Fractional CO2 Laser Therapy Research Articles

Fractional CO2 laser versus promestriene and lubricant in genitourinary syndrome of menopause: a randomized clinical trial.

The aim of this study was to compare the effects of fractional CO2 laser therapy, promestriene, and vaginal lubricants on genitourinary syndrome treatment and sexual function in postmenopausal women. We performed a randomized clinical trial including 72 postmenopausal women over the age of 50 years. The women were randomized into three intervention groups to receive one of the following treatments: three sessions of intravaginal fractional CO2 laser therapy; 10 mg of intravaginal promestriene cream 3 times a week; and vaginal lubricant application alone. Vaginal maturation, Vaginal Health Index (VHI) score, and Female Sexual Function Index (FSFI) were evaluated at baseline and after 14 weeks of therapy. We observed an improvement in the vaginal elasticity, volume, moisture, and pH in the CO2 laser and promestriene groups. The VHI score at 14 weeks was higher in the CO2 laser group (mean score 18.68) than in the promestriene (15.11) and lubricant (10.44) groups (P < 0.001). Regarding vaginal maturation, basal cells were reduced and superficial cells were increased after treatment. This improvement was more significant in the CO2 laser group (P <0.001). The FSFI score only showed improvement in the desire and lubrication domains in the CO2 laser group. There were no differences in total FSFI score among the three treatment groups. There were no adverse effects associated with any of the treatments. The use of fractional CO2 laser therapy to treat genitourinary syndrome resulted in better short-term effects than those of promestriene or lubricant with respect to improving the vaginal health in postmenopausal women.

Evaluation of using fractional CO2 laser plus NB-UVB versus NB-UVB alone in inducing marginal repigmentation of vitiligo lesions

Background: Vitiligo is a common depigmenting skin disorder, characterized by patchy loss of skin color and finding effective treatment has remained a challenging issue.Methods: A paired (half-body) randomized clinical trial study was done to compare the efficacy and the safety of narrowband ultraviolet B (NB-UVB) plus fractional CO2 versus NB-UVB alone in stimulation of marginal repigmentation of vitiliginous patches. One side of the body was randomly treated with a fractional CO2 laser and NB-UVB twice weekly, while the other side was exposed only to NB-UVB with the same manner.Results: Thirty patients with the nonsegmental stable vitiligo and mean age of 43 ± 15 years completed a 16-week treatment period with NB-UVB on one side of the body and fractional CO2 laser therapy with NB-UBV on the other side. In addition to the higher rate of response in the combination side compared to the monotherapy side of the body (p < .001), repigmentation was greater in the combination side rather than the NB-UVB monotherapy side (p = .002). In the combination treated side, marginal repigmentation pattern was more frequently seen than perifollicular pattern (p < .001) and more frequently than monotherapy side (p < .001).Conclusion: The fractional CO2 laser combined with NB-UVB seems to be a more effective therapeutic option for treatment than NB-UVB alone for inducing marginal repigmentation.

FXCO2 laser therapy of existing burn scars does not significantly improve outcomes in a porcine model

IntroductionFractional CO2 lasers have been used to improve scar properties following burn injury; however, the efficacy of laser therapy alone has been difficult to ascertain. The goal of this study was to evaluate the effect of fractional CO2 laser therapy on objectively measured scar outcomes including scar area, pigmentation, erythema, roughness, histology, and biomechanics in a porcine burn model. MethodsFull thickness burn wounds were created on female red Duroc pigs; burn eschar was excised and wounds were grafted with split-thickness autograft. Sites had no additional treatment for 105 days resulting in thick contracted scars. At 105 days post burn, scars were treated with either a single pulse or three stacked pulses of a fractional CO2 laser at 70 mJ. Three treatments were given at four-week intervals. Scar area, pigmentation, erythema, roughness, histology, and mechanics were evaluated before treatment and at days 133, 161 and 189 post-injury. ResultsNeither single nor stacked laser treatment resulted in a significant improvement in scar area, appearance, or biomechanics compared to control scars. Scar roughness was, on average, reduced with fractional CO2 treatment; however, this did not reach statistical significance. ConclusionAlthough many clinical studies have reported significant benefits when treating burn scars with fractional CO2 laser therapy, this study did not find significant differences following laser therapy. For greatest efficacy, the selection of laser delivery parameters and co-treatments must account for variability in scar properties, including thickness.

Accelerated wound healing with a dexpanthenol-containing ointment after fractional ablative CO2 laser resurfacing of photo-damaged skin in a randomized prospective clinical trial

Background: Laser therapy with an ablative CO2 laser is a prominent treatment option for photo-damaged skin. The healing process and therefore the success of a laser can be supported by an appropriate postoperative treatment of the laser-treated skin.Objective: The effect of a dexpanthenol-containing ointment with petroleum jelly on wound healing after fractional ablative CO2 laser therapy of photo-damaged skin.Methods: A total of 38 patients with photo-damaged skin received fractional ablative CO2 laser treatment. Occlusive wound care was conducted for a period of 7 days. The complete wound area was divided into two sections: one that was treated with a dexpanthenol-containing ointment and a section that was treated with petroleum jelly. This study had three primary outcome measures: (1) Overview images as well as dermatoscopic images of the laser treated skin were taken immediately after laser treatment and on days 1, 2, 5 and 14 (study visits). Dermatoscopic images were analysed to determine changes of the diameter of the individual lesions between the study visits. (2) Wound-healing rate was visually assessed, based on the measure of re-epithelialization. (3) Cosmetic results were evaluated during study visits by patients and physicians applying a visual analogue scale (VAS).Results: Measuring the diameter of laser-generated lesions revealed a significantly faster cure of the lesions in wound sections that were treated with the dexpanthenol-containing ointment on days 1 and 2, in comparison to the lesions that were treated with petroleum jelly. Concordantly, visual evaluation of the wounds revealed significantly better cosmetic results and re-epithelialization on days 1, 2 and 5 after laser treatment in wound sites that were treated with the dexpanthenol-containing ointment. All patients exhibited a completed wound healing on day 14 after laser treatment.Conclusion: In this comparative study, post-operative treatment of laser-treated skin with a dexpanthenol-containing ointment led to a significantly faster wound closure in comparison to petroleum jelly, especially during the early phase of wound healing. Moreover, assessment of the cosmetic result exhibited beneficial effects of the dexpanthenol-containing ointment in the post-operative wound care after laser treatment. These results emphasize that the use of a dexpanthenol-containing ointment in the post-operative phase following CO2 laser therapy could be a promising alternative to the routinely used treatment with petroleum jelly.

Microablative fractional CO2 laser for the genitourinary syndrome of menopause: up to 12-month results.

The aim of this study is to assess the efficacy of microablative fractional CO2 laser therapy for genitourinary syndrome of menopause (GSM) management, when three, four, or five laser therapies were applied in a follow-up period of 12 months. Retrospective study evaluating GSM symptoms at baseline, and 1, 3, 6, and 12 months after last laser therapy. Visual analog scale, International Consultation on Incontinence Questionnaires- Female Urinary Tract Symptoms, International Consultation on Incontinence Questionnaires-Urinary Incontinence Short Form, Urogenital Distress Inventory-6, and Female Sexual Function Index were used for assessment of GSM symptoms' intensity or bothering and parameters of sexual function. Overall, 94 women were included (35, 35, and 24 received three, four, and five therapies, respectively). All GSM symptoms improved statistically significantly. Intensity of dyspareunia and dryness decreased from 9 (5-10) (median [minimum-maximum]) and 8 (0-10) at baseline to 0 (0-6) and 0 (0-8), 1 month after last laser therapy (all P < 0.001), respectively. FSFI and frequency of sexual intercourse increased from 10.8 (2-26.9) and 1 (0-8) at baseline to 27.8 (15.2-35.4) and 4 (2-8) 1 month after last laser therapy (all P < 0.001), respectively. The positive laser effect remained unchanged throughout the 12 months of follow-up. The same pattern was followed for symptom-free rates. Four or five laser therapies may be superior in lowering the intensity of GSM symptoms in comparison to three laser therapies, in short and long-term follow-up. Differences between four and five laser therapies were not found. Laser therapy may provide significant improvement and/or absence of GSM symptoms up to 12 months follow-up, irrespectively to the number of laser therapies applied. Symptoms intensity 1 month after last laser therapy may be indicative of GSM symptoms intensity at 12 months. One month after third laser therapy is the critical time to decide whether treatment extension should be offered.

Microneedling versus fractional CO2 laser in the treatment of atrophic postburn scars

Background Microneedling is an evolving approach in the treatment of postburn scars based on the principle of collagen induction and neovascularization. Objective To evaluate and compare the clinical and histopathological outcome of microneedling versus ablative fractional CO2 laser targeting atrophic postburn scars. Patients and methods Twenty-five patients with atrophic postburn scars were included in this study. Each patient received four treatment sessions of both microneedling and fractional CO2 laser with 4-week interval. Histopathological and histochemical evaluations of collagen and elastic fibers were done. Quantitative morphometric studies were also performed. Results A significant increase in collagen deposition was detected after fractional CO2 laser therapy. A significant increase in elastic fiber deposition was detected after both laser therapy and microneedling with fractional CO2 laser showing more significant results than microneedling. Conclusion Ablative fractional CO2 laser is more effective than microneedling in the treatment of atrophic postburn scars; however, microneedling did show a significant increase in elastic fiber deposition and thus can be a promising therapeutic approach when combined with other treatment modalities.

Effectiveness of combined 10,600 nm fractional CO2and 1540 nm erbium GaAs laser therapy on acne scar score alteration in patients with atrophic acne scars

Aim: The aim of this study is to determine the effectiveness of combined 10,600 nm fractional CO2and 1540 nm erbium GaAs laser therapy on atrophic acne scars. Subjects and Methods: The design of this study was pre- and post-test on patients with atrophic acne scars before and after receiving the combination laser therapy of fractional CO2and erbium GaAs. The sample size consisted of 20 medical records. The Acne Goodman-Baron Scar Score was used to score acne scars, which included morphology, quantity, depth, and width of the acne scars. The therapy was administered three times at 1-month intervals. The power and wavelength of the laser were adjusted based on the degree of the severity of the acne scar in each patient. The data were analyzed the hypothesis statistically using the Wilcoxon test, using the SPSS for Windows program, version 16.0. Results: There were significant differences (P = 0.007) between the means of the Goodman–Baron acne scar scores before and after combined 10,600 nm fractional CO2and 1540 nm erbium GaAs laser therapy. Side effects occurred in 50% of patients, where 35% experienced erythema and 15% experienced pruritus. Conclusion: The combination of 1540 nm erbium GaAs and 10,600 nm fractional CO2laser therapy can be effective for treating atrophic acne scars on the face, with minimal side effects. However, longer therapy sessions are required for better results.

Comparison of Fractional CO2 Laser, Verapamil, and Triamcinolone for the Treatment of Keloid.

Objective: Scar biology is a territory less understood. The search for ideal treatment of keloid continues. The aim of this study was to compare the role of CO2 laser, triamcinolone (TAC), and verapamil in the treatment of keloid. Approach: A randomized parallel-group study was conducted in which 60 patients were randomly allocated to three groups from May 2017 to April 2018. First group received fractional CO2 laser therapy, second group received triamcinolone, and third group received intralesional verapamil. Outcomes were evaluated using Vancouver scar scale score at 3 weekly intervals for 6 months. Results: There was a reduction in scar height, vascularity, and pliability in all the three groups. However, pigmentation was not completely resolved by any of the three modalities. The response was fastest in case of triamcinolone followed by verapamil and laser, which was statistically significant. There was reduction in pain and pruritus in all the three groups and lesser injection site pain with verapamil. There was some amount of charring with CO2 laser. Innovation: Our study provides evidence that TAC has the fastest response in treating keloids when compared to other modalities. Scar pigmentation is the parameter that is not completely resolved by TAC, verapamil, or CO2 laser. Conclusion: The study revealed that fractional CO2 laser and verapamil are as efficient as triamcinolone acetonide (TAC) for treating keloids, except it takes longer for laser and verapamil to act compared to TAC. Verapamil can be used as an alternative treatment modality that is cost-effective with minimal adverse effects.

Fractional CO2 laser therapy for genitourinary syndrome of menopause (GSM) in survivors of breast cancer (BC).

202 Background: Fractional CO2 laser therapy is an emerging treatment for GSM. The objective of this study was to determine the feasibility, tolerability and preliminary efficacy of fractional CO2 laser therapy in BC survivors. Methods: This was a single arm feasibility study of BC survivors with dyspareunia and/or vaginal dryness. Participants received three treatments with office-based fractional CO2 laser on at least 30 day intervals and returned for a one-month follow-up. Feasibility was defined as treatment completion without serious adverse events (SAE) in a minimum of 80% of patients. Primary efficacy was evaluated using the mean change (∆) in the score on the Vaginal Assessment Scale (VAS). Secondary efficacy endpoints included mean ∆ in scores on the Female Sexual Function Index (FSFI) and Urogenital Distress Inventory (UDI). Descriptive statistics (means and 95% confidence intervals (CI) for continuous variables and proportions for categorical variables) were used. Results: The study is ongoing with 65 patients enrolled. To date, 37 patients have completed all study treatments and follow-up. Median age for those who have completed treatment was 57 years (range 34-72). Most were ER/PR positive (78%) and Her 2 negative (81%) with stage I (43%) or II (41%) BC. Ninety-five percent were receiving endocrine therapy, most commonly aromatase inhibitors (73%). No SAEs were reported in the 37 patients who have completed study treatments and their outcomes are as follows. Based on the VAS, 78% reported moderate-severe dyspareunia and 89% reported moderate-severe vaginal dryness at baseline. At follow up, 28% reported moderate-severe dyspareunia and 28% reported moderate-severe vaginal dryness. The VAS score improved from baseline to follow up (mean ∆ 4.1; 95% CI [3.1, 5.1]). Similarly, the FSFI score improved (mean ∆ -10.0; 95% CI [-13.2, -6.9]) and the UDI score improved (mean ∆ -5.7; 95% CI [-10.1, -1.3]). Final efficacy analysis will be reported once all patients have completed all time points. Conclusions: Fractional CO2 laser treatment is feasible and tolerable in BC survivors and may reduce symptom burden from GSM. A randomized controlled trial with sham laser is currently in development. Clinical trial information: NCT03307044.

The main clinical symptoms in patients with posterior vaginal wall prolapse and modern non-drug technologies for its relief

Background. Rectocele is one of the leading causes of abnormal position and dysfunction of the pelvic floor and rectum.&#x0D; Objective: to develop and scientifically substantiate the use of a rehabilitation complex, including general magnetotherapy, electromyostimulation with biofeedback in combination with fractional microablative CO2 laser therapy in patients of different age groups with rectocele after surgery.&#x0D; Methods. The article presents the results of treatment of 100 women with rectocele, who were divided into main and control groups, within each group, depending on their age, they were divided into 2 subgroups: women of childbearing age were included in subgroup A, and women of peri- and menopausal age were included in subgroup B. Patients of the main group in the early postoperative period after plastic surgery for rectocele (from 1 day) were given a course of General magnetotherapy and in the late postoperative period (one month after the operation) a set of measures was performed, consisting of a course of electromyostimulation with biological connection of the pelvic floor muscles 2 intravaginal procedures of fractional microablative CO2 laser therapy at intervals of 45 weeks. Patients of the control group after surgical treatment of rectocele in the late postoperative period received symptomatic therapy, including painkillers and spasmolytics and a set of Kegel exercises.&#x0D; Results. Significant improvements in postoperative treatment were observed in patients of the main group: pelvic pain and periodic pain in the lower abdomen and lower back disappeared in 100% of cases; the main complaints related to violation of rectal emptying and urination were preserved in no more than 57% of cases, sexual complaints in 5%; in 95% of cases, general, vegetative and pre-climacteric complaints disappeared.&#x0D; Conclusion. As a result of the conducted research, it is shown that under the influence of the developed rehabilitation complex, regardless of age, there was a highly reliable dynamics of all complaints due to the influence of physical factors included in it on various pathogenetic links in the development of the disease.

Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments: a retrospective study.

Vulvovaginal atrophy (VVA) is a condition frequently observed in menopause. Its symptoms can significantly affect the quality of life of patients. Since VVA is related to estrogen deficiency, chemotherapy and hormone therapy for breast cancer (BC) might cause VVA by inducing menopause. Given the lack of effective treatment for VVA in BC survivors, we retrospectively evaluated the efficacy and tolerability of fractional microablative CO2 laser therapy in these patients. We treated 82 BC survivors with three cycles of CO2 laser after failure of topical nonestrogenic therapy. The severity of symptoms was assessed with a visual analog scale (VAS) at baseline and after completion of laser therapy. Differences in mean VAS scores of each symptom before and after treatment were assessed with multiple t tests for pairwise comparisons. Multivariate analyses were used to adjust the final mean scores for the main confounding factors. Pre versus post-treatment differences in mean VAS scores were significant for sensitivity during sexual intercourse, vaginal dryness, itching/stinging, dyspareunia and dysuria (P < 0.001 for all), bleeding (P = 0.001), probe insertion (P = 0.001), and movement-related pain (P = 0.011). Multivariate analyses confirmed that results were significant, irrespective of patients' age and type of adjuvant therapy. This study shows that CO2 laser treatment is effective and safe in BC patients with iatrogenic menopause. However, the optimal number of cycles to administer and the need for retreatment remain to be defined. Prospective trials are needed to compare CO2 laser therapy with therapeutic alternatives.

077 On the Initial Treatment Experience of CO2 Fractional Laser for Vulvovaginal Atrophy Symptom in a Single Institute

Volvovaginal atrophy (VVA) symptoms in women with menopause develop because female hormone secretion decreases. Unlike general menopausal treatment, systemic and local hormone replacement therapy and traditional Chinese medicine treatment may be refractory to VVA symptoms and there is no established treatment method. Presently, fractional CO2 laser therapy of the vulva has started for such symptoms. Since 2017, our department started the laser therapy for VVA patients who showed resistance to female hormone replacement therapy. We will review and report on the outcome of the treatment retrospectively. CO2 fractional laser was performed on patients with VVA. The maximum number of lasers treatments was three (number of treatments, according to the patient's symptoms). Each treatment interval was 4 to 6 weeks. During the operation, percutaneous anesthesia was performed on the vulva, and anesthesia time of 15 minutes or more was set. We evaluated improvement of main symptoms before and after treatment (VAS), change in vaginal health index and side effects (pain, infections, discharge and bleeding).

Combination of platelet rich plasma in fractional carbon dioxide laser treatment increased clinical efficacy of for acne scar by enhancement of collagen production and modulation of laser-induced inflammation.

Platelet-rich plasma (PRP) which contains large amounts of growth factors has been tried to enhance therapeutic efficacy of laser treatment for acne scar with unknown underlying mechanism. The present study was conducted to investigate the molecular mechanism of increased clinical efficacy of PRP when combined with fractional laser treatment for treating acne scars. Subjects with mild to moderate acne scars were treated with two sessions of fractional CO2 laser therapy given with and without co-administration of PRP. Skin biopsy specimens were obtained at baseline, 1, 3, 7, and 28 days for investigation of molecular profiles associated with skin changes produced by laser plus PRP treatment. The PRP treatment increased clinical efficacy with decreased severity of adverse effects such as erythema, swelling and oozing. Productions of TGFβ1 and TGFβ3 proteins were more highly elevated on the PRP-treated side of the face compared to the control side at day 28. Furthermore, PRP-treated side showed significant increase of c-myc, TIMP, and HGF expression. Experimental fibroblast culture model was also used. PRP administration after laser irradiation increased expressions of p-Akt, TGFβ1, TGFβ3, β-catenin, collagen 1, and collagen 3 in both dose-dependent and time dependent manners in fibroblast. Moreover, we acquired clinical and histological data through randomized control clinical trial. Taken together with human study results combined with the data from cell experiments we suggest that PRP treatment increased fibrogenetic molecules induced by fractional CO2 laser, which have association with clinical effect. Lasers Surg. Med. 50:302-310, 2018. © 2017 Wiley Periodicals, Inc.

Laser Therapy for Pediatric Burn Scars: Focusing on a Combined Treatment Approach.

Treatment with laser therapy has the potential to greatly improve hypertrophic scarring in individuals who have sustained burn injuries. More specifically, recent research has demonstrated the success of using pulsed dye laser therapy to help reduce redness and postburn pruritus and using ablative fractional CO2 laser therapy to improve scar texture and thickness. This study describes our early experience using laser therapy in our pediatric burn program and details our specific treatment approach when using each laser individually and in combination during the same procedure. A retrospective before-after study of patients with hypertrophic burn scars who were treated with laser therapy at our pediatric institution was performed. One hundred and twenty-five patients were treated over a total of 289 laser sessions with more than 50% of patients under the age of 5 years at the first treatment. The majority of procedures were performed using both the pulsed dye and CO2 lasers in combination. Before-after Vancouver Scar Scale scores decreased from 7.37 (SD, 2.46) to 5.76 (SD, 2.29) after a single treatment. The results obtained from this study support the use of laser therapy to improve hypertrophic burn scars in the pediatric population. Rigorous randomized controlled trials are needed to confirm the effectiveness of this therapy.

Urge Incontinence: Updates in Non-pharmacologic Treatments

The aim of this manuscript is to provide an overview of the recent literature on non-pharmacologic therapies for urgency urinary incontinence (UUI), specifically focusing on treatments for adult women who suffer from UUI in the setting of idiopathic overactive bladder syndrome (OAB). This review describes recent studies examining the efficacy of biofeedback-assisted pelvic muscle therapy, the effect of bariatric surgery on urinary incontinence, alternative approaches for tibial and transcutaneous nerve stimulation, sacral neuromodulation as compared to botulinum toxin type A, and 5-year outcomes of sacral neuromodulation therapy. The evidence supporting acupuncture as an alternative treatment is examined, and experimental therapies including electromagnetic nerve stimulation and fractional vaginal CO2 laser therapy are reviewed. Emerging areas for UUI research including the urinary microbiome, urinary biomarkers, and considerations in refining future treatment guidelines are discussed. UUI is a complex disorder that can be improved by a wide variety of therapies. Non-pharmacologic therapies are effective and widely utilized treatment options for those suffering from UUI. As we continue to learn more about this burdensome condition, less invasive and more effective therapies will hopefully become more easily available with lower cost of care.

Effects of early combinatorial treatment of autologous split‐thickness skin grafts in red duroc pig model using pulsed dye laser and fractional CO2 laser

The use of pulsed dye laser (PDL) and fractional CO2 (FX CO2 ) laser therapy to treat and/or prevent scarring following burn injury is becoming more widespread with a number of studies reporting reduction in scar erythema and pruritus following treatment with lasers. While the majority of studies report positive outcomes following PDL or FX CO2 therapy, a number of studies have reported no benefit or worsening of the scar following treatment. The objective of this study was to directly compare the efficacy of PDL, FX CO2 , and PDL + FX CO2 laser therapy in reducing scarring post burn injury and autografting in a standardized animal model. Eight female red Duroc pigs (FRDP) received 4 standardized, 1 in. x 1 in. third degree burns that were excised and autografted. Wound sites were treated with PDL, FX CO2 , or both at 4, 8, and 12 weeks post grafting. Grafts receiving no laser therapy served as controls. Scar appearance, morphology, size, and erythema were assessed and punch biopsies collected at weeks 4, 8, 12, and 16. At week 16, additional tissue was collected for biomechanical analyses and markers for inflammatory cytokines, extracellular matrix (ECM) proteins, re-epithelialization, pigmentation, and angiogenesis were quantified at all time points using qRT-PCR. Treatment with PDL, FX CO2 , or PDL + FX CO2 resulted in significantly less contraction versus skin graft only controls with no statistically significant difference among laser therapy groups. Scars treated with both PDL and FX CO2 were visually more erythematous than other groups with a significant increase in redness between two and three standard deviations above normal skin redness. Scars treated with FX CO2 were visually smoother and contained significantly fewer wrinkles. In addition, hyperpigmentation was significantly reduced in scars treated with FX CO2 . The use of fractional carbon dioxide or pulsed dye laser therapy within 1 month of autografting significantly reduced scar contraction versus control, though no statistically significant difference was detected between laser modalities or use of both modalities. Overall, FX CO2 therapy appears to be modestly more effective at reducing erythema, and improving scar texture and biomechanics. The current data adds to prior studies supporting the role of laser therapy in the treatment of burn scars and indicates more study is needed to optimize delivery protocols for maximum efficacy. Lasers Surg. Med. 50:78-87, 2018. © 2017 Wiley Periodicals, Inc.

Enhancing hair growth in male androgenetic alopecia by a combination of fractional CO2 laser therapy and hair growth factors.

Laser therapy and growth factors have been used as alternative treatments for male androgenetic alopecia (MAA). The aim of this study is to determine the efficacy and safety of hair growth factors alone or combined with ablative carbon dioxide (CO2) fractional laser therapy in MAA. Twenty-eight men were enrolled in this randomized half-split study based on a left-head to right-head pattern. Fractional CO2 laser treatment was unilaterally performed; hair growth factors were bilaterally applied. Six sessions with 2-week intervals were performed. Global photographs and dermoscopy assessments were performed at the baseline and 4months after first treatment. Global photographs underwent blinded review by three independent dermatologists. Scanning electron microscopy was used to compare changes in hair-follicle phase and hair-shaft diameter. Twenty-seven participants completed the 4-month treatment schedule. One patient was lost. Mean hair density increased from 114±27 to 143±25/cm2 (P<0.001) in the combined group and from 113±24 to 134±19/cm2 in the growth factor group (P<0.001). The mean change from baseline between two groups was also compared (P=0.003). Global photographs showed improvement in 93% (25/27) patients in the combined group and 67% (18/27) patients in the growth factor group. Under scanning electron microscopy, hair follicles appeared to transition from telogen to anagen, and hair-shaft diameter increased in five randomly selected patients. Ablative fractional CO2 laser combined with hair growth factors may serve as an alternative treatment for MAA in individuals unwilling/unable to undergo medical or surgical treatment.

Fractional CO2 laser therapy: a new challenge for vulvovaginal atrophy in postmenopausal women

Objective: To evaluate the effects of CO2 laser in the treatment of vulvovaginal atrophy (VVA) in postmenopausal women.Methods: VVA was assessed in 87 postmenopausal women (mean age 58.6 ± 6.9 years) before and after the treatment. The protocol consisted of three monthly treatments and included the treatment of vulva. Subjective measures included VAS (Visual Analog Scale) both for vaginal dryness and dyspareunia; DIVA (Day-by-day Impact of Vaginal Aging); a questionnaire on treatment satisfaction and one about the degree of pain during the procedure. Objective measures included VHI (Vaginal Health Index) and VVHI (Vulvo-Vaginal Health Index). Time points of the study were at the screening visit (T0), at baseline (T1), at week 4 (T2), at week 8 (T3), after 3 months since the last laser application (T4), after 6 months (T5), after 9 months (T6), after 12 months (T7) and after 15 months (T8).Results: Treatment induced significant improvement in the VAS score. After treatment, VHI and VVHI indicated no VVA and this improvement was long lasting. Multivariate analysis showed that the time of follow-up was correlated with better VHI and VVHI (p < 0.001). DIVA improved over time (p < 0.001).Conclusions: This study shows that CO2 laser treatment induces a significant and long-lasting improvement of symptoms.

Inflammatory responses, matrix remodeling, and re-epithelialization after fractional CO2 laser treatment of scars.

Fractional CO2 laser therapy has been used to improve scar pliability and appearance; however, a variety of treatment protocols have been utilized with varied outcomes. Understanding the relationship between laser power and extent of initial tissue ablation and time frame for remodeling could help determine an optimum power and frequency for laser treatment. The characteristics of initial injury caused by fractional CO2 laser treatment, the rates of dermal remodeling and re-epithelialization, and the extent of inflammation as a function of laser stacking were assessed in this study in a porcine scar model. Full-thickness burn wounds were created on female Red Duroc pigs followed by immediate excision of the eschar and split-thickness autografting. Three months after injury, the resultant scars were treated with a fractional CO2 laser with 70 mJ of energy delivered as either a single pulse or stacked for three consecutive pulses. Immediately prior to laser treatment and at 1, 24, 96, and 168 hours post-laser treatment, transepidermal water loss (TEWL), erythema, and microscopic characteristics of laser injury were measured. In addition, markers for inflammatory cytokines, extracellular matrix proteins, and re-epithelialization were quantified at all time points using qRT-PCR. Both treatments produced erythema in the scar that peaked 24 hours after treatment then decreased to basal levels by 168 hours. TEWL increased after laser treatment and returned to normal levels between 24 and 96 hours later. Stacking of the pulses did not significantly increase the depth of ablated wells or extend the presence of erythema. Interleukin 6 and monocyte chemoattractant protein-1 were found to increase significantly 1 hour after treatment but returned to baseline by 24 hours post laser. In contrast, expression of transforming growth factor β1 and transforming growth factor β3 increased slowly after treatment with a more modest increase than interleukin 6 and monocyte chemoattractant protein-1. In the current study, the properties of the ablative zones were not directly proportional to the total amount of energy applied to the porcine scars with the use of triple stacking, resulting in only minor increases to microthermal zone (MTZ) depth and width versus a single pulse. Re-epithelialization and re-establishment of epidermal barrier function were observed in laser treated scars by 48 hours post therapy. Finally, many of the inflammatory genes up-regulated by the laser ablation returned to baseline within 1 week. As a whole, these results suggest that microthermal zones created by FXCO2 treatment re-epithelialize rapidly with the inflammatory response to the laser induced injury largely resolved within 1 week post treatment. Further study is needed to understand the relationship between laser stacking and MTZ properties in human scars in order to evaluate the clinical applicability of the stacking technique. Lasers Surg. Med. 49:675-685, 2017. © 2017 Wiley Periodicals, Inc.

PD44-08 EFFECTS OF FRACTIONAL MICROABLATIVE CO2 LASER THERAPY ON SEXUAL FUNCTION IN POSTMENOPAUSAL WOMEN AND WOMEN WITH A HISTORY OF BREAST CANCER TREATED WITH ENDOCRINE THERAPY

You have accessJournal of UrologySexual Function/Dysfunction: Female1 Apr 2017PD44-08 EFFECTS OF FRACTIONAL MICROABLATIVE CO2 LASER THERAPY ON SEXUAL FUNCTION IN POSTMENOPAUSAL WOMEN AND WOMEN WITH A HISTORY OF BREAST CANCER TREATED WITH ENDOCRINE THERAPY Paul Gittens and Gregory Mullen Paul GittensPaul Gittens More articles by this author and Gregory MullenGregory Mullen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2065AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the effects of fractional microablative CO2 laser therapy on sexual function and the symptoms of the genitourinary syndrome of menopause (GSM) in postmenopausal women and women with a history of breast cancer treated with endocrine therapy. METHODS From July 2015 to October 2016, 25 women underwent fractional microablative CO2 laser therapy at a single institution by a single provider. The primary objective of the study was to evaluate changes in sexual function and symptoms of GSM in women who underwent treatment by using several validated questionnaires including the Female Sexual Function Index (FSFI), Wong-Baker Faces Scale (WBFS), Female Sexual Distress Scale - Revised (FSDS-R), and the Patient Health Questionnaire (PHQ-9). Differences in outcomes between postmenopausal women and women with a history of breast cancer treated with endocrine therapy were also evaluated. RESULTS For the 25 patients, mean age was 55.2 ± 9.5 years, average onset of menopause was 47.3 ± 6.3 years, and average duration of symptoms was 9.4 ± 7.6 years. Eight of the 25 patients had a history of breast cancer treated with endocrine therapy. Symptoms were assessed at baseline prior to treatment and six weeks after each treatment. Pre-treatment mean total FSFI score was 12.8 and post-treatment was 23.6 (P = 0.004). The largest average improvements from baseline were 1.70 for arousal (P = 0.021), 1.93 for lubrication (P = 0.031), 2.27 for orgasm (P = 0.004), and 2.53 for pain (P = 0.001). No significant differences in outcomes were observed between postmenopausal women and women with a history of breast cancer treated with endocrine therapy. Additionally, statistically significant improvements were observed in vaginal itching (P = 0.013), burning (P = 0.004), dryness (P < 0.001), painful intercourse (P < 0.001), and overall sexual distress (P = 0.001). Depression was not observed to have any significant effect on outcomes. CONCLUSIONS Fractional microablative CO2 laser therapy is effective in treating the symptoms of GSM by improving sexual function and decreasing sexual distress in both postmenopausal women and women with a history of breast cancer treated with endocrine therapy. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e883 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Paul Gittens More articles by this author Gregory Mullen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...