Fractional Carbon Dioxide Laser Therapy Research Articles

Does low-energy fractional carbon dioxide laser therapy improve hair regrowth in female-pattern hair loss?

Background Female-pattern hair loss (FPHL) has the potential to impact the quality of life, physical attractiveness, and interpersonal relationships of many patients. In recent years, lasers and light therapy have been used as alternatives or supplementary therapy for hair loss. Objective To evaluate the efficacy of ablative fractional carbon dioxide (CO2) laser therapy alone in improving hair growth in FPHL. Patients and methods Thirty patients presenting with FPHL were included in a split-scalp prospective interventional study. Two areas of the scalp were studied. One area was treated with fractional CO2 laser and the second was injected with intradermal saline as control. The sessions were scheduled every 2 weeks for four sessions then monthly for 2 months. Patients were evaluated after each session and 2 months after the last session. Results were evaluated by clinical photography, trichoscopic, and folliscopic examination regarding the count of terminal and vellus hair, the thickness and density of hair shafts, and the patient’s satisfaction score. Results Fractional CO2 laser therapy alone was found to be effective in improving hair growth in FPHL. Conclusion Fractional CO2 laser therapy would have potential mechanisms in inducing hair regrowth in FPHL. However, the detailed mechanisms underlying hair regrowth and injury induced by the laser need further clarification.

Efficacy of a Combination Treatment of Ablative Fractional Carbon Dioxide Laser Therapy and Recombinant Human Epidermal Growth Factor for Atrophic Acne Scars.

Atrophic acne scars (AAS) are disfiguring and permanent changes caused by inflammatory acne. Fractional carbon dioxide is a common ablative device used to treat this condition. However, issues such as unclear effectiveness, frequent treatments, and potential side effects exist. In recent years, recombinant human epidermal growth factor (rhEGF) has also been frequently reported for its application in the treatment of acne scars. To explore the potential synergistic effect of fractional carbon dioxide laser combined with rhEGF in AAS treatment. We enrolled 15 patients with AAS. They received fractional carbon dioxide laser treatment and were then randomly assigned to receive either rhEGF or a placebo on one side of the face. The procedure was repeated three times, and the results were evaluated using the échelle d'évaluation clinique des cicatrices d'acné (ECCA) score and analyzed using the CBS camera system, 3D analysis (3DMD). Reflectance confocal microscopy (RCM) examination was also conducted. Both sides exhibited significant improvement in the appearance of the acne scars after treatment, as confirmed by the ECCA score, 3DMD data, and CBS texture score. On the rhEGF-treated side, the pore number and epidermal pigment area significantly improved as compared to the control side, whereas no significant differences were observed in the other data. Under RCM, a significant increase in epidermal thickness and appearance of reticular collagen fibers in the dermal layer after treatment was observed. Compared to the sole use of laser, the combination of fractional carbon dioxide laser and rhEGF does not significantly enhance scar therapeutic effects. However, it does shorten the recovery period after laser treatment and improves the pore appearance.

Follicular unit extraction combined with fractional carbon dioxide laser therapy for post-traumatic eyebrow scar with defects: A prospective and comparative study.

Eyebrows play a crucial role in the human body. While Follicular Unit Extraction (FUE) is a widely utilized and highly effective treatment for typical eyebrow deficiencies, it may not yield satisfactory outcomes for patients with post-traumatic eyebrow scars and defects. A prospective comparative clinical study was conducted to explore the treatment outcomes of post-traumatic eyebrow scars accompanied by defects using a combination of ablative fractional CO2 laser therapy with FUE. Between January 2019 and January 2023, we enrolled 30 patients with post-traumatic eyebrow scars and accompanying eyebrow defects, randomly assigning them to experimental and control groups. Patients in the control group received FUE treatment exclusively, whereas patients in the experimental group underwent CO2 fractional laser therapy on the eyebrow scars prior to FUE treatment. Alongside the patients' baseline data and the quantity of transplanted follicular units during surgery, we will compare the follicular survival rates between the two groups at 6 and 12 months post-treatment. Prior to FUE, there were no notable variances in baseline data between the two-patient groups. At 6 and 12 months postoperatively, the follicular survival rate in the experimental group was significantly higher compared to the control group. Additionally, patients in the control group were more prone to experiencing postoperative asymmetry between their eyebrows and developing curly hair. For patients with post-traumatic eyebrow scars accompanied by eyebrow defects, we applied ablative fractional CO2 laser therapy in combination with FUE treatment. This approach not only resulted in a higher follicular survival rate postoperatively but also led to the achievement of a well-defined eyebrow shape.

Systematic review of topical, laser, and oral treatments in acanthosis nigricans clinical trials.

Acanthosis nigricans(AN), with an estimated prevalence of 19.4% in the U.S., presents as hyperpigmented, velvety plaques in intertriginous regions. Acanthosis Nigricans negatively affects psychological well-being and particularly impacts skin of color individuals. Addressing the underlying cause of acanthosis nigricans, as current guidelines recommend, is often challenging. This highlights the importance of skin directed treatment for acanthosis nigricans. This systematic review evaluated topical, laser, and oral treatments for acanthosis nigricans and provides evidence-based recommendations for clinical use. Adhering to PRISMA guidelines, we evaluated 19 clinical trials investigating topical, oral, and laser interventions for acanthosis nigricans. Oxford Centre for Evidence-Based Medicine guidelines were used to make clinical recommendations. We strongly recommend topical tretinoin (grade A) and endorse the appropriate use of adapalene gel, urea cream, and fractional carbon dioxide laser therapy (grade B). Further research is essential to enhance our understanding of alternative treatments to determine additional evidence-based recommendations. This review aims to guide clinicians in managing acanthosis nigricans, especially when direct treatment of underlying conditions is impractical.

Prospective Evaluation of Fractional Carbon Dioxide Laser Treatment of Mature Burn Scars, Post-traumatic Scars, and Post-acne Scars.

Annually, around 100 million patients worldwide acquire scars, some of which can cause significant problems. Various treatment interventions, such as topical scar creams, steroids, laser therapy, and surgery, have been developed to manage these scars. This study was conducted to evaluate the effectiveness of fractional CO2 laser treatment by assessing outcomes using the Patient Observer Scar Assessment Scale (POSAS) and clinical photographs. A total of 47 patients were included in the study, divided into three groups: a post-acne scar group with 14 patients, a post-burn scar group with 17 patients, and a post-traumatic scar group with 16 patients. Detailed histories were taken, and clinical examinations were performed and recorded on a prepared proforma. Aesthetic outcomes were evaluated based on clinical photographs, and total patient and observer scores were recorded using POSAS at baseline, and after one and three months. POSAS comprises two components: the observer scale (POSAS-O) and the patient scale (POSAS-P). Fractional CO2 laser treatments were performed in each group, with sessions repeated every four weeks for three consecutive sessions. Data were analyzed using the paired t-test for before-and-after comparisons in each study group. Welch's ANOVA test was used for comparisons among the three groups at a significance level of p=0.05, using MS Excel(Microsoft Corporation, Redmond, Washington) and IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York). The mean age for men was 26.38 ± 8.19 years and for women 22.21 ± 6.38 years. The study comprised 34 female patients (72.34%) and 13 male patients (27.66%). The mean POSAS observer and patient scales were recorded and compared for all three types of scars from baseline to three months. The mean percentage change in POSAS-O and POSAS-P (total score) in relation to different scar sites was recorded. The most significant difference in mean percentage change, statistically significant (p-value < 0.05), was observed for facial scars, followed by scars on the neck, and was minimal for scars on the hand, in both observer and patient groups. Even a single session of fractional CO2 laser therapy had profound effects on the overall quality of scars. Fractional carbon dioxide laser therapy improves the quality of scars and produces significant improvements in skin texture, with better effects on post-traumatic scars than on post-burn and post-acne scars. Future studies are needed to better understand the mechanism of action and to optimize the doses and timing of therapy.

Efficacy of low energy fractional carbon dioxide laser therapy in management of post-surgical hypertrophic scars

Background: aberrant &amp; accelerated wound-healing process that results in hypertrophic scarring causes extracellular matrix &amp; collagen to deposit abnormally in the dermis. After tissue damage occurs, a defensive reaction called tissue repair occurs. Aim; in this review; we aimed to present the effectiveness of low-energy fractional carbon dioxide laser therapy in treating hypertrophic scars following surgery. Summary: A safe &amp; effective approach for treating hypertrophic burn scars is fractional ablative CO2 laser therapy. Even though more treatment sessions have been necessary for satisfying outcomes, a big improvement can be seen after just one round of therapy. Combination therapy with other modalities can decrease the need for repetition of therapy as efficacy increases. Though, in some studies, combination therapy may shorten the duration of studied case downtime &amp; in others, combination therapy may increase side effects. essential for laser energy setting needs to be adjusted for each hypertrophic scar condition. larger research population &amp; longer follow-up period are recommended.

SMOOTH protocol: A pilot randomised prospective intra-patient single-blinded observational study for examining the mechanistic basis of ablative fractional carbon dioxide laser therapy in treating hypertrophic scarring.

Burn injuries are the fourth most common type of trauma and are associated with substantial morbidity and mortality. The impact of burn injury is clinically significant as burn injuries often give rise to exuberant scarring. Hypertrophic scarring (HTS) is a particular concern as up to 70% of burns patients develop HTS. Laser therapy is used for treating HTS and has shown positive clinical outcomes, although the mechanisms remain unclear limiting approaches to improve its effectiveness. Emerging evidence has shown that fibroblasts and senescent cells are important modifiers of scarring. This study aims to investigate the cellular kinetics in HTS after laser therapy, with a focus on the association of scar reduction with the presence of senescent cells. We will conduct a multicentre, intra-patient, single-blinded, randomised controlled longitudinal pilot study with parallel assignments to achieve this objective. 60 participants will be recruited to receive 3 interventional ablative fractional CO2 laser treatments over a 12-month period. Each participant will have two scars randomly allocated to receive either laser treatment or standard care. Biopsies will be obtained from laser-treated, scarred-no treatment and non-scarred tissues for immune-histological staining to investigate the longitudinal kinetics of p16INK4A+-senescent cells and fibroblast subpopulations (CD90+/Thy1+ and αSMA+). Combined subjective scar assessments including Modified Vancouver Scar Scale, Patient and Observer Scar Assessment Scale and Brisbane Burn Scar Impact Profile; and objective assessment tools including 3D-Vectra-H1 photography, DermaScan® Cortex, Cutometer® and ColoriMeter®DSMIII will be used to evaluate clinical outcomes. These will then be used to investigate the association between senescent cells and scar reduction after laser therapy. This study will also collect blood samples to explore the systemic biomarkers associated with the response to laser therapy. This study will provide an improved understanding of mechanisms potentially mediating scar reduction with laser treatment, which will enable better designs of laser treatment regimens for those living with HTS. ClinicalTrials.gov: NCT04736251.

The Efficacy of Low Energy Fractional Carbon Dioxide Laser Therapy in Management of Post-Surgical Hypertrophic Scars

The Efficacy of Low Energy Fractional Carbon Dioxide Laser Therapy in Management of Post-Surgical Hypertrophic Scars

Fractional Carbon Dioxide Laser Therapy Compared to Ospemifene in the Treatment of Vaginal Atrophy in Menopause.

During the menopausal transition, women often experience an array of symptoms, including vaginal dryness, itching, pain, burning, decreased sexual desire, and inadequate lubrication, which are all due to hormonal changes called hypoestrogenism. Hypoestrogenism simply means a low level of estrogen which turn leads to a constellation of symptoms including hot flashes, urinary tract infections, decreased bone density and sleep disturbances. Some women find these symptoms embarrassing not to seek help, while some take it as a natural process of aging. Although various researchers have established different treatments in the past, such as lubricants and moisturizers, newer therapies such as fractional carbon dioxide (CO2) laser therapy and a selective estrogen receptor modulator ospemifene are currently being used and yet still researched. To highlight the lack of research on this topic, our article search involving only the PubMed database yielded 175 articles initially, but after exclusion and inclusion criteria, we were left with only 32 studies directly related to our research topic. Our study included English articles, full-text articles, articles on human studies, and articles from 2005- 2020. We excluded all studies prior to 2005, animal studies, pediatrics study, and only abstract study. All articles were chosen without limitation to the type of study. Our review suggests that patients often present with various symptoms and severity based on histology, mechanisms, and clinical findings. Therefore, treatment should be personalized. Our study aimed to further understand a better treatment option for vulvovaginal atrophy (VVA) in postmenopausal women, knowing that menopause is an inevitable stage of a woman's life.&#x0D;

The Efficacy of Low Energy Fractional Carbon Dioxide Laser Therapy in Management of Post Surgical Hypertrophic Scars

The Efficacy of Low Energy Fractional Carbon Dioxide Laser Therapy in Management of Post Surgical Hypertrophic Scars

A Double-Blind Randomized Sham-Controlled Trial to Evaluate the Efficacy of Fractional Carbon Dioxide Laser Therapy on Genitourinary Syndrome of Menopause

BackgroundDespite some prospective case series showing effectiveness of vaginal laser to treat genitourinary syndrome of menopause (GSM), there is a paucity of placebo-controlled level one evidence. AimTo assess the effect of fractional carbon dioxide (CO2) laser therapy to treat GSM against a sham comparator. MethodsWe conducted a parallel, randomized, double-blind, sham-controlled trial to compare menopausal women treated with fractional CO2 laser against sham treatment for improvement in GSM-related dyspareunia. Three treatments were given 6 weeks apart, and participants attended a 6-month visit from study start for primary (proportion improved) and secondary (vaginal health index, VHI; visual analogue scale, VAS; modified global assessment, PGI-I; Female Sexual Function Index, FSFI; Day-to-Day Impact of Vaginal Aging, DIVA; Urinary Distress Inventory short-form, UDI-6) assessments. OutcomesThe primary endpoint was a 2-stage improvement in GSM-related dyspareunia from baseline to 6 months determined by a severity scale, and the proportion of subjects who achieved this were compared between groups. ResultsThirty participants were randomized to laser (n = 14) or sham (n = 16). In the treatment arm, 13 attended all treatments, and 1 attended at least 2 while in the sham arm, 14 attended all treatments, and 2 attended at least 2 treatments. Twelve (86%) in the treatment arm and 16 (100%) in the sham arm attended the 6-month visit. There were no differences in the proportion improved between treatments and controls (64% vs. 67%, respectively, P = 1.000). Both arms showed significant within-group improvements based on VHI and VAS, but not between groups. Similar findings were observed on sexual impact questionnaires with improvements within both groups from baseline to 6 months but not by median differences between the groups at 6 months. There were no adverse events in either of the arms. Clinical ImplicationsFurther well-powered research is needed to determine efficacy of fractional CO2 laser for the treatment of GSM, especially in light of a potential placebo effect. Strengths & LimitationsWe present a sham-controlled double-blinded randomized trial using validated tools; the main limitation included an underpowered proportion of sexually active participants for the primary outcome. ConclusionThis study was underpowered to draw conclusions regarding the efficacy of fractional CO2 laser therapy in the treatment of GSM. We did observe improvements in the sham-arm to suggest a possible placebo contribution. Further well-powered level one research is needed to demonstrate the therapeutic effect of this novel modality.Cruff J, Khandwala S, A Double-Blind Randomized Sham-Controlled Trial to Evaluate the Efficacy of Fractional Carbon Dioxide Laser Therapy on Genitourinary Syndrome of Menopause. J Sex Med 2021;18:761–769.

Prospective Study of Fractional Carbon Dioxide Laser Therapy for Symptoms of Genitourinary Syndrome of Menopause: One-Year Follow-Up

Background: Our objective is to prospectively evaluate pixelated carbon dioxide (CO 2 ) laser therapy for the treatment of symptomatic genitourinary syndrome of menopause (GSM) over 1 year using both subjective and objective assessment methods. Methods: Subjects with symptomatic GSM completed pre-treatment evaluations. Subjects underwent three standardized pixelated CO 2 laser treatments 4 weeks apart. Use of other treatments during the study period was prohibited. Subjects completed five subjective GSM questionnaires (visual analog grading scale for vaginal atrophy symptoms (VAS-VA), Symptoms of Atrophic Vaginitis Questionnaire (SAVQ), and a modified Vulvovaginal Symptom Questionnaire (mVSQ), Urinary Distress Inventory (UDI-6) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12)) and physical assessments (Bachmann Vaginal Health Index (BVHI) and Vaginal Health Assessment (VHA)) 2 weeks after each treatment, and at 1 year. Vaginal cytologic maturation assessment was performed before and after each treatment. Three random subjects also underwent vaginal biopsy after treatments were completed. A P value of less than 0.05 was considered statistically significant. Results: Fifteen subjects were recruited with an average age of 58.3 years (range 43 - 70). Subjects had significant improvements on four of the five subjective assessments of GSM and on the two objective indices, from baseline to shortly after the third treatment, and were maintained at 1-year follow-up, with no worsening of the improvements. Subjects did not have significant improvement in urinary symptoms. Histologically, the surface epithelium ranged from within normal limits to mild squamous atrophy. There was mild submucosal vascular congestion in all specimens, with evident neovascularization. Conclusions: Clinically significant improvement was noted in subjective and objective assessments of GSM, and was sustained for 1 year following pixelated CO 2 laser therapy. Histologic changes were consistent with mild submucosal neovascularization rather than estrogen-like epithelial squamous maturation. J Clin Gynecol Obstet. 2021;10(1):11-17 doi: https://doi.org/10.14740/jcgo729

Prospective Study of Fractional Carbon Dioxide Laser Therapy for Symptoms of Genitourinary Syndrome of Menopause: One-Year Follow-Up

Prospective Study of Fractional Carbon Dioxide Laser Therapy for Symptoms of Genitourinary Syndrome of Menopause: One-Year Follow-Up

Laser therapy in the treatment of post-burn scars in children

Burns are one of the most common injuries in the paediatric population. Despite improved medical care, many burn patients develop permanent scars, which are a serious cosmetic, functional and psychological burden. We present the possible use of a pulsed dye laser (PDL) and an ablative fractional CO2 laser (AFCL) in the treatment of post-burn scars, with particular emphasis on the paediatric population. PDL is intended to reduce scar redness through selective photothermolysis of blood vessels to reduce local hypervascularity. This type of laser can be also used to reduce pruritus, most likely by modifying local cytochemical reactions. Ablative fractional carbon dioxide laser therapy (AFCL) may be optionally used to improve scar texture and reduce its thickness. AFCL can also restore normal function of the scarred area. It causes vaporisation of scar tissue fragments, thereby stimulating collagen reconstruction. The fact that PDL and AFCL can be safely combined during the same procedure is an important advantage of using laser therapy in the treatment of hypertrophic scars. Combined therapy allows to reduce the overall number of sessions. The use of two lasers during one session also allows to reduce the amount of anaesthesia. The combined use of PDL and AFCL is safe. No serious complications were reported during combined therapy. Doctors treating patients with burn scars should consider the use of laser therapy as a modern standard for the treatment of hypertrophic scars. Scars that cause contractures and significantly impair motor functions may require multi-stage surgical treatment, supported by laser therapy, rehabilitation and conservative treatment.

Efficacy of fractional carbon dioxide laser therapy for burn scars: a meta-analysis

Background The present study evaluates the effectiveness of fractional carbon dioxide (CO2) laser for the treatment of burn scars. Method Literature search was conducted in electronic databases and studies were selected by following pre-determined eligibility criteria. Random effect meta-analyses were performed to achieve the effect size of the changes (mean difference (MD) between post-treatment and pretreatment values) in selected scar assessment scale scores and other important outcome measures. Results 14 studies were included. Treatment of burn scars with fractional CO2 laser significantly improved Vancouver Scar Scale (MD −3.01 [95% confidence interval (CI) −3.79, −2.22]; p ˂ .00001), Patient and Observer Scar Assessment Scale (POSAS)– Patient (MD −14.38 [95% CI −17.62, −11.13]; p ˂ .00001, POSAS – Observer (MD −8.81 [9% CI −11.60, −6.02]; p ˂ .00001 and Scar Assessment Scale (MD 1.64 [95% CI 0.49, 2.78]; p = .005) scores especially with regards to pigmentation, vascularity, pliability, and height of scar. Pain and pruritis also improved with this treatment. Scar thickness measured with ultrasonography decreased non-significantly (MD −0.48 [95% CI −1.04, 0.09]; p = .1) whereas cutometer measures, R0 (scar firmness) and R2 (scar elasticity) did not change meaningfully. Conclusion Fractional CO2 laser therapy is a valuable tool for the treatment of burn scars which has potential for reducing scar severity.

Evaluation of the clinical efficacy of Fractional CO2 laser combined with topical antifungal in the treatment of onychomycosis using SCIO (Score clinical index of onychomycosis)

Background: Onychomycosis, a fungal infection of the nail, is considered one of the most prevalent disorders of the nail. Score clinical index of onychomycosis (SCIO) enable comparison of the severity of onychomycosis between nails despite differences in the clinical presentation. Recently fractional CO2 laser and topical antifungal were found to be effective in treating onychomycosis. Aim of the Work: To evaluate the clinical efficacy of fractional carbon dioxide laser combined with topical antifungal in treatment of onychomycosis. Patients and Methods: The present study included 20 patients with toenail and fingernail onychomycosis of all age groups. The affected nails received 3 sessions of laser therapy (Fractional CO2 laser) at 4 weeks intervals and once daily application of topical antifungal (Oxiconazole) available at the market under the name tinox cream. Conclusion: We concluded that fractional carbon-dioxide laser therapy, combined with a topical antifungal agent, is effective in the treatment of onychomycosis. It can treat different types of onychomycosis safely and effectively and is especially suitable for older patients with low immunity or liver and renal dysfunction who are not appropriate candidates for systemic antifungal agents. Thus, it could be considered as an alternative treatment modality.

Anesthetic Practices for Laser Rehabilitation of Pediatric Hypertrophic Burn Scars

The use of ablative fractional carbon dioxide laser therapy and pulsed dye laser therapy has led to significant improvements in the rehabilitation of hypertrophic burn scars. However, laser procedures are associated with appreciable pain among pediatric patients. Clinical consensus suggests using general anesthesia for pediatric laser procedures; however, guidelines for perioperative care are lacking. The objective of this quality improvement study is to determine whether a difference exists in postoperative pain outcomes in pediatric patients who receive intraoperative opioid regimens compared with patients who receive opioid-sparing regimens for laser therapy of hypertrophic burn scars. A retrospective review of patients who received laser therapy at a pediatric burn center from April 2014 to May 2015 was performed. Overall, 88 of the 92 procedures reviewed were included. A statistically significant difference was not found between the likelihood of postoperative pain when intraoperative opioid regimens (n = 63) were given compared with opioid-sparing regimens (n = 25) X (1, n = 88) = 2.870, P = .0902. There was also no difference between short-acting (n = 48), long-acting (n = 9), or combination (n = 6) intraoperative opioids compared with opioid-sparing regimens (n = 25) in the likelihood of postoperative pain. Despite the small sample size, the low number of postoperative pain cases is encouraging. Ultimately, these data provide a foundation for developing anesthetic guidelines for pediatric laser procedures. Specifically, clinicians should consider the potential to deliver adequate perioperative care via an opioid-sparing regimen ± adjuvant.

Fractional carbon-dioxide (CO2) laser-assisted topical therapy for the treatment of onychomycosis

Inability of topical medications to penetrate via nail plate brings a great challenge to clinicians in treating onychomycosis. Furthermore, oral medications are not appropriate for all patients because of drug interactions, adverse effects, and contraindications. We sought to evaluate the clinical efficacy of fractional carbon-dioxide laser-assisted topical therapy for onychomycosis. In total, 75 patients with 356 onychomycotic nails confirmed by mycologic examination were included in this study. All the affected nails received 3 sessions of laser therapy at 4-week intervals and once-daily application of terbinafine cream for 3 months. In all, 94.66% and 92% of the treated patients were potassium hydroxide and culture negative, respectively, after 3 months of treatment. However, only 84% and 80% were potassium hydroxide and culture negative, respectively, at 6 months of follow-up. Using Scoring Clinical Index for Onychomycosis electronic calculator, 73.33% of the patients scored higher than 6 and 26.66% of the patients scored 6 or less. Those who scored more than 6 were evaluated clinically and 98.18% of them showed response to treatment at 3 months and 78.18% of them at 6 months of follow-up. Lack of control group and short duration of follow-up are limitations. Fractional carbon-dioxide laser therapy combined with topical antifungal was found to be effective in the treatment of onychomycosis. However, randomized clinical studies are needed before it can be widely used in clinics.

Toenail onychomycosis treated with a fractional carbon-dioxide laser and topical antifungal cream

Traditional pharmacotherapy for onychomycosis has low to moderate efficacy and may be associated with adverse reactions and medication interactions limiting its use in many patients. We evaluated the clinical efficacy and safety of a fractional carbon-dioxide laser with topical antifungal therapy in the treatment of onychomycosis. In all, 24 patients were treated with fractional carbon-dioxide laser therapy and a topical antifungal cream. The laser treatment consisted of 3 sessions at 4-week intervals. Efficacy was assessed based on the response rate from standardized photographs, a microscopic examination of subungual debris, and subjective evaluations. Among the patients, 92% showed a clinical response and 50% showed a complete response with a negative microscopic result. The factors that influenced a successful outcome were the type of onychomycosis and the thickness of the nail plate before treatment. The treatment regimen was well tolerated and there was no recurrence 3 months after the last treatment episode. The study followed up only 24 patients and there were no relevant treatment controls. Fractional carbon-dioxide laser therapy, combined with a topical antifungal agent, was effective in the treatment of onychomycosis. It should be considered an alternative therapeutic option in patients for whom systemic antifungal agents are contraindicated.

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.