Laser Monotherapy Research Articles

Efficacy of Fractional Erbium Laser Combined with PRP Therapy in the Treatment of Melasma: A Comparative Study

Background: The combination of fractional Erbium laser therapy and platelet-rich plasma (PRP) has shown efficacy in treating skin conditions such as melasma. Erbium laser regenerates and remodels tissue stimulate rejuvenation, while PRP can improve healing and skin regeneration. Aim of the study: The aim of this study was to assess the efficacy of fractional erbium laser combined with PRP therapy in the treatment of melasma. Methods: This cross-sectional study was conducted in Department of Dermatology, Bangladesh Specialist Hospital, Dhaka, Bangladesh, from May 2022 to April 2024, including 60 melasma patients. Participants were divided into two groups of 30 each: Group A received only Fractional Erbium Laser therapy, while Group B received the therapy combined with PRP. Result: In this study, mean ages in group A and group B were 35.8 (± 8.2) and 36.4 (± 7.9), respectively. Initial MASI scores were 15.2 (± 3.6) for group A and 15.5 (± 3.4) for group B. Significant MASI reduction was seen in the group B at 7.2 (± 2.4) versus 9.5 (± 2.5) in the group A (p = 0.02). Satisfaction was higher in group B, with 30% reporting “very satisfied” versus 10% in the group A (p = 0.04). Adverse events, including erythema and PIH, were lower in group B. Recurrence rates at three months favored group B (80% no recurrence, p = 0.04). Conclusion: The study concludes that combining Fractional Erbium Laser therapy with PRP significantly enhances treatment outcomes for melasma compared to laser monotherapy.

A Review of Energy-Based Device Interventions to Treat Keloid Scars.

Keloids are thickened raised scars that develop due to injury and grow beyond the boundaries of their original wound, mostly affecting individuals with skin of color. This review explores the use of energy-based devices to treat keloids, both using laser monotherapy and in combination with other drugs. Laser therapy alone has shown efficacy in treating keloids. Combination laser therapy has better keloid reduction when administered with steroids, 5-fluorouracil (5-FU), and verapamil. However, monotherapy has had less adverse reactions including dermal atrophy and local pain. Therefore, physician discretion is essential when considering treatment. This review highlights the efficacy of energy-based devices (EBDs), alone and in combination. It also reveals the need to have tailored approaches with patients. Further research is needed to develop more comprehensive treatment standards for keloids using EBDs alone or in combination. J Drugs Dermatol. 2024;23(11):998-1002. doi:10.36849/JDD.8210R1.

Comparative Study of 1444 nm Laser Monotherapy versus Integrated Liposuction in the Treatment of Axillary Osmidrosis.

Background and Objectives: The 1444 nm wavelength Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser treatment is an efficient method for treating axillary osmidrosis (AO); however, it has a relatively low treatment persistence. To address this issue, we performed integrated liposuction surgery with a laser to treat AO and compared the results with those of a group treated only with a laser. Materials and Methods: This study compared the outcomes of AO treatment between the two groups up to six months postoperatively. The first group of 18 patients underwent laser treatment alone, and the second group of 12 patients underwent integrated liposuction surgery in addition to laser treatment. Outcomes were assessed using the following variables: degree of malodor (DOM), sweating area, patient satisfaction, pain levels, and complications, such as burns, swelling, and contractures. Results: Compared to the laser-only group, the integrated liposuction group demonstrated significantly superior outcomes in terms of DOM (p = 0.002) and patient satisfaction (p = 0.006), as well as a reduction in the sweating area (p = 0.012). The pain rating was higher in the liposuction group, but the difference was not statistically significant (p = 0.054). Compared with the patients in the integrated liposuction treatment group, those in the laser treatment group exhibited a significantly higher number of burns under the axillae (p = 0.025). However, no significant differences were observed in the swelling or contracture between the groups. Conclusions: Integrated liposuction with laser therapy significantly improved treatment outcomes, including malodor, patient satisfaction, sweat test results, and decreased complication rates.

Application of fractional carbon dioxide laser monotherapy in keloids: A meta-analysis.

There is no evidence-based guidance on the use of fractional CO2 laser in the excision of scars. To explore the effectiveness and safety of fractional CO2 laser in the treatment of keloids. In this meta-analysis, we searched the PubMed, Embase, and Cochrane databases from inception to April 2023. We only included studies reporting fractional CO2 laser treatment of keloids. We excluded duplicate published studies, incomplete studies, those with incomplete data, animal experiments, literature reviews, and systematic studies. The pooled results showed that the Vancouver Scar Scale (VSS) parameters of height weighted mean difference (WMD) = -1.10, 95% confidence interval (CI): -1.46 to -0.74), pigmentation (WMD = -0.61, 95% CI: -1.00 to -0.21), and pliability (WMD = -0.90, 95% CI: -1.17 to -0.63) were significantly improved after fractional CO2 laser treatment of keloids. However, vascularity did not significantly change. Additionally, the total VSS was significantly improved after treatment (WMD = -4.01, 95% CI: -6.22 to -1.79). The Patient Scars Assessment Scale was significantly improved after treatment (WMD = -15.31, 95% CI: -18.31 to -12.31). Regarding safety, the incidences of hyperpigmentation, hypopigmentation, pain, telangiectasia, and atrophy were 5%, 0%, 11%, 2% (95% CI: 0%-6%), and 0% (95% CI: 0%-4%), respectively. Fractional CO2 laser is effective in the treatment of keloids and can effectively improve the height, pigmentation, and pliability of scars, and patients are satisfied with this treatment. Further studies should explore the role of combination therapy.

The role of 755-nm alexandrite picosecond laser in melasma management.

Melasma is a skin dyspigmentation condition that disproportionately affects women, particularly those of Latino, Black, and Asian ethnicities, significantly impacting their quality of life. Efforts to identify effective treatment options have led to the exploration of picosecond laser technology which utilizes brief pulse durations to break down pigment while minimizing thermal damage to surrounding tissue. The 755-nm alexandrite picosecond laser, currently FDA approved for benign pigmented lesion removal, including melasma, is a promising solution. We aim to assess the efficacy and safety of the 755-nm alexandrite picosecond laser both as a stand-alone treatment for melasma and in combination with topical agents. We conducted a PubMed search using "755-nm picosecond" AND "melasma," "755-nm picosecond" AND "hydroquinone," and "755-nm picosecond" AND "tranexamic acid." English-written studies examining this laser as monotherapy or in combination with the topical agents were included. Those not meeting the criteria or lacking data related to melasma improvement were excluded. Monotherapy with the 755-nm picosecond laser led to a 50-75% improvement in melasma appearance in 40% of participants and a significant reduction in the average Melasma Area and Severity Index (MASI) score (p < 0.001) in all patients of one study. Notably, the use of topical tranexamic acid (TTA) in conjunction with the picosecond laser exhibited the most significant degree of improvement in hemi-MASI scores compared to the laser monotherapy group at one- and three-months post-treatment (p < 0.05). Patient satisfaction was also significantly higher for the combination group (p < 0.05). In contrast, combining hydroquinone (HQ) with the picosecond laser demonstrated no significant difference in outcomes compared to HQ alone, both of which were less effective than TTA with picosecond laser. The combination of the 755-nm picosecond laser with TTA proves promising, outperforming both laser monotherapy and laser with HQ. While monotherapy with the picosecond laser or topical agents is effective, literature favors combination therapy, especially the 755-nm picosecond laser with TTA, for superior benefits and minimal side effects. Ultimately, individualized regimens, considering factors like skin type, should be prioritized, given the heightened risk of postinflammatory hyperpigmentation, especially in skin of color patients.

Long-Term Stability of Er:YAG Laser Non-Surgical Periodontal Treatment

Background: Nonsurgical periodontal therapy is the first step of periodontal diseases treatment. It could be performed with various instruments and in recent years lasers have been tested too. The aim of the present study is to evaluate the long-term clinical effectiveness of Er:YAG laser monotherapy in the treatment of moderate chronic periodontitis. Methods: 451 teeth (1099 periodontal pockets) from 30 patients with moderate chronic periodontitis are allocated for subgingival scaling and root planing into two groups—hand instrumentation (control) and Er:YAG laser instrumentation with 100 mJ/15 Hz (test). Patients are examined for probing pocket depth, gingival recession, clinical attachment level, bleeding on probing, plaque presence at baseline, 1, 3, 6 and 12 months after instrumentation. Results: One year after therapy significant reduction of all clinical parameters examined is observed. The pocket depth decreases with 1.55 mm for the control group and 1.70 mm in the test group. The attachment level gain reveals 1.09 mm for hand instrumentation and 0.59 for laser instrumentation. The bleeding on probing reduces more significantly in the test group, where one year after treatment the index is 19.1%, whereas in the control group, it is 33.8%. Conclusions: The Er:YAG laser demonstrates similar clinical effectiveness to hand instrumentation in the non-surgical periodontal treatment. Better long-term stability is observed in the test group.

Refractive errors in infants with retinopathy of prematurity treated using laser or anti-vascular endothelial growth factor monotherapy

Background: Infants treated for retinopathy of prematurity (ROP) could develop visually significant refractive errors. In this study, we report pre-treatment refractive errors in premature infants with treatment-requiring ROP treated using laser or anti-VEGF monotherapy and compare the components of post-treatment refractive error values between the two treatment groups at different follow-up timepoints.&#x0D; Methods: In this retrospective cohort study, we analyzed 360 eyes of 181 premature infants with treatment-requiring ROP who were referred to Farabi Eye Hospital, Tehran, Iran between March 2020 and April 2021. Of the 360 eyes, 195 received laser monotherapy (laser treatment group) and 165 received an intravitreal anti-VEGF injection (anti-VEGF therapy group). All included eyes underwent pre- and post-treatment cycloplegic refraction. Cycloplegia was induced for each infant by instilling a mixed eye drop containing 1% tropicamide, 2.5% phenylephrine, and 0.5% tetracaine (in equal volumes) in each eye three times at five-minute intervals. Cycloplegic refraction was performed 30 minutes after the third instillation.&#x0D; Results: The mean (standard deviation [SD]) gestational age (GA) and birth weight (BW) of the infants were 29.0 (2.0) weeks and 1241.0 (403.0) g, respectively. The male-to-female ratio in the entire study cohort was 107 (59.1%) / 74 (40.9%), whereas the ratios in the anti-VEGF therapy group and laser treatment group were 47 (56.6%) / 36 (43.4%) and 60 (61.2%) / 38 (38.8%), respectively. The pre-treatment assessment revealed that 218 (60.6%) eyes were hyperopic, 112 (31.1%) were myopic, and 30 (8.3%) were emmetropic. In the anti-VEGF therapy group, 87 (52.7%) eyes were hyperopic, 63 (38.2%) were myopic, and 15 (9.1%) were emmetropic. In the laser treatment group, 131 (67.2%) eyes were hyperopic, 49 (25.1%) were myopic, and 15 (7.7%) were emmetropic. The mean (SD) spherical refractive error and spherical equivalent of refractive error (SEQ) at the 1-week, 1-month, and &gt; 6-month post-treatment follow-up timepoints; the mean cylindrical refractive error at the 3-month post-treatment timepoint; and the mean SEQ at the time of ROP regression were significantly different between the treatment groups (all P &lt; 0.05). The rate of anisometropia increased significantly from 3.4% at baseline to 9.2% at the 6-month post-treatment follow-up timepoint (P &lt; 0.05).&#x0D; Conclusions: In this study, the most common pre-treatment refractive status of all included eyes with treatment-requiring ROP and eyes in each treatment group was hyperopia, followed by myopia and emmetropia. At the more than 6-month post-treatment follow-up, cycloplegic refraction revealed that the laser-treated eyes were significantly more hyperopic than the anti-VEGF-treated eyes, a finding similar to the pre-treatment refraction results. Further studies of same cohort with a longer follow-up period and a control group are needed to determine the real-world effect of each treatment modality on the refractive statuses of children treated for ROP.

A systematic review and meta-analysis of efficacy, safety, and satisfaction rates of laser combination treatments vs laser monotherapy in skin rejuvenation resurfacing.

Laser therapies have been well-established in ameliorating skin-aging consequences. This systematic review aims to determine the efficacy, safety profile, and satisfaction rates of laser combination therapies on skin rejuvenation resurfacing. A systematic search was performed in four major databases up to September 2022. Skin rejuvenation studies were eligible comprising at least one laser combination arm, inclusive of all laser types (ablative or non-ablatives), and one monotherapy arm selected from one of the combined modalities. Studies combining one laser modality with radiofrequency (RF) or intense pulse light (IPL) were also assessed. Trials that did not encompass a monotherapy control arm were evaluated independently as single-arm studies. Eighteen clinical trials recruiting 448 cases were included after screening. A total of 532nm KTP + 1064nm Nd:YAG and 2940nm Er:YAG + Nd:YAG were the two most utilized laser combinations and exerted higher improvements and milder adverse events, compared to their monotherapy in most studies. Combining CO2 with rhodamine-IPL or gallium arsenide laser increased efficacy and satisfaction and brings about faster skin recovery time. Augmenting CO2 + RF did not increase improvement vs CO2 laser alone but prolonged skin erythema. Our meta-analysis revealed the pooled prevalence of quartile improvement rates as 0%, 28%, 40%, 27% in laser combination group, and 0%, 9%, 31%, 17% in laser monotherapy group, respectively. The satisfaction within each quartile category was 39%, 25%, 15%, 7% in laser combination and 20%, 25%, 16%, 17% in laser monotherapy, respectively, suggestive of the higher efficacy and satisfaction of laser combination group. The pain scores were lower in laser combination group than monotherapy (4.8 ± 1.18 vs 7.18 ± 0.7, converted on a scale of 0 to 10). Post-laser skin erythema lasted less longer in the combination group (12.8 vs 15.24days). Laser combination therapies were discovered to be superior to their monotherapies in terms of clinical improvement rates, diminished adverse events such as pain and erythema and patients satisfaction rates. Due to paucity of high-quality reportings, additional trials are warranted to corroborate these results.

Nevus of Ota: Combination Treatment with Q-Switched Neodymium-Doped Yttrium Aluminum Garnet Laser and Fractional CO2 Laser.

Nevus of Ota is a facial dermal melanocytic hamartoma occurring more commonly in Asians. The mainstay of treatment is 1064-nm Q-Switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, which has shown variable results in pigmented skin. The aim of this study was to determine whether Q-Switched Nd:YAG laser treatment combined with fractional CO2 laser is more efficacious than Q-Switched Nd:YAG laser alone. This was a prospective study with 81 patients. The patients were randomly divided into two groups. Group 1 received 1064-nm Q-Switched Nd:YAG laser alone and group 2 in addition received a fractional CO2 laser as well. Both groups received six sittings at monthly intervals. The treatment response was documented with physician global assessment (PGA) and patient's treatment satisfaction on Wong-Baker Facial Pain Scale (WBFPS). Dermoscopic evaluation was done to see subsurface pigment clearance. In the combination group, 25% of patients had more than 50% improvement as compared with 5.71% in group 1. To achieve a mean PGA score of 1.4, it took six sessions for group 1 versus only four for group 2. Dermoscopic evaluation showed faster pigment clearance in the combination group. Combining two lasers shows statistically significant faster and greater degree of improvement as compared with Q-Switched Nd:YAG laser monotherapy in nevus of Ota.

Fractional CO 2 Laser versus Fractional CO 2 Laser Plus Betamethasone/Calcipotriol Ointment in the Treatment of Nail Psoriasis.

Nail psoriasis has a major negative impact on the physical and psychological aspects of the patient's life. Treatment is often unsatisfactory because of the difficult penetration of the drug into the nail. To compare the efficacy of fractional CO 2 laser monotherapy versus combined fractional CO 2 laser and calcipotriol/betamethasone ointment preparation in treatment of nail psoriasis. Thirty patients with nail psoriasis with at least 2 affected fingernails were recruited for this study. Target NAPSI (tNAPSI) score was calculated at the start of the study and at 3 months after the last laser session. One affected fingernail of each patient received 6 sessions of fractional CO 2 laser with 4-week intervals. Another affected fingernail of each patient received topical betamethasone/calcipotriol ointment once daily in addition to the 6 fractional CO 2 laser sessions. In the monotherapy group, there was significant improvement in the nail matrix score, nail bed score, and tNAPSI score. In the combined therapy group, there was significant improvement in nail bed score and tNAPSI score, but nail matrix score showed no statistically significant improvement. Overall, there was no statistically significant difference between the 2 studied groups. Fractional CO 2 laser can be an effective and promising new treatment for nail psoriasis.

Retrospective Study of the Efficacy and Safety of Laser and Oral Combination Therapy for Non-responders to Neodymium-doped Yttrium Aluminum Garnet Laser: A Review of 20 Patients with Onychomycosis

Background: Oral antifungal drugs are the primary treatment for onychomycosis. However, there are few studies on the effectiveness and safety of oral combination therapy after laser treatment. Objective: We sought to contrast the efficacy and safety of laser and oral combination therapy with that of oral monotherapy for non-responders to laser treatment. Methods: We retrospectively evaluated the medical charts and photographs of 20 patients who received four sessions of Nd:YAG laser. Among these patients, 11 were "laser non-responders" and 9 were "laser partial responders". Afterward, 10 patients received oral drugs in addition to laser treatment (combination therapy) and the other 10 were completely altered to oral drugs, with no laser treatment (oral monotherapy). Clinical evaluation was conducted at baseline and 3 months after treatment. Recurrence was evaluated 3 months after the final evaluation. Results: Clinical evaluation revealed that combining or switching to oral antifungal drugs was substantially effective in the laser non-responder group (Z = -2.481, p = 0.013). Combination therapy was more effective than oral monotherapy (Z = -1.324, p = 0.247). Furthermore, positive baseline mycological results demonstrated a higher possibility of laser monotherapy failure (χ2 = -5.089, p = 0.024). There were two cases of recurrence in the oral monotherapy group and no adverse effect was discovered in any patient. Conclusion: This study highlighted that the combination of oral drugs with laser therapy could be beneficial regarding efficacy, recurrence, and safety in the treatment of patients who are refractory to laser therapy.

Evolving Treatment Patterns in Diabetic Macular Edema Between 2015 and 2020.

Purpose: To explore the recent evolution of diabetic macular edema (DME) treatment practice patterns over 5 years among retina specialists in the United States. Methods: This retrospective analysis assessed 306 700 eyes with newly diagnosed DME from the Vestrum Health database between January 2015 and October 2020. The year-over-year and cumulative 5-year distributions of eyes treated with antivascular endothelial growth factor (anti-VEGF) agents, steroids, focal laser, or any combination and those of untreated eyes were calculated. Changes from baseline visual acuity were assessed. Results: Yearly treatment patterns changed significantly from 2015 (n = 18056) to 2020 (n = 11042). The proportion of untreated patients declined over time (32.7% vs 27.7%; P < .001), the use of anti-VEGF monotherapy increased (43.5% vs 61.8%; P < .001), the use of focal laser monotherapy declined (9.7% vs 3.0%; P < .001), and the use of steroid monotherapy remained stable (0.9% vs 0.7%; P = 1.000). Of eyes that maintained follow-up for 5 years (from 2015 to 2020), 16.3% were untreated while 77.5% were treated with anti-VEGF agents (as monotherapy or combination therapy). Vision gains in treated patients remained approximately stable from 2015 (3.6 letters) to 2020 (3.5 letters). Conclusions: From 2015 to 2020, treatment patterns for DME evolved toward greater anti-VEGF monotherapy, stable steroid monotherapy, less laser monotherapy, and fewer untreated eyes.

Fractional CO2 laser - assisted methylene blue photodynamic therapy is a potential alternative therapy for onychomycosis in the era of antifungal resistance

BackgroundTreatment of onychomycosis is challenging by virtue of the impact of nail disfigurement, the location of the fungi within the nail and reported antifungal resistance worldwide. Light-based technologies are promising primary or adjunctive therapeutic modalities. We aimed to compare the efficacy of photodynamic therapy and fractional CO2 laser monotherapy either alone or in combination for onychomycosis. Patients and methodsThis prospective randomized comparative study was conducted on 51 onychomycosis patients divided into three groups. In group A, patients were treated using 6 photodynamic therapy sessions using methylene blue and IPL (560 to 700 nm, fluence 12 J/cm2). Group B patients were treated using 6 bimonthly fractional CO2 laser sessions (10,600 nm, 1.600 mj energy and 0.6 mm density) and group C patients were treated using 6 combined fractional CO2 laser and photodynamic therapy sessions. Patients were evaluated mycologically, dermoscopically and clinically by calculation of proximal nail diameter percentage at baseline, monthly, at the end of treatment and after a 6‐month follow‐up period post-treatment. ResultsCandida was the most commonly isolated organismin in 64.7%, 70.6% and 70.6% of the pateints in groups A, B and C, respectively. The dermoscopic findings in the total dystrophic onychomycosis was subungual hyperkeratosis in 6 patients (100%), longitudinal streaks and striae in 1 patient (16.7%). In dorsolateral subungual onychomycosis, jagged proximal edge in 31 patients (70.5%), and pigmentation in 30 patients (68.2%) were noted. In proximal subungual onychomycosis irregular matt patches were seen in 1 patient (100%). Proximal nail diameter percentage showed statistically significant improvement after treatment and 6 months follow up in the 3 studied groups. Mean increase of proximal nail diameter after treatment was highest in group C (52.94 ± 20.24), followed by group B (43.82 ± 21.03) and least in group A (35.29 ± 17.0). This difference was statistically significant (p = 0.044). Reported side effects were mild-moderate pain, discoloration and paronychia. ConclusionWe conclude that fractional CO2 laser and photodynamic monotherapy, and their combination achieve high success rates, good patient satisfaction and safety profile. Fractional CO2-assisted photodynamic therapy is associated with the highest improvement over either fractional CO2 or photodynamic therapy alone.

A comparative study of efficacy of fractional carbon dioxide laser with and without platelet rich plasma in treatment of facial acne scars

Scarring and facial disfigurement caused by severe acne can cause significant physical and psychosocial distress, particularly in adolescents. In treating acne scars, dermatologists face a therapeutic challenge. Ablative lasers Erbium YAG lasers or carbon dioxide lasers are effective, but they are associated with erythema, post-inflammatory hyperpigmentation, a longer recovery time, and scarring. With the introduction of fractional carbon dioxide lasers, acne scar treatment has become much more effective. PRP contains growth factors, which helps to speed up the natural healing process. As a result, combining fractional CO2 laser with platelet rich plasma has resulted in significant improvement of acne scars with good cosmetic results and skin rejuvenation. Through this study, we intend to assess the efficacy of fractional carbon dioxide laser with platelet rich plasma versus fractional carbon dioxide laser alone in the improvement of facial acne scars.To compare the efficacy of fractional carbon dioxide laser with and without platelet rich plasma (PRP) in treatment of facial acne scars.A total of 30 patients (18-40 years) with facial atrophic scars who attended the out-patient department at the Department of Dermatology, Venereology, and Leprosy, Adichunchanagiri Hospital and Research Centre, B.G. Nagara were randomly assigned to groups A (fractional CO2 with PRP group) and B (fractional CO2 group). Patients in both groups received four sequential treatments, with a four-week interval between each session. A side-by-side comparison of preoperative and post-operative photographs was used to assess the clinical improvement of atrophic scars one month after the last session, using Goodman and Baron's qualitative and quantitative grading system. Furthermore, patients were asked to provide feedback on scar improvement using the patient satisfaction Visual Analogue Score (VAS).Based on Goodman and Baron’s qualitative assessment one month after the last session (4 sessions), 13.33 percent (2) of patients in group A showed reduction by three grades compared to 6.66 percent (1) patient in group B, and 60 percent (9) of patients in both groups showed scar reduction by two grades. Based on Goodman and Baron’s quantitative assessment one month after the last session (4 sessions), 20 percent showed very good reduction in group A compared to 13.3 percent in group B, and 40 percent showed good reduction in group A compared to 33.3 percent in group B. [p=0.732, not statistically significant]. Patients treated with fractional carbon dioxide laser with PRP in group A had a slightly better mean percentage reduction of post acne scars at one month after the last session (4 sessions) compared to patients treated with fractional carbon dioxide laser in group B [75.83 vs 69.34 percent; p=0.72 which was statistically not significant]. At one month after the last treatment session (4 sessions), 66.67 percent (10) of patients in Group A were very satisfied with the treatment, compared to 46.67 percent (7) of patients in Group B. After four treatment sessions, the mean Patient Satisfaction VAS Score in Group A was 2.0, compared to 1.7 in Group B [p=0.000082, which was found to be statistically significant]. The result of this study shows that combination of fractional CO2 laser with intradermal PRP is slightly more efficacious than fractional carbon dioxide laser monotherapy in management of facial acne scars. Patients receiving fractional carbon dioxide laser with PRP were more satisfied with the treatment outcome.

Efficacy and safety of 755-nm picosecond alexandrite laser with topical tranexamic acid versus laser monotherapy for melasma and facial rejuvenation: a multicenter, randomized, double-blinded, split-face study in Chinese patients.

To compare the efficacy and safety of 755-nm picosecond alexandrite laser and topical tranexamic acid (TTA) combination therapy with laser monotherapy, for the treatment of melasma and facial rejuvenation. This multicenter, randomized, double-blinded, split-face study enrolled 37 patients who presented with melasma and photoaging. Facial halves were randomized to receive either laser and TTA combination therapy or laser monotherapy. Three treatments were delivered at 4-5weeks intervals. Patients were followed up for 1, 3, and 6months post-final treatment and evaluated by blinded investigators for hemi-Melasma Area and Severity Index (hemi-MASI), facial dyschromia, skin texture, laxity, and rhytids. Daily diaries rating healing progress for 7days posttreatment and satisfaction grading were performed by all patients. Adverse events were recorded. Thirty-six patients completed the follow-up. Compared with the baseline, hemi-MASI, dyschromia, and skin texture on both halves improved significantly through the follow-up (p = 0.000). A significant difference in hemi-MASI and dyschromia between combination therapy halves and monotherapy halves was noticed at 1- and 3-month follow-ups (p < 0.05). The laser monotherapy halves displayed significantly less redness and sensitivity during the 7-day posttreatment recovery period (p < 0.05). Patients' satisfaction ratings for the combination therapy halves were higher than the monotherapy halves at 1-month follow-up (p < 0.05). No severe adverse events were observed. The picosecond alexandrite laser and TTA combination therapy demonstrated synergistic efficacy for hemi-MASI and dyschromia improvements over laser monotherapy. The optimization of the picosecond laser and TTA combination regimen needs further investigation.

537 Laser-Assisted Drug Delivery in the Treatment of Hypertrophic and Keloid Scars: A Systematic Review

IntroductionHypertrophic scars (HTS) and keloids (K) cause significant morbidity and disfigurement. Care of HTS and keloids range from less invasive treatments, such as pressure garments and silicone products, to more invasive treatments, such as intralesional injections (ISI) of medication, and surgical excision. Laser-Assisted Drug Delivery (LADD) is becoming a more popular treatment for HTS and K. The ablative fractional laser creates microchannels in the skins which allows the delivery of drugs into deeper skin layers. We have conducted a systematic review of the literature to assess the effectiveness of LADD in the treatment of HTS and K.MethodsA search was performed on PubMed between January 1998-August 2021 using the following keywords: Laser Assisted Drug Delivery, Laser Combined Drug Delivery, Laser Drug Delivery, Laser Drug, Hypertrophic, Burn, Keloid, Scar. Inclusion criteria was the use of LADD in HTS or K. Exclusion criteria were studies in animal models, case reports, reviews, and non-english articles. One article was excluded due to concerns of plagiarism.ResultsA total of 11 articles were included in the final review. One study found no difference in HTS outcomes between LADD of corticosteroids (CTS) and laser with topical petrolatum used as a control. Two prospective studies found that LADD of CTS led to improved HTS outcomes. Two split-scar studies found no difference in K outcomes between LADD of CTS and ISI of CTS. One prospective study assessed LADD of CTS in K and found statistically significant improvements in scar outcomes. A retrospective study looking at K outcomes found a 50% mean improvement when treated with LADD of CTS. A split-scar study found statistically significant better HTS outcomes with LADD of 5-FU compared to topical 5-FU alone. One study found no difference in HTS outcomes between LADD of CTS and 5-Fluorouracil (5-FU). Two studies assessed both HTS and K. The first study found that both LADD of 5-FU and LADD of CTS led to significantly better scar outcomes when compared to laser monotherapy. The other reported that HTS outcomes were significantly better with LADD of Botulinum toxin A and K outcomes were better with ISI of Botulinum Toxin A.ConclusionsThe use of LADD is effective in the setting of HTS. There is evidence that LADD of scar modulating agents to HTS lesions is more effective than topical delivery or ISI of the same agent. LADD shows promise as an alternative treatment for K as it displays similar efficacy as ISI.

Immediate effect of Nd:YAG laser monotherapy on subgingival periodontal pathogens: a pilot clinical study.

PurposeThis pilot study assessed the immediate in vivo effect of high peak pulse power neodymium-doped yttrium aluminum garnet (Nd:YAG) laser monotherapy on selected red/orange complex periodontal pathogens in deep human periodontal pockets.MethodsTwelve adults with severe periodontitis were treated with the Laser-Assisted New Attachment Procedure (LANAP®) surgical protocol, wherein a free-running, digitally pulsed, Nd:YAG dental laser was used as the initial therapeutic step before mechanical root debridement. Using a flexible optical fiber in a handpiece, Nd:YAG laser energy, at a density of 196 J/cm2 and a high peak pulse power of 1,333 W/pulse, was directed parallel to untreated tooth root surfaces in sequential coronal-apical passes to clinical periodontal probing depths, for a total applied energy dose of approximately 8–12 joules per millimeter of periodontal probing depth at each periodontal site. Subgingival biofilm specimens were collected from each patient before and immediately after Nd:YAG laser monotherapy from periodontal pockets exhibiting ≥6 mm probing depths and bleeding on probing. Selected red/orange complex periodontal pathogens (Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia/nigrescens, Fusobacterium nucleatum, Parvimonas micra, and Campylobacter species) were quantified in the subgingival samples using established anaerobic culture techniques.ResultsAll immediate post-treatment subgingival biofilm specimens continued to yield microbial growth after Nd:YAG laser monotherapy. The mean levels of total cultivable red/orange complex periodontal pathogens per patient significantly decreased from 12.0% pre-treatment to 4.9% (a 59.2% decrease) immediately after Nd:YAG laser monotherapy, with 3 (25%) patients rendered culture-negative for all evaluated red/orange complex periodontal pathogens.ConclusionsHigh peak pulse power Nd:YAG laser monotherapy, used as the initial step in the LANAP® surgical protocol on mature subgingival biofilms, immediately induced significant reductions of nearly 60% in the mean total cultivable red/orange complex periodontal pathogen proportions per patient prior to mechanical root instrumentation and the rest of the LANAP® surgical protocol.

In Vivo Efficacy of Diode Laser as a Monotherapy in Root Canal Disinfection: A Systematic Review and Meta-Analysis.

Objective: The aim of this study was to conduct a systematic review and meta-analysis of the available scientific evidence to validate the use of diode laser treatment as monotherapy for disinfection of root canals during endodontic treatment. Background data: Root canal disinfection is an integral step in successful endodontic therapy. Evidence suggests better clinical outcomes when diode laser treatment is opted as compared with conventional, root canal disinfection/irrigation protocols. However, there is currently no standard protocol for the use of diode lasers in disinfection of root canals. Methods: Four electronic databases, namely PubMed, Scopus, Web of Science, and Embase, were systematically searched up to December 2020 to identify studies addressing the therapeutic efficacy of dental diode lasers in endodontic root canal disinfection as monotherapy. Two examiners assessed the eligibility and quality of relevant studies, and interobserver agreement was reached for each included study. The effect of laser treatment in reduction of bacterial growth (both aerobic and anaerobic) was studied and an appropriate forest plot was prepared. A meta-analysis of similar studies was performed by calculating the pooled weighted mean difference and 95% confidence interval using a random-effects model. Results: Six and nine articles were included in the quantitative and qualitative analyses, respectively. Although moderate to high risk of bias was detected, high heterogeneity was found among the studies. Statistically significant reduction of microorganisms was observed when diode laser treatment was used for root canal disinfection; however, a small number of reported randomized clinical trials in humans with small sample sizes and high heterogeneity provide insufficient support toward its efficacy. Conclusions: There was no concluding evidence grade for recommendation of laser monotherapy for infected root canals. This does not necessarily invalidate the effect of laser therapy, but instead underscores the need for future high-quality studies.

Laser Immunotherapy: A Potential Treatment Modality for Keratinocyte Carcinoma.

Simple SummaryIn light of expanding incidences of keratinocyte carcinoma (KC) with many patients developing multiple tumors, the demand for new treatment modalities is high. With the approval of cemplimab for locally advanced and metastasizing basal cell carcinoma and squamous cell carcinoma, KC is now included as an indication for systemic immunotherapy. At present, however, systemic KC therapy remains limited by the severe side effects associated with treatment. Immunotherapy might be more broadly applied if locally administered. Localized to the skin, KCs are easily accessible to topical drugs and physical interventions such as laser. There is an increasing appreciation of lasers’ potential to activate an immune response. Further enhancement of the laser-based immune activation might be obtained by combining laser and immunotherapeutic agents, known as laser immunotherapy. In search of new treatment modalities for KC and aiming to broaden the field of KC immunotherapy, this review discusses the current literature on immune activation following both laser monotherapy and laser immunotherapy.The role of the immune system in cancer growth is well recognized and the development of immunotherapy represents a breakthrough in cancer treatment. Recently, the use of systemic immunotherapy was extended to keratinocyte carcinoma (KC), specifically locally advanced and metastasizing basal and squamous cell carcinoma. However, since most KC lesions are non-aggressive, systemic treatment with associated side effects is rarely justified. Conversely, topical immunotherapy with imiquimod remains restricted to premalignant and superficial lesions. Use of laser in the treatment of KC has evolved from physical tumor destruction and laser-assisted drug delivery to laser-mediated immune modulation. Evidence indicates that laser monotherapy can lead to immune cell infiltration, tumor reduction and resistance to tumor re-inoculation. Combining laser with immunotherapeutic agents, termed laser immunotherapy (LIT), may further potentiate immune activation and tumor response. Studies on LIT show not only direct anti-tumor effects but systemic adaptive immunity, illustrated by the prevention of tumor recurrence and regression in distant untreated tumors. These findings imply a therapeutic potential for both local and metastatic disease. This work provides rationales for immune-based treatment of KC and presents the current status of KC immunotherapy. Aiming to expand the field of KC immunotherapy, the review discusses the literature on immune activation following laser monotherapy and LIT.

Visual acuity after intravitreal ranibizumab with and without laser therapy in the treatment of macular edema due to branch retinal vein occlusion: a 12-month retrospective analysis.

To identify factors contributing to visual improvement after treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO), and to assess the interaction between laser therapy and intravitreal ranibizumab (IVR). We retrospectively reviewed the medical records of patients who had been treated for BRVO-related ME at our hospital. Records were traceable for at least 12mo, and evaluated factors included age, sex, medical history, smoking history, treatment methods, foveal hemorrhage, and change in visual acuity. Treatments included laser therapy, IVR, sub-Tenon's capsule injection of triamcinolone (STTA), a combination, or no intervention. Multivariate logistic regression analysis and interaction terms were used to assess the clinical efficacy of the treatments, and odds ratios (OR) and 95% confidence intervals (CI) were calculated. Seventy-three patients (34 men, 39 women; 73 eyes) with a mean age of 69.4±12.1y were included. Patients who underwent IVR monotherapy, laser monotherapy, and STTA+laser had significantly higher best corrected visual acuity at 12mo compared to baseline (P<0.001, <0.001, and 0.019, respectively). Logistic regression analysis without interaction terms found that IVR was a significant visual acuity recovery factor (adjusted OR: 3.89, 95%CI: 1.25-12.1, P=0.019). Adjusted OR using an interaction model by logistic regression was 16.6 (95%CI: 2.54-108.47, P=0.003) with IVR treatment, and 8.25 (95%CI: 1.34-50.57, P=0.023) with laser treatment. No interaction was observed (adjusted OR: 0.07, 95%CI: 0.01-0.75, P=0.029). IVR contributes to improvements in visual acuity at 12mo in ME secondary to BRVO. No interaction is observed between laser therapy and IVR treatments.