Arne A. Meesters

Non-ablative 1,550 nm fractional laser therapy versus triple topical therapy for the treatment of melasma: A randomized controlled split-face study†‡

Melasma is a uichronic, often relapsing skin disorder, with poor long‐term results from all current therapies.

Spatiotemporal closure of fractional laser-ablated channels imaged by optical coherence tomography and reflectance confocal microscopy.

Optical coherence tomography (OCT) and reflectance confocal microscopy (RCM) offer high‐resolution optical imaging of the skin, which may provide benefit in the context of laser‐assisted drug delivery. We aimed to characterize postoperative healing of ablative fractional laser (AFXL)‐induced channels and dynamics in their spatiotemporal closure using in vivo OCT and RCM techniques.

Non-ablative 1550 nm fractional laser therapy not effective for erythema dyschromicum perstans and postinflammatory hyperpigmentation: a pilot study

Abstract Background: Erythema dyschromicum perstans and postinflammatory hyperpigmentation (PIH) are characterized by papillary dermal pigmentation or pigment incontinence. To date, no standard treatment is available. Fractional laser therapy (FLT) was recently reported to improve different pigment disorders. Objectives: To assess the efficacy and safety of non-ablative FLT in the treatment of erythema dyschromicum perstans and PIH. Methods: Eight patients with erythema dyschromicum perstans and six patients with PIH were included. In each patient, two similar test regions were randomized to receive either five fractional laser treatments in combination with intermittent daily topical bleaching or the same intermittent regimen of topical bleaching alone. Three months after the last treatment, improvement of hyperpigmentation was assessed by melanin index, reflectance spectroscopy, physicians assessment, patients assessment and patients satisfaction. In addition, a biopsy of both laser treated and control site was evaluated by an independent blinded pathologist. Results: No clinical improvement of hyperpigmentation was observed. Reflectance spectroscopy, melanin index, number of melanocytes and amount of dermal melanin did not significantly differ. Patients considered FLT unsatisfactory. Moreover, three patients developed laser-induced PIH. Conclusions: With these specific laser settings, non-ablative FLT was not effective for the treatment of erythema dyschromicum perstans and PIH.

Fractional CO2 laser assisted delivery of topical anesthetics: A randomized controlled pilot study

Many dermatological procedures are performed under local anesthesia. Topical anesthesia requires prolonged occlusion and is often insufficient. Infiltration anesthesia is associated with discomfort. Pretreatment with an ablative fractional laser (AFXL) may enhance penetration of topical drugs, including lidocaine. Primary aim of this study was to assess whether AFXL pretreatment enhances the efficacy of two regularly used anesthetics: (i) articain hydrochloride 40 mg/ml + epinephrine 10 μg/ml solution (AHES); (ii) lidocaine 25 mg/g + prilocaine 25 mg/g cream (EMLA cream). Secondary aim was to assess which anesthetic is superior on AFXL pretreated skin.

Long-term remission of folliculitis decalvans after treatment with the long-pulsed Nd:YAG laser

Folliculitis decalvans (FD) is a rare inflammatory scalp disorder presenting with tufted folliculitis, follicular papules and pustules, progressing to cicatricial alopecia. Current treatments mainly consist of antibiotic and immunomodulatory therapies and are often disappointing. FD has previously shown to respond to treatment with neodymium:yttrium aluminium garnet (Nd:YAG) laser in one case. We present a case of recalcitrant FD, successfully treated with a long-pulsed Nd:YAG laser.

Home vs. outpatient narrowband ultraviolet B therapy for the treatment of nonsegmental vitiligo: a retrospective questionnaire study

MADAM, Narrowband ultraviolet B (NB-UVB) therapy is considered the first-line therapy for nonsegmental vitiligo. A major drawback, though, is the fact that this treatment requires months to years of frequent visits to a clinic-based phototherapy unit. For that reason home UVB therapy was introduced in 1979, mainly for psoriasis, and in the early 1990s for vitiligo as well. However, the safety, effectiveness and compliance associated with home treatment have been debated. This study is the first to provide data on the pros and cons of home vs. outpatient UVB therapy in patients with nonsegmental vitiligo. (a) (b)

Punchgraft testing in vitiligo; effects of UVA, NB-UVB and 632.8 nm Helium-Neon laser on the outcome

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Formation of Fibrosis After Nonablative and Ablative Fractional Laser Therapy

Background Fractional laser therapy (FLT) has become a widely accepted modality for skin rejuvenation and has also been used in various other skin diseases. Objective To observe long‐term histologic effects of nonablative and ablative FLT in the treatment of pigment disorders. Methods A randomized controlled observer‐blinded study was performed in 18 patients with pigment disorders. Two similar test regions were randomized to receive FLT with intermittent topical bleaching or topical bleaching alone. Patients with ashy dermatosis (AD) and postinflammatory hyperpigmentation (PIH) were treated using nonablative 1,550‐nm FLT (15 mJ/microbeam, 14–20% coverage), whereas patients with Beckers nevus (BN) were treated with ablative 10,600‐nm FLT (10 mJ/microbeam, 35–45% coverage) for three to five sessions. Biopsies were obtained 3 months after the last treatment. Results At follow‐up, dermal fibrosis was observed in four of eight patients treated using ablative FLT and no patients treated using nonablative FLT (p < .05). Conclusions Assuming that the dermal response is comparable in AD, PIH, and BN, at the given settings, ablative FLT may induce fibrosis, whereas treatment with nonablative FLT does not. Whether formation of fibrosis has to be regarded as dermal remodeling or a subtle subclinical form of scarring should be investigated in future research.

Generalized eczematous reaction after fractional carbon dioxide laser therapy for tattoo allergy

Allergic tattoo reactions form a therapeutically difficult entity. Treatment with conventional quality-switched lasers does not completely remove the allergenic particles and may lead to generalized hypersensitivity reactions. Recently, ablative fractional laser therapy was introduced as a treatment for allergic tattoo removal. We present two cases of allergic reactions to red tattoo ink treated with 10,600-nm fractional CO2 laser. At the end of treatment, almost complete removal of red ink accompanied by a significant reduction of symptoms was observed in the first patient, whereas the second patient developed an acute generalized eczematous reaction after five treatments. These findings confirm that ablative fractional laser therapy is capable of significant removal of tattoo ink in an allergic tattoo reaction. However, it implies a risk of generalized hypersensitivity reactions. To our knowledge, this is the first case of a generalized hypersensitivity reaction following treatment of tattoo allergy with the fractional CO2 laser.

Autologous cell suspension grafting in segmental vitiligo and piebaldism: a randomized controlled trial comparing full surface and fractional CO2 laser recipient-site preparations

Autologous noncultured cell suspension transplantation is an effective treatment for repigmentation in segmental vitiligo and piebaldism. Full surface laser ablation is frequently used to prepare the recipient site before cell suspension transplantation, even though the optimal laser settings and ablation depth are unknown.