Sung Bin Cho

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.

Non-ablative 1550-nm erbium-glass and ablative 10 600-nm carbon dioxide fractional lasers for acne scars: a randomized split-face study with blinded response evaluation

Background  Non‐ablative 1550‐nm erbium‐doped fractional photothermolysis systems (FPS) and 10 600‐nm carbon dioxide fractional laser systems (CO2 FS) have been effectively used to treat scars.

New Insights in the Clinical Understanding of Behçet's Disease

Behçets disease is a chronic relapsing multisystemic inflammatory disorder characterized by four major symptoms (oral aphthous ulcers, genital ulcers, skin lesions, and ocular lesions) and occasionally by five minor symptoms (arthritis, gastrointestinal ulcers, epididymitis, vascular lesions, and central nervous system symptoms). Although the etiology of Behçets disease is still unknown, there have been recent advances in immunopathogenic studies, genome-wide association studies, animal models, diagnostic markers, and new biological agents. These advances have improved the clinical understanding of Behçets disease and have enabled us to develop new treatment strategies for this intractable disease, which remains one of the leading causes of blindness.

Efficacy of the Fractional Photothermolysis System with Dynamic Operating Mode on Acne Scars and Enlarged Facial Pores

BACKGROUND Current treatments for acne scars and enlarged facial pores have shown limited efficacy. OBJECTIVE To evaluate the efficacy and safety of the fractional photothermolysis system (FPS) with dynamic operating mode on acne scars and enlarged pores. MATERIALS AND METHODS Twelve patients with mild to moderate atrophic acne scars and enlarged pores were included in this study. Three sessions of FPS treatment were performed for acne scars and facial pores monthly. Two blinded dermatologists who compared before and after photos based on a quartile grading scale conducted objective clinical assessments of acne scar– and facial pore–treated areas. We took a biopsy immediately after one treatment with the laser from one of the authors to assess the histologic effects of the laser on facial pores. RESULTS Follow-up results at 4 months after the last treatment revealed that, of the 12 patients, for acne scars, five demonstrated clinical improvements of 51% to 75% and three demonstrated improvements of 76% to 100%, and for facial pores, five demonstrated moderate clinical improvements of 26% to 50% and three demonstrated improvements of 76% to 100%. Side effects, including pain, post-treatment erythema, and edema, were resolved within 1 week. CONCLUSION We suggest that the FPS may provide a new treatment algorithm in some cases with acne scars and enlarged pores. Considering the lack of placebo-controlled, split-face design of our study, optimized, prospective studies should be conducted to fully assess the efficacy of FPS with dynamic operating mode.

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.

Treatment of Syringoma Using an Ablative 10,600-nm Carbon Dioxide Fractional Laser: A Prospective Analysis of 35 Patients

BACKGROUND Treatment of syringoma aims to destroy the dermal tumor using methods that can include surgical excision, electrodessication, cryosurgery, chemical peeling, and laser ablation, but complete removal of syringomas is often unsuccessful, and recurrence occurs frequently. OBJECTIVE To investigate the therapeutic efficacy of an ablative 10,600‐nm carbon dioxide fractional laser system (CO2 FS) for the treatment of periorbital syringomas. METHODS Thirty‐five patients with periorbital syringomas were treated with two sessions of CO2 FS at 1‐month intervals. Laser fluences were delivered in two or three passes over the lower eyelids, using a pulse energy of 100 mJ and a density of 100 spots/cm2. Clinical improvement was assessed by comparing pre‐ and post‐treatment clinical photographs and patient satisfaction rates. We examined the histological features of human periorbital syringomas treated with CO2 FS. RESULTS Evaluation of clinical results 2 months after treatment showed that 15 of the 35 patients (42.9%) demonstrated marked (51‐75%) clinical improvement, 12 (34.3%) had moderate (26‐50%) clinical improvement, five (14.3%) showed minimal (0‐25%) improvement, and three (8.6%) showed near total (≥75%) improvement. Clinical improvement scores were less 4 months after the second CO2 FS treatment (not statistically significant). The mean maximal depth of the necrotic column was 1,236.3 &mgr;m. A specimen obtained from the infraorbital area immediately after treatment showed formation of necrotic columns on the interfollicular skin. CONCLUSION The use of CO2 FS can have a positive therapeutic effect on periorbital syringomas. The authors have indicated no significant interest with commercial supporters.

Punctate Leucoderma After 1,064-nm Q-Switched Neodymium-Doped Yttrium Aluminum Garnet Laser with Low-Fluence Therapy: Is it Melanocytopenic or Melanopenic?

Melasma is a common pigmentary disorder in Asian populations. Recently, treatment using 1,064-nm Qswitched neodymium-doped yttrium aluminum garnet laser (QSNY) with low fluence has been reported to be effective for Asian patients with melasma, but this treatment modality can rarely induce punctate hypopigmentation, and histopathology of the lesion has not been evaluated so far. In this report, we would like to demonstrate histopathologic features of a punctate hypopigmentation that occurred after several sessions of 1,064-nm QSNY with low-fluence therapy.

Lower-Fluence, Higher-Density versus Higher-Fluence, Lower-Density Treatment with a 10,600-nm Carbon Dioxide Fractional Laser System: A Split-Face, Evaluator-Blinded Study

BACKGROUND Adequate laser settings in the treatment of scars using a carbon dioxide fractional laser system (CO2 FS) have not been established. OBJECTIVE To compare the efficacy and safety of low‐fluence, high‐density with high‐fluence, low‐density treatment with CO2 FS on acne scars and enlarged pores. METHODS Ten patients with mild to severe atrophic acne scars and enlarged pores were enrolled. Half of each subjects face was treated with a single session of CO2 FS with a fluence of 70 mJ and a density of 150 spots/cm2; the other half was treated with a fluence of 30 mJ and a density of 250 spots/cm2. RESULTS Follow‐up results 3 months after a single low‐fluence, high‐density treatment with CO2 FS showed that four of 10 participants had clinical improvement of 51% to 75% from baseline. After the high‐fluence, low‐density CO2 FS treatment, five of 10 patients demonstrated marked clinical improvements of more than 76%. CONCLUSION Higher‐energy, lower‐density laser settings seem to be more effective than lower‐energy, higher‐density settings for acne scars and enlarged pores, although our results do not constitute a conclusive comparison of the two different modes of CO2 FS. &NA; The authors have indicated no significant interest with commercial supporters.

Treatment of acquired bilateral nevus of Ota-like macules (Hori's nevus) using 1064-nm Q-switched Nd:YAG laser with low fluence.

Background  Acquired bilateral nevus of Ota‐like macules (ABNOM), or Horis nevus, is a common dermal melanocytic hyperpigmentation in Asians.