Ablative Fractional Laser Research Articles

The importance of biomechanics and the kinetic chains of human movement in the development and treatment of burn scars - A narrative review with illustrative cases.

Burn scars are a major clinical sequelae of severe burn wound healing. To effectively establish a successful treatment plan and achieve durable results, understanding the pathophysiology of scar development is of utmost importance. A narrative review of the principles of the kinematic chain of movement and the hypothesised effect on burn scar development based on properties of burn scars was performed. An examination of the literature supporting these concepts is presented in conjunction with illustrative cases, with a particular focus on the effect of combination treatments that include ablative fractional resurfacing with surgical contracture releases. Ablative fractional resurfacing combined with the surgical release of contractures are an effective treatment modality for burn scar reconstruction. This treatment approach seems particularly effective because it is one of the only approaches where the principles of functional kinematics can be addressed when tailoring a reconstructive approach to an individual burn patient. The presented cases illustrate the importance of recognising and including the principles of functional kinematic chains in any reconstructive treatment approach for burn scars. Further, epifascial contracture bands are cord like structures which can be found underneath the subcutaneous fat of scar contractures which follow the principles of functional kinematics. Contractures can be more efficiently released if these structures are divided as well. Ablative fractional resurfacing combined with local tissue re-arrangements is a promising approach to address the underlying forces leading to hypertrophic burn scarring. To achieve an optimal outcome, it is essential to recognise and address the origin of the pathology when treating burn scars. Ablative fractional laser resurfacing allows a different scar approach as it is not limited to one surgical site and thus enables for effective treatment at the cause of the pathology.

A case report of Hailey-Hailey disease treated with fractional carbon dioxide laser.

Hailey-Hailey disease (HHD), or familial benign pemphigus, is a rare genetic condition characterized by recurrent blisters and erosions with a predilection for intertriginous areas. There is no specific treatment for HHD. Topical and systemic treatments tend to provide temporary remission. Alternative treatment (surgical interventions such as dermabrasion, excision, and laser) has been shown to prolong remission. Considering the risk of complications associated with surgical modalities, laser is often preferred as an alternative for patients failing to respond to first-line therapies. We report a case of recalcitrant HHD successfully treated with a fractional ablative CO2 laser procedure (wavelength of 10600 nm, power of 7-10 W, 2-3 passes) on a 35-year-old female. The patient has a 7-year history of therapy-resistant HHD. A 2-month followup showed substantially resolved lesions, with mild erythema and post-inflammatory hyperpigmentation in treated areas.

CO2 ablative fractional laser - mechanism of action and assessment of safety, effectiveness in the treatment and possible side effects based on a review of scientific literature

Introduction: Laser therapy has been used in medicine for many years. One of the most willingly used is the fractional ablative CO2 laser. As a result of its use, the improvement of pigmentation, skin texture and signs of aging are achieved. Laser therapy owes its popularity to its low invasiveness and good, long-lasting effects of the procedure. Despite its important role in aesthetic medicine, we should not forget about its participation in the treatment of scars, often extensive, causing troublesome symptoms to patients, the source of which is not only a defect of a cosmetic nature. Purpose of the work: The purpose of the study is to present mechanism of action, assessment of safety, effectiveness in the treatment and possible side effects based on a review of scientific literature. Material and methods: The work was based on a review of available medical publications on the use of the fractional ablative CO2 laser. The literature in the PubMed and Google Scholar databases was searched based on the following keywords: fractional ablative CO2 laser, mechanism of action, safety of use, side effects. Conclusion: The use of a fractional ablative CO2 laser causes the increased collagen production in the dermis. This effect contributes to the elevation of the quantity and level of collagen arrangement, and also to the reduction of the visibility of the effects of photoaging. As a result, the skin in the treated area becomes thicker, and thus firmer. The pigmentation and texture are also being improved. The procedure is relatively slightly invasive, and the side effects are self-limiting in the most cases.

Laser-assisted drug delivery of synthetic alpha melanocyte stimulating hormone and L-tyrosine leads to increased pigmentation area and expression of melanogenesis genes in a porcine hypertrophic scar model.

One symptom of hypertrophic scar (HTS) that can develop after burn injury is dyschromia with hyper- and hypopigmentation. There are limited treatments for these conditions. Previously, we showed there is no expression of alpha melanocyte stimulating hormone (α-MSH) in hypopigmented scars, and if these melanocytes are treated with synthetic α-MSH in vitro, they respond by repigmenting. The current study tested the same hypothesis in the in vivo environment using laser-assisted drug delivery (LADD). HTSs were created in red Duroc pigs. At Day 77 (pre), they were treated with CO2 fractional ablative laser (FLSR). Synthetic α-MSH was delivered as a topical solution dissolved in l-tyrosine (n = 6, treated). Control scars received LADD of l-tyrosine only (n = 2, control). Scars were treated and examined weekly through Week 4. Digital images and punch biopsies of hyper, hypo-, and normally pigmented scar and skin were collected. Digital pictures were analyzed with ImageJ by tracing the area of hyperpigmentation. Epidermal sheets were obtained from punch biopsies through dispase separation and RNA was isolated. qRT-PCR was run for melanogenesis-related genes: tyrosinase (TYR), tyrosinase-related protein-1 (TYRP1), and dopachrome tautomerase (DCT). Two-way ANOVA with multiple comparisons and Dunnett's correction compared the groups. The areas of hyperpigmentation were variable before treatment. Therefore, data is represented as fold-change where each scar was normalized to its own pre value. Within the LADD of NDP α-MSH + l-tyrosine group, hyperpigmented areas gradually increased each week, reaching 1.3-fold over pre by Week 4. At each timepoint, area of hyperpigmentation was greater in the treated versus the control (1.04 ± 0.05 vs. 0.89 ± 0.08, 1.21 ± 0.07 vs. 0.98 ± 0.24, 1.21 ± 0.08 vs. 1.04 ± 0.11, 1.28 ± 0.11 vs. 0.94 ± 0.25; fold-change from pre-). Within the treatment group, pretreatment, levels of TYR were decreased -17.76 ± 4.52 below the level of normal skin in hypopigmented scars. After 1 treatment, potentially due to laser fractionation, the levels decreased to -43.49 ± 5.52. After 2, 3, and 4 treatments, there was ever increasing levels of TYR to almost the level of normally pigmented skin (-35.74 ± 15.72, -23.25 ± 6.80, -5.52 ± 2.22 [p < 0.01, Week 4]). This pattern was also observed for TYRP1 (pre = -12.94 ± 1.82, Week 1 = -48.85 ± 13.25 [p < 0.01], Weeks 2, 3, and 4 = -34.45 ± 14.64, -28.19 ± 4.98, -6.93 ± 3.05 [p < 0.01, Week 4]) and DCT (pre = -214.95 ± 89.42, Week 1 = -487.93 ± 126.32 [p < 0.05], Weeks 2, 3, and 4 = -219.06 ± 79.33, -72.91 ± 20.45 [p < 0.001], -76.00 ± 24.26 [p < 0.001]). Similar patterns were observed for scars treated with LADD of l-tyrosine alone without NDP α-MSH. For each gene, in hyperpigmented scar, levels increased at Week 4 of treatment compared to Week 1 (p < 0.01). A clinically-relevant FLSR treatment method can be combined with topical delivery of synthetic α-MSH andl-tyrosine to increase the area of pigmentation and expression of melanogenesis genes in hypopigmented HTS. LADD of l-tyrosine alone leads to increased expression of melanogenesis genes. Future studies will aim to optimize drug delivery, timing, and dosing.

Effectiveness and Safety of Energy-Based Devices for Acne Scars: A Network Meta-Analysis of Randomized Controlled Trials.

Background: Acne vulgaris is an inflammatory disease of the pilosebaceous unit in teenagers. Acne-induced inflammation leads to acne scarring. Scholars have discussed acne scar treatments; however, energy-based devices with satisfactory outcomes remain unidentified. Objective: To measure quartile grading scale and visual analog scale (VAS) to study the difference between energy-based devices. Methods: We included randomized controlled trials that evaluated patients with acne scars. The primary outcomes were the quartile grading scale and VAS scores. We used Confidence in Network Meta-Analysis to evaluate indirectness, imprecision, heterogeneity, and incoherence. Results: A total of 26 studies met the inclusion criteria. The quartile grading scale results revealed that ablative fractional laser was significantly more effective than nonablative fractional laser (standard mean difference [SMD]: 0.516, confidence interval [95% CI]: 0.281-0.750) and radiofrequency treatment (SMD: 0.941, 95% CI: 0.540-1.342). Moreover, nonablative fractional laser was significantly more effective than radiofrequency treatment (SMD: 0.426, 95% CI: 0.049-0.802). No significant difference in VAS score was found among the devices. Conclusion: Ablative fractional laser is an effective treatment for acne scars although it is associated with more pain.

Assessment of the immune status of women after ablative fractional laser photothermolysis procedure for the correct of involutional facial skin changes

Introduction. Ablative fractional laser photothermolysis (A-FLPh), used for rejuvenation of aging skin, is based on its controlled damage. Factors of the immune system are involved in the reparative regeneration processes triggered, which, in turn, is also subject to age-related remodeling or immunostaining. The aim of the work was to evaluate in dynamics the response of the immune system to the A-FLPh procedure performed for correction of age-associated facial skin changes. Materials and methods. The study included 25 women aged 42 to 55 years who underwent A-FLPh treatment of facial skin with an Erbium laser. The number of leukocytes, monocytes, neutrophils, lymphocytes, T-lymphocytes, T-helpers, cytotoxic T-cells, regulatory T-cells, NKT-lymphocytes, NK-lymphocytes were counted in the peripheral blood before, on the 8th and 24th after the procedure. We studied phagocytic function of neutrophils and monocytes, NBT-reducing and lysosomal activity of neutrophils; determined the amount of IgA, IgM, IgG, IL-4, IL-6, IL-8, IL-10, circulating immune complexes (CIC). Results. On the 8th day after A-FLPh, the number of neutrophils, neutrophils and monocytes phagocytosis, the number of lymphocytes, regulatory T-cells, IL-6 and IL-8 levels significantly increased; in parallel, the number of CD11b+ NK-lymphocytes, CD11b+ NKT-lymphocytes, IgA, IgG, IL-10 concentrations decreased. On the 24th day, quantitative functional indices of neutrophils, total number of lymphocytes, concentrations of IgA and IgG had no reliable difference from pre-procedure values, phagocytic parameters of monocytes, number of regulatory T-cells, IL-6 and IL-8 levels remained significantly higher, while the number of CD11b+ NK-lymphocytes, CD11b+ NKT-lymphocytes and IL-10, on the contrary, significantly lower than the initial level. Discussion. The revealed changes of systemic immunity indices after A-FLPh testify to both direct and regulatory-modulatory influence of immune factors on skin repair and remodeling after laser damage. Conclusion. The A-FLPh procedure induces a response from both cellular and humoral factors of the immune system, predominantly innate immunity.

The Safety and Efficacy of a Dual CO 2 and 1570-nm Hybrid Laser for Periorbital Rejuvenation.

Many modalities are used for periorbital rejuvenation, with a wide range of efficacy and safety. To achieve favorable outcomes with minimal downtime and adverse effects, professionals developed a hybrid laser, which allows simultaneous treatment with 2 wavelengths: fractional ablative and fractional nonablative lasers. To evaluate the safety and efficacy of a new hybrid laser for periorbital rejuvenation. This retrospective single-center study includes 24 patients who underwent a single-pass treatment with a CO 2 and 1570-nm hybrid laser for periorbital rejuvenation between 2020 and 2022. Patients' standardized clinical photographs before and after the treatment were assessed by 4 independent physicians for objective improvement. Treatment data, safety, and patients' satisfaction were also reviewed. Statistically significant objective improvements were found in all investigated scales with an improvement of 1 to 2 points on each scale. Patients' satisfaction was 3.1/4. Average downtime was 5.9 ± 1.7 days. Most adverse effects were mild to moderate in severity (89.7%), including erythema, crusting, pruritis, edema, and hyperpigmentation. After a single-pass treatment, the laser generates 26% to 50% improvement in the periorbital area, with a strong safety profile and a relatively simple recovery. Further research is needed to validate the efficacy of this technology compared with more aggressive modalities.

The Role of Fractional CO2 and Pulsed Dye Laser in Scar Management

Introduction: An estimated 100 million patients acquire scars of any type every year, a few of which will lead to hypertrophic, contracting scars or keloids. Management remains challenging and encompasses surgical and non-surgical treatment options. The introduction of fractional photothermolysis (FP) in 2004,marked a major advancement in treatment. Unlike classic non-fractional ablative lasers, FP uses well focused laser beams to create small columns of ablation called microscopic treatment zones (MTZ).FP has since been discovered to be particularly useful in relieving scar contractures with efficacy on improving functionality and cosmetic outcomes. We aim to present a case of a contracting scald burn over the buttocks improving exceptionally following pulsed dye (595 nm) laser and fractional resurfacing using an ablative CO2 (10600 nm) laser associated with transepidermal triamcinolone delivery. Materials and Methods: Case presentation of the management of a hypertrophic scar following a scald burn. Results: A 12 year old boy suffered a third degree scald burn on the right buttock requiring a split thickness skin graft. The follow-up was complicated by a contracting, hypertrophic scar with a negative impact on his soccer playing due to diminished running ability. we started treatment with pulsed dye laser (595 nm, handpiece of 12 mm, pulse duration of 6 ms, fluence of 5 à 6 J/cm2),fractional resurfacing treatments using an ablative fractional CO2 laser(10600 nm, Deep-Fx, 30 to 50 mJ/MTZ, 5% coverage)followed by topical triamcinolone application by the principle of fractional laser-assisted drug delivery. We applied a hydrocolloid dressing 24/7,wearing compression shorts and to massage the scar regularly. After a total of 19 treatments, we observed a smooth scar without any signs of contraction and a normal range of motion of the hip joint. The patient was highly satisfied with the functional and aesthetic result. Conclusion: Lasers are a safe and effective treatment option for traumatic scars. Choosing the appropriate laser with the appropriate dosimetry is one of the cornerstones to a good scar-management.

Early Fractional Ablative Laser for Skin Cancer Excision Scars: A Randomized Split-Scar Study.

Fractional ablative laser resurfacing has been shown to improve the final cosmetic appearance of surgical scars, but optimal timing is unknown. To compare surgical scars treated with fractional carbon dioxide (CO 2 ) laser performed on Day 0 and Day 14. Prospective, randomized, split-scar, physician-blinded study of 30 surgical scars on the limbs. Scars halves received fractional CO 2 laser on either Day 0 or Day 14. Scar assessment at 6 months evaluated patient preference, physician modified Manchester Scar Scale (MMSS) score, and quantitative scar analysis on histology (fractal dimension [F D ] and lacunarity [L] analysis). There was no significant difference in patient assessment (54% preferred Day 0 side, 46% preferred Day 14 side, p = .58) or physician assessment (mean MMSS 8.4 for Day 0 vs 8.7 for Day 14, p = .28). Fractal dimensions were similar for both interventions (mean 1.778 for Day 0 vs 1.781 for Day 14, p = .80). Lacunarity was similar for both interventions (mean 0.368 for Day 0 vs 0.345 for Day 14, p = .44). Single-center study with wounds limited to limbs of skin Phototype I-II subjects; 4 of whom were lost to follow-up. Intraoperative CO 2 laser is noninferior to Day 14 laser resurfacing for surgical scar treatment.

Comparison Between Er: Yag and Co2 Ablative Fractional Lasers in The Treatment of Keloid and Hypertrophic Scars: Histopathological, Immuno-Histochemical and Ultrastructural Study

Comparison Between Er: Yag and Co2 Ablative Fractional Lasers in The Treatment of Keloid and Hypertrophic Scars: Histopathological, Immuno-Histochemical and Ultrastructural Study

A systematic review of the comparison between needling (RF-needling, meso-needling, and micro-needling) and ablative fractional lasers (CO2, erbium YAG) in the treatment of atrophic and hypertrophic scars.

The aim of this study is to compare needling (RF-needling, meso-needling, micro-needling) and ablative fractional lasers (CO2, erbium-YAG) in the treatment of atrophic and hypertrophic scars in a systematic review. The database was searched, and 10 articles were selected that were relevant in terms of content, topic, and purpose and met the inclusion criteria. Of all the articles reviewed in this study, there were 2 randomized split-face trials (20%), 1 controlled nonrandomized trial (10%), 1 controlled randomized phase III clinical trial (10%), 1 prospective trial (10%), 1 prospective nonrandomized open-label trial (10%), and 1 randomized comparative trial (10%), with the type of study not reported in 3 articles. We used Endnote X8 to review the articles and extract data. After review, the studies were analyzed and categorized. No statistically significant difference was found between the two methods, laser and micro-needling, in the treatment of atrophic and hypertrophic scars in 60% of the articles studied, and both showed significant improvement (70% or more improvement to complete response). Significant improvement was noted in 20% of the studies reviewed for the laser and micro-needling treatment methods. The results of this study show that needling and ablative fractional lasers are tolerable and safe procedures with no significant difference in the treatment of skin scars in sixty percent of the studies.

Laser Treatment of Hypertrophic Scar in a Porcine Model Induces Change to Epidermal Histoarchitecture That Correlates to Improved Epidermal Barrier Function.

Mechanisms and timing of hypertrophic scar (HTS) improvement with laser therapy are incompletely understood. Epidermal keratinocytes influence HTS through paracrine signaling, yet they are understudied compared to fibroblasts. It was hypothesized that fractional ablative CO2 laser scar revision (FLSR) would change the fibrotic histoarchitecture of the epidermis in HTS. Duroc pigs (n = 4 FLSR and n = 4 controls) were injured and allowed to form HTS. HTS and normal skin (NS) were assessed weekly by noninvasive skin probes measuring trans-epidermal water loss (TEWL) and biopsy collection. There were 4 weekly FLSR treatments. Immediate laser treatment began on day 49 postinjury (just after re-epithelialization), and early treatment began on day 77 postinjury. Punch biopsies from NS and HTS were processed and stained with H&E. Epidermal thickness and rete ridge ratios (RRR) were measured. Gene and protein expression of involucrin (IVL) and filaggrin (FIL) were examined through qRT-PCR and immunofluorescent (IF) staining. After treatment, peeling sheets of stratum corneum were apparent which were not present in the controls. TEWL was increased in HTS vs NS at day 49, indicating decreased barrier function (P = .05). In the immediate group, TEWL was significantly decreased at week 4 (P < .05). The early group was not significantly different from NS at the prelaser timepoint. After four sessions, the epidermal thickness was significantly increased in treated scars in both FLSR groups (immediate: P < .01 and early: P < .001, n = 8 scars). Early intervention significantly increased RRR (P < .05), and immediate treatment trended toward an increase. There was no increase in either epidermal thickness or RRR in the controls. In the immediate intervention group, there was increased IVL gene expression in HTS vs NS that decreased after FLSR. Eight scars had upregulated gene expression of IVL vs NS levels pretreatment (fold change [FC] > 1.5) compared to four scars at week 4. This was confirmed by IF where IVL staining decreased after FLSR. FIL gene expression trended towards a decrease in both interventions after treatment. Changes in epidermal HTS histoarchitecture and expression levels of epidermal differentiation markers were induced by FLSR. The timing of laser intervention contributed to differences in TEWL, epidermal thickness, and RRR. These data shed light on the putative mechanisms of improvement seen after FLSR treatment. Resolution of timing must be further explored to enhance efficacy. An increased understanding of the difference between the natural history of HTS improvement over time and interventional-induced changes will be critical to justifying the continued approved usage of this treatment.

Fetal Fibroblast Transplantation via Ablative Fractional Laser Irradiation Reduces Scarring

Scar treatments include fractional laser treatment, cell transplantation, surgery, skin needling, and dermal fillers. Fractional laser treatments are used to reduce scarring and blurring. Cell transplantation is promising, with mature fibroblasts and adipose-derived stem cells being used clinically, while embryonic fibroblasts are used experimentally. Herein, we developed a combination of ablative CO2 (carbon dioxide) fractional laser and cell transplantation for the treatment of scars. Eight-week-old male C57Bl/6 mice were used to create a full-layer skin defect in the back skin and create scars. The scar was then irradiated using a CO2 fractional laser. The cells were then transplanted onto the scar surface and sealed with a film agent. The transplanted cells were GFP-positive murine fetal fibroblasts (FB), fetal fibroblasts with a long-term sphere-forming culture (LS), and fetal skin with a short-term sphere-forming culture (SS). After transplantation, green fluorescent protein (GFP)-positive cells were scattered in the dermal papillary layer and subcutis in all the groups. LS significantly reduced the degree of scarring, which was closest to normal skin. In conclusion, the combination of ablative fractional laser irradiation and fetal fibroblast transplantation allowed us to develop new methods for scar treatment.

Characterization of an ablative fractional CO2 laser-induced wound-healing model based on in vitro 3D reconstructed skin.

This study describes the development and characterization of a novel in vitro wound-healing model based on a full-thickness reconstructed skin by exposing the tissue to fractional ablative laser treatment. A 3D full-thickness skin model was fabricated and treated with fractional ablative CO2 laser. Wound-healing process was characterized by HE staining, noninvasive OCT imaging, immunostaining, as well as transepidermal water loss measurement. Cytokines and proteins involved in the inflammatory and dermal remodeling process were studied by ELISA and protein array assays. Fractional ablative CO2 treatment induced a wound zone of 9 mm in diameter, containing 56 micro-wounds with 200 μm diameter and 500-700 μm in depth on reconstructed full-thickness skin model. HE staining revealed a typical wound morphology and healing process with migration of keratinocytes, formation and extrusion of necrotic tissue, and cell inclusion in dermis, which correlates with clinical observations. Based on OCT and TEWL measurements, the re-epithelialization took place over 2 days. Laser-triggered keratinocytes proliferation and differentiation were demonstrated by activated Ki67 and Filaggrin expression respectively. Injury-invoked cytokine ICAM-1 showed instant upregulation on Day 1. Decreased epidermis thickness and depression of IGFBP-2 protein level synergistically indicated the unavoidable thermal side effects from laser treatment. Downregulated DKK-1 protein level and upregulation of α-SMA together implicated the risk of potential fibrosis post-laser treatment. This in vitro laser wounded reconstructed skin model captured the key events of wound-healing process, could be used to investigate the mechanisms of wound-healing triggered by a commonly used beauty procedure, and also provides a valuable tool for evaluating the efficacy of novel actives for the post-procedure application.

Combination of Fractional Microneedling Radiofrequency and Ablative Fractional Laser versus Ablative Fractional Laser Alone for Acne and Acne Scars.

Fractional microneedle radiofrequency (FMR) systems are used to treat inflammatory acne and scarring. Nonetheless, few controlled studies have combined this treatment with the traditional ablative fractional laser (AFL). We aimed to assess the safety and efficacy of the combination of FMR and AFL versus AFL alone in treating acne and acne scars. In this 20-week, randomized, split-face study, 23 Korean patients with facial acne and acne scars underwent FMR and AFL treatments. One half of each patient's face was randomly assigned to receive FMR+AFL, whereas the other half received AFL alone. Treatments were administered in three consecutive sessions at 4-week intervals. This study investigated the severity of inflammatory acne, acne scars, individual lesion counts, depressed scar volumes, as well as patient and physician satisfaction. In addition, five patients underwent skin biopsy, and sebum output was measured. The FMR+AFL treatment demonstrated superior efficacy compared to AFL alone in terms of inflammatory acne and acne scar grading, lesion counts, and subjective satisfaction. The side effects were minimal and well-tolerated in both groups. Immunohistochemical findings from skin biopsy samples revealed that the application of FMR+AFL could induce an inhibitory effect on sebum secretion at the molecular level. FMR combined with AFL is a well-tolerated and effective treatment modality for inflammatory acne and acne scarring.

Fractional Laser Resurfacing for Acne Scars: Our Experience at Tertiary Care Hospital of North India.

Acne is very common among adolescents, which may sometimes persist into adulthood, and acne scars continue to have a profoundly negative impact on quality of life. Of all the various modalities available, fractional lasers have shown effective results. The aim of this study was to assess the efficacy and safety of fractional carbon dioxide (CO2) laser resurfacing in atrophic facial acne scars. The study included 104 subjects aged ≥18 years with atrophic acne scars on face of more than 6 months of duration recruited over a period of 1 year. All the patients were treated with fractional CO2 laser (600 W power and wavelength 10,600 nm). Four sessions of fractional CO2 laser resurfacing were done at 6-week intervals in each patient. We compared the improvement rate of scars after every session at 6-week interval, 2 weeks after the last session, and finally 6 months after the last laser session. The difference between the mean baseline score (3.43) and mean final score (1.83) using Goodman and Baron's qualitative scar scale was found to be statistically significant (P = 0.001). Mean improvement increased from first treatment session to the end of the treatment course from 0.56 to 1.62 indicating the role of the number of sessions in the overall improvement of acne scars. With regard to overall satisfaction, maximum number of patients were either very satisfied (55.8%) or satisfied (25%) as compared to those who were only slightly satisfied (11.5%) or completely unsatisfied (7.7%). Fractional ablative laser gives excellent results in the management of acne scars and has emerged as an appealing non-invasive option for this indication. Being a safe and effective option for atrophic acne scar treatment, it can be recommended wherever available.

LASER ADJUVANTS: KEY FEATURES AND SPECIFICITY

Increasing the vaccine effectiveness and the search for new adjuvants that directly influence immunocompetent cells and stimulate the development of a pronounced adaptive immune response remain significant problems for modern medicine. Currently, aluminum salts and other chemicals with certain side effects are used as adjuvants. Therefore, it is relevant to search for other methods to increase vaccine effectiveness while reducing its toxic effect on the patients. One of such methods is laser irradiation of the injection sites, which, among other things, makes it possible to reduce vaccine amount. The purpose of this review is to analyze publications on the use of laser to stimulate the immune response. Four different classes of lasers are known to systemically enhance the immune response to intradermal vaccination: pulsed lasers, continuous mode lasers, non-ablative fractional lasers, and ablative fractional lasers. Each laser vaccine adjuvant is characterized by radiation parameters, modes of action, and immunological adjuvant effects that differ significantly. The authors consider main classes of lasers used as immunological adjuvants. The specificity of each laser will help to choose the most effective option to achieve the clinical goal when using a particular vaccine.

Laser-Induced Smoke in Dermatologic Practice: A Survey to Explore Hazard Perceptions, Safety Measures and Unmet Needs.

Introduction: Inhalation of laser-induced smoke is a potential health hazard to exposed physicians and laser operators. To date, little is known about the perception of health hazards related to laser-induced smoke exposure among physicians and the actual use of safety measures to mitigate these risks. Methods: In May 2020, 514 members of the European Society for Lasers and Energy-Based Devices (ESLD) were invited by email to participate in an online survey. The survey comprised 16 questions including multiple-choice and open-ended questions. Results: Responses were received from 109 participants. The majority (90%) were aware of potential hazards and highlighted a desire for better protective measures (60%). A smoke evacuation system was frequently used with ablative lasers (66%) and fractional ablative lasers (61%), but less the case with non-ablative lasers (30%) and hair removal lasers (28%). The COVID-19 outbreak had no clear effect on the use of smoke evacuation systems. Prior to the COVID-19 outbreak, mainly surgical masks were used (40-57%), while high filtration masks (FFP1, FFP2 or FFP3) were used by only a small percentage (15-30%). Post COVID-19 outbreak, the use of high filtration masks increased significantly (54-66%), predominately due to an increase in the use of FFP2 masks. Reasons mentioned for inadequate protective measures were sparse knowledge, limited availability, discomfort, excessive noise, high room temperatures, and financial costs. Conclusion: While there is considerable awareness of the hazards of laser-induced smoke among physicians and laser operators, a substantial number of them do not use appropriate protective measures. The implementation of regulations on safety measures is hampered by sparse knowledge, limited availability, discomfort, excessive noise, financial issues, and high room temperatures.

Correction of atrophic post-acne scars with ablative erbium laser, taking into account the predominant type of scar

Background. The choice of an effective method of laser correction of atrophic post-acne scars, suitable for a particular type of scar, remains a difficult task, despite the variety of interventions.&#x0D; Aim. To study the effectiveness of a combination of planar and fractional laser ablation in patients with atrophic post-acne scars, taking into account the predominant type of scar.&#x0D; Material and methods. An open clinical intervention study included 60 patients with IIIV scar severity grade, 36 females and 24 males, with a mean age of 28.874.81 years. The predominance of V-shaped scars was observed in 11 (18.3%) patients, U-shaped in 29 (48.3%), M-shaped in 12 (20.0%), macular in 8 (13.3%) patients. An erbium laser with a wavelength of 2940 nm was used to resurface the edge of the scars, followed by fractional ablation of the affected area. The change in the severity and quantitative index of the severity of post-acne scars after treatment, as well as the results on the international scale of aesthetic improvement, were evaluated. The safety of the method was assessed during a clinical examination on the 7th day after each procedure and 3 months after the last one, any adverse events and complications were recorded. The significance of differences was calculated using the Wilcoxon, MannWhitney, KruskalWallis and the 2 tests. Differences were considered statistically significant at p 0.05.&#x0D; Results. Reduction of scar severity was registered, the quantitative index after treatment decreased from 11.43.25 to 6.23.1 points (p=0.000, Wilcoxon criterion). Regression of quantitative indices was established in patients with U-shaped and macular scars compared with patients with a predominance of M- and V-shaped scars (p 0.05, MannWhitney test). The average effectiveness of treatment on a scale of aesthetic improvement was 2.420.72 points, in 33 (55.0%) people the result corresponded to a significant improvement, in 19 (31.7%) moderately pronounced improvement, a noticeable improvement in appearance compared to baseline was noted in 8 (13.3%) patients (2=23.55, p 0.000). Complications of procedures were not registered.&#x0D; Conclusion. Correction of atrophic scars with an erbium laser, which combines planar and fractional ablation, is effective and safe for various types of atrophic scars; the optimal result is achieved in patients with U-shaped and macular scars.

Feasibility of Intratumoral Anti-PD1 as Treatment of Human Basal Cell Carcinoma: An Explorative Study with Adjuvant Ablative Fractional Laser

The use of immune checkpoint inhibitors (ICI) is expanding with the approval for advanced/metastatic keratinocyte carcinoma; however, most tumors are non-aggressive. Local administration could broaden ICI, but adequate immune response might require an immune-attractive adjuvant such as ablative fractional laser (AFL). Accordingly, this study aimed to explore intratumoral injection of anti-PD1 with and without AFL in basal cell carcinoma (BCC), exploring anti-PD1 concentration, immune cell infiltration, tumor response, and safety. This open-label, proof-of-concept trial investigated intratumoral anti-PD1 + AFL combination therapy versus anti-PD1 or AFL monotherapy in 28 BCC patients. The primary endpoints were immune cell infiltration evaluated immunohistochemically and clinical tumor response after 3 months. The secondary outcomes were tumoral drug concentration and safety. The most robust response was obtained following intervention with combined anti-PD1+AFL, leading to a ~2.5-fold increase in CD3+ cells (p = 0.027), and tumor reduction ≥25% in 73%, including two tumors with complete remission. Upon anti-PD1 monotherapy, a slight decrease in CD3+ cells was observed while a non-significant increase following AFL was seen. Tumor reduction ≥25% was seen in 45% and 50%, respectively, after anti-PD1 and AFL monotherapy. The CD8/CD3 ratio remained unchanged after anti-PD1+AFL and anti-PD1 monotherapy, while AFL led to a decreased ratio. A non-significant decline in the Foxp3/CD3 ratio was observed for all groups. Side-effects were mild with no systemic drug concentration detected. Intratumoral anti-PD1 injection is feasible, and a single exposure to locally injected anti-PD1 with adjuvant AFL increased immune cell infiltration and reduction in BCC with limited side-effects.