orbicularis oculi muscle near medial canthal ligament and the fiber between the medial canthal ligament and skin were completely released; then the medial canthal ligament was shortened precisely and the incision was tension-free sutured followed the Langer's line near eyes. All the incisions healed by first intention. All patients were followed up 6 months to 2 years (mean, 8.6 months). The bilateral hypertrophic scar on both bilateral medial canthal incisions happened in 3 patients at 3-6 months after operation; and the scarring gradually subsided at 10 months after the diprospan injections and the siliconegel and carbon dioxide laser treatment. Good effectiveness were obtained in the other patients, whose inner intercanthal distance significantly narrowed, both of the horizontal lid fissure length increased, the lacrimal caruncle fully exposed, and no obvious scar could be seen. The modified transsection and longitudinal suture in epicanthoplasty has the advantages of simple design, easy operation, minimally invasive, inconspicuous scar, and obvious, stable, and lasting postoperative effectiveness.

Ablative Fractional CO2 Laser for Facial Atrophic Acne Scars.

Ablative fractional carbon dioxide laser resurfacing is a well-established treatment for acne scars. However, there are limited consensus and guidelines regarding the procedure, such as its treatment plan, efficacy, and safety. In this study, we performed a systematic review to assess the efficacy and safety of the fractional carbon dioxide laser treatment procedure, and to provide evidence-based recommendations concerning its practical use on atrophic acne scars. A comprehensive search was performed in, EMBASE, Ovid, Web of Science, and Cochrane databases, using the keywords "scar(s)," "acne vulgaris," "carbon dioxide," and "fraction* laser(s)" for the period from January 1987 to December 2016. The initial literature search identified 337 articles. The final selection included 30 studies: 12 retrospective studies and 18 prospective randomized clinical trials. Ablative fractional carbon dioxide laser is an effective therapy for the treatment of acne scars. The treatment session, interval, and parameters should be customized for each patient. Combination therapy should be considered for ice-pick type acne scars. The use of dermocosmetics in pre- and postoperative care may be beneficial to patients.

Fractional ablative carbon-dioxide laser treatment improves histologic and clinical aspects of striae gravidarum: A prospective open label paired study

Fractional ablative carbon-dioxide laser treatment improves histologic and clinical aspects of striae gravidarum: A prospective open label paired study

Combination of platelet rich plasma in fractional carbon dioxide laser treatment increased clinical efficacy of for acne scar by enhancement of collagen production and modulation of laser-induced inflammation.

Platelet-rich plasma (PRP) which contains large amounts of growth factors has been tried to enhance therapeutic efficacy of laser treatment for acne scar with unknown underlying mechanism. The present study was conducted to investigate the molecular mechanism of increased clinical efficacy of PRP when combined with fractional laser treatment for treating acne scars. Subjects with mild to moderate acne scars were treated with two sessions of fractional CO2 laser therapy given with and without co-administration of PRP. Skin biopsy specimens were obtained at baseline, 1, 3, 7, and 28 days for investigation of molecular profiles associated with skin changes produced by laser plus PRP treatment. The PRP treatment increased clinical efficacy with decreased severity of adverse effects such as erythema, swelling and oozing. Productions of TGFβ1 and TGFβ3 proteins were more highly elevated on the PRP-treated side of the face compared to the control side at day 28. Furthermore, PRP-treated side showed significant increase of c-myc, TIMP, and HGF expression. Experimental fibroblast culture model was also used. PRP administration after laser irradiation increased expressions of p-Akt, TGFβ1, TGFβ3, β-catenin, collagen 1, and collagen 3 in both dose-dependent and time dependent manners in fibroblast. Moreover, we acquired clinical and histological data through randomized control clinical trial. Taken together with human study results combined with the data from cell experiments we suggest that PRP treatment increased fibrogenetic molecules induced by fractional CO2 laser, which have association with clinical effect. Lasers Surg. Med. 50:302-310, 2018. © 2017 Wiley Periodicals, Inc.

Carbon Dioxide Laser Treatment Using Methylene Blue–Assisted Sinus Tract Identification in Hidradenitis Suppurativa

Carbon Dioxide Laser Treatment Using Methylene Blue–Assisted Sinus Tract Identification in Hidradenitis Suppurativa

皮膚科・形成外科領域の炭酸ガスレーザー

皮膚科・形成外科領域の炭酸ガスレーザー

Carbon dioxide laser treatment of penile intraepithelial neoplasia

Introduction & objectiveThe non-invasive nature of penile intraepithelial neoplasia (PeIN) allows for curative penile sparing therapy and is recommended, in their guidelines, by the European Association of Urology (EAU). Treatment options include topical chemotherapy, immunotherapy, laser treatment, photodynamic therapy and surgical excision. Our primary aim was to evaluate the outcome of carbon dioxide (CO2) laser treatment of penile intraepithelial neoplasia. MethodsA retrospective review of 47 patients who underwent CO2 laser ablation of PeIN, from May 2008 to June 2015, in our tertiary referral centre was performed. All patients underwent acetic acid mapping and had their lesions ablated with a Lumenis Shaplan CO2 laser device. Patients had regular follow up and further suspicious areas underwent re-biopsy. ResultsForty-seven men had primary PeIN. After laser treatment, 8 men (17%) had a recurrence and the average time to recurrence was 19.4 months. Seven of the eight patients with recurrences, pathologically had further PeIN and one patient developed G1 pT1 disease. These patients underwent further laser treatment, glans resurfacing or local excision. No patients required penectomy. The average length of follow-up was 29 months (rg: 1–76). Penile cancer-specific survival was 100% and overall survival 98%. No patients required re-admission or developed other long-term complications, such as meatal stenosis from their treatment. ConclusionCarbon dioxide laser treatment for penile intra-epithelial neoplasia is effective due to its 100% response rate, low progression rate and lower recurrence rate compared with topical agents. The laser has minimal morbidity with cosmetically acceptable outcomes compared to more invasive resurfacing surgeries.

Treatment of cutaneous larva migrans with a single session of carbon dioxide laser: a study of ten cases in the Philippines.

Cutaneous larva migrans (CLM) has a detrimental effect on patients' emotional and physical quality of life. Due to local unavailability of gold standard oral treatments for CLM, carbon dioxide laser was attempted. We present a case series where a single session of carbon dioxide laser treatment was associated with cessation of signs and symptoms of CLM. The aim of this study was to assess the efficacy of a single session of carbon dioxide laser in the treatment of CLM. Ten cases (eight patients) with CLM were treated with one session of carbon dioxide laser treatment and followed up daily for the first week with photographic documentation and then weekly for the next 3 weeks to complete a 4 week follow-up period. The first cases in our series, who received one to two passes of fractional CO2 laser, experienced further larval migration for 2-3 days, after which no more progression was noted. For the next seven cases, we increased the number of CO2 laser passes to 3-4, and noted no further larval migration. At the end of the 4-week follow-up period, all CO2 laser-treated areas were completely healed, leaving postinflammatory hyperpigmentation of the serpiginous track. The results of this case series indicate the efficacy of a single session of CO2 laser in treating CLM. Further studies are required to identify the minimum number of passes required to effectively control CLM.

Carbon Dioxide Laser Treatment Using Methylene Blue–Assisted Sinus Tract Identification in Hidradenitis Suppurativa

This is the peer reviewed version of the following article: Grimstad, O. & Ingvarsson, G. (2016). Carbon Dioxide Laser Treatment Using Methylene Blue-Assisted Sinus Tract Identification in Hidradenitis Suppurativa. Dermatologic Surgery, 42(11), 1304-1304. https://doi.org/10.1097/DSS.0000000000000824, which has been published in final form at https://doi.org/10.1097/DSS.0000000000000824 . This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.

233 Carbon dioxide laser treatment of penile intraepithelial neoplasia

233 Carbon dioxide laser treatment of penile intraepithelial neoplasia

Efficacy of autologous platelet-rich plasma combined with fractional ablative carbon dioxide resurfacing laser in treatment of facial atrophic acne scars: A split-face randomized clinical trial.

Autologous platelet-rich plasma has recently attracted significant attention throughout the medical field for its wound-healing ability. This study was conducted to investigate the potential of platelet-rich plasma combined with fractional laser therapy in the treatment of acne scarring. Sixteen patients (12 women and 4 men) who underwent split-face therapy were analyzed in this study. They received ablative fractional carbon dioxide laser combined with intradermal platelet-rich plasma treatment on one half of their face and ablative fractional carbon dioxide laser with intradermal normal saline on the other half. The injections were administered immediately after laser therapy. The treatment sessions were repeated after an interval of one month. The clinical response was assessed based on patient satisfaction and the objective evaluation of serial photographs by two blinded dermatologists at baseline, 1 month after the first treatment session and 4 months after the second. The adverse effects including erythema and edema were scored by participants on days 0, 2, 4, 6, 8, 15 and 30 after each session. Overall clinical improvement of acne scars was higher on the platelet-rich plasma-fractional carbon dioxide laser treated side but the difference was not statistically significant either 1 month after the first treatment session (P = 0.15) or 4 months after the second (P = 0.23). In addition, adverse effects (erythema and edema) on the platelet-rich plasma-fractional carbon dioxide laser-treated side were more severe and of longer duration. Small sample size, absence of all skin phototypes within the study group and lack of objective methods for the evaluation of response to treatment and adverse effects were the limitations. This study demonstrated that adding platelet-rich plasma to fractional carbon dioxide laser treatment did not produce any statistically significant synergistic effects and also resulted in more severe side effects and longer downtime.

Fractional Carbon Dioxide Laser in Treatment of Acne Scars.

BACKGROUND:Scars appear as a result of skin damage during the process of the skin healing. There are two types of acne scars, depending on whether there is a loss or accumulation of collagen: atrophic and hypertrophic. In 80-90% it comes to scars with loss of collagen compared to smaller number of hypertrophic scars and keloids.AIM:The aim of the study was to determine efficiency and safety of fractional carbon dioxide laser in the treatment of acne scars.MATERIAL AND METHODS:The study was carried out in Acibadem Sistina Clinical Hospital, Skopje at the Department of Dermatovenerology, with a total of 40 patients treated with fractional carbon dioxide laser (Lutronic eCO2). The study included patients with residual acne scars of a different type.RESULTS:Comedogenic and papular acne in our material were proportionately presented in 50% of cases, while the other half were the more severe clinical forms of acne - pustular inflammatory acne and nodulocystic acne that leave residual lesions in the form of second, third and fourth grade of scars.CONCLUSION:The experiences of our work confirm the world experiences that the best result with this method is achieved in dotted ice pick or V-shaped acne scars.

Carbon dioxide laser treatment for Hailey-Hailey disease: a retrospective chart review with patient-reported outcomes.

Hailey-Hailey disease (HHD) is an autosomal dominant genodermatosis that leads to skin breakdown and blister formation, usually in intertriginous areas. Laser ablation is a known surgical treatment for HHD. We report outcomes in a series of patients with HHD treated with carbon dioxide (CO2 ) laser ablation. A retrospective chart review of data for 13 patients who underwent CO2 laser ablation for HHD was conducted. Questionnaires assessing effectiveness, pain, healing time, recurrence, new disease, complications, additional ablation, improvement in quality of life (QoL), and overall satisfaction were completed by all patients. All patients had been recalcitrant to previous treatments prior to CO2 laser ablation. Anatomic sites treated and anesthesia techniques for the procedure varied. The mean ± standard deviation (SD) score for the effectiveness of CO2 laser ablation for HHD was 9.3 ± 0.9 (maximum: 10). All patients reported improved QoL. No patient had recurring disease within the treatment field. Five patients underwent additional CO2 laser treatments at new sites. One patient reported postoperative infection. No other complications were identified. The mean ± SD score for overall satisfaction with CO2 laser ablation was 8.9 ± 1.1. Treatment with CO2 laser ablation is very effective and can lead to prolonged or permanent remission in most HHD patients. Patients are highly satisfied with the results and report a substantial improvement in QoL.

Assessment of efficacy and tolerability of different concentrations of trichloroacetic acid vs. carbon dioxide laser in treatment of xanthelasma palpebrarum.

There are numerous methods currently available for the management of xanthelasma. These include surgical excision, laser ablation using a variety of lasers and chemical cauterization. However, each method of treatment is associated with particular limitations and side effects. To assess the clinical efficacy and tolerability of different concentrations of topical trichloroacetic acid (TCA) vs. carbon dioxide laser in the treatment of patients with xanthelasma palpebrarum. Thirty patients with xanthelasma palpebrarum were classified into four groups, treated by TCA 35%, 50%, 70%, and CO2 laser, respectively. Lipid profile was estimated for all patients. Both TCA peeling 70% and carbon dioxide laser ablation showed more significant clinical efficacy and tolerability with least number of sessions in the treatment of xanthelasma palpebrarum than 50% and 35% TCA peeling. Post-therapy erythema and hypopigmentation were more with TCA 70%. Post-therapy hyperpigmentation was more with TCA (50%). There was a significant improvement in patients with normal lipid profile than those with abnormal profile. Both TCA peeling 70% and carbon dioxide laser ablation are highly effective and well tolerated with least number of sessions in the treatment of xanthelasma palpebrarum.

Discussing Fractional Carbon Dioxide Laser and Other Physical Treatments for Scar Prevention With Patients.

Discussing Fractional Carbon Dioxide Laser and Other Physical Treatments for Scar Prevention With Patients.

Clinical analysis of pseudoepitheliomatous keratotic and micaceous balanitis: five case reports

Objective To investigate clinical and pathological features of pseudoepitheliomatous keratotic and micaceous balanitis (PKMB). Methods The clinical and pathological features as well as treatment of PKMB were retrospectively analyzed in 5 male patients collected from January 2008 to December 2013. Results The age at onset of PKMB varied from 56 to 67 years in these 5 patients, and none of the patients had received prepucectomy. Indurated keratotic plaques were observed in the glans of penis and inner lamina of the prepuce with no tenderness on palpation, whose surfaces were covered with grayish yellow, adherent and hard micaceous crusts. Histopathological study revealed obvious hyperkeratosis complicated by parakeratosis, epidermal pseudoepitheliomatous hyperplasia, thickened spinous layer, and normal cell polarity in the epidermis, as well as telangiectasis and mild to moderate lymphocytic infiltration in the upper dermis. Immunohistochemical examination showed positive nuclear staining of epidermal cells for human papillomavirus (HPV) in 2 cases. Two patients took small doses of prednisone, but achieved no obvious improvement. Oral isotretinoin had resulted in a favorable outcome in another two cases, but relapse occurred after dose reduction, and thick crusts still appeared after topical application of glucocorticoid cream and tacrolimus cream, or carbon dioxide laser treatment and photodynamic therapy. Conclusions PKMB is a chronic and obstinate disease, and should be diagnosed based on pathological findings. Its treatment is difficult, and tretinoin has some effects, but relapse often occurs after drug withdrawal and maintenance treatment is needed. Key words: Papillomavirus infections; Skin manifestations; Treatment outcome; Pathology, clinical; Pseudoepitheliomatous keratotic and micaceous balanitis

Carbon dioxide laser treatment in Hailey–Hailey disease: A series of 10 patients

Carbon dioxide laser treatment in Hailey–Hailey disease: A series of 10 patients

Clinical investigation of carbon dioxide laser treatment for lingual leukoplakia

ObjectivePrevious studies have described the clinical statistics and treatment outcomes of leukoplakia of the oral cavity. However, because leukoplakia is often clinically diagnosed without any histopathological examination, current opinion regarding treatment methods and preoperative pathological diagnosis is inconsistent and no standard site-specific treatment guidelines exist for oral leukoplakia. The purpose of this study is to clinically evaluate carbon dioxide (CO2) laser treatment for leukoplakia of the tongue. MethodsWe examined 38 lesions in 35 patients of lingual leukoplakia who underwent CO2 laser treatment with using Lugol staining at our department over a 10-year period, i.e., from 2001 to 2010. We investigated gender-related differences, age distribution, left and right differences, clinical classification, histopathological diagnosis (presence or absence of epithelial dysplasia), treatment technique (excision or evaporation), recurrence rate, residual rate, and malignant transformation among these cases. ResultsOf the 38 lesions that fulfilled the inclusion requirements, 35 were excised and 3 were evaporated. After CO2 laser treatment, the recurrence and residual rates for lingual leukoplakia were 10.5% and 7.9%, respectively. The recurrence rate of cases examined in this study was lower than that reported by our hospital previously (2004) and many other hospitals. None of the lesions exhibited malignant transformation. ConclusionsOur results suggest that the CO2 laser excision method with using Lugol staining, as performed at our hospital, is useful for the treatment of lingual leukoplakia.