Won Soon Chung

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.

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.

Hypertrophic scarring after burn scar treatment with a 10,600-nm carbon dioxide fractional laser.

Many therapeutic modalities have been attempted for the treatment of burn scarring, including the application of various silicone products, lesion excision, skin grafting, collagen induction therapy, and laser abrasion. Emerging evidence suggests that treatment with a 10,600-nm carbon dioxide fractional laser system (CO2 FS) can significantly reduce burn scarring without any notable side effects. In general, CO2 FS therapy is regarded to be a convenient and safe therapy because CO2 FS treatments require little time in skilled laser hands and results in minimal bleeding and oozing and short recovery times, although new data from Avram and colleagues suggest that CO2 FS therapy may not be as benign as originally believed. In their case series, the authors describe five patients who developed hypertrophic scarring of the neck after treatment with CO2 FS and ultimately contend that hypertrophic scarring may be an unrecognized complication of CO2 FS treatment.

Combination of 595‐nm pulsed dye laser, long‐pulsed 755‐nm alexandrite laser and microdermabrasion treatment for keratosis pilaris

mechanobullous epidermolysis bullosa acquisita to combined treatment with immunoadsorption and rituximab (anti-CD20 monoclonal antibodies). Arch Dermatol 2007; 143: 192–198. 6 Sadler E, Schafleitner B, Lanschuetzer C et al. Treatment-resistant classical epidermolysis bullosa acquisita responding to rituximab. Br J Dermatol 2007; 157: 417–419. 7 Crichlow SM, Mortimer NJ, Harman KE. A successful therapeutic trial of rituximab in the treatment of a patient with recalcitrant, high-titre epidermolysis bullosa acquisita. Br J Dermatol 2007; 156: 194–196. 8 Saha M, Cutler T, Bhogal B, Black MM, Groves RW. Refractory epidermolysis bullosa acquisita: successful treatment with rituximab. Clin Exp Dermatol 2009; 34: e979–e980. 9 Kubisch I, Diessenbacher P, Schmidt E, Gollnick H, Leverkus M. Premonitory epidermolysis bullosa acquisita mimicking eyelid dermatitis: successful treatment with rituximab and protein A immunoapheresis. Am J Clin Dermatol 2010; 11: 289–293. 10 Meissner C, Hoefeld-Fegeler M, Vetter R et al. Severe acral contractures and nail loss in a patient with mechano-bullous epidermolysis bullosa acquisita. Eur J Dermatol 2010; 20: 543–544.

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.

A patient with cupping-related post-inflammatory hyperpigmentation successfully treated with a 1,927 nm thulium fiber fractional laser.

Abstract Post-inflammatory hyperpigmentation is a rare complication following cupping therapy. We report a case of a 26-year-old woman who presented with hyper-pigmented skin lesions on her lower back which was persistent for 6 months following cupping therapy. The 1,927 nm thulium fiber laser (Fraxel re:store Dual, Solta Medical Inc., Hayward, CA) was tested leading to near complete resolution within four sessions.

Treatment of periorbital syringoma by the pinhole method using a carbon dioxide laser in 29 Asian patients

Abstract Background: Pinhole method has been used to treat various types of scars and dermal tumors by making multiple small holes in target tissues of the deep dermis using an ablative 10,600-nm carbon dioxide (CO2) laser. Objectives: We prospectively investigated the efficacy and safety of using a CO2 laser to treat periorbital syringomas via the pinhole method. Methods: A total of 29 patients with periorbital syringomas were treated with two sessions of CO2 laser treatment using the pinhole method at two-month intervals. Laser fluences were delivered under the following settings: pulse duration of 200 μs, frequency of 50 Hz, on time of 0.04, and an off time of 0.01. Results: Among the 29 patients, 13 patients (44.8%) presented with small discrete papular syringomas, 10 (34.5%) had plaque-type lesions, and six (20.7%) had mixed lesions. Evaluation of the clinical results at 2 months after the second treatment session revealed marked clinical improvement (51–75%) in 10 of the 29 patients (34.5%), moderate clinical improvement (26–50%) in eight (27.6%), near-total improvement (≥ 75%) in seven (24.1%), and minimal improvement (0–25%) in four patients (13.8%). Conclusions: Our observations indicated that application of the pinhole method using a CO2 laser exerts positive therapeutic effects in Asian patients with periorbital syringomas.

Combination of 595-nm pulsed dye laser, long-pulsed 755-nm alexandrite laser, and microdermabrasion treatment for keratosis pilaris: retrospective analysis of 26 Korean patients.

Abstract Keratosis pilaris (KP) has beenpresented as small keratotic follicular papules with or without surrounding erythema. Various treatments with laser or light therapy have been used for the management of KP with various clinical outcomes. In the present study, we investigated the efficacy and safety of a combination therapy for KP. A total of 29 anatomical sites with KP in 26 patients were treated using a 595-nm pulsed dye laser (PDL) with nonpurpuragenic fluences, a long-pulsed 755-nm alexandrite laser, and microdermabrasion. Clinical improvement was assessed by comparing preand posttreatment clinical photographs and patient satisfaction rates. Evaluation of the clinical results three months after the treatments showed that 12 of the 29 anatomical sites (41.4%) demonstrated Grade 3 clinical improvement, ten (34.5%) had Grade 2 clinical improvement, four (13.8%) showed Grade 1 improvement, and three (10.3%) showed Grade 4 improvement. We observed that KP lesions improved not only in erythema and skin texture, but also in brownish dyschromias. Potential adverse events were not observed, except prolonged posttherapy scaling. Our observations demonstrate that combination therapy using a 595-nm PDL, a long-pulsed 755-nm alexandrite laser, and microdermabrasion can have a positive therapeutic effect on KP.

Vibration Anesthesia for Pain Reduction During Intralesional Steroid Injection for Keloid Treatment

BACKGROUND Patients suffer significant pain during intralesional steroid injection treatment for keloids and hypertrophic scars. Vibration anesthesia has been shown to effectively and safely alleviate pain sensations, likely by reducing pain transmission from peripheral receptors to the brain. OBJECTIVE The objective was to evaluate the efficacy, safety, and patient satisfaction associated with vibration anesthesia for reducing pain during intralesional corticosteroid injection. METHODS The authors recruited 40 patients with 58 keloids who were scheduled to undergo intralesional triamcinolone acetonide (TA) injections. Half of each keloid was injected with concomitant vibration anesthesia, whereas the other half was injected without vibration anesthesia. Pain experienced by patients during both procedures was assessed according to visual analog scale (VAS) score. The authors also assessed procedure safety. RESULTS The mean VAS score during intralesional TA injection therapy without vibration was 5.88 ± 2.34. By contrast, the same patients yielded a mean VAS score during intralesional TA injection therapy with vibration of 3.28 ± 1.85; the difference between the mean scores was significant (p < .05). Thirty-nine (97.5%) patients tolerated this therapy well. CONCLUSION Vibration anesthesia is a promising option for reducing pain during keloid treatment with intralesional steroid injection.