Sessions Of Fractional CO2 Laser Research Articles

THE USE OF SUBCISION IN CONJUNCTION WITH FRACTIONAL CARBON DIOXIDE LASER TO IMPROVE ATROPHIC ACNE SCARS

Objective: Acne is a prevalent skin condition affecting a wide range of age groups, often leading to severe scarring if left untreated. The use of subcision combined with fractional CO2 laser therapy has been posited as a potentially more effective treatment method for atrophic acne scars compared to standalone laser treatment. Methods: This clinical trial was conducted at Asha Derma Clinic, Gorakhpur, Uttar Pradesh, from 30th March 2023 to 30th March 2024. Thirty patients with ice pick and rolling-type atrophic acne scars were enrolled. Participants were treated on one side of their face with five sessions of fractional CO2 laser and on the other side with one session of subcision with fractional CO2 laser combined with four sessions of fractional CO2 laser alone. Outcomes were assessed through scar improvement and patient satisfaction at 1, 2, and 6 mo post-treatment, with data analysis performed using ANOVA and the Wilcoxon rank-sum test. Results: Significant improvements were observed in both recovery levels and patient satisfaction. The combined method showed higher recovery percentages (40-65%, Mean±SD: 54.7±7) compared to the laser alone (30-55%, Mean±SD: 43±11.1), with a p-value of 0.0005. Patient satisfaction also favored the combined method (1.8-3, Mean±SD: 6.6±1.2) over laser treatment alone (1.6-4, Mean±SD: 5.2±1.8), with a p-value of 0.0007. Conclusion: The study demonstrated that subcision combined with fractional CO2 laser therapy significantly enhances recovery levels and patient satisfaction in the treatment of atrophic acne scars, suggesting a robust advantage of integrating both treatments.

Fractional Ablative Carbon Dioxide Laser-Assisted Photodynamic Therapy for keloids: Clinical, Histopathological and Immunohistochemical Evaluation

Abstract Background Keloids present a therapeutic challenge due to lack of satisfactory treatment and high rate of recurrence. Various treatment modalities exist, including intralesional steroids, photodynamic therapy (PDT), lasers and different combinations have been used to reach better results. Aim To study whether fractional ablative CO2-assisted delivery of Methylene blue-PDT is an effective method of treatment of keloids. Methods twenty patients with untreated keloids have been treated with 3 monthly sessions of fractional CO2 laser and methylene blue PDT. In the first session debulking of the keloid’s height by at least 50% with ablative CO2 was performed. Patients were photographed and assessed before treatment and 2 months after last session, clinically using modified Vancouver Scar Scale (mVSS) & patient and observer scar assessment scale (POSAS), histopathologically by H&E, Masson trichrome and immunohistochemically by TGF-b. Results total score for mVSS dropped from 8.25 ± 2.489 to 6.45 ± 2.8 (p = 0.013) after treatment, with a percentage change of -18.6 ± 39.6. Also, POSAS (observer) decreasaed from 26.90 ± 6.545 to 18.75 ± 8.045 (p = 0.001). POSAS (patient) decreased from 27.40 ± 6.644 to 19.05 ± 7.722 (p = 0.0001) Histopathologically, collagen improved from 3.45 ± 1.05to 2.65 ± 0.875. The TGFb staining increased post treatment but not significantly. Conclusions clinical and histopathological improvement was seen after MB-PDT but further controlled studies are needed to compare its effectiveness with other established modalities. Also compare results of different parameters of fractional CO2-PDT, more treatment sessions and study the long term follow up results.

Combination of Fractional Carbon Di Oxide Laser with Narrow Band Ultravoilet B Therapy to induce repigmentation in stable resistant vitiligo- A split-lesional study

Context: Resistant vitiligo is challenging to treat and needs new therapeutic approaches such as combining fractional carbon dioxide (CO2) laser and narrow-band ultraviolet B (NB-UVB) therapy. Aims: The study aimed to determine the efficacy and safety of combining fractional CO2 laser and NB-UVB therapy to induce repigmentation in resistant localized vitiligo patches. Materials and Methods: In this open, prospective, split-lesional study, 40 stable resistant vitiligo patches in 30 patients were included and assessed. After an initial assessment, a few resistant patches of vitiligo were identified, and a symmetrical half of it was given two sessions of fractional CO2 laser 1 month apart, followed by NB-UVB sessions to both sides thrice weekly for 3 months. Photographs were taken at baseline and 12 weeks, and repigmentation responses were assessed by calculating the mean percentage of improvement and mean grade of pigmentation on the fractional CO2 laser with NB-UVB site (test) and the only NB-UVB site (control) and then compared using Wilcoxon signed-rank test, with significance determined by P value <0.05. Results: The mean grade of pigmentation (1.8±0.88) and mean surface area improvement (8.40 ± 6.82 cm2) on the fractional CO2 laser with NB-UVB site (test) were statistically better than the mean grade of pigmentation (1.27 ± 0.71) and mean surface area improvement (5.37 ± 6.76 cm2) on the NB-UVB site. A better grade of pigmentation was noted over sun-protected areas with fractional CO2 and NB-UVB therapy, while NB-UVB therapy fared better in sun-exposed areas. Conclusions: Fractional CO2 laser with NB-UVB therapy is an effective treatment in resistant vitiligo patches, especially for sun-protected areas.

Autologous Nanofat Injection Combined with Fractional CO2 Laser in the Treatment of Atrophic Acne Scars.

Atrophic acne scarring is a widely prevalent condition and one of the most distressing complications of acne vulgaris. Numerous options with variable outcomes are available for the treatment of acne scarring. Laser is considered a first-line therapy for acne scars, and recently there has been a growing interest in using stem cells and their derivatives for treating acne scars. In addition, combined therapeutic modalities often achieve more satisfactory results than a single treatment. We tried to evaluate the role of nanofat and fractional CO2 laser as a combined treatment approach for atrophic acne scarring. Twenty-five patients with atrophic acne scarring were enrolled. They received a single session of intradermal nanofat injection, at different points 1 cm apart, for acne scars. Two weeks later, they were treated with three sessions of fractional CO2 laser at monthly intervals. Patients were evaluated three months after the last session using the quantitative Goodman and Baron scoring system. Pain, side effects, and patients' satisfaction were also evaluated. There were two males and 23 females with a mean age of 25.96 years. Their skin type ranged between Fitzpatrick skin type III, IV, and V. Boxcar scars were the most common scar type in 13 patients (52%). After treatment, there was a significant reduction (p <0.05) in the quantitative Goodman and Baron scores. The improvement was more evident in rolling scars. Seven patients reported significant improvement, and 12 reported marked improvement. This study showed that combining nanofat and fractional CO2 laser is a safe and effective treatment modality for atrophic acne scars.

A triple combination of latanoprost, fractional CO2 laser, and platelet-rich plasma in localized vitiligo: A clinical and histopathologic study.

Several treatment modalities are available for the treatment of vitiligo due to the lack of a uniformly effective therapy. Topical latanoprost 0.005% is an effective topical treatment. Fractional CO2 laser alone or combined with platelet-rich plasma (PRP) has been proposed as effective adjunctive therapies. We aimed to compare the efficacy of topical latanoprost 0.005% (Ioprost®, Orchidia, Egypt) combined with either add-on fractional CO2 laser or fractional CO2 -PRP versus topical latanoprost monotherapy in the treatment of localized stable vitiligo. The study included 60 patients randomly assigned into three equal groups. Group A patients received topical latanoprost drops only. Group B patients received topical latanoprost drops and fractional CO2 laser sessions at 2-week interval for 3 months. Group C patients received topical latanoprost drops and fractional CO2 laser sessions combined with PRP at a 2-week interval for 3 months. The mean improvement score by the physician was calculated 4 months after the start of the study. Punch skin biopsies were obtained before treatment and 4 months from the beginning of the study and stained with H&E and HMB-45 antibody for evaluation of pigmentation. Significant clinical improvement of vitiligo lesions with significant increase of re-pigmentation were reported in the three treated groups. Latanoprost in combination with fractional CO2 and PRP was associated with more significant therapeutic outcomes than either combined latanoprost and fractional CO2 or latanoprost alone. Fractional CO2 laser-PRP enhances the therapeutic efficacy of latanoprost 0.005% in the treatment of localized stable vitiligo.

Combined clinical and radiological remission of rectovaginal fistulas using fractional CO2 vaginal laser: a case series and medium-term follow-up

IntroductionDespite the advances in surgical and clinical approaches, there is no consensus regarding the best line of treatment from rectovaginal fistula (RVF). Faced with a challenging scenario in the approach of RVF, the fractional CO2 laser receives attention as a possible form of treatment.ObjectivesA single-center, prospective, open-label study evaluating the effectiveness and safety of laser therapy for RVF treatment.Subjects and methodsThe total of 15 patients was recruited at the Juiz de Fora University Hospital between August 2018 and July 2022. Inclusion criteria were presence of clinically suspects RVF of any etiology confirmed by pelvic magnetic resonance image (MRI) and gynecological examination. Five fractional CO2 laser sessions with monthly interval followed by complete evaluation through clinical examination and pelvic MRI were performed for all patients after the completion of treatment. Analysis of sexual function before and after the treatment was performed using Female Sexual Quotient (FSQ).ResultsThe evaluation through physical examination showed no persistent inflammatory signs in the vagina for all patients. Additionally, 10 of out 15 (67.7%) patients achieved clinical remission of RVF symptoms, while 33.3% patients reported significant improvement. Of note, five patients who did not have previous sexual activity returned to regular sexual activity while seven patients who have baseline sexual activity had improvement in their sexual function as assessed by the FSQ. Three out of four ostomized patients had their ostomy reversed and remained without complains. All six patients with RVF secondary to Crohn’s disease reported a marked improvement in symptoms and sexual function. In seven (47%) patients radiological remission was confirmed by pelvic MRI.ConclusionCO2 fractional laser can be considered a promising and safe therapeutic alternative for the management of RVF.

Fractional CO 2 Laser Combined With Autologous Nanofat Injection Versus Fractional CO 2 Laser Combined With Platelet-Rich Plasma in the Treatment of Atrophic Acne Scars: A Split-Face Comparative Study With Optical Skin Imaging.

Atrophic acne scarring is a common problem. If left untreated, its implications can impair the quality of life. Various treatments, with differing degrees of success, are used to alleviate atrophic scars. To assess the efficacy of nanofat versus platelet-rich plasma (PRP) as an adjuvant therapy to fractional CO 2 laser (FCL) for atrophic acne scars. This study included 35 patients with atrophic acne scars who received 3 sessions of FCL at 1-month intervals on both sides of the face, followed by intradermal PRP injection on the left side. A single session of nanofat was injected into the right side of the face 2 weeks before the laser sessions. The evaluation was conducted 3 months after the final treatment session. After treatment, the right side of the face showed a significant reduction in Goodman scores and the indentation index of the Antera camera. The left side showed a significant difference in Goodman scores, yet the Antera camera showed a nonsignificant improvement. Nonetheless, the difference between the 2 sides was statistically insignificant. Atrophic acne scars improved with both modalities. As a result, cotreatment with these techniques may synergistically affect atrophic acne scars in efficacy and safety.

Comparative Study of Polydioxanone Monofilament (PDO) Threads Combined with Scar Subcision versus Fractional CO2 Laser Combined with Scar Subcision in Management of Atrophic Post Acne Scars

Abstract Background Acne is an inflammatory disorder of the pilosebaceous unit characterized by comedones, inflammatory papules, pustules, and nodules of the face, chest, and back. The inflammatory response in some acne patients results in permanent, disfiguring scars from either increased tissue formation or due to loss or damage of tissue. Many treatments have been attempted in order to improve acne scarring such as: chemical peels, surgical excision, subcision, punch grafting, dermabrasion, fillers and laser have been used to ameliorate atrophic acne scars with varying degrees of success Objectives The aim of this work was to study the efficacy of polydioxanone (PDO) monofilament threads combined with scar subcision versus fractional Co2 laser combined with scar subcision in management of atrophic acne scars. Patients and Methods This is a split-face pilot study included 10 patients with atrophic acne scars. The patients recruited from the Outpatient Dermatology Clinic at Ain Shams University Hospitals. Fractional CO2 laser sessions were done for the right side of the face (2 sessions - one month apart), and Polydioxanone (PDO) threads were inserted to the left side of the face (2 sessions - one month apart), each treatment modality was preceded by scar subcision. The patients were followed up for 3 months. The response of treatment was evaluated by Antera 3D camera. Results Our study revealed that treatment of the right side of the face with fractional CO2 Laser led to statistically significant improvement more than what was achieved by PDO threads on the left side. It was also found that both PDO monofilament threads and Fractional Co2 laser improved the skin texture. Conclusion .The current study confirmed the superiority of fractional CO2 laser for the management of atrophic post acne scars. Polydioxanone threads had an effect in improving the skin texture but their overall effect is not comparable to the effect of fractional CO2 laser. To the best of our knowledge, we were the first to compare between Fractional Co2 laser and poydioxanone threads regarding there efficacy in management of atrophic acne scars and to evaluate the response using Antera 3D camera.

Fractional CO2 Laser resurfacing treatment of acne scar comparing high and low energy levels

Background : Fractional CO2 laser resurfacing in the treatment of acne scars, attempts to reduce the adverse effect of laser resurfacing by creating microscopic injury zones to the dermis with skipped interval areas. Aim of the study : The purpose of this study is to compare the safety and efficacy of high pulse energy (70 mJ) and low pulse energy (45 mJ) of fractional CO2 laser resurfacing in the treatment of facial acne scars. Patients and Methods : Twenty patients with moderate to severe atrophic acne scars were treated with three sessions of fractional CO2 laser resurfacing at four-week intervals with high and low energy levels applied to each side of the face separately. The severity of acne scars at baseline and after treatment was assessed using Goodman and Baron’s qualitative scar grading system. Patient satisfaction score was obtained using a quartile grading scale. Results : The severity of acne scars on both sides was comparable to each other before the treatment (p = 0.643). At the final assessment, both sides with high and low energy levels demonstrated an excellent response (p = 0.000). However, the difference between the mean final scores of both sides was not significant (p = 0.731). The most frequently reported side effects were crustation and erythema. Crustation lasted longer on the right side (mean = 6.75 days) whereas for the left side (mean = 5.45 days). Erythema was transient and only in four cases persisted beyond a week (right side mean = 10.5 days while left side mean = 8.75 days) Conclusions : Both high energy (70 mJ/pulse) and low energy (45 mJ/pulse) CO2 fractional laser resurfacing of acne scar results in satisfactory outcomes with no statistically significant differences. While the duration of side effects (crustation and erythema) was increased slightly with higher fluence.

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.

Fractional CO2 laser with topical 1% terbinafine cream versus oral itraconazole in the management of onychomycosis: A randomized controlled trial.

Background Onychomycosis accounts for 20-40% of all nail disorders. It is difficult to cure with resistance to anti-fungal drugs, their side effects and drug interactions limiting treatment options. Itraconazole is a widely accepted oral medication used for onychomycosis while fractional CO2 laser along with a topical anti-fungal has shown promising results for nail plate clearance in onychomycosis. Aim To compare the efficacy of fractional CO2 laser with 1% terbinafine cream versus itraconazole in the management of onychomycosis. Methods A prospective, randomised, single-centre, two-arm, parallel-group interventional study was conducted at Command Hospital Air Force, Bangalore. Onychomycosis cases confirmed by KOH mount/culture-positive were included. Patients were randomly divided into two groups. Group A received 4 sessions of fractional CO2 laser every fourth week with twice-daily application of 1% terbinafine cream; Group B received one-week pulse therapy with capsule itraconazole once every four-week for three pulses. The response was assessed by Onychomycosis Severity Index, a validated onychomycosis assessment scale, at baseline and at six months. Results Group A had 50 patients with a total of 98 nails. Clinical improvement was seen in 83/98 (84.7%) nails. The average reduction in Onychomycosis Severity Index was 8.65 (P < 0.05). Group B had 50 patients with a total of 136 nails. Clinical improvement was seen in 104/136 (76.5%) nails. The average reduction in Onychomycosis Severity Index was 7.37 (P < 0.05). Both groups showed statistically significant improvement measured by 'Reduction in Onychomycosis Severity Index' at six months; however, there was no significant difference between the two arms. Limitations The main limitations of the study are the small sample size and lack of long-term follow-up to assess recurrence of infection. Conclusion Fractional CO2 laser with 1% terbinafine cream is an effective and safe method for inducing nail clearance in onychomycosis and has efficacy similar to itraconazole pulse therapy.

28596 Efficacy of laser CO2 treatment for lymphedema secondary to gynecologic cancer therapy

Genital lymphedema is a debilitating possible side effect of gynecologic and pelvic malignancies. With a prevalence of 2-3 million cases in the US, lymphedema is a common chronic inflammatory condition due to lymphatic insufficiency often occurring secondary to surgery, tumor burden, trauma or radiation. Studies estimate 1 in 5 breast cancer patients will experience chronic upper extremity edema; however, other malignancies are less explored. Genital lymphedema may significantly affect quality of life with sequela of lymphorrhea, swelling, and urinary retention. Suggested first line care is non-surgical management; however, no standard recommendations exist. We present a 62-year-old woman with stage IIB grade 3 cervical cancer presenting to dermatologic surgery for evaluation of chronic vulvar lymphedema after total abdominal hysterectomy with bilateral salpingoopherectomy and lymph node dissection with subsequent chemotherapy and pelvic radiation. She developed painful bilateral lower extremity, anterior pelvis and mons pubis lymphedema within two months of treatment. The patient experienced emotional distress due to seven episodes of cellulitis, admissions to the hospital, impaired ability to exercise and decreased aesthetic satisfaction. After failing traditional management with chronic antibiotic therapy, compression stockings and massage therapy and having been rendered a poor surgical candidate for lymph node transfer, she visited dermatology. Six sessions of fractional CO2 laser [Lumenis Deep Fx Fractional CO2 laser, Coherent USA] therapy have been performed with success in decreasing lymphorrhea, edema, and cellulitis episodes allowing stoppage of prophylactic antibiotics. This case explores and highlights the use of fractional CO2 laser therapy for treatment of lymphedema and its sequela.

Assessment of efficacy and tolerability of fractional CO2 laser in the treatment of axillary hyperpigmentation

Background: Axillary hyperpigmentation is a common and troublesome complaint especially among dark-skinned women. It is believed to be a form of post-inflammatory hyperpigmentation and so far, there is no universally accepted treatment for the disorder. Objective: The aim of this study is to assess the efficacy of fractional CO2 laser in the treatment of axillary hyperpigmentation Patients and methods: Thirty Egyptian females with axillary hyperpigmentation were recruited. The severity of the condition was estimated by both self-assessment and expert dermatologist before treatment. Four sessions of fractional CO2 laser were done. Both the efficacy and complications were assessed by the patient and the dermatologist six month after the last session. Results: There was a statistically significant difference of percentage of improvement of pigmentation before compared to one month after treatment as detected by self-assessment (p value= 0.002) and the observer’s assessment (p value= 0.001). Conclusion: Fractional CO2 laser, in properly chosen parameters, is an effective method for the treatment of axillary hyperpigmentation.

EFFICACY OF FRACTIONAL CO2 LASER WITH TOPICAL PLATELET RICH PLASMA IN TREATMENT OF ACNE SCARS

Background: Acne scars are most distressing sequelae of acne vulgaris having a major impact on psychosocial aspect and quality of life of an individual. In spite of various therapeutic modalities available treatment of acne scars is challenging. Resurfacing techniques such as Fractional Co2 Laser is a well-established treatment option for acne scar. Platelet-Rich Plasma (PRP), an autologous preparation of growth factors helps in wound healing and tissue regeneration.&#x0D; Aim: To study the efficacy of Fractional CO2 Laser with Topical Platelet-Rich Plasma in Acne scars.&#x0D; Materials and Methods: A total of 15 patients with atrophic facial acne scar, aged 18-40 years attending Outpatient Department of Dermatology, Venereology and Leprosy at tertiary care centre during January 2019 to December 2019 were included for this interventional study after written informed consent. The patients underwent six sessions of Fractional CO2 Laser with Topical application of Platelet-Rich Plasma at monthly intervals. Pre and post treatment comparative Goodman and Baron’s quantitative global scarring grading and patients self-assessment score were used for assessment.&#x0D; Results: At the end of study mild reduction in Goodman and Baron’s quantitative score for acne scar was noted in 13 patients (86.6%). Mean Goodman and Baron’s quantitative score att 4 weeks after sixth sitting was 13.13 ± 4.60. On patients self-assessment moderate resolution of acne scar was noted in 8 patients (53.3%).&#x0D; Conclusion: Fractional CO2 Laser with Topical Platelet-Rich Plasma application has mild to moderate improvement of acne scars and shorter down time of Fractional CO2 Laser.&#x0D; Keywords: Acne scar, Fractional Co2 Laser, Topical Platelet-Rich Plasma

Fractional carbon dioxide laser-assisted delivery of lyophilized-growth factors is a promising treatment modality of post-acne scars.

Lyophilized-growth factors (L-GFs), is a new platelet rich plasma (PRP) preparation that is standardized in growth factors concentrations. The aim of this study was to compare the therapeutic efficacy of ablative fractional CO2 laser in combination with L-GFs vs PRP in post-acne scars. This study was conducted on 45 patients presented with facial post-acne scars. Each patient received three sessions of fractional CO2 laser on both sides of the face followed by topical application of L-GFs on one side and conventional PRP on the other side. Assessment was done before and after treatment semiquantitatively by Echella d'Èvaluation Clinique des Cicatrices d'Acné (ECCA) score and qualitatively by Goodman and Baron's qualitative scar (GBQS) scale, in addition to dermoscopic evaluation. The current study reported significant clinical improvement of post-acne scars on both sides of the face evidenced by significant reduction of both ECCA score and GBQS scale with minimal side effects. The degree of clinical improvement and patients' satisfaction were significantly higher with shorter downtime in response to fractional CO2 laser combined with L-GFs rather than its combination with PRP. In conclusion, laser assisted delivery of L-GFs via fractional CO2 laser could be considered a novel successful therapeutic modality for post-acne scars.

Fractional Carbon Dioxide Laser is Effective in Amelioration of Pruritus in Primary Cutaneous Amyloidosis: A Clinical and Biochemical Study.

Primary cutaneous amyloidosis (PCA) is a pruritic disease characterized by amyloid deposition in the skin. Interleukin-31 (IL-31) is a pruritus-mediating cytokine. Fractional carbon dioxide (CO2 ) laser has shown efficacy in the treatment of PCA regarding the clinical appearance, histological pattern, and pruritus. The aim of this study is to assess the effect of fractional CO2 laser on pruritus associated with PCA, and analyze whether this effect is related to IL-31 and IL-31 receptor (R) expression. The study included 24 patients with PCA and 24 healthy controls. Each patient received four fractional CO2 laser sessions, 4 weeks apart, using the superficial ablative mode. Skin biopsies were taken from patients before and after treatment, as well as controls, for assessment of IL-31 and IL-31R by real-time polymerase chain reaction. Treatment resulted in significant improvement of all clinical parameters, including pruritus (P < 0.001). Patients before treatment had significantly higher IL-31 and IL-31R than controls (P = 0.000 for both). In addition, there was a statistically significant decrease in IL-31 and IL-31R after treatment than their values before treatment (P = 0.000 for both). This study confirms the therapeutic efficacy of fractional CO2 laser in treatment of PCA. Reduction of IL-31 and its receptor seems to be one of the involved mechanisms; however, its relation to improvement of pruritus is still not clear. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Effect of fractional carbon dioxide (CO2) laser on improving minoxidil delivery for treatment of androgenetic alopecia

Introduction: Recently, laser treatment for hair loss has become very popular. Laser-assisted drug delivery (LAD) is an evolving technology with potentially broad clinical applications. This work aims at inspecting the effect of the fractional carbon dioxide laser (CO2) on improving the delivery of minoxidil in patients with androgenetic alopecia and detecting the role of the fractional CO2 laser in its treatment. Methods: We enrolled 45 Egyptians with male androgenetic alopecia (MAGA); clinical grading was assessed based on Norwood-Hamilton classification. The patients were divided into 3 groups: the first group (combined group) received the fractional CO2 laser session followed by topical application of minoxidil and also in between sessions; the second group received fractional CO2 laser sessions only and 6 sessions with 2-week intervals were performed; the third group applied topical minoxidil only for 3 months. Global photographs and dermoscopic assessments were performed before treatment and 3 months after the treatment. Results: Several dermoscopic findings were detected, including peripilar sign, hair diversity, yellow spot, white dots, and arborizing red lines. The number of double hair units significantly increased after the treatment in the combined group. The mean number of hair after the treatment in the 3 groups significantly increased, mostly in the combined group. The hair thickness (thin & thick) significantly increased after the treatment in the combined group and the fractional group; however, in the minoxidil group, only thin hair thickness increased. In all the 3 groups, there was a significant improvement in hair count and thickness. Conclusion: The ablative fractional CO2 laser alone or combined with minoxidil may serve as an additional treatment for MAGA.

Combination Treatment with Human Adipose Tissue Stem Cell-derived Exosomes and Fractional CO2 Laser for Acne Scars: A 12-week Prospective, Double-blind, Randomized, Split-face Study.

A variety of applications of human adipose tissue stem cell-derived exosomes have been suggested as novel cell-free therapeutic strategies in the regenerative and aesthetic medical fields. This study evaluated the clinical efficacy and safety of adipose tissue stem cell- derived exosomes as an adjuvant therapy after application of fractional CO2 laser for acne scars. A 12-week prospective, double-blind, randomized, split-face trial was performed. A total of 25 patients received three consecutive treatment sessions of fractional CO2 laser to the whole face, with a follow-up evaluation. Post-laser treatment regimens were applied; for each patient, one side of the face was treated with adipose tissue stem cell-derived exosomes gel and the other side was treated with control gel. Adipose tissue stem cell-derived exosomes-treated sides had achieved a significantly greater improvement than the control sides at the final follow-up visit (percentage reduction in échelle d’évaluation clinique des cicatrices d’acné scores: 32.5 vs 19.9%, p < 0.01). Treatment-related erythema was milder, and post-treatment downtime was shorter on the human adipose tissue stem cell-derived exosomes-treated side. In conclusion, the combined use of this novel material with resurfacing devices would provide synergistic effects on both the efficacy and safety of atrophic acne scar treatments.

A Comparative Study to Assess the Efficacy of Fractional Carbon Dioxide Laser and Combination of Fractional Carbon Dioxide Laser with Topical Autologous Platelet-rich Plasma in Post-acne Atrophic Scars.

Context:Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit prevalent in adolescent population. Atrophic acne scarring negatively affects the quality of life. Although challenging to treat, the introduction of fractional carbon dioxide (CO2) laser and platelet-rich plasma (PRP) therapy for atrophic scars has opened up new avenues.Aim:The aim of this study was to evaluate and compare the efficacy of fractional CO2 laser alone and in combination with topical PRP in treating post-acne atrophic scars.Subjects and Methods:A hospital-based prospective, double-blinded, randomized, and comparative study was conducted. A total of 33 cases with post-acne atrophic scars of moderate to severe grade were randomly allotted into Group A and Group B who were treated for three monthly sessions of fractional CO2 laser followed by topical PRP and fractional CO2 laser monotherapy, respectively. Evaluation at baseline and every visit was carried out and compared at the end of 12 weeks.Results:Of the 33 patients, 25 completed the study. The mean change in score was higher in subjects of Group A. The mean scar score significantly reduced in both groups. The mean visual analog scale was higher in Group A. The reduction in scar score was significantly higher in patients with rolling scars and boxcar scars and least in ice pick scars. Erythema, edema, pain, and hyperpigmentation were higher in Group B.Conclusion:Combination therapy with PRP is more efficacious in reducing post-acne atrophic scars and reducing adverse effects of laser therapy as compared to fractional CO2 laser monotherapy.

Clinical & ultrastructural evaluation of the effect of fractional CO2 laser on facial melasma

ABSTRACTMelasma represents the most obvious and disfiguring change of the face leading to psychological problems especially in females. Ablative lasers have also been used by many professionals to treat melasma, although there is few scientific data supporting this indication. The exact mechanism of action of ablative lasers in melasma is not yet clear enough. We aimed to evaluate the ultrastructural effect of fractional ablative CO2 (FrCo2) laser on facial melasma. Eleven melasma patients evaluated clinically by clinical modified area and severity index (MASI) score, treated by two sessions of fractional CO2 laser one month a part. Two punch biopsies of 2 mm diameter were obtained from all subjects one before and the other 3 months after treatment. All biopsies were analyzed by light and electron microscopy. Clinically, significant improvement of pigmentation and 48% reduction of (MASI) score were observed after two sessions of laser treatments. Light microscopic analysis of specimens revealed significant decrease in melanocyte count after treatment. Electron microscopic analysis of specimens after treatment revealed significant decrease in the number and size of melanocytes and significant decrease or complete absence of melanin granules in the surrounding keratinocytes compared to pre-treatment specimens. No scarring or post inflammatory hyper or hypopigmentation. We concluded that repeated application of Fractional CO2 laser on melasma skin may result in long lasting improvement due to its destructive effect on melanocytes.