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Treatment of scars using ablative carbon dioxide fractional laser
P3606
P3608
Treatment of scars using ablative carbon dioxide fractional laser Jin Young Jung, MD, Yonsei University College of Medicine, Seoul, South Korea; Dong Jin Ryu, Yonsei University College of Medicine, Seoul, South Korea; Ji Hyun Kim, Yonsei University College of Medicine, Seoul, South Korea; Ju Hee Lee, MD, PhD, Yonsei University College of Medicine, Seoul, South Korea; Kee Yang Chung, MD, PhD, Yonsei University College of Medicine, Seoul, South Korea
Initial evaluation of a novel ablative fractional plasma radiofrequency technology for treatment of photoaging and scars Shlomit Halachmi, MD, PhD, Rabin Medical Center, Petach Tikva, Israel; Moshe Lapidoth, MD, MPH, Rabin Medical Center, Petach Tikva, Israel
A variety of modalities have been used for treatment of scars including excision, dermabrasion, and traditional ablative and nonablative laser treatments. Ablative lasers provide the greatest improvement, but significant adverse effects limit their use. Nonablative lasers have reduced adverse effects but have limited efficacy. Fractional photothermolysis is a new skin resurfacing laser technology for treating wrinkles, melanocytic pigmentation, scars, and photodamaged skin. Fractional photothermolysis produces arrays of microscopic thermal wounds at specific depths in the skin without injuring the surrounding tissue. Nonablative fractional laser have been proven to be effective and generally well tolerated to various dermatologic diseases. The ablative carbon dioxide (CO2) fractional laser was more recently introduced for pronounced clinical outcomes with fewer treatment sessions in pigmentation, skin texture, and wrinkling than nonablative fractional laser. However, small studies have recently reported the efficacy of ablative CO2 fractional laser for the treatment of scars. Herein, we evaluated the effect of ablative CO2 fractional laser on various scars. We retrospectively analyzed a total of 28 Asian patients (Fitzpatrick skin types III-IV) with scars treated with ablative CO2 fractional laser. Atrophic scars was 16 and hypertrophic scars was 12. The scars included postoperative, posttraumatic, postviral infection, burn, and acne scars. The patients received one to four treatments every 1 to 2 months. Clinical improvement was evaluated the two blinded physicians who compared pre- and posttreatment photographs using a 4-point scoring system (0 ¼ \25%, 1 ¼ 25-50%, 2 ¼ 51-75%, and 3 ¼ [75% improvement) at 2-month time points after the last treatment. The mean improvement score in all scars was 1.96. In atrophic scars, the average improvement score was 2.06, while it was 1.83 in hypertrophic scars. Statistically significant differences were not observed between type of scars. Quartile grading scores correlating to at least 50% to 75% improvement in overall improvement were noted in 64.3% of patients. The treatments were well tolerated and complications were limited and transient. This study demonstrates that ablative CO2 fractional laser is safe and effective treatment modality for various scars including atrophic and hypertrophic scars.
Background: Fractional lasers have gained popularity because of their combination of efficacy with reduced downtime. Radiofrequency (RF) can also be applied in a fractional manner, and when the technology is applied under conditions of plasma, fractional RF can deliver a precise grid of discrete sparks for fractional ablation. A novel fractional RF plasma device has been developed that delivers fractional RF via plasma using a roller handpiece, for continuous and rapid coverage of large areas. Histologic analyses after treatment demonstrate focal ablation 80 to 120m in diameter, limited in depth to the uppermost papillary dermis, and complete epidermal recovery after 3 days. Methods: Twelve patients (11 females, 1 male) 16 to 54 years of age were treated (PixelRF, Alma Laser) for improvement of photoaged skin (N ¼ 10) or acne scars (N ¼ 2). Large areas were treated with the roller handpiece, while small areas were treated with the stationary handpiece. Participants completed four to six treatments (mean, 4.6) at 3- to 4-week intervals. At each treatment, three to four passes were applied at 45 to 55 watts. Results were monitored photographically. Results: Treatment was well tolerated by all participants, with transient erythema and short-lived fractional patterned pinpoint scale. Facial rhytides demonstrated reduced depth after two treatments and marked improvement after four treatments. Acne scars showed marked improvement after two to four treatments. Conclusions: Fractional RF-plasma technology provides an effective, short downtime modality for minimally ablative fractional radiofrequency. Its applicability to both focal lesions and large areas makes is a valuable tool in the armamentarium of fractional technologies. Commercial support: None identified.
Commercial support: None identified.
P3607 Treatment of xanthelasma palpebrarum by fractional carbon dioxide laser Hyo Jin Roh, MD, Department of Dermatology and Cutaneous Biology Research Institute, College of Medicine, Yonsei University, Seoul, South Korea; Dong Jin Ryu, MD, Department of Dermatology and Cutaneous Biology Research Institute College of Medicine, Yonsei University, Seoul, South Korea; Jin Young Jung, MD, Department of Dermatology and Cutaneous Biology Research Institute College of Medicine, Yonsei University, Seoul, South Korea; Ju Hee Lee, MD, Department of Dermatology and Cutaneous Biology Research Institute College of Medicine, Yonsei University, Seoul, South Korea; Su Hyun Lee, MD, Department of Dermatology and Cutaneous Biology Research Institute College of Medicine, Yonsei University, Seoul, South Korea Xanthoma is a benign tumor consisting of foam cells. Among subtypes of xanthoma, xanthelasma palpebrarum is the most common cutaneous xanthoma. It is characterized by a idiopathic benign progressive yellow plaques, with no significant relationship reported with hypercholesterolemia. It occurs most commonly at the medial canthus of the eyelid bilaterally, more often on the upper than than the lower lid. It does not regress spontaneously and can cause serious cosmetic problems to the patients. Histologically, xanthelasma differs from other xanthomas by its more superficial site in the middle and superficial layers of the dermis. It is composed of foamy histiocytes arranged around dermal capillaries. Intrahistiocytic vacuoles contain esterified cholesterol. Many treatment options have been described in the literature, including surgical resection, trichloroacetic acid peeling, CO2 laser, Nd:YAG laser, pulsed dye laser, cryotherapy, or electrodessication. However, scarring and recurrence remain the most important long-term issues. A new modality, fractional CO2 laser device, has been introduced recently, which is a novel variation on the theory of selective photothermolysis wherein microscopic treatment zones (MTZs) of controlled width, depth, and densities are created. These controlled zones of thermal heating and tissue damage are surrounded by spared areas of viable epidermis and dermis. Therefore, the healing process is more rapid compared to fully ablative CO2 laser and the risk is lower than convetional CO2 laser. Fractional CO2 laser has been reported to be a safe and effective treatment for facial rejuvenation, melasma, rhytides, and acneiform scars. As far as we know, there have been no reported cases of xanthelasma treated with fractional CO2 laser. In this study, we performed treatment for xanthelasma in females from 32 to 55 years of age using fractional CO2 laser. The results revealed significant improvement of the treated area. We suggest that fractional CO2 laser is a possible candidate as a new therapeutic option for the treatment of xanthelasma. Commercial support: None identified.
MARCH 2010
P3609 Effect of fullerene as an antioxidant during laser therapy Takahiro Fujimoto, MD, PhD, MBA, Clinic F, Chiyoda-ku, Tokyo, Japan; Masayuki Ito, Vitamin C60 BioResearch, Chuo-Ku, Tokyo, Japan; Shinobu Ito, Ito, Musashino, Tokyo, Japan; Shuichi Yamana, Vitamin C60 BioResearch, Chuo-Ku, Tokyo, Japan Objectives: Resurfacing laser therapy is a popular antiaging technology. Electron paramagnetic resonance (EPR) analysis revealed that free radicals, including hydrogen and superoxide radicals, were generated in guinea pig skin with a 1440nm fractional laser. They damage melanocytes and may induce the production of inflammatory molecules. Fullerene, a carbon allotrope, is a potent antioxidant that effectively protects melanocytes against free radicaleinduced oxidative stress. Because it is insoluble to water, we used polyvinylpyrrolidone (PVP)-fullerene. We examined the effectiveness of a combination of fullerene and laser treatment as an antiaging technology. Methods: EPR analysis: Guinea pig skin slices were treated with PVP-fullerene to detect free radical adducts with 10 L DMPO or DPPMPO, as a spin-trapping agent. Samples were irradiated several times with the Affirm laser (3J/cm2; Cynosure [Nd:YAG], 1440nm). After irradiation, free radical adduct signals were detected with an EPR spectrometer. Measurement of COX-2 mRNA: We applied 0.5% water-soluble fullerene (C60: 10ppm) to the backs of five guinea pigs 2 days before laser irradiation (3J/cm2, once at area). After irradiation for 1.5hours, RNA samples were extracted from the normal, laser-irradiated, and fullerene-treated with laser-irradiated skin. COX-2 mRNA was quantified by the SYBR Green method with the ABI 7500 using GAPDH3 as an internal control. Evaluation of hyperpigmentation: We applied 0.5% PVP-fullerene/2% hydroquine (HQ) or 2% HQ creams to two pigment spots on human skin, respectively. After 1 week, these were treated with a laser (Cynosure Accolade; 4.6J/cm2), and follow-up photographs were obtained. Results: Both hydrogen and superoxide radicals generated by laser irradiation were significantly decreased because of PVP-fullerene. When hemoglobin was used instead of guinea pig skin, the comparable result was obtained. Thus, hemoglobin was guessed to be one of free radical sources. Expression of COX-2 mRNA in laserirradiated skin was remarkably higher than that in nonirradiated skin. In the PVPfullereneetreated area, COX-2 mRNA expression was lower than that in the laserirradiated area. After 2 weeks of clinical testing, the 0.5% PVP-fullerene/2% HQtreated area was found to be slightly brighter than the 2% HQ-treated area. These data suggest that fullerene can protect skin against free radicals generated by laser irradiation and might exhibit an antiphlogistic action. Commercial support: None identified.
J AM ACAD DERMATOL
AB149
P3608
Treatment of scars using ablative carbon dioxide fractional laser Jin Young Jung, MD, Yonsei University College of Medicine, Seoul, South Korea; Dong Jin Ryu, Yonsei University College of Medicine, Seoul, South Korea; Ji Hyun Kim, Yonsei University College of Medicine, Seoul, South Korea; Ju Hee Lee, MD, PhD, Yonsei University College of Medicine, Seoul, South Korea; Kee Yang Chung, MD, PhD, Yonsei University College of Medicine, Seoul, South Korea
Initial evaluation of a novel ablative fractional plasma radiofrequency technology for treatment of photoaging and scars Shlomit Halachmi, MD, PhD, Rabin Medical Center, Petach Tikva, Israel; Moshe Lapidoth, MD, MPH, Rabin Medical Center, Petach Tikva, Israel
A variety of modalities have been used for treatment of scars including excision, dermabrasion, and traditional ablative and nonablative laser treatments. Ablative lasers provide the greatest improvement, but significant adverse effects limit their use. Nonablative lasers have reduced adverse effects but have limited efficacy. Fractional photothermolysis is a new skin resurfacing laser technology for treating wrinkles, melanocytic pigmentation, scars, and photodamaged skin. Fractional photothermolysis produces arrays of microscopic thermal wounds at specific depths in the skin without injuring the surrounding tissue. Nonablative fractional laser have been proven to be effective and generally well tolerated to various dermatologic diseases. The ablative carbon dioxide (CO2) fractional laser was more recently introduced for pronounced clinical outcomes with fewer treatment sessions in pigmentation, skin texture, and wrinkling than nonablative fractional laser. However, small studies have recently reported the efficacy of ablative CO2 fractional laser for the treatment of scars. Herein, we evaluated the effect of ablative CO2 fractional laser on various scars. We retrospectively analyzed a total of 28 Asian patients (Fitzpatrick skin types III-IV) with scars treated with ablative CO2 fractional laser. Atrophic scars was 16 and hypertrophic scars was 12. The scars included postoperative, posttraumatic, postviral infection, burn, and acne scars. The patients received one to four treatments every 1 to 2 months. Clinical improvement was evaluated the two blinded physicians who compared pre- and posttreatment photographs using a 4-point scoring system (0 ¼ \25%, 1 ¼ 25-50%, 2 ¼ 51-75%, and 3 ¼ [75% improvement) at 2-month time points after the last treatment. The mean improvement score in all scars was 1.96. In atrophic scars, the average improvement score was 2.06, while it was 1.83 in hypertrophic scars. Statistically significant differences were not observed between type of scars. Quartile grading scores correlating to at least 50% to 75% improvement in overall improvement were noted in 64.3% of patients. The treatments were well tolerated and complications were limited and transient. This study demonstrates that ablative CO2 fractional laser is safe and effective treatment modality for various scars including atrophic and hypertrophic scars.
Background: Fractional lasers have gained popularity because of their combination of efficacy with reduced downtime. Radiofrequency (RF) can also be applied in a fractional manner, and when the technology is applied under conditions of plasma, fractional RF can deliver a precise grid of discrete sparks for fractional ablation. A novel fractional RF plasma device has been developed that delivers fractional RF via plasma using a roller handpiece, for continuous and rapid coverage of large areas. Histologic analyses after treatment demonstrate focal ablation 80 to 120m in diameter, limited in depth to the uppermost papillary dermis, and complete epidermal recovery after 3 days. Methods: Twelve patients (11 females, 1 male) 16 to 54 years of age were treated (PixelRF, Alma Laser) for improvement of photoaged skin (N ¼ 10) or acne scars (N ¼ 2). Large areas were treated with the roller handpiece, while small areas were treated with the stationary handpiece. Participants completed four to six treatments (mean, 4.6) at 3- to 4-week intervals. At each treatment, three to four passes were applied at 45 to 55 watts. Results were monitored photographically. Results: Treatment was well tolerated by all participants, with transient erythema and short-lived fractional patterned pinpoint scale. Facial rhytides demonstrated reduced depth after two treatments and marked improvement after four treatments. Acne scars showed marked improvement after two to four treatments. Conclusions: Fractional RF-plasma technology provides an effective, short downtime modality for minimally ablative fractional radiofrequency. Its applicability to both focal lesions and large areas makes is a valuable tool in the armamentarium of fractional technologies. Commercial support: None identified.
Commercial support: None identified.
P3607 Treatment of xanthelasma palpebrarum by fractional carbon dioxide laser Hyo Jin Roh, MD, Department of Dermatology and Cutaneous Biology Research Institute, College of Medicine, Yonsei University, Seoul, South Korea; Dong Jin Ryu, MD, Department of Dermatology and Cutaneous Biology Research Institute College of Medicine, Yonsei University, Seoul, South Korea; Jin Young Jung, MD, Department of Dermatology and Cutaneous Biology Research Institute College of Medicine, Yonsei University, Seoul, South Korea; Ju Hee Lee, MD, Department of Dermatology and Cutaneous Biology Research Institute College of Medicine, Yonsei University, Seoul, South Korea; Su Hyun Lee, MD, Department of Dermatology and Cutaneous Biology Research Institute College of Medicine, Yonsei University, Seoul, South Korea Xanthoma is a benign tumor consisting of foam cells. Among subtypes of xanthoma, xanthelasma palpebrarum is the most common cutaneous xanthoma. It is characterized by a idiopathic benign progressive yellow plaques, with no significant relationship reported with hypercholesterolemia. It occurs most commonly at the medial canthus of the eyelid bilaterally, more often on the upper than than the lower lid. It does not regress spontaneously and can cause serious cosmetic problems to the patients. Histologically, xanthelasma differs from other xanthomas by its more superficial site in the middle and superficial layers of the dermis. It is composed of foamy histiocytes arranged around dermal capillaries. Intrahistiocytic vacuoles contain esterified cholesterol. Many treatment options have been described in the literature, including surgical resection, trichloroacetic acid peeling, CO2 laser, Nd:YAG laser, pulsed dye laser, cryotherapy, or electrodessication. However, scarring and recurrence remain the most important long-term issues. A new modality, fractional CO2 laser device, has been introduced recently, which is a novel variation on the theory of selective photothermolysis wherein microscopic treatment zones (MTZs) of controlled width, depth, and densities are created. These controlled zones of thermal heating and tissue damage are surrounded by spared areas of viable epidermis and dermis. Therefore, the healing process is more rapid compared to fully ablative CO2 laser and the risk is lower than convetional CO2 laser. Fractional CO2 laser has been reported to be a safe and effective treatment for facial rejuvenation, melasma, rhytides, and acneiform scars. As far as we know, there have been no reported cases of xanthelasma treated with fractional CO2 laser. In this study, we performed treatment for xanthelasma in females from 32 to 55 years of age using fractional CO2 laser. The results revealed significant improvement of the treated area. We suggest that fractional CO2 laser is a possible candidate as a new therapeutic option for the treatment of xanthelasma. Commercial support: None identified.
MARCH 2010
P3609 Effect of fullerene as an antioxidant during laser therapy Takahiro Fujimoto, MD, PhD, MBA, Clinic F, Chiyoda-ku, Tokyo, Japan; Masayuki Ito, Vitamin C60 BioResearch, Chuo-Ku, Tokyo, Japan; Shinobu Ito, Ito, Musashino, Tokyo, Japan; Shuichi Yamana, Vitamin C60 BioResearch, Chuo-Ku, Tokyo, Japan Objectives: Resurfacing laser therapy is a popular antiaging technology. Electron paramagnetic resonance (EPR) analysis revealed that free radicals, including hydrogen and superoxide radicals, were generated in guinea pig skin with a 1440nm fractional laser. They damage melanocytes and may induce the production of inflammatory molecules. Fullerene, a carbon allotrope, is a potent antioxidant that effectively protects melanocytes against free radicaleinduced oxidative stress. Because it is insoluble to water, we used polyvinylpyrrolidone (PVP)-fullerene. We examined the effectiveness of a combination of fullerene and laser treatment as an antiaging technology. Methods: EPR analysis: Guinea pig skin slices were treated with PVP-fullerene to detect free radical adducts with 10 L DMPO or DPPMPO, as a spin-trapping agent. Samples were irradiated several times with the Affirm laser (3J/cm2; Cynosure [Nd:YAG], 1440nm). After irradiation, free radical adduct signals were detected with an EPR spectrometer. Measurement of COX-2 mRNA: We applied 0.5% water-soluble fullerene (C60: 10ppm) to the backs of five guinea pigs 2 days before laser irradiation (3J/cm2, once at area). After irradiation for 1.5hours, RNA samples were extracted from the normal, laser-irradiated, and fullerene-treated with laser-irradiated skin. COX-2 mRNA was quantified by the SYBR Green method with the ABI 7500 using GAPDH3 as an internal control. Evaluation of hyperpigmentation: We applied 0.5% PVP-fullerene/2% hydroquine (HQ) or 2% HQ creams to two pigment spots on human skin, respectively. After 1 week, these were treated with a laser (Cynosure Accolade; 4.6J/cm2), and follow-up photographs were obtained. Results: Both hydrogen and superoxide radicals generated by laser irradiation were significantly decreased because of PVP-fullerene. When hemoglobin was used instead of guinea pig skin, the comparable result was obtained. Thus, hemoglobin was guessed to be one of free radical sources. Expression of COX-2 mRNA in laserirradiated skin was remarkably higher than that in nonirradiated skin. In the PVPfullereneetreated area, COX-2 mRNA expression was lower than that in the laserirradiated area. After 2 weeks of clinical testing, the 0.5% PVP-fullerene/2% HQtreated area was found to be slightly brighter than the 2% HQ-treated area. These data suggest that fullerene can protect skin against free radicals generated by laser irradiation and might exhibit an antiphlogistic action. Commercial support: None identified.
J AM ACAD DERMATOL
AB149