Treatment of burn scars with the 1,550 nm nonablative fractional Erbium Laser.

BACKGROUND: Scarring is a major source of morbidity in patients with burns. Burn scars are difficult to treat and are among the worst scars seen in clinical medicine. Fractional laser resurfacing is a promising treatment option because of its unique wound healing response and depth of penetration. OBJECTIVE: To evaluate the efficacy of nonablative fractional resurfacing as a therapeutic option for extensive cutaneous scarring in burn patients. METHODS: Prospective, single-arm, pilot study. Ten subjects with second and third degree burn scars were treated with five nonablative fractional resurfacing treatments given at 4-week intervals. Three independent investigators evaluated subject outcomes at 3 months post-treatment (primary outcome); patients also provided subjective assessments of improvement (secondary outcome). RESULTS: Nonablative fractional resurfacing resulted in overall improvement in 90% of subjects, as determined by independent investigators; improvements were moderate to excellent in 60%. Ninety percent of subjects had improved skin texture, 80% had improved dyschromia, and 80% had improved hypertrophy/atrophy. Patients' self-reports also revealed moderate to excellent improvements (on average) in burn scar area, and significant improvements in self-esteem at 3 months post-treatment (P = 0.03). LIMITATIONS: Small sample size and lack of control group. CONCLUSIONS: Fractional resurfacing is a promising new treatment modality for burn scars. We should continue to identify novel approaches and management strategies for the spectrum of diverse burn scars so that we can better treat this patient population.

An open-label trial examining the efficacy and safety of a pre- and postprocedure topical five-product system (Clinique Medical Optimizing Regimen) specifically formulated to complement laser/light-based facial cosmetic procedures.

BACKGROUND: Specialized skin care regimens may help to minimize adverse events (AEs) following non-ablative facial procedures. METHODS: A 14-week, open-label, three-center study evaluated the efficacy and safety of a topical five-product system (Clinique Medical Optimizing Regimen; Allergan, Inc., Irvine, CA, USA) for minimizing localized AEs during two 6-week procedure cycles with fractionated laser (FL) or intense pulsed light (IPL). The skin care regimen consisted of a 2-week preprocedure phase, a 1-week postprocedure phase, and a 3-week maintenance phase. Investigators and patients rated the presence and severity of erythema, itching, stinging/burning, edema, pain, pruritus, swelling, crusts/erosion, and photodamage. RESULTS: Two days after the FL/IPL treatment (IPL: n = 27; FL: n = 21), most assessments, including erythema, were near baseline values; at 4 weeks postprocedure, all investigator scores were comparable to baseline. Patients missed work or avoided social situations a mean of only 0.8 days. Mean subject ratings for itching, stinging/burning, pain, swelling, and redness for 2 weeks postprocedure were 'none' to 'mild'. Treatment-related AEs (acne, facial rash) occurred in four patients. All investigators stated they would recommend this topical over-the-counter regimen again in conjunction with non-ablative FL/IPL treatments. CONCLUSIONS: This topical five-product skin care system was safe and effective in conjunction with non-ablative FL/IPL procedures.

Cosmeceuticals for rejuvenation.

Facial plastic surgeons are frequently called upon to enhance the appearance of their patients. Typically, this involves surgery of the face or neck. Increasingly, this may also require the use of injectables such as botulinum toxins, fillers, and volumizers. Lasers and light sources are used to enhance the appearance of the surface of the skin. Each of these modalities will help to improve the patient but are limited by the fact that they require the patient to be treated in the office. With the advent of effective topical agents, patients are increasingly able to improve their appearance with the use of prescription and nonprescription topical products. It is incumbent upon the facial plastic surgeon to have an understanding of these topical agents so that they can assist the patient in deciding what does and does not make sense. In addition, many cosmetic physicians will dispense these products in their office, and it behooves them to understand the various products available and what will likely be produced in the future.

Disfiguring scarring following mesotherapy-associated Mycobacterium cosmeticum infection.

Mesotherapy is a popular procedure that poses risks that include scarring, contour changes and bacterial infections. The benefits of the procedure remain to be objectively delineated in a placebo-controlled, blinded study. Despite the lack of evidence to support its use, it is marketed as a "nonsurgical and safe" way to remove fat. The authors report a case of mycobacterial infection resulting from mesotherapy. This infection should be considered when a patient presents with a mesotherapy complication and should be discussed with the patient prior to the procedure. Options for treatment of the scarring are considered.

Ablative fractional laser resurfacing for the treatment of a third-degree burn.

Burn scars are the result of wound healing following a partial-thickness or full-thickness thermal injury. Thermal injury can frequently result in extensive scarring, which may have profound psychologic impact on the victim, serving as a visible and palpable reminder of a traumatic event. Standard treatments for scars include the use of skin grafts, intralesional steroid injections, and pulsed-dye laser treatments. The authors have previously described successful treatment of a burn scar with nonablative fractional resurfacing. Ablative fractional lasers may offer burn patients advantages over nonablative techniques, including improved function and cosmetic outcomes. In addition, ablative fractional laser may require fewer treatments, and therefore, be a more cost-effective treatment option for patients. The authors report the use of fractional ablative laser for the treatment of a disfiguring scar that was more than 50-years-old. To our knowledge, this is the first report of this technology for the treatment of a scar resulting from a third-degree burn in the literature. The demonstrated successful outcome in this case patient may indicate a progessive treatment option for many patients who have been disfigured by these types of thermal injuries.