Fractional Thulium Fiber Laser Research Articles

Unveiling the mystery of Riehl's melanosis: An update from pathogenesis, diagnosis to treatment.

Riehl's melanosis is a hyperpigmentation disorder that has a significant psychological and social impact on individuals. In the past 10 years, new categories have been developed, raising questions about how to classify Riehl's melanosis. The mechanism of this disease remains unclear, although the type IV hypersensitivity response caused by allergic sensitization, as well as genetic, ultraviolet radiation, and autoimmune factors, is to blame. Clinical manifestation, dermoscopy, reflectance confocal microscopy, patch/photopatch testing, histopathology, and a novel multimodality skin imaging system have been used for the diagnosis. A variety of therapies including topical skin-lightening agents, oral tranexamic acid, glycyrrhizin compound, chemical peels, and lasers and light therapies (intense pulsed light, 1064-nm Q-Switched Nd: YAG laser, 755-nm PicoWay laser, nonablative 1927-nm fractional thulium fiber laser, new pulsed-type microneedling radiofrequency), with improved effectiveness. The latest findings on possible biomarkers and their relationship to other autoimmune diseases were also summarized.

Prospective study of efficacy and safety of non-ablative 1927 nm fractional thulium fiber laser in Asian skin photoaging.

Photoaging manifests as deeper wrinkles and larger pores. It has been tried to rejuvenate photoaging skin using a variety of lasers, including fractionated lasers, which are a popular photorejuvenation treatment. A new breakthrough for skin rejuvenation is the 1927 nm fractional thulium fiber laser (FTL), a laser and light-based treatment option. Clinical data regarding the FTL for treating photoaging are limited despite its effectiveness and safety. This study is aim to evaluate FTL' clinical effectiveness and safety. Fitzpatrick skin types II-IV subjects with mild to moderate photoaging signs were enrolled in this prospective study. At intervals of one month, patients received three full face treatments. Wrinkles, spots, texture, pores, melanin index, erythema index (MI and EI), skin elasticity and hydration were measured with non-invasive tool. The epidermal thickness and dermal density on ultrasonography were compared between baseline and one month after all treatment sessions. The Global Score for Photoaging scale (GSP) was rated by two independent evaluators at the baseline and final follow-up visit. Secondary outcomes included patient-rated pain on a 10-point visual analog scale (VAS), as well as overall satisfaction. Following each treatment, adverse events were noted. Totally 27 subjects (24 females and 3 males) with Fitzpatrick skin types II to IV and a mean age of 44.41 (range33-64) were enrolled. Results suggests that the epidermal thickness has significantly improved after treatment. Statistically significant improvements in melanin index, skin elasticity and wrinkles were noted. An analysis of 12 subjects' reports (44%) suggested their skin felt brighter. No post-inflammatory hyperpigmentation changes or adverse events were observed. 70% patients reporting "satisfied" or "extremely satisfied". In this study, FTL was found to be a safe and effective treatment option for treating photoaging.

Safety and Effectiveness of Low-Energy, Low-Density 1927-nm Fractional Thulium Fiber Laser With Tranexamic Acid for Postinflammatory Hyperpigmentation.

Wang, Jordan V. MD, MBE, MBA*; Lopez, Adriana MD†; Geronemus, Roy G. MD*,† Author Information

Safety and Effectiveness of Low-Density 1927-nm Fractional Thulium Fiber Laser for Hyperpigmented Scar Treatment in Fitzpatrick Skin Types II-V.

Safety and Effectiveness of Low-Density 1927-nm Fractional Thulium Fiber Laser for Hyperpigmented Scar Treatment in Fitzpatrick Skin Types II-V.

Combining cosmetic injectables with low-energy, low-density 1927nm fractional thulium fiber laser: A 2.5-year examination on the safety of same-day treatments.

Combining laser treatments with cosmetic injectables can offer synergistic benefit, increased convenience for both patients and physicians, and lessened overall patient downtime. Although paired treatments can be effective, there remain theoretical concerns that this may add new risks. Theoretical risks of combining laser treatment with neurotoxin injections include unintentional spread of the neurotoxin, which may result in eyelid ptosis and muscle weakness. Potential risks with soft-tissue fillers include unexpected loss of filler volume, necrosis, burn, and product migration. This retrospective chart review of single-session, same-day facial treatments using a low-energy, low-density 1927nm fractional thulium fiber laser and cosmetic injectables found no adverse events related to this combination approach. This is important safety information that can offer reassurance to physicians using this clinical approach.

Non-Ablative 1927 nm Fractional Thulium Fiber Laser: New, Promising Treatment Modality for Riehl's Melanosis.

The treatment of Riehl's melanosis, also known as pigmented contact dermatitis, is highly challenging. Intense pulsed light (IPL) and 1064 nm Q-switched Nd:Yag (QS-Nd:YAG) laser are reported to have some efficacy. However, no single effective treatment has yet been identified. In this study, we demonstrated the efficacy and safety of the non-ablative 1927 nm fractional thulium fiber laser (TFL, LASEMD™; Lutronic Corp., Goyang, Korea) for patients with Riehl's melanosis. A retrospective chart and photographic review of nine patients with Riehl's melanosis, who had received at least three sessions of TFL treatment, was performed. Before the start of TFL treatment, combination treatment with a topical cream containing hydroquinone, low-fluence QS-Nd:YAG laser, pulsed dye laser, and IPL was used with variable and discouraging effects. Seven patients were treated on the face and two patients on the neck with three to seven sessions at 1-month intervals. Clinical improvement was assessed using clinical photos taken before and after every treatment session according to dermal pigmentation area and severity index (DPASI) and a quartile grading scale by two blinded dermatologists. Patients underwent three to seven sessions of TFL treatment depending on severity of pigmentation. Of nine patients, six demonstrated a clinical improvement of 51%-75%, one demonstrated an improvement of 76%-100%, and two showed an improvement of 26%-50% after treatment. The DPASI was significantly decreased from 9.55 to 5.25 on average. Melanin index was decreased after treatment in two patients whose melanin index were measured at initial visits. Treatment-related adverse events, such as scarring or postinflammatory hyperpigmentation (PIH), were not observed in all patients except for transient erythema and swelling. This report suggests that TFL could be an alternative and/or additive treatment option for hyperpigmentation in intractable Riehl's melanosis and might be a promising treatment for PIH caused by any reason including Riehl's melanosis. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Laser-assisted delivery of tranexamic acid for melasma: Pilot study using a novel 1927nm fractional thulium fiber laser.

Melasma can be associated with immense psychosocial stress, which can impact quality of life. One theory suggests that ultraviolet light can increase plasmin activity in keratinocytes, which has led to the investigation of tranexamic acid for treating melasma, since it possesses anti-plasmin properties. The use of laser-assisted drug delivery can also increase the uptake of topical medications. A prospective pilot study was performed to assess the utility of combination treatment with low-energy, low-density 1927nm fractional thulium fiber laser and topical tranexamic acid for melasma. A total of 10 subjects were enrolled. Each received 5 treatments to the full face with a low-energy, low-density 1927nm fractional thulium fiber laser. Immediately following treatment, topical tranexamic acid was applied, and subjects were instructed to apply it twice daily for 7days. Clinical measures, quality of life, and patient satisfaction were assessed. Mean improvements in Melasma Area and Severity Index (MASI) scores were 1.1 (P=.0899), 3.5 (P=.0395), and 2.5 (P=.2429) at 30-, 90-, and 180-day follow-up, respectively. Maximum improvement occurred at 90-day follow-up. The mean improvement of Melasma Quality of Life Scale (MELASQOL) score was 9.6 (P=.0024) at 30-day follow-up. In addition to changes in pigmentation, subjects also believed their skin felt better, looked more radiant, and had improvements in skin texture and tone. Combination of low-energy, low-density 1927nm fractional thulium fiber laser and topical tranexamic acid improved clinical outcomes and quality of life associated with melasma. This combination treatment was safe, well-tolerated, and well-liked by subjects.

Report of experience on 1927-nm fractional thulium fiber laser for the treatment of nonfacial areas

Report of experience on 1927-nm fractional thulium fiber laser for the treatment of nonfacial areas

A retrospective study of the management of Chinese melasma patients using a 1927 nm fractional thulium fiber laser

Background: A new fractional photothermolysis device is used in our retrospective study to treat melasma in Chinese patients. Objectives: To evaluate the efficacy and safety of the 1927 nm fractional thulium fiber laser in the treatment of melasma in Chinese patients. Methods: Eleven melasma patients who received treatment between November 2009 and May 2010 were included. Photographic images at baseline and follow-up were assessed for clinical efficacy and complications by two independent and blinded physicians. Questionnaires were also completed by patients. Results: Significant MASI improvements were seen at 1 week, 1 month and 2 months, but not at 3 months. Patients’ degree of satisfaction was high. Significant improvement in skin texture and pore size was seen for up to 2 months and improvement in wrinkles for up to a month. There was no change in skin laxity. Main adverse effects seen were erythema, edema, and crusting in the early days. One patient developed PIH. Conclusion: The novel 1927 nm fractional thulium fiber laser is safe and effective in the management of melasma in Chinese patients for up to 2 months. It is also useful in photo-rejuvenation. Complications were limited to erythema and edema in the early days, and transient PIH.

Treatment of melasma with the 1,927‐nm fractional thulium fiber laser: A retrospective analysis of 20 cases with long‐term follow‐up

Melasma is a common acquired symmetrical hyperpigmentation that is often recurrent and refractory. To investigate the efficacy and safety of a single administration of high-density fractional thulium fiber laser (1,927 nm) for the treatment of refractory melasma in 20 patients. A retrospective chart and photographs review of 20 women (Fitzpatrick skin type II-IV) with clinical diagnosis of melasma treated with the 1,927-nm fractionated thulium laser at 10 or 20 mJ/cm(2) , with 60-70% surface area coverage. Four investigators independently evaluated Melasma Area Severity Index (MASI) scores before, 4 weeks, 3-6 months, and 6-12 months after treatment. Mean MASI scores decreased dramatically from 13.2 ± 5.4 before treatment to 8.5 ± 3.5 at 4 weeks after laser treatment (P = 0.004). Patient assessment revealed that 12 of the 20 subjects had more than 50% clearance of their melasma. Recurrence was reported by 7 out of 15 patients who were successfully followed-up (mean 10.2 months). Two patients developed postinflammatory hyperpigmentation that subsided with topical bleaching after 3 months. High-density coverage fractional 1,927-nm thulium laser proved to be safe and effective for melasma with long-term remission.

Treatment of Melasma Using a Novel 1,927-nm Fractional Thulium Fiber Laser: A Pilot Study

A 1,927-nm wavelength was recently added to the 1,550-nm erbium-doped fiber laser. This wavelength possesses a higher absorption coefficient for water than the 1,550-nm, conferring greater ability to target epidermal processes such as dyschromia. To evaluate the efficacy and safety of a novel 1,927-nm fractional thulium fiber laser in the treatment of melasma. Fourteen patients underwent three to four laser treatments (at 4-week intervals) at pulse energies of 10 to 20 mJ and total densities of 252 to 784 microscopic treatment zones per cm(2) (6-8 passes) using a 1,927-nm thulium fiber laser. Three blinded assessors and the patients evaluated clinical improvement of treatment areas at 1-, 3-, and 6-month follow-ups. Side effects were assessed, and pain was scored using a visual analog scale (0-10). A statistically significant 51% reduction in MASI score was observed at 1-month post 3 to 4 laser treatments. A 33% (p = .06) and 34% (p = .07) reduction in Melasma Area and Severity Index score was observed at the 3- and 6-month follow-up visits, respectively. Skin responses observed after treatment were moderate erythema and mild edema. No scarring or postinflammatory hyper- or hypopigmentation was observed. The 1,927-nm fractional thulium fiber laser is a safe, effective treatment for melasma.

1,927-nm Fractional Thulium Fiber Laser for the Treatment of Nonfacial Photodamage: A Pilot Study

A 1,927-nm wavelength was recently added to the 1,550-nm erbium-doped fiber laser. This wavelength possesses a higher absorption coefficient for water than the 1,550-nm, conferring greater ability to target epidermal processes. To evaluate the efficacy and safety of a novel 1,927-nm fractional thulium fiber laser in the treatment of nonfacial photodamage. Nine participants with nonfacial photodamage underwent three laser treatments (at 3- to 4-week intervals) at pulse energies of 10 to 20 mJ and 30% to 55% surface area coverage (4-8 passes) with a 1,927-nm thulium fiber laser. A blinded assessor and participants evaluated clinical improvement of treatment areas at 1-month follow-up using a quartile grading scale (0-4). Nine participants with a total of 12 treatment areas completed three treatments and the 1-month follow-up visit. At follow-up, a blinded assessor rated mean improvement in photodamage as 3.25 ± 1.0 and lentigines as 3.33 ± 0.9 on a scale of 0 to 4 (0=none, 1=1-25%, 2=26-50%, 3=51-75%, and 4=76-100% improvement). Skin responses observed after treatment were moderate erythema, mild edema, itching, and desquamation. No scarring or postinflammatory hyper- or hypopigmentation was observed. The 1,927-nm fractional thulium fiber laser is a safe, effective treatment for nonfacial photodamage. Dr. Polder is a principal investigator and Dr. Suzanne Bruce is a consultant for Solta Medical.