Carbon Dioxide Laser Treatment Research Articles

The effect of cold-air anesthesia during fractionated carbon-dioxide laser treatment: Prospective study and review of the literature

Forced cold-air anesthesia has been reported to decrease the discomfort associated with various dermatologic laser therapies. We sought to evaluate the effect of cold-air anesthesia on patient comfort during ablative fractionated carbon-dioxide (CO(2)) laser treatment for photoaging. We conducted a prospective split-face study to evaluate the effect of cold-air anesthesia on patient comfort during ablative fractionated CO(2) laser treatment for photoaging. Both patients and physicians rated the perceived discomfort of the treatment on each half of the face on a pain scale of 0 to 10. In addition, patients were asked to evaluate the side effects of the procedure (erythema, edema, crusting, scaling) on each half of the face. At 6 months posttreatment, blinded physician photograph evaluation was performed of 5 clinical indicators of photoaging. For the side of the face treated with topical anesthesia alone, the mean patient-reported pain score was 7.47. On the side treated with cold-air anesthesia and topical anesthesia, the mean pain score was 4.27 (P < .01). For the side treated with topical anesthesia alone, the mean physician-reported pain score was 7.8, relative to the side treated with cold-air anesthesia and topical anesthesia, for which the mean physician-reported pain score was 3.73 (P < .01). Although significant differences were found in pain tolerance with fractionated CO(2) laser with the use and absence of forced-air cooling, additional large-scale studies are needed to confirm the device's use in patient tolerability and side-effect profile. The use of forced cold-air device in conjunction with topical anesthesia provides a well-accepted modality for patient comfort during ablative fractionated CO(2) resurfacing.

Fractional Carbon Dioxide Laser Treatment to Enhance Skin Permeation of Ascorbic Acid 2-Glucoside with Minimal Skin Disruption

Topical treatment with vitamin C has been used to treat photoaged skin and as a skin whitener, but no standard procedure exists for percutaneous delivery. To compare skin histology and the permeation of ascorbic acid 2-glucoside (AA2G) after fractional and conventional carbon dioxide (CO(2) ) laser pretreatment. The effect on porcine skin of treatment with different strengths of fractional and conventional CO(2) laser treatment was examined using scanning electron microscopy and transmission electron microscopy. Permeation of AA2G through porcine skin was tested in vitro using a Franz diffusion chamber. In vivo changes in fluorescein thiocyanate permeability in nude mice were examined using confocal laser scanning microscopy. Fractional CO(2) laser treatment with four or fewer passes caused less disruption than conventional laser treatment at the same fluence. AA2G permeation using four passes of fractional laser treatment was similar to that seen with conventional CO(2) laser treatment of the same fluence. Changes in permeability and in depth of permeation were higher with conventional than fractional laser treatment. Fractional CO(2) laser treatment can cause similar transdermal delivery of AA2G to conventional laser treatment with less skin disruption and a different pattern of histologic change.

Calcium Hydroxylapatite Nodule Resolution After Fractional Carbon Dioxide Laser Therapy

Injection of calcium hydroxylapatite filler may result in nodule formation owing to superficial placement of the filler. Calcium hydroxylapatite nodules are difficult to reverse. Previously reported therapeutic options are limited and include intralesional triamcinolone, massage, needling, and excision, each with inconsistent results or potential for scarring. We have observed complete resolution of calcium hydroxylapatite nodules after a single treatment with fractional carbon dioxide laser. A single session of fractional carbon dioxide laser treatment may resolve selected cases of calcium hydroxylapatite nodules. The mechanism of action may involve conversion of the product into tricalcium phosphates which dissolve readily. This novel therapeutic technique may enhance treatment options for a difficult clinical problem.

Bacteriology of hidradenitis suppurativa exacerbations and deep tissue cultures obtained during carbon dioxide laser treatment

Previous studies have shown different bacteria in hidradenitis suppurativa (HS) lesions, but the literature regarding bacteria in acute exacerbation of HS is sparse. To determine the type of bacteria isolated from HS lesions during exacerbations of the disease. Patients with HS with acute nodules or abscesses were examined and treated by carbon dioxide laser vaporization. Bacterial samples for aerobic and anaerobic cultures were taken from the skin surface (before surgery) and then from the deeper layers (during surgery) of the lesions. At each level two samples were taken, one with a punch biopsy and one by pressing a soft agar gel against the skin. The bacterial findings were typed and quantified. A total of 10 patients (eight women and two men), with a mean age of 37·2 years and a mean HS duration of 14·5 years, were included. All of them had an ongoing exacerbation (mean duration 5·6 days) of their HS, with one inflamed lesion that was treated by carbon dioxide laser vaporization. Coagulase-negative staphylococci (CNS) were found in the deep layers in all 10 patients. Nine of the patients carried Corynebacterium spp. and two alpha-haemolytic streptococci at various levels. Among the anaerobic microorganisms, Gram-positive cocci were the most common bacteria. As found in a previous study, CNS were the most common bacteria, but contrary to what we expected, Staphylococcus aureus was not found in any cultures from acute inflammatory nodules of HS exacerbations.

Ultrapulse Carbon Dioxide Laser Treatment of Porokeratotic Eccrine Ostial and Dermal Duct Nevus

Porokeratotic eccrine ostial and dermal duct nevus (PEODDN) is a rare, benign, cutaneous hamartoma. Approximately 45 cases of PEODDN have been reported, with little information regarding treatment. We report a patient with PEODDN treated successfully using an ultrapulse carbon dioxide laser.

Laser therapy for Hailey-Hailey disease: review of the literature and a case report.

Medical therapy for Hailey-Hailey disease (HHD) generally only provides temporary suppression. Surgical intervention has been shown to prolong remission, but may lead to significant morbidity. Laser therapy is becoming the preferred method of treatment because of its successful results and lower risk of complications compared to surgical modalities. We report a case of fractional ablative carbon dioxide (CO2) laser treatment for HHD and review the relevant literature. Fractional CO2 laser therapy was performed in our patient with a 14-year history of HHD. No recurrence was observed 5 months after laser therapy in right inframammary and axillary regions. Symptomatic recurrence was noted after treatment of inguinal areas. In conclusion, traditional laser ablation remains the treatment of choice for prolonged remission of recalcitrant plaques in HHD.

Fractionated Carbon Dioxide Laser Treatment of Photoaging: Prospective Study in 45 Patients and Review of the Literature

Ablative fractional photothermolysis (AFP) has been reported to be effective for photoaging. To perform a clinical trial in 45 patients with moderate to severe skin photoaging to quantify improvement with AFP. A prospective, single-blind study in 45 patients who presented for desired treatment of photoaging. Patients received a series of two to three treatments with AFP. Thirty-nine women (86.7%) and six men (13.3%) were enrolled. Patients received two or three treatment sessions (mean 2.4). There were no incidence of adverse events of scarring, prolonged erythema (lasting more than 7 days), postinflammatory hyper- or hypopigmentation, or infection in the 108 treatment sessions given during this study. Mean improvement was 48.5% (95% confidence interval (CI)=44.6-52.4%) for skin texture, 50.3% (95% CI=46.1-54.5%) for skin laxity, 53.9% (95% CI=49.5-58.5%) for dyschromia, and 52.4% (95% CI=47.9-56.9%) for overall cosmetic outcome (all p<.05). Significant improvement in photoaging of the face can be achieved using an AFP device with skin types I to III after a series of two to three treatments.

Immunohistological Evaluation of Skin Responses After Treatment Using a Fractional Ultrapulse Carbon Dioxide Laser on Back Skin

Fractional photothermolysis (FP) lasers have been widely used in treating photo-aged skin, acne scars, and other skin conditions. Although plenty of clinical data have demonstrated the efficacy of the FP laser, only limited histologic studies have been available to observe serial short- to long-term skin responses. Seven healthy Chinese women received one pass of fractional carbon dioxide laser treatment on the left upper back. Biopsies were taken at the baseline and 4 hours, 1 day, 5 days, 1 month, 3 months, 6 months, and 1 year after the procedure for hematoxylin and eosin stains, immunohistochemical evaluation (for heat shock proteins and elastin), and Verhoeff-iron-hematoxylin stains (for collagen and elastic fiber). Remarkably greater expression of heat shock protein (HSP)70 could be observed 4 hours after the procedure, which diminished significantly by 3 months, 6 months, and 1 year after the procedure. HSP47 reached its peak expression 1 month after the procedure, especially around microscopic thermal zones, and maintained its high level of expression 3 and 6 months after the procedure. Distinct new formation and remodeling of collagen and elastic fibers could be observed 3 and 6 months after procedure. FP-induced HSP expression and new formation of collagen and elastic fibers lasted as long as 6 months, longer than the previously acknowledged 3 months.

Commentary: Predicting Efficacy of Fractional Carbon Dioxide Laser Treatment for Resurfacing

is an impor-tant advancement in our knowledge of in vivo der-mal modeling after fractional ablative lasertreatment. Maximizing clinical response and mini-mizing adverse events are the ultimate goal of everylaser surgeon. We have all had patients who pre-operatively presented as excellent candidates forablative treatment only to have suboptimal responseto multiple sessions. Conversely, other patients havean outstanding response to identical parameters andend up as an example of success on our lecture slides.This type of rigorous scientific work adds to ourunderstanding of the factors that may differentiatethese two types of patient responses.The objective nature of this work challenges usto reassess our assumptions regarding clinical results.The finding that midfacial areas such as forehead,lip, and chin had a statistically significantly greaterincrease in dermal collagen than cheeks and neckis surprising. In practice, patient satisfaction istypically higher in the thinner skin of the cheeks,particularly in the periocular area. This may be afunction of the thicker skin in this central area, re-quiring a larger increase in collagen to confer asimilar clinical response.The future for fractional ablative lasers will probablyinclude real-time adjustment of fluence and pulseduration from ultrasound feedback of ablation depthas a ratio to tissue depth. This may be coupledwith feedback on tissue temperature and othermeasurements to optimize results. Perhaps aninterface will also have information such as patientage, retinoid use, and other variables to adjustparameters accordingly.

Facial Acne Scarring

Facial Acne Scarring

Prospective, uncontrolled examination of ablative fractional photothermolysis on Asian and Caucasian skin

Abstract Background and objectives Ablative fractional carbon dioxide (CO2) laser treatment has gained popularity for several clinical indications due to its superiority in the treatment of rhytides, scars and photodamaged skin. The concept of ablative fractional photothermolysis (AFP) enables the induction of dermal coagulative injury without confluent epidermal damage, reduces side effects and shortens downtime. To date, less is known about its safety and efficacy on Asian skin where dyspigmentation is suspected to be one of the most challenging adverse events. Materials and methods 78 Asian and 7 Caucasian subjects underwent 1–3 AFP treatments using a scanned 250 μm CO2 laser beam for the indications of scar reduction (n = 42), skin tightening (n = 32), enlarged pores (n = 6) and others (n = 5). Two patients were treated for both acneiform scars of the face and atrophic scars on the neck so that in summary, 87 treatment sites received laser therapy. Post-treatment erythema (redness) and edema (swelling) as well as overall satisfaction were graded on a quartile scale with scores from 0 to 3. All designated and observed side effects were noted by blinded observers. Results The patient satisfaction (scored by a blinded observer) after AFP for scar reduction, skin tightening, and enlarged pores ranged from minimal to marked clinical improvement with a tendency for a better outcome after repeated treatments. Erythema and edema lasted for 1–4 days in all patients and only one patient developed post inflammatory hyperpigmentation (PIH) after the first treatment. Conclusion The presented results allow the conclusion that AFP performed by a scanned CO2 laser is a safe and effective treatment modality for the improvement of rhytides and photodamaged skin, scarring, enlarged pores and hyperpigmentation in both Asian and Caucasian people, with a minor risk of dyspigmentation. Potential refinement of the number of sessions and treatment parameters need further evaluation to maximize the therapeutic efficacy for the different indications.

Reactivation of Anti-Human Alpha-Enolase Antibody-Positive Behçet’s Disease by Carbon Dioxide Laser Treatment

Reactivation of Anti-Human Alpha-Enolase Antibody-Positive Behçet’s Disease by Carbon Dioxide Laser Treatment

Dental implant removal to facilitate suspension laryngoscopy and laser treatment of an obstructed airway

A 29-year-old patient presented with dysphonia, dysphagia and a progressive history of stridor over 6 weeks. His past medical history included childhood nasolabial rhabdomyosarcoma treated by surgery, chemotherapy and radiotherapy. This had resulted in marked abnormalities of the facial skeleton, limited neck extension and restricted mouth opening of 1 cm, in part due to dental implants. After careful discussion and planning within a multidisciplinary team, the airway was optimised by temporary removal of the dental implants. This enabled a suspension laryngoscope to be passed, permitting carbon dioxide laser treatment to an obstruction at the laryngeal inlet and eliminating the need for a tracheostomy.

Treatment of ranula using carbon dioxide laser – Case series report

Ranulas are mucus extravasation phenomenon formed after trauma to the sublingual gland or mucus retention from the obstruction of the sublingual ducts. There are various methods for treating ranulas, including marsupialization with or without open packing, excision of ranula with or without removal of sublingual gland, and laser excision and vaporization of ranula. The authors present a case series report on the use of carbon dioxide laser treatment for ranula and a literature review of cases treated using carbon dioxide laser. The authors' experience and reports in the literature indicate that carbon dioxide laser excision of ranula is safe with minimal or no recurrence.

Factors affecting carbon dioxide laser treatment for oral precancer: A patient cohort study

Although the benefits of CO(2) laser surgery in oral precancer management have been evaluated, little consideration has been given to the factors which may influence treatment outcome, especially amongst patients developing recurrence or malignant transformation. Seventy eight patients (51 males, 27 females; mean age 57.8 years) undergoing CO(2) laser excision of single, new dysplastic oral precancer lesions (OPLs) were followed up for a minimum of 2 years and the influence of clinico-pathological parameters, socio-demographic factors and the presence or absence of residual dysplasia in excision margins upon clinical outcome were examined. Seventy three percent of patients were smokers and 78% consumed alcohol regularly. The majority of lesions were leukoplakias arising in the floor of mouth and ventro-lateral tongue and moderate or severe dysplasia accounted for 86% of histopathological diagnoses. Patient follow up ranged from 24 to 119 months (mean 58 months). Sixty four percent of patients were disease free at most recent clinical follow up, whilst 32% developed local recurrent dysplasia or new site dysplasia with 4% developing oral squamous cell carcinoma (but at sites distinct from their initial OPL). Excision margins were clear in 55% of cases, but 19% showed mild, 21% moderate and 5% severe dysplasia on histopathological examination. No statistically significant associations were seen between patients' age, gender, lesion appearance, site of origin, histopathological grading, presence of dysplasia in resection margins, or alcohol consumption and clinical outcome. Smokers, however, were at significantly higher risk of dysplasia recurrence compared to ex-smokers or non-smokers (P = 0.04). In the absence of agreed treatment protocols for OPLs, we recommend CO(2) laser surgery as an effective treatment modality offering precise lesion excision, full histopathological assessment, minimal post-operative morbidity and a 64% disease free clinical outcome. Regular patient follow up is encouraged due to the persistence of field cancerisation effects.

Laser Carbon-dioxide treatment of Complete Hydatidiform Mole Presenting as Bartholin Gland Cyst

A 31-year-old woman underwent carbon-dioxide laser treatment [1] for a 5-cm vulvar enlargement, suspected to be a Bartholin gland cyst. Two months earlier, a spontaneous abortion at 8 weeks with nonmolar histology was reported.

Outcomes of treatment of nine cases of recalcitrant severe hidradenitis suppurativa with carbon dioxide laser

Hidradenitis suppurativa (HS) is a chronic and often a recalcitrant inflammatory skin condition. To present the results of carbon dioxide (CO2) laser treatment of recalcitrant HS in nine patients who had failed to improve on medical and other surgical treatments. HS lesions consisting of abscesses, sinuses and granulation tissue were completely excised using the cutting mode of a CO2 laser, leaving only healthy residual subcutaneous fat. The wounds were closed by primary intention where possible and left to granulate otherwise. Outcomes were determined by clinical review and questionnaire. Twenty-seven sites were treated in 19 sessions on nine patients. Seven procedures were performed under general anaesthesia and 12 under local. All patients rated their postoperative discomfort as less or equal to their preoperative state. Seven of the nine patients had complete remission for 12 months or longer after their last laser treatment and ceased all medications. High levels of patient satisfaction were reported with CO2 laser treatment. The main complication was axillary scar contracture in two patients but this was insufficient to limit limb movement. CO2 laser treatment should be considered as a treatment option in recalcitrant HS, where multiple medical treatments have been ineffective.

CO2 Laser Zenker's Diverticulotomy: 10-year Experience

Objective Zenker's diverticula occur primarily in older patients, resulting in dysphagia, aspiration, and weight loss. A number of surgical options are available for treatment. While small diverticula (smaller than 2 cm) may require no surgical treatment, the presence of dysphagia, asiration, may necessitate surgery. Surgical options include both traditional open and endoscopic procedures. Many patients are elderly and cannot undergo open surgical procedures. Endoscopic techniques have become the preferred approaches by physicians because of their safety, effectiveness, and fewer complications. Methods Retrospective chart review of 65 patients who underwent endoscopic carbon dioxide (CO2) laser treatment of Zenker's diverticulum at a single tertiary care institution. In some of the procedures, the incision was sealed with a tissue sealant. Results Age ranged from 56 to 89 years. All patients had significant improvement in their symptoms such as dysphagia, aspiration, and weight gain. The endoscopic incision was performed in 1 session using the CO2 laser and a microscope. 2 complications (cervical emphysema) were managed conservatively and 1 postoperative bleeding required return to the operating room. The endoscopic exposure was not achieved in 2 patients due to difficult exposure. There were no mortalities. Mean follow-up was 27 months. There was no recurrence of dysphagia and all patients remained asymptomatic. Conclusions CO2 laser endoscopic treatment of symptomatic Zenker's diverticulum is an effective and safe method. It is quick and simple, and permits a short hospital stay and quick return to activities. Tissue sealant provides additional safety and reduces the incidence of postoperative complications.

Long-term Results of Carbon Dioxide Laser Resurfacing of the Face

To evaluate the long-term effectiveness of, and the complications associated with, carbon dioxide laser treatment of rhytidosis and solar aging. This retrospective report describes our experience with 47 patients who underwent entire facial carbon dioxide laser resurfacing. The mean improvement in facial rhytid score at long-term follow-up was 45%. This improvement was consistent in all facial subsites. With the exception of 1 case of hyperpigmentation, which resolved within 2 years of treatment, hypopigmentation was the only long-term adverse effect. This complication was present in 6 patients (13%). The patients who developed hypopigmentation were more likely to have a greater response to treatment. Our findings show that carbon dioxide laser resurfacing is a safe and effective treatment for facial rhytids.

Topical interferon α-2b as an adjunctive therapy in recurrent conjunctival papilloma

Conjunctival squamous papilloma is a benign tumor of presumed viral origin. Small sessile papillomas may regress spontaneously, but an extensive papilloma as seen in adults requires treatment [1]. Papillomas of the conjunctiva are however known for their high recurrence rate of 6–27% [2]. Several types of therapy have been described, including liquid nitrogen cryotherapy, cautery, diathermy, irradiation, and carbon dioxide laser treatment. Topical and systemic interferon have also been tried and found effective [3–6]. We report a case of recurrent papilloma treated successfully with surgical excision, amniotic membrane transplant, and topical interferon a-2b.