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Ablative fractional laser resurfacing for treatment of sclerosis and contractures in chronic graft-versus-host disease: A pilot study
摘要： To the Editor: Cutaneous sclerosis is a disabling complication of chronic graft-versus-host disease (cGVHD) that leads to joint contractures and reduced range of motion (ROM). Current therapies are limited by adverse effects and poor efficacy, and no systemic treatment successfully reverses cGVHD-induced sclerotic skin changes.1 There is an urgent need for therapies to address the debilitating effects of cutaneous sclerosis in cGVHD. The ablative fractional CO2 laser remodels collagen and reduces fibrosis. It has been used for treatment of scars and contractures secondary to linear morphea, burns, and traumatic injury, conditions resembling the sclerosis of cGVHD.2,3 We evaluated the safety, tolerability, and efficacy of the ablative fractional CO2 laser for cGVHD-related sclerosis and joint contractures. Six patients with cGVHD-related sclerosis were enrolled prospectively and completed the study. Eligible patients had clinically severe, refractory sclerosis from longstanding cGVHD, with demonstrable ROM limitation and contractures across a joint amenable to laser therapy. After administration of topical anesthesia, patients had 3 monthly treatments of an approximately 10 3 6-cm area of skin at the target joint using the 10 600-nm fractional Ultrapulse CO2 laser (Ultrapulse Encore; Lumenis, Inc, Santa Clara, CA) in Deep FX mode (energy settings, 20-25 mJ; density, 5%-15%). Photographs, ROM measurements, and high-resolution ultrasonography were recorded at baseline, 1 week after each laser session, and 3 months after the final session. Punch biopsy and patient and provider assessments, including validated health and disability questionnaires, were performed at baseline and 3 months after the final session. The study was approved by the University of Pennsylvania institutional review board, and all patients provided written informed consent. Before enrollment, patients had received a mean of 5.5 systemic therapies for cGVHD-related sclerosis. Laser treatments were well tolerated, without infectious or other serious complications. ROM measurements, particularly the twisting motions of supination and pronation, improved in all patients (Table I). Immunohistochemical analysis of skin biopsy specimens showed decreased thickened collagen bundles, decreased intensity of collagen staining, and greater abundance of type III collagen in treated areas (Fig 1).3 Dermal echogenicity measured via high-resolution ultrasonography increased after the laser treatment, suggestive of collagen remodeling. Less haphazard organization of collagen is postulated to produce increased echogenicity.4 Patient photographs and disability assessments similarly showed evidence of improvement. The results of this pilot study highlight the safety, tolerability, and potential efficacy of the fractional ablative CO2 laser for treatment of cGVHD-related sclerosis and joint contracture, resulting in small but measurable histologic, radiologic, and functional improvements. Small sample size, small treatment area, and imperfect objective response measures are limitations. Longer follow-up, larger treatment areas, use of other laser settings, and laser-assisted delivery of topical medications should be evaluated in future studies.5 In summary, the fractional ablative CO2 laser was safe and well tolerated in a small group of medically complex patients with treatment-refractory cGVHD. Treatment of a target area of sclerotic skin appeared to induce collagen remodeling, with resulting modest improvement in ROM and joint function. These findings suggest that the fractional ablative CO2 laser may be an effective novel therapy for disabling sclerotic joint contractures in some patients with cGVHD.
关键词： sclerosis,ablative fractional laser resurfacing,contractures,chronic graft-versus-host disease,collagen remodeling
更新于2025-09-16 10:30:52
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1550-nm Nonablative Fractional Laser Versus 10,600-nm Ablative Fractional Laser in the Treatment of Surgical and Traumatic Scars
摘要： BACKGROUND The appearance and symptoms of scars can cause significant distress to patients. OBJECTIVE To assess and compare efficacy of the 1,500-nm nonablative fractional laser (NAFL) and 10,600-nm ablative fractional laser (AFL) in reducing symptoms and improving the appearance of traumatic or surgical scars. MATERIALS AND METHODS Single-center prospective, randomized, blinded, split-scar study was conducted on 100 patients with a scar obtained through trauma or surgery. Three treatments of NAFL or AFL were administered to each half of the scar at 4-week intervals. Scars were self-rated by the patient using the Patient and Observer Scar Assessment Scale and a satisfaction score and objectively evaluated by blinded dermatologists using the Manchester Scar Scale and visual analog scale. RESULTS Blinded observers found no statistically significant difference in scar appearance. Patient rating showed improvement of scar appearance (p < .0001). Pain was worse after treatment with AFL (p = .0492). Overall, there was no statistically significant evidence of one laser being superior or inferior to the other for patient and blinded observer scores (p = .3173 and p = .2513, respectively). CONCLUSION Scar treatment with AFL or NAFL is associated with high patient satisfaction. Objective evaluation of scars did not identify improvement in scar appearance.
关键词： efficacy,treatment regimen,10,550-nm nonablative fractional laser,scar treatment,1,600-nm ablative fractional laser
更新于2025-09-12 10:27:22
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Evaluation of the Safety and Efficacy of a Picosecond Alexandrite Laser With DLA for Acne Scars in Chinese Patients
摘要： Background and Objectives: Recently, picosecond laser treatment has been used as an effective treatment for acne scars. To evaluate the efficacy and safety of a picosecond alexandrite laser with a diffractive lens array in the treatment of acne scars in Chinese patients. Study Design/Materials and Methods: Patients with facial acne scars were treated with a picosecond alexandrite laser in three sessions at 4‐ to 6‐week intervals and followed up for 2 months. Primary outcomes were measured by physicians’ blinded evaluation of the acne scar using the ECCA (échelle d’éva physicians’luation clinique des cicatrices d’acné) grading scale. The secondary outcomes included the investigator global assessment (IGA) on the improvement of post‐inflammatory erythema (PIE), patients’ assessment of improvement on a 4‐point scale and of satisfaction on a 5‐point scale. Pain scores and adverse effects were also evaluated. Result: Twenty patients with Fitzpatrick skin types III and IV were enrolled in the study and completed all treatment and follow‐up visits. The mean ECCA scores fell from 197.75 ± 35.26 to 142.00 ± 35.92 (a 28% improvement), and the change was significant (P = 0.000). The mean IGA score of PIE improvement was 3.03 ± 0.75 (0 = no improvement and 4 = 76–100% improvement). On the basis of the patients’ self‐assessment, the average improvement scores were 2.30 ± 0.98 (0 indicating 0–25% improvement and 3 indicating >75% improvement). In total, 50% and 30% of the patients were “satisfied” and “very satisfied,” respectively, with the treatment. The mean pain score was 3.20 ± 0.50 (0 = no pain, 10 = maximum pain) with topical anesthesia. The adverse effects included transient and mild erythema, edema, and scabbing. Conclusions: Treatment with a picosecond alexandrite laser with a diffractive lens array is effective and safe for acne scars in Chinese patients. Lasers Surg. Med. ? 2019 Wiley Periodicals, Inc.
关键词： picosecond laser,post‐inflammatory erythema,alexandrite laser,acne scars,fractional laser
更新于2025-09-12 10:27:22
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Ablative Fractional Laser Resurfacing
摘要： Normal wound healing is a well-orchestrated process that occurs in 3 characteristic overlapping phases after injury: in?ammation, proliferation, and remodeling/maturation. During the proliferation phase of healing, granulation tissue grows from the base of the wound, ?lling the volume de?cit of the wound, and facilitating epithelialization and wound closure. Aberrantly prolonged stimulation of ?broplasia and angiogenesis, believed to be caused by an imbalance of matrix metalloproteinases, results in hyper-granulation, or “proud ?esh.” Risk factors contributing to the development of hypergranulation include wounds that heal by secondary intention, a prolonged (>1 week) in?ammatory phase of healing, or exposure to excessive external friction or moisture. Hypergranulation is clinically identi?able as red, friable, exophytic tissue that spills over the edges of the wound. Its presence impedes normal wound healing, resulting in persistent wounds that diminish quality of life (pain, bleeding, or malodor), contributing to development of contractures in burn wounds and grafts, and increasing risk of subsequent infection. Treatment is often dif?cult, and multiple modalities have been reported in the literature with varying success including chemical cautery with silver nitrate or tricholoracetic acid, both intralesional or topical corticosteroids, hydrocolloid dressings, surgical excision, pulsed dye laser (PDL), and potassium titanyl phosphate (KTP) laser.1,2 Treatment of surgical, traumatic, and burn scars with the ablative fractional CO2 laser is a recent, highly successful development.3 This infrared laser targets water and vaporizes vertical microcolumns of tissue, creating a zone of coagulation surrounding the ablated microcolumns. After this controlled microscopic injury, a sequential and predictable induction of growth factors and cytokines occurs, leading to a coordinated expression of matrix metalloproteinases, growth factors, and heat-shock proteins.4 Three recently reported case series detail the successful treatment of 10 patients with chronic ulcers with ablative fractional laser resurfacing.3–5 In this report, we describe the successful treatment of 2 patients with hypergranulation tissue using ablative fractional laser resurfacing. To the best of our knowledge, this has not previously been described in the literature.
关键词： Ablative Fractional Laser Resurfacing,Pulsed Dye Laser,CO2 Laser,Hypergranulation Tissue,Wound Healing
更新于2025-09-12 10:27:22
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Efficacy and safety of 1927 nm fractional Thulium fiber laser for the treatment of melasma: a retrospective study of 100 patients
摘要： Background: Melasma is an acquired hyperpigmentation of the skin that mostly affects areas exposed to the sun. The treatment of melasma can be challenging as it is prone to relapse. Recently, new laser and light-based treatment options have been used; one of these treatment modalities is the 1927 nm fractional Thulium fiber laser. Objective: This study aimed to retrospectively evaluate the efficacy and safety of a 1927 nm fractional Thulium fiber laser for the treatment of melasma. Materials and methods: This study retrospectively evaluated patients who were admitted to the dermatology outpatient clinic between September 2015 and March 2018 and treated with a 1927 nm fractional Thulium fiber laser. The MASI score was used to assess improvements of the lesions. Results: The current study included a total of 100 patients who received 1927 nm fractional Thulium fiber laser treatment. Each patient received two treatments at one month intervals. The mean baseline MASI score was 11.8 ± 6.3, the mean MASI score after the first session was 6.7 ± 4.1, and the mean MASI score after the second session was 3.4 ± 3.8. The differences between these three MASI scores were significant, and the laser treatment had no major side effects. Conclusion: Results of this study indicate that the 1927 nm fractional Thulium fiber laser is a safe and effective treatment option for melasma.
关键词： Melasma,1927 nm thulium fiber laser,fractional laser
更新于2025-09-12 10:27:22
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Laser-assisted MAL-PDT associated with acoustic pressure wave ultrasound with short incubation time for field cancerization treatment: a left-right comparison
摘要： Background: Laser-assisted MAL-PDT has been reported to increase the effectiveness of conventional PDT. Nonetheless, clinical effects of this association when reducing MAL is poorly discussed. Furthermore, the association of acoustic pressure wave ultrasound with laser-assisted MAL-PDT with short incubation time for field cancerization had not been reported before. Objectives: To compare clinical effects of ablative fractional laser-assisted MAL-PDT associated with acoustic pressure wave ultrasound (IMPACT US) with 1-hour field cancerization on the forearms, as well as the impact on safety and tolerability. Methods: Fifteen patients with 638 AK (grade I-III) with field cancerized-skin on the forearms were enrolled in this left-right trial. Two protocols were randomly chosen. One side was treated with conventional MAL-PDT, whereas the other with laser-assisted MAL-PDT associated with acoustic pressure wave ultrasound with 1-hour incubation time. Actinic keratoses were quantitively measured, and the other signs of sun-damaged skin, like pigmentation and texture, in field cancerized skin were qualitatively evaluated before and after six months. Side effects were assessed subjectively during the procedure and one week after. Results: All patients completed the study. At six months after treatment, both protocols reduced the number of AK (72%; CO2 + PDT, and 65%; MAL-PDT). The difference between these two protocols was not statistically significant (p = 0.77). The improvement of pigmentation and texture of field cancerized skin was more significant on the side treated with laser-assisted MAL-PDT associated with acoustic pressure wave ultrasound. Both protocols were well tolerated and without significant difference in adverse events. Conclusion: Laser-assisted MAL-PDT using CO2 laser and acoustic pressure wave ultrasound with short incubation time of 1 hour was as effective as conventional MAL-PDT for field-cancerized skin with actinic keratosis in forearms with better cosmetic outcome.
关键词： Incubation time,Skin field cancerization,Actinic keratosis,Ablative fractional laser assisted photodynamic therapy,laser-assisted drug delivery
更新于2025-09-12 10:27:22
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Laser-Assisted Delivery of Topical Rapamycin
摘要： Birt–Hogg–Dube syndrome (BHDS) is a genodermatosis that presents with multiple adnexal tumors (fibrofolli- culomas and trichodiscomas) and has increased suscep- tibility for renal tumors, pulmonary cysts, and spontaneous pneumothorax. No specific treatment exists for the cutaneous lesions of BHDS, and ablative laser therapies have only demonstrated modest results with relapse after 6 months. We present a patient with BHDS whose fibrofolliculomas were successfully treated with topical rapamycin and nonablative fractional laser.
关键词： Birt–Hogg–Dube syndrome,mTOR inhibition,fibrofolliculomas,nonablative fractional laser,topical rapamycin
更新于2025-09-12 10:27:22
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Nonablative Fractional 1,550-nm Laser for the Treatment of an Unusual Nevus Sebaceus
摘要： Nevus sebaceus is a benign congenital neoplasm that presents as a hairless yellow, waxy thin plaque on the scalp or face. Initially asymptomatic, the nevus sebaceus often becomes verrucous during puberty prompting evaluation by a dermatologist. Historically, the mainstay of treatment was prophylactic surgical excision due to the potential for malignant transformation; however, the literature has now demonstrated that the incidence of developing a malignancy within a nevus sebaceous is actually quite low at approximately 1%. Currently, there is a lack of consensus regarding the optimal management of nevus sebaceus, and less-invasive approaches are being explored. In this article, we report a case of an unusual nevus sebaceus treated successfully with a nonablative fractional 1,550-nm laser.
关键词： nevus sebaceus,dermatology,nonablative fractional laser,treatment
更新于2025-09-12 10:27:22
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Application of reflectance confocal microscopy to investigate the non-ablative, micro-ablative, and ablative effects of CO2 fractional laser irradiation on skin
摘要： CO2 fractional laser, as an ablative fractional laser, is commonly used in cosmetic treatment. We applied CO2 fractional laser irradiation to skin in vitro and used reflectance confocal microscopy (RCM) to image and detect the presence of any non-ablative, micro-ablative and ablative effects, in order to better understand the features of a CO2 fractional laser. In vitro irradiation of foreskin was performed using a CO2 fractional laser. Foreskin specimens were divided into 4 groups that received different amounts of irradiation energy, based on the number of irradiation passes they received: 5, 10, 15, and 20 passes, respectively. This corresponds to fluence energy of 16.3, 32.6, 48.9, 65.3 J/cm2. Immediately after irradiation, digital microscopy (DM), RCM, and histopathology were performed to observe whether the non-ablative, micro-ablative, and ablative phenomenon occurred, and the injury features of MTZs. Immediately after CO2 fractional laser irradiation, RCM and DM showed that when the numbers of passes were 5 and 10, a micro-ablative column (MAC) could not be observed or was very small. We mainly observed a thicker thermal coagulation zone (TCZ), representing non-ablative or micro-ablative effects. When the number of passes were increased to 15 and 20, the MAC was significantly enlarged and surrounded by a TCZ of medium thickness, representing ablative effects. For the first time, this study used RCM and DM to demonstrate that a CO2 fractional laser could achieve non-ablative, micro-ablative, and ablative effects on irradiated skin via different energy levels.
关键词： Microscopic treatment zone (MTZ),Non-ablative,Digital microscopy (DM),Micro-ablative,Reflectance confocal microscopy (RCM),CO2 fractional laser
更新于2025-09-12 10:27:22
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Topical Nanofat Biocrème Improves Aesthetic Outcomes of Nonablative Fractionated Laser Treatment: A Preliminary Report
摘要： Background: Improvements in skin erythema and elasticity have been seen with topical application of platelet-rich plasma after fractional laser treatment. Nanofat, when injected in small needles into the dermis has shown improvements in tissue thickness, discoloration and wrinkle depth. Objective: To evaluate improvements in skin following a nonablative fractional laser (FXD) treatment combined with the application of a novel topical nanofat biocrème, called neo-U. Methods: Fifty patients were treated with a nonablative FXD followed by application of a topical nanofat biocrème. Harvested fat was processed into nanofat, which was compounded with a transdermal liposomal delivery vector to produce a topical biocrème. In two patients, post-auricular skin punch biopsies were performed pre/post-treatment and examined for histological changes. Photos of a historical group treated with only the FXD laser were compared to photos of the patients treated with topical nanofat biocrème and a FXD laser. Results: Findings from postauricular skin biopsies show the skin exposed to FXD with nanofat biocrème had more elastin fibers and a slight increase in the thickness of the epidermis. Patients having FXD plus nanofat biocrème had a statistically significant improvement in the degree of wrinkles, nasolabial fold depth and texture compared to historical controls. Conclusions: Transdermal delivery of nanofat topical biocrème applied after fractional laser treatment can serve as a delivery system to improve fine lines, depth of nasolabial folds and overall texture of the tissue to a greater degree than laser resurfacing alone.
关键词： fractional laser,nanofat,transdermal delivery,skin rejuvenation,biocrème
更新于2025-09-11 14:15:04