Ablative Fractional Laser Research Articles

595 Hypochlorous Acid for Skin Preparation in Fractional Ablative CO2 Laser Treatment of Burn Scars

IntroductionWhile complications from fractional ablative CO2 laser treatment for burn hypertrophic scar (HTS) are relatively rare, the risk of surgical site infection (SSI) after laser treatment exists. When infection occurs, it has been linked to further morbidity, such as scar development in previously unaffected skin. Hypochlorous acid is a non-flammable and colorless antiseptic solution that has been used to treat wounds and is believed to be a less cytotoxic alternative to other agents such as betadine and chlorhexidine. This study aims to investigate the use of hypochlorous acid solution as a skin prep for patients undergoing laser scar revision for HTS and determine its efficacy in preventing SSI.MethodsAll patients undergoing fractional ablative CO2 laser revision of HTS at a single center from September 2016 through September 2021 were retrospectively reviewed. Data pertaining to patient demographics, skin characteristics, treatment sessions, and post-treatment complications were recorded. All patients underwent topical skin preparation with hypochlorous acid-soaked laparotomy pads for 10 minutes before laser treatment. No perioperative oral or topical antibiotics were given to any included patient. Patients were excluded from analysis if they were not treated with a fractional ablative CO2 laser, were treated for a scar etiology outside of burn injury, or if insufficient follow-up was documented.ResultsA total of 208 patients undergoing a total of 758 laser treatments were identified. Average patient age was 45 years (SD 16), with 112 (53.8%) patients being female and 96 (46.2%) being male. Median number of laser treatments was 3 (IQR: 1-5). Patients from all Fitzpatrick skin types were treated, with the most common type being type 5 (n=54, 26.0%). None (n=0, 0.0%) of the 208 patients experienced a surgical site infection after any of the laser treatments received.ConclusionsHypochlorous acid is a safe and effective skin preparation for patients undergoing laser burn-scar revision to prevent SSI. Moreover it is non-flammable, colorless and does not need to dry prior to procedure.

723 Carbon Dioxide Laser Treatment Practices for Hypertrophic Burn Scars Amongst American Burn Association Burn Centers

IntroductionScarring is a major outcome of severe burn wound healing. Severe scars often persist and diminish quality of life by disfigurement, pain, and pruritis. In the last decade, utilization of ablative fractional carbon dioxide (CO2) laser therapy has become a popular treatment modality for severe burn scars. Although the efficacy of CO2 lasers for the treatment of hypertrophic burn scars has been established via systematic reviews, there have been no attempts to query the 63 American Burn Association (ABA) centers across the United States regarding specific treatment parameters involving serious, sometimes high, total body surface area (TBSA) burns.MethodsThroughout October and November of 2020, a Qualtrics survey consisting of 14 questions was administered to burn surgeons practicing at all 63 ABA burn centers across the United States. Topics assessed were specific laser parameters utilized (5), treatment preferences (2), peri-operative follow-up (5), scar assessment practices (1), and TBSA treatment tolerance (1).ResultsExploratory, descriptive data was analyzed. Surgeons practicing at 27 of the 63 total ABA burn centers responded to the survey (43% response rate). Data elucidates the level of variance regarding current initial management of hypertrophic burn scars via CO2 laser treatment. Surgeons demonstrated variation in the level of TBSA treatment tolerance and pulse energy settings, respectively.ConclusionsOur findings show a substantial amount of variation in several aspects of CO2 laser hypertrophic scar revision between ABA centers across the country, including preoperative evaluation, laser settings, treatment regimen, and postoperative recommendations . Standardization of care when utilizing ablative fractional CO2 lasers should be further explored.

614 Laser-treatment of Hypertrophic Scar Induces Change to Epidermal Histoarchitecture Correlating to Improved Epidermal Barrier Function

IntroductionMechanisms and timing of hypertrophic scar (HTS) improvement with laser therapy are incompletely understood. Epidermal keratinocytes influence HTS through paracrine signaling, yet they are understudied compared to fibroblasts. It was hypothesized that fractional ablative CO2 laser scar revision (FLSR) would change the fibrotic histoarchitecture of the epidermis in HTS.MethodsDuroc pigs (n=4 FLSR and n=4 controls) were injured and allowed to form HTS. HTS and normal skin (NS) were assessed weekly by non-invasive skin probes measuring trans-epidermal water loss (TEWL) and biopsy collection. There were 4 weekly FLSR treatments. Early laser treatment began on day 49, and late began on day 77. Punch biopsies from NS and HTS were processed and stained with H&E. Image J was used to obtain epidermal thickness and rete ridge ratios (RRR). Gene and protein expression of involucrin (IVL) was examined through qRT-PCR and immunofluorescent (IF) staining.ResultsAfter treatment, peeling sheets of stratum corneum were apparent which were not present in the controls. TEWL was increased in HTS vs. NS at day 49 indicating decreased barrier function (42.2±8.0 vs. 22.0±4.62g/m2h, p=0.05). In the early group, TEWL was significantly decreased at week 4 to 16.4±3.5 g/m2h (p< 0.05). The late group was not significantly altered from NS at the pre-laser timepoint (day 77=12.1±1.99 g/m2h). Hence, there was no decrease in TEWL post-FLSR. After 4 sessions, epidermal thickness was significantly increased in treated scars in both FLSR groups (early:pre=85.6±6.8 vs. week 4=115.2±12.0 µm, p< 0.01) and (late:pre=75.2±6.6 vs. week 4=125.7±12.0 µm p< 0.001, n=8 scars,). There was no increase in controls. Late intervention significantly increased RRR (pre=1.3±0.1 vs. week 4=1.9±0.1, n=8 scars, p< 0.05), and early treatment trended towards increase (pre=1.17±0.05 vs. week 4=1.4 + 0.1). There was no increase in controls. There was increased IVL gene expression in HTS vs. NS that decreased after FLSR. Eight scars had up-regulated gene expression of IVL vs. NS levels pre-treatment (FC >1.5) compared to 4 scars at week 4. This was confirmed by IF where IVL staining decreased at week 4.ConclusionsChanges in epidermal HTS histoarchitecture and expression levels of epidermal differentiation markers were induced by FLSR. The timing of laser intervention contributed to differences in TEWL, epidermal thickness, and RRR.

596 Implementation of a Burn Laser Program at a Children’s Hospital

IntroductionCarbon dioxide ablative fractional laser (CO2-AFL) therapy has become standard of care for adult burn hypertrophic scars (HTS). This therapy option has not been widely adopted in pediatric burn care and no established guidelines for treatment protocols have been published. We sought to modify our American Burn Associated Adult Verified Burn Centers laser protocol at our Children’s Hospital with hopes to provide optimal care to our pediatric burn population. We present our protocol and early experience of CO2-AFL therapy for pediatric burn HTS.MethodsWe conducted a retrospective chart review of pediatric burn patients undergoing CO2-AFL treatment of HTS during the study period of Jan 2021-Oct 2021. Pediatric burn patients were offered laser treatment if their scars were symptomatic with patient complaints of HTS, pruritis, neuropathic pain, and scar contractures. 37 pediatric patients ≤13 years of age were included in our review.ResultsWe treated 13 pediatric patients for a total of 40 laser sessions with each patient averaging 3 sessions. Of the 13 patients that were treated with laser, 62% (8 of the 13 patients) had split-thickness skin grafting with 38% (3 of the 8 patients) of those having a staged grafting procedure with dermal substitute. 15% (2 of the 13 patients) healed primarily and 15% (2 of the 13 patients) required excision and closure. Only 1 patient treated with ASCS alone required laser therapy. Our protocol requires patients to receive pre-operative Tylenol, Benadryl, Pepcid, and Oxycodone. The patients then received MAC anesthesia with Toradol, Dexamethasone, Ketamine or Propofol, and Zofran. Patients with extensive HTS on the face or neck were intubated for the procedures. Oxycodone and/or Dilaudid were provided if needed in the post-operative phase. All patients were discharged with Tylenol or Motrin and Triamcinolone 0.1% ointment to be applied daily for 48 hours and then 3-4x/day until the follow-up clinic appointment at one week. Patients were able to resume normal activities the day following the procedure.ConclusionsPatients and their parents have reported improvements in pigment, pliability, thickness, and pruritis following laser treatments. We created a protocol that allows on average 8 pediatric patients per day to receive laser treatment without it over burdening the pre-operative and post-operative recovery room nursing staff. We are currently tracking outliers of patients requiring increased post-operative analgesia and/or greater than 1 hour in the recovery phase. With the implementation of a laser protocol, we have successfully introduced laser therapy as a viable option for our pediatric burn survivors.

537 Laser-Assisted Drug Delivery in the Treatment of Hypertrophic and Keloid Scars: A Systematic Review

IntroductionHypertrophic scars (HTS) and keloids (K) cause significant morbidity and disfigurement. Care of HTS and keloids range from less invasive treatments, such as pressure garments and silicone products, to more invasive treatments, such as intralesional injections (ISI) of medication, and surgical excision. Laser-Assisted Drug Delivery (LADD) is becoming a more popular treatment for HTS and K. The ablative fractional laser creates microchannels in the skins which allows the delivery of drugs into deeper skin layers. We have conducted a systematic review of the literature to assess the effectiveness of LADD in the treatment of HTS and K.MethodsA search was performed on PubMed between January 1998-August 2021 using the following keywords: Laser Assisted Drug Delivery, Laser Combined Drug Delivery, Laser Drug Delivery, Laser Drug, Hypertrophic, Burn, Keloid, Scar. Inclusion criteria was the use of LADD in HTS or K. Exclusion criteria were studies in animal models, case reports, reviews, and non-english articles. One article was excluded due to concerns of plagiarism.ResultsA total of 11 articles were included in the final review. One study found no difference in HTS outcomes between LADD of corticosteroids (CTS) and laser with topical petrolatum used as a control. Two prospective studies found that LADD of CTS led to improved HTS outcomes. Two split-scar studies found no difference in K outcomes between LADD of CTS and ISI of CTS. One prospective study assessed LADD of CTS in K and found statistically significant improvements in scar outcomes. A retrospective study looking at K outcomes found a 50% mean improvement when treated with LADD of CTS. A split-scar study found statistically significant better HTS outcomes with LADD of 5-FU compared to topical 5-FU alone. One study found no difference in HTS outcomes between LADD of CTS and 5-Fluorouracil (5-FU). Two studies assessed both HTS and K. The first study found that both LADD of 5-FU and LADD of CTS led to significantly better scar outcomes when compared to laser monotherapy. The other reported that HTS outcomes were significantly better with LADD of Botulinum toxin A and K outcomes were better with ISI of Botulinum Toxin A.ConclusionsThe use of LADD is effective in the setting of HTS. There is evidence that LADD of scar modulating agents to HTS lesions is more effective than topical delivery or ISI of the same agent. LADD shows promise as an alternative treatment for K as it displays similar efficacy as ISI.

The use of lasers in vitiligo, an overview.

Various types of lasers have been demonstrated to be effective in the treatment of vitiligo. The mode of action of these lasers is just as varied as the purpose of intervention. Many clinicians are not aware of the unique opportunity these lasers offer to improve the outcomes of vitiligo treatment. To date, no clear overview exists of the use of lasers in vitiligo treatment. Thus, the aim of this review is to discuss the various types of lasers and provide an overview of the evidence for their efficacy. We found good evidence from a systematic review that the excimer laser is effective, induces repigmentation rates comparable to NB‐UVB and has improved outcomes when combined with calcineurin inhibitors. Ablative lasers are commonly used for tissue graft or melanocyte–keratinocyte cell graft transplantation. They provide safe, fast and uniform denudation of the epidermis with propitious repigmentation outcomes. We found conflicting evidence from two systematic reviews regarding the efficacy of fractional ablative lasers for improving outcomes of NB‐UVB therapy, a systematic review including only fractional ablative lasers provided evidence for efficacy. Q‐switched nanosecond lasers have shown to be safe and effective for inducing depigmentation, although recurrence is common, and most studies were small and retrospective. Despite proven efficacy and safety, laser treatments are relatively expensive and suited for limited body surface areas and selected cases. Each type of laser has benefits and risks associated and should, therefore, be individually chosen based on location, extent, activity and type of vitiligo.

Treatment of acne scars with fractional carbon dioxide laser in Asians: a retrospective study to search for predicting factors associated with efficacy.

Ablative fractional laser treatment has been extensively used for resurfacing atrophic acne scars. However, few studies have investigated how the parameters set during laser procedures affect efficacy. In this retrospective study, we examined the relationship between efficacy and Fitzpatrick skin type, gender, age, follow-up duration, energy, and treatment sessions utilizing ablative fractional carbon dioxide (CO2) laser in Asians with Fitzpatrick skin types III-IV. We then analyzed the relationship between outcome and adverse effects including hyperpigmentation. Three blinded dermatologists used the ECCA (Echelle d'Evaluation Clinique des Cicatrices d'Acnluation Clinique des Cicospectively review 82 of 1034 patients who presented at our institution for atrophic acne scar treatment between August 2013 and August 2019. Factors associated with efficacy, including age, gender, Fitzpatrick skin type, energy, treatment sessions, follow-up duration, and pigmentation, were analyzed. 82 patients met inclusion criteria. Patients underwent one to three CO2 laser treatment sessions. Parameter settings for individual patients were consistent across treatments. Mean ECCA scores decreased from 102.70 ± 24.95 to 87.28 ± 24.48 (p ≤ 0.001). The number of treatment sessions and duration of pigmentation lasting shorter than 3months positively correlated with better outcomes. All patients had erythema, which lasted longer than 3months in 16 patients (19.51%). Post-inflammatory hyperpigmentation (PIH) affected 60 patients (73.17%) and lasted longer than 3months in 26 patients (31.71%). One patient experienced hypopigmentation (1.22%), while 8 experienced acne flare-up (9.76%). Post-laser scars occurred in 2 patients (2.44%). Our data suggest that in atrophic acne scar treatment in Asians using fractional CO2 laser, 3 treatment sessions and duration of hyperpigmentation within 3months have better outcomes regardless of energy, gender, age, Fitzpatrick skin type, follow-up duration, and disease course.

Fractional carbon dioxide LASER for acne scars

Acne is a common disease and patients frequently suffer from its distressing sequela of scarring which affects their quality of life. The treatment strategy for acne scars is usually influenced by multiple factors and we need to choose the best fit from amongst the various therapeutic modalities available. Lasers are increasingly being used and fractional ablative lasers create microthermal zones leading to collagen regeneration and reorganization in the target area. Fractional carbon dioxide laser has shown clinical efficacy in skin renewal in atrophic acne scars. Patient selection, counseling, pre, and postprocedure care guidelines form essential factors influencing the procedure outcomes. Here we discuss practical aspects of the use of fractional carbon dioxide laser in acne scar management along with pointers on patient selection, pre and postprocedure care, and side effects.

Neutrophils and their extracellular traps impair ablative fractional carbon dioxide laser-induced dermal remolding in mice.

Ablative fractional CO2 laser (AFL) therapy is an effective intervention to induce dermal remodeling. AFL treatment of the skin triggers the recruitment of immune cells, with neutrophils dominating the early phase. However, the role of recruited neutrophils in AFL-induced microinjuries and their subsequent dermal remodeling capacity remains elusive. A mouse model of AFL-induced dermal remodeling was established. RNA sequencing was used to identify the prominent features of AFL-treated tissues. Histological analysis, including H&E and Masson staining, ultrastructure observation by transmission microscopy, immunofluorescence, and quantitative real-time polymerase chain reaction were used for dermal remodeling analysis. Moreover, AFL-treated mice were intraperitoneally injected with anti-mouse Ly6G antibodies to deplete neutrophils. Neutrophil extracellular traps (NETs) were explored using immunofluorescence, transmission microscopy, and in vitro coculture experiments. Dermal remodeling, characterized by an increased number of CD31-positve vessels and elevated messenger RNA (mRNA) expression of genes encoding transforming growth factor-β (TGF-β), collagen I, and collagen III, was observed at 15 days after AFL treatment. In the AFL-induced inflammation phase, RNA sequencing identified neutrophil chemotaxis, and degranulation genes were significantly enriched. Histology and immunofluorescence staining of human and mouse tissues harvested at Day 1 after AFL treatment revealed significant neutrophil infiltration surrounding thermal-induced microinjuries. Neutrophil depletion decreased the expression of stress-related genes such as S100A8 and S100A9 in the early phase following AFL treatment. Importantly, neutrophil depletion enhanced dermal remodeling at Day 15, as reflected by enrichment of the extracellular matrix and collagen biosynthesis genes based on RNA sequencing. Moreover, increased collagen I, collagen III, and TGF-β mRNA expression, increased cell proliferation, and vascularity were observed. Interestingly, NETs, which could be induced by AFL-treated fibroblasts in vitro, were identified in both human and mouse tissues on Day 1 after AFL treatment. AFL-treated human and mouse skin recruited a large number of neutrophils. The neutrophil surge impaired dermal remodeling in mice. The microenvironment and fibroblast functional modulation mediated by neutrophil degranulation and NET formation were determined to be the underlying mechanisms. Our results indicate that modification of infiltrated neutrophil activity might be a potential therapeutic target for AFL-induced dermal remodeling.

Review of Lasers and Energy-Based Devices for Skin Rejuvenation and Scar Treatment With Histologic Correlations.

Lasers and energy-based devices (EBD) are popular treatments for skin rejuvenation and resurfacing. Achieving desired outcomes and avoiding complications require understanding the effects of these devices at a histologic level. Currently, no comprehensive review summarizing the histologic effects of laser and energy-based treatments exists. To describe how lasers and EBD alter skin histology and improve the overall understanding of these devices. A PubMed search was conducted for studies with histologic analysis of fractional picosecond laser, fractional radiofrequency microneedling, nonablative lasers, and ablative lasers. Fractional picosecond lasers induce intraepidermal and/or dermal vacuoles from laser-induced optical breakdown. Fractional radiofrequency microneedling delivers thermal energy to the dermis while sparing the epidermis, making it safer for patients with darker skin phototypes. Fractional nonablative lasers induce conical zones of coagulation of the epidermis and upper dermis. Ablative lasers vaporize the stratum corneum down to the dermis. Traditional ablative lasers cause diffuse vaporization while fractional ablative lasers generate columns of tissue ablation. Lasers and EBD are effective for skin resurfacing and rejuvenation and have different mechanisms with disparate targets in the skin. Safe and effective use of devices requires understanding the histologic laser-tissue interaction.

Efficacy of ablative fractional carbon dioxide laser combined with autologous platelet‐rich plasma versus ablative fractional carbon dioxide laser and placebo in the treatment of striae gravidarum: A randomized clinical trial

Striae gravidarum (SG) is a connective tissue disorder seen commonly in primigravidas. It is associated with impairment in the quality of life. To determine the efficacy of ablative fractional carbon dioxide (CO2 ) laser combined with autologous platelet-rich plasma (PRP) versus ablative fractional CO2 laser and placebo in the treatment of SG. Randomized, double-blinded, and placebo-controlled trial. The study was conducted in 16 patients with SG. The assigned treatment area (abdomen) was divided into two sides and was randomly assigned to the PRP side and the control side. All patients received ablative fractional CO2 laser. Immediately after each laser procedure, the PRP side received autologous PRP, while the control side received plain normal saline solution (pNSS) as a placebo. The study was done for three sessions, at intervals of 4weeks. An independent assessor used the photographs taken at Weeks 6, 10, 14, and 16 to assess the clinical improvement. The patient satisfaction was reported at the same intervals. A quartile grading scale was used to measure both the clinical improvement and patient satisfaction. Data were analyzed using the Jonckheere-Terpstra test. Histopathology was done before treatment and at the end of the study period. The combination of ablative fractional CO2 laser and autologous PRP had better clinical improvement and patients' satisfaction compared with ablative fractional CO2 laser and placebo. However, both outcome measures were not statistically significant. Ablative fractional CO2 laser combined with autologous PRP appears to be an effective treatment in SG.

Laser therapy in the treatment of melasma: a systematic review and meta-analysis.

Melasma is a highly prevalent and cosmetically disfiguring pigmented skin disease. The post-treatment results are often unsatisfactory. A large number of clinical trials have tried to prove the effectiveness of the combination therapy involving laser therapy, but the results have been indeterminate. This study aimed to evaluate the effectiveness of laser treatment for melasma via a systematic review and meta-analysis. We respectively searched 4 databases and clinicaltrials.gov as of June 8, 2021. Two researchers independently searched for literature and extracted data. Study outcomes were computed by weighted mean differences (WMD). All statistical analyses were performed by the Review Manager version 5.3, STATA version 14 software at 95% confidence interval. We obtained 22 eligible studies which involved a total of 694 patients. After the heterogeneity test and sensitivity analysis, we took a subgroup meta-analysis on the before and after treatment of different laser types. We found that most lasers and laser-based combinations were associated with reduced melasma area and severity index (MASI), such as low-fluence Q-switch 1,064-nm Nd: YAG laser (QSNYL) (WMD: - 2.76; 95% CI: - 3.53 to - 1.99), fractional ablative CO2 laser (WMD: - 9.36; 95% CI: - 12.51 to - 6.21), and fractional ablative 2940-nm Er: YAG laser (WMD: - 2,72; 95% CI: - 3.94 to - 1.49). Significant decrease was seen in neither MASI score of non-ablative 1550-nm fractional laser (WMD: - 1.29; 95% CI: - 2.80 to 0.21) and picosecond laser (WMD: - 0.58; 95% CI: - 1.43 to 0.27), nor melanin index (MI) of low-fluence QSNYL treatment (WMD: 10.17; 95% CI: - 4.11 to 24.46). When using laser to treat melasma, various adverse reactions may occur, most of which will resolve quickly without subsequent treatment, such as edema, erythema, scaling, and burning sensation after treatment. However, for patients with darker skin, there are risks of postinflammatory hyperpigmentation and hypopigmentation. The laser and laser-based combination treatment for melasma could significantly reduce the MASI score, which was showed by our systematic review and meta-analysis.

Skin Wound Tension Reduction Device Combined with Ablative Fractional Carbon Dioxide Laser to Reduce Scar Formation After Excision of Pediatric Facial Skin Lesions: A Prospective Cohort Study.

PurposeTo investigate the efficacy of skin wound tension reduction device (SWTRD) combined with ablative fractional carbon dioxide laser (CO2-AFL) for the prevention of scar formation following the excision of facial cutaneous lesions in children.MethodsPatients undergoing surgical excision of facial cutaneous lesions in our hospital between May 2019 and April 2021 were enrolled. After the excision of facial cutaneous lesions and based on the personal intents and conditions, patients were assigned to undergo SWTRD combined with CO2-AFL. Outcome evaluations were as follows: defect size, incision width, scar width, the Vancouver Scar Scale (VSS) and University of North Carolina 4P Scar Scale (UNC4P).ResultsA total of 25 pediatric patients (mean age, 9.88 years) were enrolled in the study. Following the treatment of SWTRD+CO2-AFL, scar widths were relatively narrow and the appearance of the incision scars was significantly improved. A significant reduction in the patient-reported UNC4P scores at 6 months (3, 1–4) was observed when compared with that at 2 months (0, 0–1) after surgery (p<0.001). A similar reduction in the VSS scar scale was also evident (6 months: 1, 0.75–2.5 vs 2 months: 6.5–8.5; p<0.001).ConclusionCombined SWTRD and CO2-AFL treatment effectively modulates the scar formation after the incision is healed and resulting in preventing scar widening, leading to the improvement of scar appearance, reduction in wound pain and pruritus and its overall prognosis.

Effect of mRNA Delivery Modality and Formulation on Cutaneous mRNA Distribution and Downstream eGFP Expression.

In vitro transcribed messenger ribonucleic acid (mRNA) constitutes an emerging therapeutic class with several clinical applications. This study presents a systematic comparison of different technologies—intradermal injection, microneedle injection, jet injection, and fractional laser ablation—for the topical cutaneous delivery of mRNA. Delivery of Cy5 labeled mRNA and non-labeled enhanced green fluorescent protein (eGFP) expressing mRNA was investigated in a viable ex vivo porcine skin model and monitored for 48 h. Forty 10 µm-thick horizontal sections were prepared from each skin sample and Cy5 labeled mRNA or eGFP expression visualized as a function of depth by confocal laser scanning microscopy and immunohistochemistry. A pixel-based method was used to create a semi-quantitative biodistribution profile. Different spatial distributions of Cy5 labeled mRNA and eGFP expression were observed, depending on the delivery modality; localization of eGFP expression pointed to the cells responsible. Delivery efficiencies and knowledge of delivery sites can facilitate development of efficient, targeted mRNA-based therapeutics.

Therapeutic Efficacy of a Plasma Rich in Growth Factors Gel Combined with Fractional Ablative Laser in the Management of Post-acne Scars.

Acne vulgaris is a common condition that often results in secondary cutaneous damage in the form of scarring. Scars require shape-specific scaffolds. Recently, a new 3D gel derived from plasma rich in growth factors technology (PRGF) has been developed with the aim of overcoming these limitations. The aim of this study was to preliminarily assess the clinical performance of the combination therapy with PRGF-gel (PG) and fractional ablative laser for post-acne scar amelioration. Nine patients suffering from post-acne scars received a combination of PG and fractional ablative laser therapy. Macrophotographs were taken and patients completed a satisfaction survey. Images were also analyzed following the ECCA score. Clinicians were also asked to fulfill a clinical improvement score and any undesired side effects were recorded. Patients were referred to be highly satisfied as an 8.7 ± 0.9 satisfaction score was achieved. Healthcare specialists objectivated that the scar reduction and overall skin quality at the end of the study had noticeably improved. The ECCA score showed a significant 55% of improvement compared with baseline. No major side effects were recorded, and the tolerance of the treatment was excellent. The combined therapy with PG and fractional ablative laser might help in the management of post-acne scars and overall skin rejuvenation.

Facilitated delivery of topical steroids after fractional ablative carbon dioxide laser benefits postthyroidectomy hypertrophic scar

Background: Thyroidectomy results in unsightly scarring at the anterior neck of the patient. Objectives: This prospective clinical study aimed to assess the effectiveness of laser assisted drug delivery (LADD) of topical steroid ointment for the treatment of postthyroidectomy hypertrophic scars. Methods: Five courses of a fractional ablative carbon dioxide laser combined with topical 0.05% clobetasol propionate were applied every 4 weeks to treat postthyroidectomy hypertrophic scars in ten adult female patients. The effectiveness was assessed by the patient themselves according to the Patient and Observer Scar Assessment Scale (POSAS) and by three different doctors according to photography evaluations before and 1 year after the first treatment. Results: Assessments of the scars by POSAS revealed significant improvements in terms of itchiness, color, softness, thickness, irregularity, and distorted appearance of the scars, albeit without any significant pain relief. In addition, all indicative characteristics of the scar, namely, vascularity, pigmentation, thickness, relief, pliability, surface area, and overall opinion, as assessed by the treating doctor and based on photographic evaluations by three different doctors, revealed significant improvements in the scars after treatment. Conclusion: In this study, we demonstrated that the topical delivery of steroids after fractional ablative carbon dioxide laser treatment showed an encouraging outcome in postthyroidectomy hypertrophic scarring.

Factors affecting the outcome of fractional carbon dioxide laser resurfacing of various types of scars in skin of color.

Fractional laser resurfacing has been used widely in management of scars. However, data for post-traumatic and post-burn scar are limited in skin of color. This retrospective study assessed the efficacy of fractional ablative carbon dioxide laser in treatment of various types of scars other than acne scars. We also tried to find out the effect of different factors like skin type, duration, shape, location, and color of the scars on the outcome. Forty-two patients with 67scars including post-traumatic (43), post-burn (15), post-surgical (5), and post-folliculitis (5) scars treated during 2019-2020 were analyzed. The improvement was graded according to investigator and patient global assessment (IGA & PGA) through percentage improvement and quartile scale. Overall, there was 45.4% and 32.7% of improvement according to PGA and IGA, respectively. Scars with >50% improvement were recorded in 13.43% of the scars with IGA and 41.78% with PGA. Early scars, scars without hyperpigmentation, lighter skin type, post-traumatic scars had better results. There was no significant difference for other parameters like atrophic versus hypertrophic, facial versus extra facial, linear versus non-linear, or the number of sessions. Fractional carbon dioxide laser efficacious for non-acne facial and extra facial scars in the skin of color. Early intervention could yield more satisfactory results.

Anti-PD-1 Therapy with Adjuvant Ablative Fractional Laser Improves Anti-Tumor Response in Basal Cell Carcinomas.

Simple SummaryIn some mouse models, ablative fractional laser (AFL) enhances the efficacy of anti-programmed cell death1 therapy (aPD-1), which was recently approved for basal cell carcinoma (BCC). In this explorative study, we aimed to assess locally applied AFL as an adjuvant to systemic aPD-1 treatment in a clinically relevant BCC model. BCC-carrying mice received aPD-1 alone, AFL alone, aPD-1+AFL, or no treatment. Both aPD-1 and AFL alone significantly increased survival time relative to the untreated controls, while aPD-1 that had been complemented with AFL further promoted survival and improved tumor clearance and growth rates. The BCCs were poorly immune infiltrated, but aPD-1 with adjuvant AFL and AFL alone induced substantial immune cell infiltration in tumors and increased the levels of relevant immune cell subtypes. Thus, the anti-tumor response that was generated by aPD-1 with adjuvant AFL may potentially be promoted by increased immune activity in tumors. In conclusion, the use of a local AFL adjuvant to systemic aPD-1 therapy could hold substantial promise for BCC treatment.The efficacy of anti-programmedcelldeath1therapy (aPD-1), which was recently approved for basal cell carcinoma (BCC) treatment, can be enhanced by adjuvant ablative fractional laser (AFL) in syngeneic murine tumor models. In this explorative study, we aimed to assess locally applied AFL as an adjuvant to systemic aPD-1 treatment in a clinically relevant autochthonous BCC model. BCC tumors (n = 72) were induced in Ptch1+/−K14-CreER2p53fl/fl-mice (n = 34), and the mice subsequently received aPD-1 alone, AFL alone, aPD-1+AFL, or no treatment. The outcome measures included mouse survival time, tumor clearance, tumor growth rates, and tumor immune infiltration. Both aPD-1 and AFL alone significantly increased survival time relative to untreated controls (31 d and 34.5 d, respectively vs. 14 d, p = 0.0348–0.0392). Complementing aPD-1 with AFL further promoted survival (60 d, p = 0.0198 vs. aPD-1) and improved tumor clearance and growth rates. The BCCs were poorly immune infiltrated, but aPD-1 with adjuvant AFL and AFL alone induced substantial immune cell infiltration in the tumors. Similar to AFL alone, combined aPD-1 and AFL increased neutrophil counts (4-fold, p = 0.0242), the proportion of MHCII-positive neutrophils (p = 0.0121), and concordantly, CD4+ and CD8+ T-cell infiltration (p = 0.0061–0.0242). These descriptive results suggest that the anti-tumor response that is generated by aPD-1 with adjuvant AFL is potentially promoted by increased neutrophil and T-cell engraftment in tumors. In conclusion, local AFL shows substantial promise as an adjuvant to systemic aPD-1 therapy in a clinically relevant preclinical BCC model.

Clinical efficacy of different therapeutic modes of CO2 fractional laser for treatment of static periocular wrinkles in Asian skin.

Periocular fine lines and wrinkles usually appear as a first visible sign of facial aging. Fractional ablative laser has been used to treat periorbital wrinkles. To compare the efficacy on treatment of static periorbital wrinkles using different emission modes of CO2 fractional laser. A total of 30 patients with static periorbital wrinkles were enrolled. The subjects were randomly assigned into two split-face groups: One side was treated with a deep (n=15) or mid-mode of CO2 superficial laser (n=15), and the other side of periocular region was treated by a fusion mode in combination of both modes (n=30). The patients in three groups showed significant improvements on indexes of periocular wrinkles, skin textures, and elasticity at three-month follow-up as compared with baseline (p<0.05). Fusion mode resulted in a significantly progressive improvement on periocular wrinkles at three-month follow-up as compared with one-month follow-up (p<0.05), which were not observed in other modes. Fusion mode delivered better improvements of periocular wrinkles and skin textures as compared to deep and mid-modes at three-month follow-up (p<0.05). Fusion mode also resulted in better scores of global esthetic improvement scale and patient satisfaction as compared to other modes at both follow-ups. The fusion mode has a synergistic effect in periorbital static wrinkle treatment, which is worthy of further evaluation and investigation.

Study of the effectiveness of fractional laser ablation in patients with atrophic postacne scars using the quantitative scar index

Introduction. Atrophic scars are common in acne patients. Regardless of their number and size, they are persistent defects and reduce patients' quality of life. With a variety of treatment options, effective scar correction remains a challenge. Laser technology continues to evolve and is considered promising for the treatment of scars.The aim of the study was to investigate the effectiveness of the fractional laser ablation method in patients with atrophic postacne scars using the quantitative postacne scar index.Materials and methods. The study involved 60 patients with ARP of II-IV severity, 35 women and 25 men. The patients underwent fractional ablation of scars with an Erbium laser (2940 nm). To assess the scars before and after treatment, we used the post-acne scar severity index according to the quantitative assessment scale according to G.J. Goodman et al. Goodman et al. (2006). The international scales Patient's Satisfaction Score, Physician's Satisfaction Score, and Definitive Graduated Score were used to assess physician and patient satisfaction with the results of the procedures.Results. The quantitative index of postacne scars before treatment ranged from 4.0 to 16.0 points and averaged 10.9±3.56 points; median was 12.0 points (8.0±13.0 points). After fractional laser ablation procedures, improvement of quantitative indexes scores (p&lt;0.05), positive dynamics of the doctor's and patients' evaluation of procedure results were noted; no gender differences were noted.Discussion. Quantitative indices of scar expression reflect the severity of the affected skin areas in patients with postacne. This study confirms the effectiveness of fractional ablation with the Erbium laser in patients with ARP, which is confirmed by a decrease in quantitative scar severity indices. Dynamic growth of PSS, PhSS, DGS indices testifies to high satisfaction of the physician and the patient with the results of treatment and correlates with regression of clinical manifestations in these patients.Conclusion. Despite the limitations and laboriousness of counting quantitative indices of postacne scars, this approach allowed to establish and objectify the clinical efficacy of treatment of patients with ARP by fractionated ablation.