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Fractional photothermolysis for the treatment of striae distensae
P3106
P3108
Multiwaves: A new device for skin rejuvenation Valeria Campos, MD, MD, Clinica Valeria Campos, Jundiai, SC, Brazil; Christiane Ferreira, MD, Clinica Valeria Campos, Jundiai, Brazil Background: The use of visible or infrared spectral light alone for the purpose of skin rejuvenation has been previously reported. A new method of light emitting diode (LED) photo rejuvenation incorporating a combination of these wavelengths is proposed. Objective: To assess the efficacy and local tolerability of combination light therapy in photo rejuvenation of facial skin. Methods: Forty subjects with facial rhytids, mean age 48-years-old (range, 35 to 62 years), received 12 light-therapy treatments using the Multiwaves LED system (Industra, Sa˜o Carlos e SP Brazil). The treatments were applied twice a week using alternating wavelengths of 635 nm (red) and 940 nm (infrared) and fluences of 19,78 J/cm2 or 11 mw/cm2 and 9 J/cm2 or 5 mw/cm2 respectively, 20 minutes of light exposure for both.
Cracks on the tip-unusual cause of complication in Fraxel laser treatment Sang Ju Lee, MD, PhD, Yonsei Star Skin & Laser Clinic, Seoul, South Korea; Jin Moon Kang, MD, Yonsei Star Skin & Laser Clinic, Seoul, South Korea; Young Koo Kim, MD, Yonsei Star Skin & Laser Clinic, Seoul, South Korea; Dong Hyun Kim, MD, Yonsei University College of Medicine, Seoul, South Korea
Results: Blinded observers of standardized photographs taken before and after the last treatment scored percent improvement as follows: 25% (poor), 26-50% (good), 51-75% (very good), 75% (excellent) and all the patients answered a questionnaire at the end of the evaluation. Results: All patients showed some level of improvement, 75% of all patients showed an improvement of good or very good, 25% poor. The questionnaire showed that 100% of the patients had felt improvement and 75% would recommend the same treatment to a friend. There were no complications associated with treatment. Conclusion: Although results are not as impressive as those of ablative treatments, Multiwaves LED system red and infrared therapy represents a safe and cost-effective method that provides significant results and a high degree of patient satisfaction. Further studies with larger number of subjects and biopsy specimens for histological assessment is required. Commercial support: None identified.
In contrast to selective photothermolysis, which produces bulk thermal injury in target area, fractional photothermolysis creates hundreds to thousands of coagulated columns of tissue, namely microthermal treatment zones (MTZs). MTZs are 70 to 100 m in diameter and extend through the epidermis and deeply into the dermis. Because the most part surrounding the MTZs are intact, it leaves no raw surface and helps to heal more easily. Over several weeks the MTZs are replaced by new collagen tissue. Since MTZs are invisible to the naked eye, fractional photothermolysis requires little downtime. As treatment is repeated, more skin surface is replaced. This seems to be very effective in the treatment of photoaging skin and scars. We have experienced an unusual result of Fraxel laser (Reliant Technologies, Palo Alto, CA) treatment for acne scars. A 27-year-old Korean female with acne scars was treated with Fraxel laser. Single treatment at pulse energy of 8 mJ with a density of 1,000 MTZs and 20 mJ with 750 MTZs was performed on the full face. Prophylactically, patient took acyclovir for 3 days. Although the density of MTZs and treatment techniques of this case were as usual, one day after the treatment multiple tiny pustules and oozing erythematous patch had developed on the entire treated area. While we investigate the cause of this complication, multiple cracks on the Fraxel laser tip had been found accidentally. We assumed that the beams passing through small cracks could not focus on the skin but scatter randomly. This might overheat the treated area and make bulk thermal injury to the skin. Consequently, the results of treatment were shown like those of ablative laser rather than those of fractional ablative laser. The complicated lesion resolved after the treatment with prednisolone and minocycline for 4 days. Although the precise cause of crack formation remains yet to be proven, we believe blackheads or black dusts might have a role in making cracks during the Fraxel laser treatment. In order to prevent this crack formation, it is desirable to remove foreign materials on the skin completely before treatment. If you suspect cracks on the tip, physicians had better change the tip. Commercial support: None identified.
P3107 Treatment of lobular capillary hemangioma with Nd:YAG laser, CDL mode Marie-Sophie Bedard, MD, Laval University, Quebec City, PQ, Canada; Jean Boulanger, MD, Clinique de Vinci, Quebec City, PQ, Canada Background: Lobular capillary hemangioma, also known as pyogenic granuloma, is a common benign vascular neoplasm of the skin and mucous membranes. The standard treatment is a shave excision followed by electrosurgery of the base. Recurrence is frequent. Vascular lasers, such as the pulsed dye laser, are already used for the treatment of this condition. To our knowledge, there is no case report regarding the use of the Nd:YAG laser, 1,064 nm, CDL mode, for the treatment of this type of lesion. Objectives: Demonstrate the efficacy of this novel treatment. Evaluate adverse events during the treatment, recurrence rate, cosmetic results, and global satisfaction of the patient. Methods: This is a case series using data from private dermatology clinic records from February 2004 to April 2006. All patients treated for lobular capillary hemangioma were included. Treatment was done using an Nd:YAG laser, 1,064 nm, cooled deep lesion (CDL) mode. The size of the lesion, number of treatments, laser settings, adverse events, recurrence, cosmetic results, and satisfaction of the patient were recorded. Results: Twenty-five (25) patients (15 females, 10 males) were treated for lobular capillary hemangioma. The mean number of treatments necessary for complete resolution was 2.32 (median 2). Forty-four (44) percent of patients cleared with only one treatment. Adverse events reported were pain (8/25) during treatment (reduced with anesthesia), transient swelling (5/25) of the treated area, bleeding (4/25), hypopigmentation (5/25), and/or sclerosis (13/25). No recurrence was noted at the 2-months follow-up visit. Patient satisfaction was very high. Conclusion: The treatment of lobular capillary hemangioma with the Nd:YAG laser, 1,064 nm, CDL mode is a novel approach. There was no recurrence and overall satisfaction was very high. Commercial support: None identified.
AB204
J AM ACAD DERMATOL
P3109 Fractional photothermolysis for the treatment of striae distensae Otavio Roberto Macedo, MD, Ota´vio Macedo, Sa˜o Paulo, Brazil; Maria Bussade, MD, Consulto´rio Dr. Otavio Macedo, Sa˜o Paulo, Brazil; Adriana Salgado, MD, Consultorio Dr. Ota´vio Macedo, Sa˜o Paulo, Brazil; Marjorie Mello Ribeiro, MD, ´ rio Dr. Ota´vio Macedo, Sa˜o Paulo, Brazil Consulto Background and Objectives: Striae distensae are a challenging condition to treat. Current laser treatment utilizes both ablative and non ablative approaches, that are limited either by post-operative morbidity or minimal degree of improvement. Fractional phothermolysis provides a promising new modality for treatment that is investigated in this study. Methods and Materials: Fifteen female patients, skin types I-IV, with mature striae distensae were treated with fractional photothermolysis (1,550 nm Fraxel SL Laser). Treatments included 4-5 sessions at weekly intervals, pulse energy of 8-10 mJ/MTZ and a final density of 2,000 MTZs per cm2. The treatment response was assessed by comparing pre and 2-week post-treatment clinical photography evaluated by two physicians, as well as patient questionnaires. Results: As demonstrated by digital photography and patient surveys, fractional photothermolysis laser treatment significantly improves the clinical appearance and texture of striae distensae. No change was observed in color. Conclusion: Fractional photothermolysis is a safe and effective modality for the treatment of striae distensae. Further exploration is necessary in order to maximize benefits. Commercial support: None identified.
FEBRUARY 2007
P3108
Multiwaves: A new device for skin rejuvenation Valeria Campos, MD, MD, Clinica Valeria Campos, Jundiai, SC, Brazil; Christiane Ferreira, MD, Clinica Valeria Campos, Jundiai, Brazil Background: The use of visible or infrared spectral light alone for the purpose of skin rejuvenation has been previously reported. A new method of light emitting diode (LED) photo rejuvenation incorporating a combination of these wavelengths is proposed. Objective: To assess the efficacy and local tolerability of combination light therapy in photo rejuvenation of facial skin. Methods: Forty subjects with facial rhytids, mean age 48-years-old (range, 35 to 62 years), received 12 light-therapy treatments using the Multiwaves LED system (Industra, Sa˜o Carlos e SP Brazil). The treatments were applied twice a week using alternating wavelengths of 635 nm (red) and 940 nm (infrared) and fluences of 19,78 J/cm2 or 11 mw/cm2 and 9 J/cm2 or 5 mw/cm2 respectively, 20 minutes of light exposure for both.
Cracks on the tip-unusual cause of complication in Fraxel laser treatment Sang Ju Lee, MD, PhD, Yonsei Star Skin & Laser Clinic, Seoul, South Korea; Jin Moon Kang, MD, Yonsei Star Skin & Laser Clinic, Seoul, South Korea; Young Koo Kim, MD, Yonsei Star Skin & Laser Clinic, Seoul, South Korea; Dong Hyun Kim, MD, Yonsei University College of Medicine, Seoul, South Korea
Results: Blinded observers of standardized photographs taken before and after the last treatment scored percent improvement as follows: 25% (poor), 26-50% (good), 51-75% (very good), 75% (excellent) and all the patients answered a questionnaire at the end of the evaluation. Results: All patients showed some level of improvement, 75% of all patients showed an improvement of good or very good, 25% poor. The questionnaire showed that 100% of the patients had felt improvement and 75% would recommend the same treatment to a friend. There were no complications associated with treatment. Conclusion: Although results are not as impressive as those of ablative treatments, Multiwaves LED system red and infrared therapy represents a safe and cost-effective method that provides significant results and a high degree of patient satisfaction. Further studies with larger number of subjects and biopsy specimens for histological assessment is required. Commercial support: None identified.
In contrast to selective photothermolysis, which produces bulk thermal injury in target area, fractional photothermolysis creates hundreds to thousands of coagulated columns of tissue, namely microthermal treatment zones (MTZs). MTZs are 70 to 100 m in diameter and extend through the epidermis and deeply into the dermis. Because the most part surrounding the MTZs are intact, it leaves no raw surface and helps to heal more easily. Over several weeks the MTZs are replaced by new collagen tissue. Since MTZs are invisible to the naked eye, fractional photothermolysis requires little downtime. As treatment is repeated, more skin surface is replaced. This seems to be very effective in the treatment of photoaging skin and scars. We have experienced an unusual result of Fraxel laser (Reliant Technologies, Palo Alto, CA) treatment for acne scars. A 27-year-old Korean female with acne scars was treated with Fraxel laser. Single treatment at pulse energy of 8 mJ with a density of 1,000 MTZs and 20 mJ with 750 MTZs was performed on the full face. Prophylactically, patient took acyclovir for 3 days. Although the density of MTZs and treatment techniques of this case were as usual, one day after the treatment multiple tiny pustules and oozing erythematous patch had developed on the entire treated area. While we investigate the cause of this complication, multiple cracks on the Fraxel laser tip had been found accidentally. We assumed that the beams passing through small cracks could not focus on the skin but scatter randomly. This might overheat the treated area and make bulk thermal injury to the skin. Consequently, the results of treatment were shown like those of ablative laser rather than those of fractional ablative laser. The complicated lesion resolved after the treatment with prednisolone and minocycline for 4 days. Although the precise cause of crack formation remains yet to be proven, we believe blackheads or black dusts might have a role in making cracks during the Fraxel laser treatment. In order to prevent this crack formation, it is desirable to remove foreign materials on the skin completely before treatment. If you suspect cracks on the tip, physicians had better change the tip. Commercial support: None identified.
P3107 Treatment of lobular capillary hemangioma with Nd:YAG laser, CDL mode Marie-Sophie Bedard, MD, Laval University, Quebec City, PQ, Canada; Jean Boulanger, MD, Clinique de Vinci, Quebec City, PQ, Canada Background: Lobular capillary hemangioma, also known as pyogenic granuloma, is a common benign vascular neoplasm of the skin and mucous membranes. The standard treatment is a shave excision followed by electrosurgery of the base. Recurrence is frequent. Vascular lasers, such as the pulsed dye laser, are already used for the treatment of this condition. To our knowledge, there is no case report regarding the use of the Nd:YAG laser, 1,064 nm, CDL mode, for the treatment of this type of lesion. Objectives: Demonstrate the efficacy of this novel treatment. Evaluate adverse events during the treatment, recurrence rate, cosmetic results, and global satisfaction of the patient. Methods: This is a case series using data from private dermatology clinic records from February 2004 to April 2006. All patients treated for lobular capillary hemangioma were included. Treatment was done using an Nd:YAG laser, 1,064 nm, cooled deep lesion (CDL) mode. The size of the lesion, number of treatments, laser settings, adverse events, recurrence, cosmetic results, and satisfaction of the patient were recorded. Results: Twenty-five (25) patients (15 females, 10 males) were treated for lobular capillary hemangioma. The mean number of treatments necessary for complete resolution was 2.32 (median 2). Forty-four (44) percent of patients cleared with only one treatment. Adverse events reported were pain (8/25) during treatment (reduced with anesthesia), transient swelling (5/25) of the treated area, bleeding (4/25), hypopigmentation (5/25), and/or sclerosis (13/25). No recurrence was noted at the 2-months follow-up visit. Patient satisfaction was very high. Conclusion: The treatment of lobular capillary hemangioma with the Nd:YAG laser, 1,064 nm, CDL mode is a novel approach. There was no recurrence and overall satisfaction was very high. Commercial support: None identified.
AB204
J AM ACAD DERMATOL
P3109 Fractional photothermolysis for the treatment of striae distensae Otavio Roberto Macedo, MD, Ota´vio Macedo, Sa˜o Paulo, Brazil; Maria Bussade, MD, Consulto´rio Dr. Otavio Macedo, Sa˜o Paulo, Brazil; Adriana Salgado, MD, Consultorio Dr. Ota´vio Macedo, Sa˜o Paulo, Brazil; Marjorie Mello Ribeiro, MD, ´ rio Dr. Ota´vio Macedo, Sa˜o Paulo, Brazil Consulto Background and Objectives: Striae distensae are a challenging condition to treat. Current laser treatment utilizes both ablative and non ablative approaches, that are limited either by post-operative morbidity or minimal degree of improvement. Fractional phothermolysis provides a promising new modality for treatment that is investigated in this study. Methods and Materials: Fifteen female patients, skin types I-IV, with mature striae distensae were treated with fractional photothermolysis (1,550 nm Fraxel SL Laser). Treatments included 4-5 sessions at weekly intervals, pulse energy of 8-10 mJ/MTZ and a final density of 2,000 MTZs per cm2. The treatment response was assessed by comparing pre and 2-week post-treatment clinical photography evaluated by two physicians, as well as patient questionnaires. Results: As demonstrated by digital photography and patient surveys, fractional photothermolysis laser treatment significantly improves the clinical appearance and texture of striae distensae. No change was observed in color. Conclusion: Fractional photothermolysis is a safe and effective modality for the treatment of striae distensae. Further exploration is necessary in order to maximize benefits. Commercial support: None identified.
FEBRUARY 2007