To the Editor: We are pleased that Fitzpatrick et al found our commentary regarding the need for improvement in laser nomenclature interesting, and we appreciate their willingness to offer constructive suggestions. That being said, we disagree that the term “ablative” is unrelated to depth of injury or that it does not involve structurally breaching the epidermis, as we are unsure how the epidermis could be ablated without having an injury of greater than zero depth in the original untreated skin, or how the epidermis could be removed if its structure were not affected in any way. Fitzpatrick et al also put forth that ablation or the lack thereof has no association with erosions, serous weeping, bleeding or other wound healing events. While this may be true in a theoretical framework, cutaneous lasers are used on people, who do bleed, ooze, and heal. If it were not for the fact that nonablative and ablative lasers are different with association to wound management, the descriptors “nonablative” and “ablative” would be irrelevant to patient care and laser companies would not be so adamant about specifying the relevant degree of ablation in their promotional literature. With regard to the term “subsurfacing,” Fitzpatrick et al agree that this is an awkward term and, as awkwardness is to be avoided in issues of nomenclature, we are unsure as to why they are insistent in wanting to preserve it. Similarly, we are surprised that Fitzpatrick et al compare the term “partially ablative” to the impossibility of being “partially pregnant” after noting that they can see at least two different ways in which a partially ablative treatment could occur. Which is it? Are there two types of partial ablation or no partially ablative treatments or does ablation occur along a continuum? Fitzpatrick et al also state that our definition of the appropriate pixel size of a fractional laser covers only 99% of the observed instances. If this figure is accurate, as they assert, we feel we are to be commended for devising a definition that is almost always right and is far preferable to the confusion that currently prevails. We would rather stand with the 99% than the 1%. We certainly agree with Fitzpatrick et al that terminology should be standardized for communicating fractional resurfacing treatment density, or the proportion of the skin surface per unit area that is actively treated during one pass or session. Our original commentary was designed to highlight a few specific issues of laser nomenclature and, given space limitations, was not meant to be a comprehensive document. We are delighted that Fitzpatrick et al applaud us for highlighting the deficiencies in the nomenclature currently in use in cutaneous laser surgery. Regarding their suggestion that a committee address these problems in greater detail, as they know, such a committee has already been formed under the aegis of the American Society for Dermatologic Surgery. Several of them, and of us, now serve on this committee. As to why there is so much disagreement on the issues described above, we believe it may stem from a misguided view of the function of nomenclature in this context. Different cutaneous laser and energy devices are often not strictly comparable, and yet they have significant clinical effects that we need to predict to some extent to ensure patient safety and comfort. So uniform nomenclature, a common language, can facilitate practical communication in an efficient manner. However, endless argument over minute details is probably not constructive since no set of terms will work in every instance or please everyone. The goal is to develop a simple naming system that most can live with, that is easy to use, and that usually conveys necessary information with acceptable accuracy and precision. We believe the focus should be on achieving consensus on a reasonable set of improvements rather than aiming for an elusive perfection. Since dermatologists are collegial and cooperative, we should succeed in this and, in so doing, perform a service for our patients, other physicians, and even laser manufacturers. Nomenclature proposal on laser ablation and nonablationJournal of the American Academy of DermatologyVol. 67Issue 4PreviewTo the Editor: Although there is a need for improving definitions used in dermatologic laser surgery, we believe that the suggestions by Alam et al1 are inaccurate and in many instances further confuse laser surgery terminology. Full-Text PDF
Read full abstract
Jun 18, 2024
Connie Liu + 5
Open Access