Rungsima Wanitphakdeedecha

Efficacy and safety of a carbon-dioxide ablative fractional resurfacing device for treatment of atrophic acne scars in Asians

BACKGROUND Treatment of atrophic scars with a fractional laser resurfacing technique has demonstrated favorable outcomes, although data on the efficacy and adverse effects of this procedure in persons with dark-skinned phototypes are limited. OBJECTIVE This study was conducted to evaluate the efficacy and safety of carbon-dioxide ablative fractional resurfacing on atrophic acne scars in Asian individuals. METHODS Thirteen subjects (8 female and 5 male, aged 25-52 years) with skin phototype IV and atrophic acne scars were treated with 3 sessions of carbon-dioxide ablative fractional resurfacing laser on an average of 7-week interval. Objective (ultraviolet A-light video camera) and subjective (clinical evaluation by two blinded dermatologists) assessments were obtained at baseline and at 1, 3, and 6 months after the final treatment. RESULTS At the 6-month follow-up, 85% of the subjects were rated as having at least 25% to 50% improvement of scars. Improvement significantly progressed from the 1-month follow-up to the 6-month follow-up (P = .002). At 1 month after 3 treatments, surface smoothness (P = .03) and scar volume (P < .001) significantly improved, compared with baseline measurements. Of the subjects, 62% rated themselves as having at least 50% improvement in their scars. Mild postinflammatory hyperpigmentation was the most common adverse effect observed in 92% of the subjects or 51% of treatment sessions, and was completely resolved in an average of 5 weeks. LIMITATION The small sample size was a study limitation. CONCLUSIONS Carbon-dioxide ablative fractional resurfacing appears to be effective and well tolerated for the treatment of atrophic acne scars in Asians.

Treatment of cellulite with a bipolar radiofrequency, infrared heat, and pulsatile suction device: a pilot study

Background  Very few therapeutic options have proven effective in the treatment of cellulite.

Improvement of Postfractional Laser Erythema with Light-Emitting Diode Photomodulation

BACKGROUND The most common side effects of fractional laser skin treatment are erythema and edema. Low‐level light therapy and light‐emitting diode (LED) devices have been used to stimulate fibroblast activity and hasten wound healing. OBJECTIVE To determine whether LED treatment immediately after fractional laser skin resurfacing affects the severity and duration of postoperative eythema. MATERIALS AND METHODS Twenty patients received treatment with a 590‐nm wavelength LED array to randomly selected facial halves immediately after undergoing full‐face fractional laser skin resurfacing with a 1,550‐nm erbium‐doped fiber laser. Differences in erythema between LED‐treated and untreated facial halves were recorded at 24, 48, and 96 hours post‐treatment. RESULTS The LED‐treated facial halves were less erythematous in all 20 patients 24 hours postoperatively. The six patients who received the highest mean energy densities during fractional laser treatment continued to exhibit decreased erythema in the LED‐treated areas at 48 hours. At 96 hours post‐treatment, no discernible differences between facial halves were observed in any patient. CONCLUSIONS Photomodulation with a 590‐nm‐wavelength LED array can decrease the intensity and duration of postfractional laser treatment erythema. The authors have indicated no significant interest with commercial supporters.

Comparison of fractional erbium-doped yttrium aluminum garnet and carbon dioxide lasers in resurfacing of atrophic acne scars in Asians.

BACKGROUND The efficacy of fractional erbium‐doped yttrium aluminum garnet (Er:YAG) and carbon dioxide (CO2) lasers are well substantiated. OBJECTIVE To compare the efficacy and safety of these two laser systems for treatment of atrophic scars in dark‐skinned patients. MATERIALS AND METHODS Twenty‐four subjects with acne scars were randomly treated with a fractional Er:YAG laser on one side and a fractional CO2 laser on the other side. All subjects received two treatments with a 2‐month interval. Objective and subjective assessments were obtained at baseline and 1, 3, and 6 months after the final treatment. RESULTS At the 6 month follow up, 55% and 65% of Er: YAG and CO2 laser sites, respectively, were graded as having more than 50% improvement of scars. Improvement progressed significantly from 1‐ to 6‐month follow‐up (p < .001). There was no significant difference in clinical improvement between the two systems at 1‐ (p = .90), 3‐ (p = .54), and 6‐month (p = .87) follow‐up. Reduction in scar volume corresponded to clinical evaluation. CONCLUSIONS Fractional Er:YAG and CO2 lasers provided comparable outcomes of scar treatment, but fractional CO2 laser was associated with greater treatment discomfort.

Treatment of Melasma Using Variable Square Pulse Er: YAG Laser Resurfacing

BACKGROUND Treatment of melasma remains a challenge. Laser treatments show limited efficacy, with a high rate of recurrence and side effects. Recently, variable‐pulsed erbium:yttrium aluminum garnet (Er:YAG) lasers have shown favorable results in skin resurfacing, with minimal downtime and adverse effects. OBJECTIVE To determine the efficacy and side effects of variable square pulsed (VSP) Er:YAG laser resurfacing for treatment of epidermal type melasma. METHODS Twenty Thai women with epidermal‐type melasma were treated with two passes of VSP Er:YAG laser resurfacing using a 7‐mm spot size, pulse duration of 300 μs, and a fluence of 0.4 J/cm2. Two treatments were given 1 month apart. Visual analog scale (VAS), Melasma Area and Severity Index (MASI) score and melanin index (MI) were measured at baseline and 1, 2, and 4 months after treatment. RESULTS There was a significant improvement in VAS from baseline at 1‐, 2‐, and 4‐month follow‐up visits (p<.001). Significant improvement in MASI score at the 2‐month visit from baseline (p=.004) was also observed. The average MI measured using melanin reflectance spectrometry measurements corresponded to MASI score rating. CONCLUSIONS VSP Er:YAG laser resurfacing effectively but temporarily improved epidermal‐type melasma. Recurrence was observed after the treatment was discontinued. The authors have indicated no significant interest with commercial supporters.

Treatment of Punched‐Out Atrophic and Rolling Acne Scars in Skin Phototypes III, IV, and V with Variable Square Pulse Erbium:Yttrium‐Aluminum‐Garnet Laser Resurfacing

BACKGROUND Treatment of acne scars remains a challenge, especially in dark‐skinned individuals. Treatment parameters may be optimized by selecting appropriate pulse width and laser energy that enhance tissue thermal response with limited morbidity. OBJECTIVE To determine the efficacy and side effects of variable square pulse (VSP) erbium:yttrium‐aluminum‐garnet (Er:YAG) laser resurfacing for treatment of punched‐out atrophic and rolling acne scars. METHODS Twenty‐four subjects with acne scars were treated monthly for 2 months with four passes of VSP Er:YAG laser resurfacing using a 7‐mm spot size and a fluence of 0.4 J/cm2. Subjects were divided into two groups and treated with two different pulse widths: 300 μs (short pulse, SP) and 1,500 μs (extra‐long pulse, XLP). Objective and subjective assessments were obtained at baseline and 1, 2, and 4 months after treatment. RESULTS In the SP group, skin smoothness improved significantly (p<.01); in the XLP group, skin smoothness (p<.05) and scar volume (p<.05) improved significantly from baseline. Adverse effects consisted of transient postinflammatory hyperpigmentation (18%) and acneiform eruption (9%). CONCLUSIONS Low‐fluence VSP Er:YAG laser resurfacing is a promising treatment option for acne scars, with minimal risk of side effects. Laser pulse width and energy determine the efficacy and the risk of side effects.

Physical means of treating unwanted hair

ABSTRACT:  Unwanted facial and body hair is a common problem, generating a high level of interest for treatment innovations. A wide range of modalities for the management of unwanted hair have been advocated over the years with varying degrees of clinical success. Most recently, lasers and light sources have been used to address this problem with improved clinical success rates in properly selected patients. The full range of temporary and permanent hair removal techniques will be outlined in this review of physical means of treating unwanted hair.

The efficacy in treatment of facial atrophic acne scars in Asians with a fractional radiofrequency microneedle system

Treatment of acne scars remains a challenge to dermatologists. Multiple modalities have been employed with variable results and adverse effects.

Carbon dioxide laser ablation and adjunctive destruction for Darier-White disease (keratosis follicularis).

An otherwise healthy 31-year-old Caucasian female presented with a diagnosis of Darier’s disease since 11 years of age. She sought treatment to ameliorate the malodorous crusting and recurrent skin infection. On physical examination, keratotic papules coalesced into large macerated, hyperkeratotic plaques that were predominately located in the flexural areas (inframammary area, axilla, and groin). The lesions covered more than 30% to 40% of her total body surface area (Figure 1). She tried medical (isotretinoin, hormone), surgical (Er:YAG laser, CO2 laser, and deep wire-brush dermabrasion), and complementary medical (acupuncture, herbal) therapies with temporary and disappointing results. The details of her treatment and clinical outcome are described in Table 1.

Efficacy and safety of 1064-nm Nd:YAG laser in treatment of onychomycosis

Abstract Background: Onychomycosis is a common nail disease, especially in older patients. Various treatment options are currently available for onychomycosis; however, their limitations include high failure rates, time-consuming nature, high cost and high risk of drug interactions. Previous studies on the treatment of dermatophyte onychomycosis with a long-pulsed 1064-nm Nd:YAG laser demonstrated excellent outcomes without severe side effects. Objective: To evaluate the efficacy and side effects of onychomycosis treatment with a long-pulsed 1064-nm Nd:YAG laser. Methods: Sixty-four onychomycotic nails (35 patients) were evaluated. The first treatment cycle involved treatment with a long-pulsed 1064-nm Nd:YAG laser in four sessions at 1-week intervals. A potassium hydroxide examination and fungal culture were performed every week during this treatment course and then at a 1-month follow-up visit. If either test was positive for a pathogenic organism, a second treatment cycle was performed. If the two tests produced negative results, each affected nail was followed up at 3- and 6-month visits after completion of the second treatment protocol. In cases of resistance (positive for a pathogenic organism after completion of the second treatment cycle), the onychomycotic nails were excluded from the study and treated by standard methods. Results: Of all 64 nails evaluated, 59 completed the first cycle of treatment and 24 (40.7%) demonstrated mycological clearance at the 1-month follow up. Thirty-five of the 59 nails (59.3%) were positive for a pathogenic organism and underwent a second treatment cycle. Upon completion of the second treatment cycle, 28 nails remained enrolled in the study, and the mycological test results were negative in nine of these (31.2%). For all nails that completed the first or second treatment cycle, the overall cure rates at the 1-, 3- and 6-month follow-up visits were 63.5, 57.7 and 51.9%, respectively. Side effects were mild and limited to erythema and swelling after the laser procedure. Conclusions: Long-pulsed 1064-nm Nd:YAG laser therapy is safe and effective for the treatment of onychomycosis. However, a larger sample and longer follow-up period are needed to confirm our findings.