Jin Moon Kang

The Efficacy and Safety of 10,600-nm Carbon Dioxide Fractional Laser for Acne Scars in Asian Patients

BACKGROUND The nonablative 1,550‐nm erbium‐doped fractional photothermolysis system (FPS) has been effectively used for scar treatments, but it seems that several sessions of treatment must be delivered to achieve satisfactory improvement. OBJECTIVES To evaluate the efficacy and safety of the combined use of two treatment modes of an ablative 10,600‐nm carbon dioxide fractional laser system (CO2 FS) on acne scars. METHODS Twenty Korean patients with atrophic acne scars treated with a single session of Ultrapulse Encore laser (Lumenis Inc., Santa Clara, CA) were enrolled. The laser fluences were delivered to the scars using the Deep FX mode. Additional treatment using the Active FX mode was performed throughout the entire face. RESULTS Follow‐up results revealed that one patient had clinical improvement of 76% to 100%, nine had improvements of 51% to 75%, seven had moderate improvements of 26% to 50%, and three had minimal to no improvements. The mean duration of post‐therapy crusting or scaling was 6.3±3.0 days, and post‐therapy erythema lasted 2.8±4.6 days. CONCLUSION We suggest that CO2 FS used with a combination of two different treatment modes may provide a new treatment algorithm for acne scars in Asians.

Treatment of Striae Distensae Using an Ablative 10,600-nm Carbon Dioxide Fractional Laser: A Retrospective Review of 27 Participants

BACKGROUND Late‐stage striae distensae is a type of scar characterized by a loss of collagen and elastic fibers in the dermis. Ablative 10,600‐nm carbon dioxide fractional laser systems (CO2 FS) have been used successfully for the treatment of various types of scars. OBJECTIVE To investigate the therapeutic efficacy of using CO2 FS for the treatment of striae distensae. METHODS Twenty‐seven women with striae distensae were treated in a single session with a CO2 FS. Deep FX mode with a pulse energy of 10 mJ and a density of 2 (percent coverage of 10%) was used. Clinical improvement was assessed by comparing pre‐ and post‐treatment clinical photographs and participant satisfaction rates. RESULTS The evaluation of clinical results 3 months after treatment showed that two of the 27 participants (7.4%) had grade clinical 4 improvement, 14 (51.9%) had grade 3 improvement, nine (33.3%) had grade 2 improvement, and two (7.4%) had grade 1 improvement. None of the participants showed worsening of their striae distensae. Mean clinical improvement score was 2.6. Surveys evaluating overall participant satisfaction administered after the treatment was completed showed that six of the 27 participants (22.2%) were very satisfied, 14 (51.9%) were satisfied, five (18.1%) were slightly satisfied, and two (7.4%) were unsatisfied. CONCLUSION Our observations demonstrated that the use of CO2 FS can have a positive therapeutic effect on late‐stage striae distensae. The authors have indicated no significant interest with commercial supporters.

Use of Fractionated Microneedle Radiofrequency for the Treatment of Inflammatory Acne Vulgaris in 18 Korean Patients

Background Nonablative radiofrequency (RF) devices have been shown to be clinically effective for the treatment of moderate to severe acne lesions. Objective To evaluate the efficacy and safety of a fractionated microneedle RF device in the treatment of inflammatory acne vulgaris. Methods Eighteen patients (15 male, 3 female; mean age 27, range: 19–33; Fitzpatrick skin type IV) with moderate to severe acne vulgaris who were treated with two sessions of fractionated microneedle RF at 1‐month intervals were enrolled in this study. Results Evaluation of improvement, which took into account number of inflammatory acne lesions, showed that two of the 18 patients had grade 4 clinical improvement, eight had grade 3 improvement, and six had grade 2 improvement. Improvement scores in terms of lesion severity were also evaluated. One of the 18 patients had grade 4 clinical improvement, eight grade 3, and seven grade 2. No patient had worsening of inflammatory acne lesions. Conclusion Fractionated microneedle RF can have a positive therapeutic effect on inflammatory acne vulgaris and related scars. In addition, this technique does not worsen active acne lesions.

Burn scars treated by pinhole method using a carbon dioxide laser

Many patients with burn injuries have various complications and emotional problems due to scars. Although various modalities to improve burn scars have been attempted, such as excision of scars, skin grafts, laser abrasion and silicone product usage, the cosmetic outcomes have not been satisfactory for a large portion of patients. Herein, we describe two cases which showed satisfactory cosmetic results after treatment of burns scars with the pinhole method using a carbon dioxide (CO2) laser that allowed us to make deep, closely set holes reaching down to the upper dermis. A 20‐year‐old female patient with a scar on her neck and a 25‐year‐old female patient with a scar on her right forearm after burn injuries are presented. As early as only a few weeks after the treatment, the scars showed relaxation of contracture, reduction of wrinkles and improvement of texture and color compared to before the treatment. Treatment of burn scars with the pinhole method can be easily performed and results in dramatic improvement in scar quality with only a few side‐effects.

Treatment of striae alba using the 10 600-nm carbon dioxide fractional laser

Modalities for the treatment of striae distensae include topical tretinoin, intense pulsed light, the 585-nm pulsed dye laser, the 578-nm copper bromide laser, and non-ablative radio-frequency therapy (1 – 7). Also, non-ablative 1550-nm erbium-doped fractional photothermolysis (FP) has proved its effectiveness and safety in patients with striae distensae (8,9); however, pronounced clinical improvement appears to require multiple treatment sessions. In Asian patients, postinfl ammatory dyschromia developing after ablative laser therapy has always been a concern; especially with lesions other than the face. Nouri et al. (10) concluded that patients with skin types IV – VI should avoid carbon dioxide (CO 2 ) laser treatments of striae, although the CO 2 laser could theoretically stimulate the fi broblast activity and improve the lesions by controlled abrasion of the skin. A 27-year-old Korean woman with Fitzpatrick type IV skin presented a striae alba on the anterior thigh, which occurred at the age of 13 years. On her initial presentation to our clinic, the patient showed several hypopigmented and atrophied lesions with irregular surfaces and textural changes (Figure 1A). She had neither a remarkable past medical history, including keloid and hypertrophic scars, nor a specifi c treatment history for the lesions of striae alba. After obtaining informed consent, she was treated with two sessions of CO 2 fractional laser (FS) using the Ultrapulse ® Encore TM laser (Lumenis Inc., Santa Clara, CA, USA) with 4 weeks of elapsed time between treatments. For local anesthesia, the lesion was cleansed with 70% alcohol and topical EMLA cream (eutectic mixture of 2.5% lidocaine HCl and 2.5% prilocaine; AstraZeneca AB, S ö dert ä lje, Sweden) was applied under an occlusion an hour prior to laser treatment. At each treatment session, the laser fl uences were delivered on two-thirds of the upper lesion with Deep FX TM mode at settings of 15 mJ, density 2, and 300 Hz. The patient was prescribed prophylactic oral antibiotics for 3 days. She was instructed to use Cicaplast ® (La Roche-Posay, Paris, France) for a month after each treatment session to promote wound healing and prevent dryness, and was also recommended to avoid overexposure to sunlight. A photograph was taken 2 months after the last treatment (Figure 1B) and the lesions of striae alba were noticeably improved after the two treatments compared with the untreated area. The patient showed satisfaction with the results and complained of no adverse effects. The CO 2 laser has been widely used for treating various epidermal and dermal lesions. Nowak et al. (11) described that the CO 2 laser enhances fi broblast replication, stimulates basic fi broblast growth factor secretion, and reduces transforming growth factor β 1 secretion. However, because of the possibility of pigmentary alteration, the use of ablative laser is limited to patients with dark skin (10). Fractional laser technology decidedly shortens the recovery time and reduces the risk of adverse events by leaving an intact epidermal architecture surrounding each coagulated microthermal treatment zone. By adopting CO 2 on the advanced technology of the fractional laser system, CO 2 FS can be expected to obtain the effect of ablative laser Journal of Cosmetic and Laser Therapy, 2010; 12: 118–119

Treatment of refractory arcuate hyperpigmentation using a fractional photothermolysis system

This is a case report of a 27-year-old Korean woman with Fitzpatrick skin type IV presenting with refractory arcuate hyperpigmentation, which developed after non-ablative 1450-nm diode laser therapy. The refractory arcuate hyperpigmentation was unresponsive to the use of Q-switched lasers, vitamin C iontophoresis, and a bleaching agent, but was responsive to fractional photothermolysis system treatment.

Treatment of hypertrophic burn scars by combination laser‐cision and pinhole method using a carbon dioxide laser

Hypertrophic burn scars induce cosmetic and functional complications. Although there are various treatment modalities, an ideal method has not yet been found. Recently, numerous laser treatment modalities have been introduced with encouraging results.

Paradoxical bulging of muscle after injection of botulinum neurotoxin type A into hypertrophied masseter muscle

pigmentation around the affected area. We also need to consider a possible differential diagnosis of pediatric blaschkitis (BL). BL is typically distributed over multiple areas in broad bands, and shows spongiosis without lichenoid tissue reaction histopathologically. While BL occurs commonly in adults, Keegan et al. described cases of pediatric BL as an entity of its own, and concluded that pediatric BL and LS differed substantially despite some overlaps. More recently, however, Müller et al. discussed how BL and LS had similar clinical and histopathological characteristics, and they proposed the concept of a wide spectrum of blaschkolinear dermatoses, which include both BL and LS. Our case may be better described as LS, rather than as pediatric BL, by exhibiting typical manifestations of LS, namely narrow bands with lichenoid tissue reaction. The presence of multiple lesions, which is nevertheless typical of BL, indicates that LS and BL are indeed closely related. Hiroyuki SATO, Akira SHIRAI, Akihiko ASAHINA Department of Dermatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan

Stevens‐Johnson syndrome‐induced facial scar treated by the fractional photothermolysis system

Sirs, We would like to report an unusual case of Stevens-Johnson syndrome (SJS)-induced facial scar treated with the fractional photothermolysis system (FPS). A 24-year-old Korean female patient with Fitzpatrick type IV skin presented with facial scars that developed at the age of 5 years because of SJS. She had been treated with an unspecified kind of laser 8 years previously and underwent superficial to medium-depth chemical peeling several times 5 years prior to presentation at a private dermatology clinic. However, she did not achieve satisfactory improvement with these treatments. On initial presentation to our clinic, her face showed reticulated hyperand hypopigmentations with some degree of atrophy, and perinasal and periorbital atrophic scars with irregular surfaces and textural changes (Figure 1). Prior to the treatment, her entire face was completely cleansed with a skin cleanser. The patient was prescribed oral acyclovir for 3 days as a prophylactic measure. Topical EMLA cream (AstraZeneca AB, Södertälje, Sweden) for local anesthesia was applied 1 hour prior to the procedure. A single treatment using a 1550-nm wavelength Fraxel SR laser (Reliant Technologies, Palo Alto, CA, USA) with a pulse energy of 8 mJ, a density of 250 microthermal treatment zones (MTZ)/cm, and 20 mJ with 125 MTZ/cm was performed on her entire face. At each setting, four passes were delivered with an appropriate overlap, reaching a final density of 1000 MTZ/cm and 500 MTZ/cm. Five sessions of Fraxel SR laser treatment were performed at 4-week intervals. Because redness developed in her face, two sessions of the 595-nm V Beam pulsed dye laser (Candela Corporation, Wayland, MA, USA) were followed at 1-month intervals. After the treatments, the lesion showed improvement in texture and color (Figure 2). The patient was satisfied with the results and complained of no side effects. Most of the cutaneous lesions caused by SJS heal without scarring except in extremely severe cases with secondary infections, where contractures, alopecia, and anonychia may develop. Our patient presented various forms of scarring because of SJS, including hyperand hypopigmentations with some degree of atrophy, atrophic scars around the eyes and nose, irregular surfaces and textural changes. Except for FPS, previous treatments, as described above, did not result in satisfactory improvement. Previously reported treatment modalities for hypopigmented scars, such as medium-depth chemical peels, carbon dioxide and erbium laser resurfacing, cosmetic tattooing, dermabrasion, and skin grafting have shown limited efficacy and variable side effects (1–4). For our patient, a safe and effective treatment was necessary to correct both the color and texture of her scars. By using FPS, we can transfer energy to the tissue much more deeply and safely because entire epidermal and dermal ablation is not necessary. Moreover, by rearranging and stimulating collagen production, FPS may improve the texture of the scar and correct atrophy (5). Since FPS needs little recovery time, we can treat the scar tissue and normal skin, resulting in textural improvement of the face and minimizing the prominence of the scars.

Combination of Q-switched and quasi long-pulsed 1064-nm Nd:YAG laser, non-ablative 1450-nm diode laser, and ablative 10 600-nm carbon dioxide fractional laser for enlarged pores.

Abstract Currently, there is no gold standard for the treatment of enlarged facial pores. In this report, we describe a patient with enlarged nasal pores which were treated with a combination of a non-ablative 1450-nm diode laser, a Q-switched and quasi long-pulsed 1064-nm Nd:YAG laser, and an ablative 10 600-nm carbon dioxide fractional laser system. Four months after the final treatment, the condition of the patients pores had markedly improved, and the patient was satisfied with the results.