Ultrapulse Carbon Dioxide Research Articles

Impact of 30% supramolecular salicylic acid combined with ultra-pulse carbon dioxide fractional laser therapy on facial atrophic acne scars

Objective: To assess the impact of 30% supramolecular salicylic acid (SSA) combined with ultra-pulse carbon dioxide (CO2) fractional laser therapy on facial atrophic acne scars. Methods: This retrospective study included patients with atrophic acne scars treated from June 2020 to June 2022. The patients were divided into the combination group (SSA combined with ultra-pulse CO2 fractional laser therapy) and the laser group (ultra-pulse CO2 fractional laser therapy alone). Four treatment sessions were conducted for each group. Follow-up visits were performed every 2 months after each treatment and included assessments of the Échelle d'Évaluation clinique des cicatrices d'acné (ECCA) score, effective rate, and visual analogue scale score. Results: The combination and laser groups comprised 72 and 61 patients, respectively. There were no significant differences in sex, age, or baseline ECCA score between the two groups. The effective rate (95.8% vs. 67.2%, P < 0.001) was higher and the pain scores (during and after the intervention) were lower in the combination group than in the laser group (P < 0.001). The severity of erythema, edema, and crusting was milder in the combination group (P < 0.001). The proportion of highly satisfied patients was higher (73.6% vs. 31.2%, P < 0.001) and the Dermatology Life Quality Index showed greater improvement (0.15 ± 0.40 vs. 1.39 ± 1.53, P < 0.001) in the combination group than in the laser group. Conclusion: The combination of ultra-pulse CO2 fractional laser therapy and 30% supramolecular SSA had improved efficacy in treating facial atrophic acne scars without increasing pain or inducing adverse reactions.

Ultrapulse carbon dioxide dot matrix laser for facial scar treatment: A meta-analysis.

A meta-analysis was performed to investigate the efficacy of ultrapulse carbon dioxide dot matrix laser treatment for patients with facial scars. PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, China Biomedical Literature Database, and Wanfang Database were systematically searched for randomised controlled trials (RCTs) investigating ultrapulse carbon dioxide dot matrix laser treatment for facial scars, and the search was conducted from the time of database inception to July 2023. The retrieved literature was screened independently by two researchers, and data extraction and quality assessments were performed. The meta-analysis was conducted using RevMan 5.4 software. Outcome metrics included overall treatment effectiveness, complication rate, and Echelle d'évaluation clinique des cicatrices d'acné (ECCA) scores. Seventeen RCTs comprising 3703 patients were included, with 1853 patients in the experimental group and 1850 in the control group. The results showed that the experimental group had significantly increased overall treatment efficacy rates (odds ratio [OR]: 3.84, 95% confidence interval [CI]: 3.02-4.90, p < 0.001), reduced complication rates (OR: 0.35, 95% CI: 0.27-0.44, p < 0.001), and improved ECCA scores (standardised mean difference: -1.79, 95% CI: -2.53 to -1.05, p < 0.001) compared with the control group. In conclusion, as the primary treatment modality for facial acne depression scars, ultrapulse carbon dioxide dot matrix laser can significantly increase the overall treatment efficacy rate and ECCA scores and reduce the incidence of complications; however, higher-quality studies are needed for further validation.

Effectiveness and Safety Analysis of Plasma Beam in the Treatment of Facial Depressed Scars.

The study aimed to analyze the effectiveness and safety of microplasma beam in the treatment of facial depression scars. 106 patients with facial depression scars treated in the hospital between January 2017 and September 2021 were selected as the observation subjects. According to different treatment methods, the patients were divided into the control group (receiving ultrapulsed carbon dioxide lattice laser treatment, n = 51) and the observation group (undergoing plasma beam treatment, n = 55). The two groups were treated for 6 months, and the treatment effects were compared between the two groups. The Visual Analogue Scale (VAS) was used to compare the pain between the two groups, and the duration of pain and the time of scab shedding were recorded. The improvement of scars was compared between the two groups according to the Evaluation Clinique des Cicatrices d' Acne (ECCA), and the adverse reactions during treatment were compared between the two groups. A clinical effective rate of 94.55% in the observation group was higher than a clinical effective rate of 82.35% in the control group (P < 0.05). The VAS score in the observation group was lower than that in the control group, and the pain duration and the scab shedding time were shorter than those in the control group (P < 0.05). ECCA scores in the observation group after twice and 3 times of treatments were lower than those in the control group (P < 0.05). The total incidence rate of adverse reactions of 10.91% in the observation group was lower, whereas it was 25.49% in the control group (P > 0.05). Plasma beam has a significant efficacy in the treatment of facial depressed scars, and it has mild pain, quick recovery, and high safety. Clinical Trial Registration Number. The clinical trial registration number is T2017081.

A systematic review and meta-analysis on the effects of the ultra-pulse CO2 fractional laser in the treatment of depressed acne scars.

Acne is a chronic inflammatory disease that occurs in the sebaceous glands of the hair follicles. Depressed acne scars, also known as depressed scars, remain after recovery. Clinical treatments of depressed scars include chemical peels, surgical treatments, radio frequency treatments, and laser treatments. Ultra-pulse carbon dioxide (CO2) fractional laser treatment has become the main method for treating depressed scars in recent years, but there are no systematic reports on the effectiveness and safety of this treatment. English databases, including PubMed, Embase, and Ovid-Medline, were searched to retrieve relevant articles. The search period ran from the establishment of the databases to April 2021. The search terms included CO2 lattice laser, depressed acne scars, depressed scars, and effectiveness. A total of 6 articles comprising 467 patients with depressed acne scars were included in the meta-analysis. The results showed that patients treated with ultra-pulsed CO2 fractionated laser scored higher in skin smoothness compared to other methods [standard mean difference (SMD) =0.49, 95% confidence interval (CI): 0.13-0.84; P=0.008], and significantly higher total skin lesion scores (SMD =0.35, 95% CI: -0.00 to 0.70; P=0.05). A total of 6 articles were included in this study on the clinical efficacy of the ultra-pulse CO2 fractional laser in the treatment of depressed acne scars. The study found that compared to other treatments, this laser had a better curative effect in terms of the effective rate and patient skin smoothness score.

Evaluating the Long-Term Outcome of the Ablative Lasers in the Treatment of Facial Angiofibromas in Tuberous Sclerosis: A TwoYear Follow-Up Study

Background: Tuberous sclerosis (TS), a genetic multisystem disorder, is characterized by widespread hamartomas in multiple organs. The classic clinical symptoms consist of angiofibromas, epilepsy, and developmental delay. Dermatological change is one of the major features. Bilateral facial angiofibromas (FA), a common form of presentation, cause significant cosmetic, medical, and emotional problems. The emerging treatment for skin lesions is laser therapy. However, there is no report on the long-term outcome of combined use of ultra-pulse carbon dioxide (UPCD) laser and ablative fractional (AF) Er: YAG lasers to treat skin lesions in patients suffering TS. Methods: A retrospective study, conducted from March 2014 to July 2018, investigated 9 patients from the Northwest part of China who had TS treated with a sequential treatment of UPCD laser and AF Er: YAG laser. Results: The sequential use of the UPCD and AF Er: YAG laser is a safe and effective method for the treatment of FA in patients suffering TS with satisfactory long-term outcomes. Conclusions: The sequential use of the UPCD and AF Er: YAG laser is a safe and effective method for the treatment of FA in patients suffering TS with satisfactory long-term outcomes.

A Prospective Interventional Study of Xanthelasma Palpebrarum Treated with Ultrapulse Carbon Dioxide Laser

Introduction: Xanthelasma palpebrarum (XP) is the most common of all the xanthomas which presents as asymptomatic, often bilateral, soft, yellow, papules and plaques around the eyelids. Although, the lesions are benign, it is aesthetically upsetting. The surgical laser is the most effective treatment modality to this problem. Aim: To evaluate the efficacy and safety of ultrapulse Carbon dioxide (CO2) laser in XP in Indian patients. Materials and Methods: It is a prospective, interventional study carried out for two years in which 29 patients with 61 XP lesions were part of the study. Ultrapulse CO2 (Fraxis Duo laser; 10,600 nm) laser treatment was done in every patient for a single sitting. Statistical significance was calculated using Chi-square test using Statistical Packages for Social Sciences (SPSS) version 19.0. The p-value of 0.001 was considered statistically significant. Results: A total number of 29 patients with 61 xanthelasma lesions were included in the study, of which 11 were males and 18 were females with an age range of 27-54 years. In the present study XP lesions were completely resolved in majority (54 lesions in 25 patients) of treated patients. No intraoperative complications were observed. Two patients showed hypopigmentation. There was neither scarring nor recurrence seen after six months follow-up. Conclusion: Ultrapulse CO2 laser is a safe and effective option of treatment for xanthelasma. It is considered as less painful procedure with fewer side effects and recurrences in the present study.

Efficacy of ultrapulse carbon dioxide laser ablation versus 30% trichloroacetic acid in xanthelasma palpebrarum - A randomised controlled trial

Context: Xanthelasma palpebrarum (XP) is the most common cutaneous xanthoma that develops around the eyes. A number of treatment modalities have been tried for its removal, but none are truly satisfactory. Trichloroacetic acid (TCA) is commonly used in Indian setting as it is easily available and cost-effective whereas carbon dioxide (CO2) laser has been tried increasingly due to its favorable cosmetic outcome. Aims: This study aims to compare the efficacy of ultrapulse CO2 laser ablation with 30% TCA in the treatment of XP. Setting and Design: Prospective, interventional, randomized study at a Dermatology Centre of a Tertiary Level Hospital from January 2017 to June 2018. Methods: Seventy-four patients with 100 lesions of XP were divided into two groups of flat and elevated lesions. Each group was further randomly divided into two subgroups and administered CO2 laser once a month and 30% TCA once in 2 weeks respectively for 3 months. Patients were clinically assessed at baseline and then at monthly intervals using visual analog scale (VAS), patient satisfaction score (PSS), and standardized photographs. The follow-up was done at the end of 3 and 6 months. Statistical Analysis and Results: Mean PSS and VAS score of TCA and laser in flat and elevated lesions were compared using independent group Student's t-test. Response to laser in elevated lesions was found to be statistically better whereas in flat lesions the response to TCA and laser were similar. Recurrence was 17% and 6% at 3 months' follow-up and 24% and 11% at 6 months' follow-up in TCA and laser groups, respectively. Conclusions: The end results of ultrapulse CO2 laser and 30% TCA are comparable in flat lesions of XP. In elevated lesions, laser has better efficacy, requires fewer sittings with lesser chance of recurrence.

Ultra-pulsed Carbon Dioxide Laser for the Treatment of Melanocytic Nevi

Abstract: Congenital melanocytic nevi (CMN) even small-sized as well as acquired melanocytic nevi (AMN) are of common cosmetic concerns and getting rid of them remain challenging. The aim of this study is to evaluate the efficacy and safety of the ultra-pulsed CO2 laser for the treatment of melanocytic nevi. 15 male and female Libyan patients with 16 AMN and 7 CMN were treated with multiple sessions of ultra-pulsed CO2 laser at 1-month intervals. Clinical response at 6 months after final treatment was graded as poor (&lt; 50%), moderate (50–75%), good (&gt; 75%) and excellent where the skin of the lesion returned normal as the rest of the surrounding skin. All treated nevi showed good to excellent cosmetic outcomes after 2 or 4 treatment sessions. The post laser complication were minimal and transit except for one atrophic scar. No recurrence of pigmentation during the six months of follow-up period. Conclusion: Ultra-pulsed CO2 laser seems to be effective and associate with minimum adverse side effect in the treatment of small CMN and AMN.

Multiple Apocrine Hidrocystomas of the Eyelids: A Case Successfully Treated Using Ultrapulsed Carbon Dioxide Laser and Literature Review

Apocrine hidrocystomas of the eyelids are cystic tumors that have their origin in the glandular portion of the apocrine gland; in most cases they cause only mild or absent symptoms, but they may annoy patients when in huge number, usually interfering with the field of view and disfiguring of upper part of the face. Consequently, those affected usually ask these lesions to be removed. Although a solitary lesion can be treated easily with surgical excision, the elimination of multiple lesions may be problematic because of their number and locations. Many approaches were proposed for solving this particular clinical presentation. We present a difficult case of multiple apocrine hidrocystomas successfully treated using carbon dioxide laser with a good cosmetic outcome taking the opportunity for a literature review.

Comparative Evaluation of Clinical Outcomes of Laser Skin Resurfacing Using an Ultra-Pulse Carbon Dioxide Laser and Manual Dermabrasion Using a Medium-Grit Drywall Sand Screen for Scar Revision in Adults: A Split-Scar Prospective Study

The purpose was to evaluate the clinical outcomes of laser skin resurfacing using an ultra-pulse carbon dioxide (CO2) laser and manual dermabrasion with a medium-grit drywall sand screen for scar revision in adults with Fitzpatrick skin type III to V. A total of 20 postsurgical and post-traumatic scars in individuals with Fitzpatrick skin type III to V were included in this study. Preoperative evaluation of the scars was performed by 3 blinded observers using the Manchester scar rating scale. Each scar to be treated was divided into 2 equal halves, and each half was randomly allotted to either ultra-pulse CO2 laser resurfacing (group A) or manual dermabrasion (group B). Postoperative clinical evaluation was performed by the same observers using the Manchester scar rating scale at the end of the first month, third month, and sixth month. This study showed that both methods were effective in improving the appearance of the postsurgical and post-traumatic scars. No significant difference was found between them (P=.978). Hyperpigmentation occurred in 4 scars in both the half treated with manual dermabrasion and the half treated with laser resurfacing; however, it had resolved by the end of the sixth month in all 4 scars. CO2 laser resurfacing and manual dermabrasion are equally efficacious and safe methods for scar resurfacing in adults with Fitzpatrick skin type III to V.

Therapeutic effect of ultra pulse carbon dioxide fractional laser on treating hypertrophic scar after burn

Objective To study the therapeutic effect of ultra pulsed carbon dioxide fractional laser on treating hypertrophic scar after burn. Methods Forty-five patients with hypertrophic scar after burn were selected. Each laser treatment included an ultra-pulse mode and a Scaar FX mode scan irradiation, and the treatment was conducted once a month for 4 to 6 times. In the ultra-pulse irradiation, the energy was 150~175 mJ, frequency was 40 Hz, hole spacing was about 4~5 mm, and irradiation time per hole was 2~3 s, and in Scaar FX mode energy was 60~150 mJ, frequency 250 Hz, and density 1% to 3%. Before the first treatment and 6 months after the end of the treatment, the Vancouver scar scale (VSS) was used to score the scar morphology, and the visual analog scale (VAS) was used to score the scar pain and itching. The effect of the treatment was classified as significant, effective and invalid. In addition, adverse reactions occurred during the treatment were recorded. Results After six months of the treatments, the VSS score, VAS pain score, and VAS pruritus score of the patients were 4.16±1.72, 1.58±0.62, and 1.24±0.74, respectively, while the pre-treatment values were 10.17±1.96, 2.98±0.89, and 2.31±0.97, respectively. The differences were statistically significant (all P<0.01). The treatment was effective in all patients, and the effect was significant in 35 cases, effective in 10 cases, and no recurrence occurred within 6 months after treatment. In 3 patients, blisters appeared on the scar after the first treatment, and the blister collapsed to form a wound. After the dressing change, the blisters healed after 7 to 10 days. Conclusion Ultra pulsed carbon dioxide fractional laser is effective in treating hypertrophic scar after burn, with mild adverse reactions and no relapse, which is worthy of clinical promotion. Key words: Burns; Scar; Ultra pulsed CO2 fractional laser; Laser therapy

Clinical effects of different modes of ultra pulse carbon dioxide fractional laser used in combination on the treatment of hypertrophic scar on face and neck

To explore the clinical effects of ultra pulse mode of ultra pulse carbon dioxide fractional laser combined with Deep FX mode or Scaar FX mode on the treatment of patients with hypertrophic scars on face and neck. One hundred and fifty-eight patients with hypertrophic scars on face and neck who met the inclusion criteria were admitted to Hunan Provincial People's Hospital from January 2012 to January 2015. Firstly, the scar areas were cleaned and given compound lidocaine cream for surface anesthesia. Then the scar areas were treated with ultra pulse mode of ultra pulse carbon dioxide fractional laser, with energy from 150 to 175 mJ, frequency of 40 Hz, hole to hole distance of 4 mm or 5 mm, and the treatment time of each hole of 2 s or 3 s. For mild scar, Deep FX mode was added for treatment with energy from 30 to 50 mJ, frequency of 300 Hz, and density of 5%; for moderate and severe scar, Scaar FX mode was additionally used for therapy, with energy from 80 to 150 mJ, frequency of 300 Hz, and density of 3%. The above-mentioned treatments were performed per three months, totally for 3 times, 10-15 min per treatment. After each treatment, wounds were moisturized and given sun protection. Before the first treatment and 6 months after treatment of 3 times, the curative effect was assessed by Vancouver Scar Scale (VSS) and University of North Carolina Scar Scale. Six months after treatment of 3 times, satisfaction degree of patient and loss of working time were recorded. The adverse effects of whole treatment course were recorded. Data were processed with t test. (1) Six months after treatment of 3 times, VSS score of patients was (3.1±1.0) points, which was significantly lower than that before the first treatment [(9.4±1.8) points, t=53.096, P<0.05]; University of North Carolina Scar Scale score of patients was (1.6±0.7) points, which was significantly lower than that before the first treatment[(8.0±1.4) points, t=63.730, P<0.05]. (2) Six months after treatment of 3 times, 150 patients were very satisfied with the curative effect, 6 patients were satisfied, and 2 patients were relatively satisfied. The loss of working time of patients was 10-15 (10.5±0.3) d. (3) During the treatment, mild erythema appeared in 5 patients which disappeared without treatment; pigmentation appeared in 6 patients 2 weeks after the first treatment, and pruritus and rash appeared in 2 patients 3 days after the first treatment, which were all improved with pharmaceutical therapy. Ultra pulse mode of ultra pulse carbon dioxide fractional laser combined with Deep FX mode or Scaar FX mode has definitely clinical effect on patients with hypertrophic scars on face and neck with few adverse effects, which is worth to popularize and apply for clinic.

Clinical efficacy of fractionated ultrapulse carbon dioxide laser combined with microneedle for the treatment of acne scars

Objective To investigate the clinical efficacy of fractionated ultrapulse carbon dioxide laser combined with microneedle for depressed acne scars. Methods Totally 86 patients with depressed acne scar were randomly divided into 2 groups: the treatment group received fractionated ultrapulse carbon dioxide laser combined with microneedle technology and the control group only received fractionated ultrapulse carbon dioxide laser. The treatment interval was 1 to 3 months, and the whole course was 2-8 times. The total effective rate and the adverse reaction were analyzed in the facial acne scar. Results The surface of depressed acne scars was significantly improved. ECCA score of all patients declined obviously after treatment, the score of the treatment group declined from 61±11 to 45±15, and the control group declined from 57±14 to 40±16. There were significantly statistical differences in the results of each group (P<0.05). More treatment times resulted in better surface improvement. The total effective rate were 81.8% (18/22) and 100% (24/24) in the treatment group, and 80.0% (16/20) and 100% (20/22) in the control group. The course was 6.8±1.6 months in the treatment group and 20.8±4.6 months in the control group (P<0.05) to get a similar satisfied result. There were no obvious adverse reactions except two cases of erythema and pigmentation in the treatment group and 5 cases in the control group. The former was with less adverse reactions. Conclusions Ultrapulse carbon dioxide laser combined with microneedle technique is effective for facial acne scars, with less complications and shorten treatment course. Key words: Fractional laser; Micro needle; Acne scars

Clnical observation, of the effects of lattice ultra pulse carbon dioxide laser combined with traditional Chinese medicine on the treatment of hyperplastic scar

To explore the clinical effects of lattice ultra pulse carbon dioxide laser combined with traditional Chinese medicine ( Fuchunsan ) on the treatment of postburn hyperplastic scar. Sixty-three patients with hyperplastic scar after burn injury hospitalized from February 2012 to June 2014 in our department were treated with lattice ultra pulse carbon dioxide laser combined with traditional Chinese medicine (Fuchunsan). Patients were divided into early stage group (E, n = 35), middle stage group (M, n = 25), and late stage group ( L, n = 3) according to the formation time of scar, which was respectively 3 weeks to 3 months, longer than 3 months and less than or equal to 6 months, and 3 to 15 years in groups E, M, and L. The number of times of laser treatment of patients in each group was recorded. The degree of scar pain in patients of the three groups was assessed by the Numerical Rating Scale (NRS) before treatment and after treatment for 1, 2, and 3 times. The scar condition of patients in groups E and M was assessed by the Vancouver Scar Scale (VSS) before treatment and after treatment for 1, 3, and 5 times. Patients in group L did not receive VSS assessment but were evaluated by clinical observation only. Photos of scar in treating area were taken before treatment and after treatment for 3 and 5 times to evaluate the clinical effect. Data were processed with t test. Patients in groups E and M were treated with laser for (4.8 ± 1.1) and (7.7 ± 2.1) times respectively. In group L, the treatment was stopped in 2 patients after laser treatment for 5 times, and 1 patient received laser treatment for 12 times. The degree of pain in patients of groups E and M was alleviated significantly after treatment for one time, and the number of patients scoring 1-4 point(s) in NRS increased from 5 cases to 38 cases. After treatment for 2 and 3 times, the increase in the number of patients scoring 1-4 point (s) in NRS was on a small scale. Before treatment and after treatment for 1 time, VSS scores of patients in groups E and M were similar (with values respectively 0.641 and 0. 082, P values above 0. 05). After treatment for 3 and 5 times, VSS scores of patients in group E were respectively (9.2 ± 0.8) and (7.0 ± 1.1) points, which were significantly lower than those in group M [ (9.7 ± 1.0) and (8.2 ± 1.0) points, with values respectively -1.993 and -4.433 , P < 0.05 or P < 0.01]. After treatment for 3 times, the rate of improvement in appearance was respectively 88.6% (31/35) and 72.0% (18/25) in groups E and M, and it was respectively 100.0% (35/35) and 96.0% (24/25) after treatment for 5 times. No significant effect in appearance was found in the 3 patients in group L. Early application of lattice ultra pulse carbon dioxide laser combined with traditional Chinese medicine (Fuchunsan) for the treatment of postburn hyperplastic scar is effective.

Efficacy of ultrapulse carbon dioxide laser for the treatment of facial angiofibroma in patients with tuberous sclerosis: an observatioal study

Objective To estimate the clinical efficacy and adverse effects of ultrapulse carbon dioxide laser for the treatment of facial angiofibroma in tuberous sclerosis patients, and to observe the recurrence of facial angiofibroma in the patients after treatment with ultrapulse carbon dioxide laser. Methods Thirty-six tuberous sclerosis patients with facial angiofibroma were enrolled in this study. Ultrapulse carbon dioxide laser(Ultrapulse Encore)was used for the treatment of facial angiofibroma in these patients. Laser parameters were selected according to the type of skin lesions. Results Finally, 28 patients who received single irradiation treatment and completed 6-month follow up were evaluated for efficacy and safety. Of the 28 patients, 10 were cured, 10 showed marked response, 5 response, 3 no response, and 18 experienced recurrence, with the response rate, marked response rate and recurrence rate being 89.3%, 71.4% and 64.3% respectively. Patients with a relatively small number of sparsely distributed primary lesions showed a relatively good response. There was no significant correlation between the response rate and patients′ age, gender or medical history(all P> 0.05). No permanent pigmentation, depigmentation, atrophy or hyperplastic scar was observed in any of these 36 patients. Conclusions Ultrapulse carbon dioxide laser is effective for the treatment of facial angiofibroma in tuberous sclerosis patients with few adverse effects but high recurrence risk. There seems to be a relatively good response to ultrapulse carbon dioxide laser in patients with a small number of primary lesions. Key words: Lasers, gas; Tuberous sclerosis; Face; Angiofibroma; Treatment outcome

Ultrapulse carbon dioxide laser ablation of xanthelasma palpebrarum: A case series

Context:Xanthelasma palpebrarum is the most common form of xanthomas. Albeit a benign entity, it is cosmetically disturbing and a frequently recurring dermatologic referral. Although the classical treatment option remains surgical excision, alternatively, chemical cauterization, cryosurgery and electrofulguration have all been tried in the past with mixed results. The use of laser systems such as carbon dioxide laser, Erb:YAG laser, Q-switched Nd:YAG laser, diode laser, pulsed dye laser and KTP laser have become popular in the treatment of these lesions. Recent literature suggests minimal pigmentary changes and scarring with the use of ultrapulse carbon dioxide laser treatment of these lesions.Aim:To study and evaluate the effectiveness of ultrapulse carbon dioxide laser ablation for treatment of xanthelasma palpebrarum.Materials and Methods:10 patients presenting with bilateral xanthelasma palpebrarum, new and with recurrence were studied for results after a single treatment with ultrapulse carbon dioxide laser (10,600 nm; 100-200 Hz; 200-400 μsec). The follow-up time was 9 months.Results:All lesions were treatable with a single-laser treatment session. Two patients (20%) developed recurrence during the follow-up period. Side effects included post inflammatory hyperpigmentation in two patients (20%), but no visible scarring was observed.Conclusions:The ultrapulse carbon dioxide laser is an effective and safe therapeutic alternative in treatment of xanthelasma palpebrarum.

Dystrophic Calcification and Accentuated Localized Argyria After Fractionated Carbon Dioxide Laser Therapy of Hypertrophic Scars

Fractionated, ultrapulsed carbon dioxide (CO2) laser therapy is a powerful tool for the treatment of scars. Common adverse effects of this therapeutic modality have been previously documented. We describe 2 unreported adverse effects of ultrapulsed CO2 laser treatment of mature scars in a patient previously treated with silver-impregnated dressings. A teenage survivor of toxic epidermal necrolysis presented with faint but diffuse dyschromia clinically and histologically consistent with localized argyria secondary to silver-impregnated dressings used years earlier. The patient was subsequently treated with fractionated CO2 for her scarring, but her hyperpigmentation worsened with each treatment. A subsequent biopsy specimen revealed a zone of dystrophic calcification with adjacent pseudo-ochronotic fibers that were not appreciated on biopsy specimens taken before CO2 laser treatment, suggesting unique complications not previously reported. We present 2 unique complications secondary to ultrapulsed, fractionated CO2 laser treatment in a patient previously treated with silver-impregnated dressings: (1) the appearance of pseudo-ochronotic fibers in areas of worsening pigmentation and (2) evidence of dystrophic calcification limited to columns of fractionated laser ablation. Therefore, a history of argyria or treatment with silver-impregnated dressings should be considered before treatment with fractionated CO2 lasers.

63 Intravascular laser blood irradiation of different spectral and frequency range in the correction of hormonal imbalance of patients with bronchial asthma

For patients seeking aesthetic rejuvenation of the eyes, transconjunctival blepharoplasty is an effective means of dealing with proptotic lower eyelid fat. For dermatochalasis of infraorbital skin, Ultrapulse carbon dioxide (CO2) laser resurfacing can be used simultaneously with blepharoplasty to “tighten” periorbital skin. This article describes the technique, results, and complications in a series of 101 patients. Histological and electron microscopic study of laser wounding provides an understanding of tissue biophysics unique to human eyelid skin. The entire procedure can be performed with the laser, by starting with a 0.2 mm CO2 laser handpiece to incise the conjunctiva and resect fat, then switching to a computer pattern generator (CPG) for skin resurfacing. Meticulous hemostasis, avoidance of the inferior oblique muscle, and complete fat excision are the mainstays of this procedure. The technique has been extremely safe and free from complications of ocular morbidity, bleeding, ectropion, scleral show, hypopigmentation, skin slough, or scarring. There was one case of herpes simplex. Duration of healing averaged 7 weeks when the CPG was used. In contrast, the single-spot, manual sweep handpiece significantly prolonged erythema to 11 weeks or more. The incidence of hyperpigmentation was 16%, and equal in patients undergoing transconjunctival blepharoplasty with resurfacing and those receiving periorbital laser resurfacing alone. Treatment with hydroquinone cleared all patients. Histological study showed variance in total eyelid skin thickness, from 483 to 1,371 μms with epidermis comprising 63.5 μm on average. The first pass of the laser characteristically exfoliates the epidermis in a clean plane, 60 to 80 μm, with nominal dermal effect. A second pass produces dermal coagulation of approximately 40 μms, sparing adnexal structures. With a second pass of the laser, electron microscopy confirms collagen fibril contraction in the reticular dermis, with a 30% increase in diameter and a 9% contraction in periodicity. At the same level, microvasculature is preserved. Transconjunctival lower lid blepharoplasty, performed with Ultrapulse CO2 laser incision and skin resurfacing, avoids morbidity typically associated with standard subciliary blepharoplasty, and with no increase in ocular or laser-related sequelae. For resurfacing, two passes with the CPG enhances dermal collagen contraction, and dermal viability and collagen contraction are confirmed by microscopic examination.

Outcomes of 52 patients with congenital melanocytic naevi treated with UltraPulse Carbon Dioxide and Frequency Doubled Q-Switched Nd-Yag laser

A variety of treatment options exist for the management of congenital melanocytic naevi (CMN). Surgical treatment has been the traditional approach. Recently, lasers have been introduced to treat CMN. This study assesses the effectiveness of UltraPulse Carbon Dioxide (UCO2) and Frequency Doubled Q-Switched (FDQS) Nd-Yag laser up to a 15 year period which is the longest follow-up period of any study, as far as we are aware. We performed a retrospective review of 52 patients with 314 CMN, treated with UCO2 laser and FDQS Nd-Yag laser. The reduction in visible pigmentation, signs of recurrence and any adverse skin changes were evaluated clinically by two clinicians independent to the laser operator. There was minimal visible pigmentation after completion of treatment in 40 patients. Treatment failure occurred in 5 patients, recurrence in 5 and partial success in 2. 5 patients developed hypertrophic scarring, 1 developed hyperpigmentation and 1 patient developed an intracranial melanoma. 87% of patients were satisfied with their treatment and in hindsight would not have chosen surgery. Mean follow-up period was 8 years (interquartile range 3-11 years). UCO2 and FDQS Nd-Yag lasers are clinically useful treatment options for patients with CMN and have minimal complications. This combined laser regime is particularly effective for the treatment of CMN in cosmetically sensitive and anatomically critical areas, especially when surgical excision may not be straight forward and/or leave unacceptable scars.

Ultrapulse Carbon Dioxide Laser Treatment of Porokeratotic Eccrine Ostial and Dermal Duct Nevus

Porokeratotic eccrine ostial and dermal duct nevus (PEODDN) is a rare, benign, cutaneous hamartoma. Approximately 45 cases of PEODDN have been reported, with little information regarding treatment. We report a patient with PEODDN treated successfully using an ultrapulse carbon dioxide laser.