Fractional Carbon Dioxide Laser Research Articles

Novel long pulse potassium-titanyl-phosphate with substructured pulses – An effective tool in treating post-inflammatory erythema: A report of two cases in darker skin

The utilization of lasers is advancing as the range of applications for laser therapy expands, and new devices have been introduced. Vascular coagulation, pigment ablation, skin regeneration, tissue cutting or ablation, and hair removal are the five primary applications of laser therapy for the treatment of dermatological conditions. We present two cases of female patients with bilateral facial redness, one due to electromedical plasmage and the other from fractional carbon dioxide (CO2) laser, in which the target of their therapy was to improve acne scarring. Facial redness in both cases was successfully treated using a potassium-titanyl-phosphate (KTP) laser with cryogen cooling. The KTP laser has demonstrated efficacy in treating erythema associated with various conditions, including CO2 fractional laser and plasmage therapy. One of the advantages of the KTP laser is that it minimizes post-operative purpura and erythema, making it a favorable option for treating erythema itself.

Efficacy and safety of sequential treatment with botulinum toxin type A, fractional CO2 laser, and topical growth factor for hypertrophic scar management: a retrospective analysis

Hypertrophic scars arise from aberrant wound healing and can lead to functional and aesthetic impairments. One of the common interventions for treating hypertrophic scars is fractional carbon dioxide (CO2) laser, which employs narrow laser beams to stimulate dermal collagen deposition. Recent studies and reports have suggested that combining laser therapy with other interventions such as botulinum toxin type A (BTX-A) and topical growth factors may enhance treatment outcomes. Here, we examine the efficacy and safety of a sequential combination of BTX-A, fractional CO2 laser, and topical growth factors, referred to as combined therapy, for treating hypertrophic scars compared with only using fractional CO2 laser and topical growth factors, referred to as monotherapy. Our retrospective study includes 128 patients with hypertrophic scars (56 underwent monotherapy and 72 underwent combined therapy), which were followed-up for up to 15 months after the initiation of treatment to collect demographic and clinical data. Our analysis showed that the combined therapy significantly outperformed monotherapy in improving Vancouver scar scale scores (P < 0.05) and in the reduction of scar thickness (P < 0.05), without increasing adverse complications. Repeated treatments further augmented the efficacy of the combined therapy. Subgroup analysis revealed that combined therapy was notably more effective in reducing Vancouver scar scale scores and scar thickness in early-stage scars compared to late-stage (P = 0.023 and P = 0.045, respectively). Our study suggests that including BTX-A treatment before fractional CO2 laser and topical growth factors offers superior efficacy in reducing hypertrophic scars. We encourage early intervention and repeated treatments for optimal treatment outcomes.

A case of resistant granuloma faciale successfully treated with ablative fractional carbon dioxide laser

ABSTRACT Granuloma faciale is a benign and rare skin disease, which usually presents as well-defined red-purple asymptomatic plaques or nodules on the face but can also present extra-facially. It poses a significant therapeutic challenge, with varying degrees of success reported by a range of medical and surgical treatments. We describe a 41-year-old lady with biopsy-confirmed facial granuloma faciale, affecting her nose, cheeks, upper lip, and forehead, who had failed a variety of medical treatments, UVB phototherapy, and pulsed dye laser. She was successfully treated with ablative fractional CO2 laser, with a sustained response, without recurrence or complications maintained for 1 year.

Knowledge Structure and Trends of Vitiligo From 2002 to 2023: A Bibliometric Analysis

Introduction: Vitiligo is a common acquired depigmenting dermatosis resulting from a loss of epidermal melanocytes. The academic attention to vitiligo has gradually increased over the past two decades. Objective: We aimed to explore the current research structure and trends of vitiligo. Methods: Publications about vitiligo from the Web of Science Core Collection (WoSCC) database were searched. VOSviewer, CiteSpace, GraphPad Prism 8, ArcGIS, and Charticulator were implemented for data description and visual analysis. Results: A total of 3,037 publications authored by 10,993 individuals from 2,753 institutions across 88 countries/regions were collected. These publications were published in 616 journals and cited a total of 39,433 references. China was the most productive country. Cairo University and Ezzedine Khaled were the most prolific institution and author, respectively. Additionally, the British Journal of Dermatology stood out as the journal with the highest number of publications. According to the analysis of keywords and references, “quality of life,” “depression,” and “validation” were hotspots in terms of clinical characteristics, while “prevalence”, “comorbidity,” “association,” and “immunotherapy” gained more research interest with respect to epidemiology and genetics. The frontiers of pathogenesis focused on “unfolded protein response,” “migration,” “biomarkers,” and “CXCL10.” As far as treatment is concerned, there was increasing attention to “janus kinase inhibitor,” “fractional carbon dioxide laser,” “platelet-rich plasma,” and “5-fluorouracil.” Conclusion: The bibliometric analysis elucidates the foundational knowledge structure on research forces and unveiled the hotspots and frontiers, aiding researchers in gaining a deeper comprehension of the future development trends in the field of vitiligo.

Triple combination of fractional carbon dioxide laser, 308-nm excimer lamp, and platelet-rich plasma in refractory vitiligo: A randomized split-body comparative study

Objectives: Vitiligo significantly impacts patients’ quality of life. Current evidence indicates that combination therapy results in faster improvement, enhancing patient adherence to treatment and leading to higher satisfaction among patients. In this study, we compare the efficacy of combined fractional carbon dioxide (FCO2) laser and excimer lamp with platelet-rich plasma (PRP) or topical tacrolimus in patients with refractory vitiligo. Material and Methods: This is a prospective, single-blind, randomized split-body clinical trial involving 41 patients with resistant focal patches of vitiligo vulgaris. Each patient had two similar lesions randomly assigned to receive either a combination of FCO2 laser, excimer lamp, and intradermal PRP injections or a combination of FCO2 laser, excimer lamp, and topical 0.1% tacrolimus (applied twice daily for 12 weeks). The FCO2 laser and PRP treatments were administered in three monthly sessions, and the excimer lamp was used twice a week over 12 weeks. The efficacy of treatment was assessed based on the physician’s assessment and patient’s satisfaction Results: Despite significant improvement in both treatment groups during the course of treatment, the PRP group showed significantly superior efficacy (more than 50% improvement) compared to the tacrolimus group (56.1% and 26.8%, respectively). Furthermore, the PRP group exhibited greater improvement in resistant acral areas compared to the tacrolimus group (51.2% and 19.5%, respectively). Conclusion: The combination of FCO2, an excimer lamp, and PRP demonstrates superior efficacy, particularly in resistant acral areas. As a result, this combination can be recommended in difficult-to-treat areas in patients with vitiligo.

Recovery in patients undergoing ablative fractional carbon dioxide laser for adult hypertrophic burn scars: a longitudinal cohort study

IntroductionAblative fractional carbon dioxide laser (AFCO2L) is widely used as a treatment for hypertrophic burn scars. This study aimed to evaluate clinician and patient-reported outcomes after AFCO2L treatment, safety, and identify factors influencing outcomes. MethodsThis longitudinal study recruited adult patients with hypertrophic burn scars treated with AFCO2L at a single Australian burn unit. Patients received up to four AFCO2L treatments over approximately 12 months. Outcomes were ultrasound scar thickness, the Patient and Observer Scar Assessment Scale (POSAS), and the Brisbane Burn Scar Impact Scale (BBSIP), measured at baseline and 3, 6, and 12-months post first AFCO2L treatment. Analysis used mixed effects linear models. Results47 patients were included with median age 32 years (IQR:24,53) and median burn TBSA of 35% (IQR:7.5%,48%). Statistically significant improvements between baseline and 12-month follow-up occurred in scar thickness, all POSAS and BBSIP subscores. Most improvements remained when accounting for TBSA, Fitzpatrick skin type, scar maturity, and body area treated. Patients reported transient symptoms after 61 of 89 (69%) AFCO2L treatments, but infection or delayed wound healing occurred after only 4 of 89 (4%) treatments. ConclusionThis study supports safety and improved clinician and patient-reported outcomes in patients undergoing AFCO2L for hypertrophic burn scars.

Devices for treatment of nail psoriasis.

Nail psoriasis (NP) affects a significant proportion of cutaneous psoriasis patients, often leading to functional impairment and psychosocial distress. Despite available treatment options, challenges persist in achieving efficacy and with drug delivery, prompting investigation into novel therapeutic devices. A literature search was performed using the PubMed database for devices and lasers for NP on 17 October 2023 using the following search terms: device OR laser AND "nail psoriasis." Twenty-two articles were included describing treatment with pulsed dye laser, fractional carbon dioxide (CO<inf>2</inf>) laser, long-pulsed Nd:YAG laser, excimer laser, photodynamic therapy, intense pulsed light, and microneedling device. While some recent studies on use of therapeutic devices have shown promising results for NP treatment, current evidence supports an algorithmic approach including topical therapies, intralesional kenalog injections, and systemic therapies, depending on number of nails affected, presence of psoriatic arthritis, cutaneous psoriasis, comorbidities, and effect on quality of life. Laser therapy, although promising, requires further validation through extensive randomized trials before its inclusion in treatment regimens. These exploratory findings highlight emerging therapies that may expand the spectrum of options available. Use of lasers for NP treatment could provide dermatologists with a broader arsenal for customizing treatment plans that address individual patient needs, taking into account comfort, cost, and compliance to enhance overall patient outcomes.

Fractional Carbon Dioxide Laser for Treatment of Microstomia and Rhytids in Systemic Sclerosis Patients.

Systemic sclerosis (SSc) is an autoimmune disorder characterised by skin fibrosis leading to skin tightening and disfigurement. However, there is no definite treatment for SSc and its skin complications. Fractional carbon dioxide laser has been widely used for different cutaneous pathologies. This study aims to evaluate the benefits of CO2 laser resurfacing on microstomia and peri-oral rhytids in systemic sclerosis patients. 33 systemic sclerosis patients were enrolled. Four sessions of CO2 laser treatment were performed at an interval of four weeks. Patients were evaluated monthly. The interincisal distance (IID) measurement was used to evaluate maximal mouth opening capacity, and the mouth handicap in systemic sclerosis (MHISS) scale was used to assess the improvement after treatment. All of the participants were female with a mean age of 47.46 and a standard deviation of 7.11. The mean disease duration was 12.35. The mean total core of the MHISS scale was 25.24, and the mean IID was 48.11 millimetres before the treatment with CO2 laser. The MHISS score decreased, and patient satisfaction increased after treatment. However, observed differences in the results of IID were not statistically significant. In conclusion, it seems that the fractional carbon dioxide laser is effective in the improvement of perioral rhytids, patient satisfaction based on the MHISS score, and mouth disability in SSc patients.

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.

Effects of Fractional Carbon Dioxide Laser and CPP-ACP Paste on Remineralization and Discoloration of Enamel White Spot Lesions

Effects of Fractional Carbon Dioxide Laser and CPP-ACP Paste on Remineralization and Discoloration of Enamel White Spot Lesions

52917 A UK regional prospective clinical audit of the use of fully ablative and fractional Carbon Dioxide Laser treatment for a variety of skin conditions

52917 A UK regional prospective clinical audit of the use of fully ablative and fractional Carbon Dioxide Laser treatment for a variety of skin conditions

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.

Comparative study in treatment of acne scars fractional carbon dioxide laser versus micro needling fractional radio frequency - A retrospective study.

Efficacy of fractional carbon dioxide laser and microfractional radiofrequency in treatment of acne scars is well substantiated. The objective of this study was to compare the efficacy and safety of carbon dioxide laser versus microfractional radiofrequency in treatment of acne scars in skin type 3,4. Thirty-two patients of skin types 3-4 with grade 3 and 4 atrophic acne scars, of which 16 were treated with fractional carbon dioxide (CO2) laser and 16 were treated with microfractional radiofrequency were retrospectively analyzed. All patients received either treatment 4 sessions at an interval of 4-6 weeks. Objective assessment was done with qualitative and quantitative Goodman and baron acne scar grading system by assessment of photographs at baseline and 3 months after last session. All the data collected were entered in a Microsoft Excel worksheet and analyzed using R Software R-4.2.1. The study variables acne scar grades were described using frequency with percentage, acne scar scores were described using Mean with Standard deviation, and Median with interquartile range (IQR) (Q1-Q3). Since the data were ordinal, which is non-normal, hence, non-parametric tests are applied. To compare grades between the groups, Mann-Whitney U-test was applied. There was no difference in the last session (after the treatment) between the groups, the Mann- Whitney U-test was 109.5 with P-value of 0.484 >0.05. Therefore, there was no statistically significant difference between the microfractional radiofrequency and carbon dioxide laser group. There were 2 (12.5%) cases reported with post-inflammatory hyperpigmentation in the CO2 laser group and zero cases in the microfractional radiofrequency group.

Successful Treatment of Darier-White Disease with Ablative Fractional Carbon Dioxide Laser.

We present this as the fourth published case of Darier disease treated successfully with ablative fractional carbon dioxide laser.

Comparative Efficacy of Fractional CO2 Laser Combined with Topical Steroid Cream versus Solution for Post-Thyroidectomy Scar Treatment: A Prospective Study.

Post-thyroidectomy scarring is a common illness impacting patient quality of life. Fractional carbon dioxide (CO2) lasers and topical steroids delivered via laser-assisted drug delivery (LADD) have shown potential for scar treatment. However, ideal steroid formulations (cream vs. solution) when combined with laser therapy remain unclear. This study included 12 patients receiving fractional CO2 laser on post-thyroidectomy scars. After laser treatment, one scar half received topically applied steroid cream, while the other half received steroid solution. The Patient and Observer Scar Assessment Scale (POSAS) was used to measure the scar conditions at the time prior to the first treatment and one year later by the patients themselves and by the surgeon who did the laser treatment. Scar appearance was photographically assessed at baseline and 6 months post-treatment by four blinded evaluators using scales. This study discovered a modest improvement in the appearance of post-thyroidectomy scars when combining fractional CO2 laser treatment with either topical steroid cream or solution. Patients and treating physicians examined the POSAS scores one year after treatment found significant improvements in all aspects of the scar conditions, with high efficacy and satisfaction levels reported by patients. Fractional CO2 laser combined with topical steroid delivery, either cream or solution form, significantly enhanced post-thyroidectomy scar appearance with modest effect and high patient satisfaction. This approach may represent a promising scar management strategy along with current scar treatment for the post-thyroidectomy scar.

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.

Impact of 30% supramolecular salicylic acid combined with ultra-pulse carbon dioxide fractional laser therapy on facial atrophic acne scars

Objective: To assess the impact of 30% supramolecular salicylic acid (SSA) combined with ultra-pulse carbon dioxide (CO2) fractional laser therapy on facial atrophic acne scars. Methods: This retrospective study included patients with atrophic acne scars treated from June 2020 to June 2022. The patients were divided into the combination group (SSA combined with ultra-pulse CO2 fractional laser therapy) and the laser group (ultra-pulse CO2 fractional laser therapy alone). Four treatment sessions were conducted for each group. Follow-up visits were performed every 2 months after each treatment and included assessments of the Échelle d'Évaluation clinique des cicatrices d'acné (ECCA) score, effective rate, and visual analogue scale score. Results: The combination and laser groups comprised 72 and 61 patients, respectively. There were no significant differences in sex, age, or baseline ECCA score between the two groups. The effective rate (95.8% vs. 67.2%, P &lt; 0.001) was higher and the pain scores (during and after the intervention) were lower in the combination group than in the laser group (P &lt; 0.001). The severity of erythema, edema, and crusting was milder in the combination group (P &lt; 0.001). The proportion of highly satisfied patients was higher (73.6% vs. 31.2%, P &lt; 0.001) and the Dermatology Life Quality Index showed greater improvement (0.15 ± 0.40 vs. 1.39 ± 1.53, P &lt; 0.001) in the combination group than in the laser group. Conclusion: The combination of ultra-pulse CO2 fractional laser therapy and 30% supramolecular SSA had improved efficacy in treating facial atrophic acne scars without increasing pain or inducing adverse reactions.

Fractional Carbon Dioxide Laser versus Cryotherapy in the Treatment of Alopecia Areata: A Pilot Comparative Study

Abstract Alopecia areata, one or more round bald patches appear suddenly, most often on the scalp. It can affect males and females at any age. The exact mechanism is not yet understood and there is not yet any reliable cure for alopecia areata. Several topical treatments used for alopecia areata are reported to result in temporary improvement in some people. Superficial cryotheray is introduced as a possible treatment for Alopecia Areata with minimal side effects and being less painful. In addition, fractional CO2 laser is introduced as a effective option in AA treatment. Aim of the Study the current study aimed to assess the efficacy and safety of FCO2 laser in comparison to cryotherapy in the treatment of AA. Patients and Methods this study included 22 patients (with patchy AA (at least three patches) of both sexes. Patients were subjected to full history taking, complete general and dermatological examination then digital photography and dermoscopic examination were performed. The three patches in each patient were divided according to therapy used; one patch was treated with Fractional CO2 laser, second one was treated with superficial cryotherapy and the third was left without treatment as control. Results Regarding FCO2 laser treated patches, trichoscopic assessment revealed that BDs, YDs and EMHs count showed significant decrease after treatment compared to before treatment. In addition, SVHs count showed significant increase after treatment compared to before treatment. Concerning cryotherapy treated patches, trichoscopic assessment revealed that BDs, YDs and EMHs count showed significant decrease after treatment compared to before treatment. Also, there was as increase in the TH and SVHs count after treatment in comparison to before treatment, but the results were statistically insignificant. Conclusion Both cryotherapy and fractional CO2 laser therapy are safe and effective modalities in the treatment of AA with superiority for FCO2 laser.

Enhancing Skin Flap Survival with Preoperative Carbon Dioxide Fractional Laser Treatment: A Novel Approach in Reconstructive Surgery

Background: Skin flap necrosis remains a significant challenge in reconstructive surgery, predominantly due to insufficient blood supply. Traditional methods like the surgical delay procedure, while effective, are invasive and associated with considerable patient discomfort and health care costs. This study explores the efficacy of Carbon Dioxide Fractional Laser (CDFL) treatment as a novel, less invasive alternative to enhance skin flap survival. Methods: Twenty-nine adult male Sprague-Dawley rats were divided into 2 groups: a CDFL treatment group (n=14) and a control group (n=15). The CDFL group received laser pretreatment 1 week before flap surgery, whereas the control group underwent flap surgery without pretreatment. Flap survival was assessed 7 days postsurgery using indocyanine green fluorescence angiography. In addition, histological analysis was conducted to evaluate tissue integrity, capillary density, and VEGF expression. Results: The CDFL-treated flaps showed significantly increased survival areas compared with controls (P&lt;0.01). Histological evaluation revealed enhanced capillary dilation and increased VEGF expression in the CDFL group (P&lt;0.05). Although capillary density was higher in the CDFL group, it did not reach statistical significance (P=0.052). Conclusion: CDFL pretreatment significantly improves skin flap survival in rats, suggesting potential as a minimally invasive alternative to traditional surgical delay techniques. This approach could offer substantial benefits in reconstructive surgery, reducing patient morbidity and associated costs. Further studies are warranted to confirm these findings in clinical settings.

Preconditioning Strategies for Improving the Outcome of Fat Grafting.

Autologous fat grafting is a common procedure in plastic, reconstructive, and aesthetic surgery. However, it is frequently associated with an unpredictable resorption rate of the graft depending on the engraftment kinetics. This, in turn, is determined by the interaction of the grafted adipose tissue with the tissue at the recipient site. Accordingly, preconditioning strategies have been developed following the principle of exposing these tissues in the pretransplantation phase to stimuli inducing endogenous protective and regenerative cellular adaptations, such as the upregulation of stress-response genes or the release of cytokines and growth factors. As summarized in the present review, these stimuli include hypoxia, dietary restriction, local mechanical stress, heat, and exposure to fractional carbon dioxide laser. Preclinical studies show that they promote cell viability, adipogenesis, and angiogenesis, while reducing inflammation, fibrosis, and cyst formation, resulting in a higher survival rate and quality of fat grafts in different experimental settings. Hence, preconditioning represents a promising approach to improve the outcome of fat grafting in future clinical practice. For this purpose, it is necessary to establish standardized preconditioning protocols for specific clinical applications that are efficient, safe, and easy to implement into routine procedures.