Treating Field Cancerization by Ablative Fractional Laser and Indoor Daylight: Assessment of Efficacy and Tolerability.

Objective: To assess if ablative fractional laser combined with indoor daylight photodynamic therapy are effective and safe for the treatment of skin field cancerization associated with actinic keratosis (AK). Methods: A total of 46 patients with field cancerized skin and AK were treated by a single session of laser assisted drug delivery (LAAD) and indoor daylight photodynamic therapy (IDL-PDT). LAAD was applied using a CO2 ablative fractional laser (AFXL) and aminolevulonic acid. Thereafter, IDL-PDT was administered using a novel device that mimics the sun radiation with a total dose of 48 J/cm². Results: All patients showed remission following subsequent to the study protocol (complete: 71.7%, partial: 28.3%). Pain scores using a visual analog scare immediately following treatments were 9.0 ± 2.0. Conclusions: AFXL-LAAD combined with IDL-PDT is extremely effective for the treatment of skin field cancerization associated with AK. Nevertheless, the high pain scores associated with this combined approach may prove to be a limiting factor. Thus, further protocol modifications in larger scale studies are still warranted. J Drugs Dermatol. 2020;19(3):425-427. doi:10.36849/JDD.2020.4589.

Stimulation of collagen and elastin production in-vivo using 1,540 nm Er:Glass laser: assessment of safety and efficacy.

Introduction: Induction of collagen and elastin remodeling in the human skin can be achieved by non-ablative fractional laser (NAFXL) and ablative fractional laser (AFXL). Our objective was to compare the safety, efficacy, tolerability, and ability to induce collagen and elastin remodeling of NAFXL versus AFXL in a series of treatments over time.Materials and Methods: In this prospective, proof of principle, single-case study, the safety, tolerability and efficacy of the laser systems were assessed via histopathology and clinical evaluations including photographs. Optical biopsies by means of multiphoton tomography (MPT) were used to evaluate the induction of collagen and elastin remodeling.Results: Treatments by both NAFXL and AFXL were well tolerated. The NAFXL system was found to be less painful and resulted in a shorter down- and healing times. MPT findings showed the superior capability of the AFXL procedure to induce collagen; on the other hand, elastin induction was more pronounced after NAFXL treatments.Conclusions: While NAFXL is as effective and safe as the traditional AFXL, it is better tolerated and has a shorter downtime. Serial optical biopsies over time over time can be a useful tool to assess the induction of collagen and elastin remodeling in the human skin.

New lasers and light sources - old and new risks?

Recent developments (new wavelengths, treatment concepts, and combinations) in the field of lasers, intense pulsed light (IPL), LED, as well as new energy and light sources have opened up new therapeutic options that extend beyond mere aesthetic indications. Thus, while fractional lasers used to be employed to merely treat wrinkles, the same devices - in the context of laser-assisted drug delivery - have now become important tools in the treatment of scars, field cancerization, and epithelial tumors. The requirements posed to physicians, both with respect to establishing the indication and conducting treatment, have been growing along with the increase in technological complexity as well as the rising number of comorbidities and comedications in a patient population that continues to age. At the same time, home-use devices have been introduced for a variety of indications. These devices are characterized by low power and special safety features aimed at preventing accidents, risks, and side effects. Despite the reduced efficacy of such self-treatment devices, there is an increased risk of misuse, given that the basic prerequisite for adequate treatment cannot be ensured, to wit, the exact diagnosis and therapeutic indication. Consequently, during hair removal or anti-wrinkle treatment, pigmented lesions and cutaneous neoplasms may be altered, thus giving rise to expected, unexpected and new side effects and complications. In the aforementioned setting, it is important that all potential users of these new technologies be properly trained in a manner that ensures those treated a maximum of safety and efficacy in accordance with the guiding principle "diagnosis certa - ullae therapiae fundamentum".

Non-ablative fractional laser provides long-term improvement of mature burn scars--a randomized controlled trial with histological assessment.

BACKGROUND AND OBJECTIVES: Non-ablative fractional laser-treatment is evolving for burn scars. The objective of this study was to evaluate clinical and histological long-term outcome of 1,540 nm fractional Erbium: Glass laser, targeting superficial, and deep components of mature burn scars. MATERIALS & METHODS: Side-by-side scar-areas were randomized to untreated control or three monthly non-ablative fractional laser-treatments using superficial and extra-deep handpieces. Patient follow-up were at 1, 3, and 6 months. Primary outcome was improvement in overall scar-appearance on a modified-Patient-and-Observer-Scar-Assessment-Scale (mPOSAS, 1 = "normal skin", 10 = "worst imaginable scar"). Secondary outcomes included histology, patient satisfaction (0-10), patient-assessed improvement, and safety. RESULTS: Study was completed by 17 of 20 randomized patients with normotrophic (n = 11), hypertrophic (n = 5) or atrophic (n = 1) scars. Scar-appearance improved from laser-treatments (P < 0.001 vs. untreated) and histology at 6 months supported collagen-remodeling. Improvement appeared continuously during the post-operative period (mPOSAS baseline: 7 [5-8], 6 months: 4 [3-5] P = < 0.001). At 6 months, patients were satisfied with treatment (6 [3-9]) and 82% reported improved scar-texture. Treatments caused mild to moderate pain (4 [2-7]). Adverse effects decreased during follow-up and at final assessment, discrete erythema, hyperpigmentation or imprints from laser-grid were present in 11 patients. No patients experienced worsening of scar-appearance. CONCLUSIONS: Combined superficial and deep non-ablative fractional laser-treatments induce long-term clinical and histological improvement of mature burn scars.

[Health economic studies in dermatology--review of the literature, evaluation and practical aspects]. / Gesundheitsökonomische Studien in der Dermatologie--Review der Literatur, Bewertung und zugrunde liegende Aspekte der Durchführung.

BACKGROUND: Health economic studies attempt to objectivity treatment results to place them in economic. These studies summarize both physician care and other medical services to allow a more rational use of limited resources and are of great value. METHODS: The health economic studies in the literature were analyzed by the conducting countries, financing, the study period and the interval until publication. A quantitative comparison to other specialties in medicine was performed. On the basis of a checklist of basic criteria, a qualitative assessment of the studies was performed to rate the significance. RESULTS: The number of studies showed a fivefold increase. A third of the dermatological studies (n = 71) were conducted in the United States, 23.94% in Great Britain, 9.86% in Sweden and 35.23% in other countries. The interval until publication was 0 to 9 years. CONCLUSIONS: The increase in the number of studies may be explained by the growing demand for clarification of the economical situation. Reasons for the significant differences between different countries might be the financing of the studies or the nature of the dominant health care system. Whereas American studies are predominantly sponsored by pharmaceutical companies, the ones in Great Britain and Sweden are supported by public authorities. The long delays in publishing may be accounted for by long review periods and by difficulties in transferring large amounts of data in international studies. Particularly the introduction of the DRG system in Germany has increased demands for cost-effective action on the basis of well-founded and high-quality health economic studies.