Clinical Outcome of 1064-nm Picosecond Neodymium-Doped Yttrium Aluminium Garnet Laser for the Treatment of Hypertrophic Scars.

BACKGROUND: Currently no study has evaluated the effect of the novel 1064-nm picosecond neodymium-doped:yttrium aluminium garnet laser (ps-Nd:YAG) for reducing Hypertrophic scarring (HS). OBJECTIVE: The aim of this study was to verify the efficacy and safety of a 1064-nm ps-Nd:YAG in the management of HS. MATERIALS AND METHODS: A retrospective chart review and photographic analysis were conducted on patients treated with a low-fluence 1064-nm ps-Nd:YAG for HS improvement. The Vancouver Scar Scale (VSS), 5-point Global Assessment Score (GAS), and patient satisfaction score were used to determine the effect of scar improvement. RESULTS: A total of 24 Korean patients (9 males and 15 females; mean age of 33.25 ± 15.50 years) were retrospectively evaluated. Mean treatment settings were 1064-nm wavelength, 750 ps pulse duration, 7.94 mm spot size, 0.93 J/cm2 fluence, and 9.69 Hz frequency. The average VSS score decreased significantly (from 5.33 to 2.71) after laser treatment (p < 0.001). The average GAS (3.02 ± 0.93) showed fair cosmetic improvement, and patient satisfaction scores (6.88 ± 2.66) indicated moderate satisfaction. CONCLUSION: The novel low-fluence 1064-nm ps-Nd:YAG could be considered as an effective and safe optional modality for the treatment of HS in Asian skin.

Median canaliform nail dystrophy treated with a 1064-nm quasi-long pulsed Nd:YAG laser.

Median canaliform nail dystrophy (MCND) is an uncommon and idiopathic dystrophic change, which typically appears as central, longitudinal groove or split involving one or both thumbnails. Various treatments including a potent topical steroid, an intralesional injection of triamcinolone 2.5-3 mg/dL, medications for systemic treatment, and topical psoralen plus ultraviolet A (PUVA) have been tried to treat the disease. However, each treatment has limitations including severe pain, inconsistent treatment results, long treatment periods, and dissatisfaction with effects of treatment. In recent years, 1064-nm Nd:YAG laser is used for skin rejuvenation by the effect of collagen synthesis and remodeling via induction of growth factor expression. Therefore, we tried 1064-nm Nd:YAG laser to treat this nail dystrophy. A 53-year-old man presented with median nail dystrophy on both thumbs for 3 years. The nail dystrophy was treated only with 1064-nm quasi-long pulsed Nd:YAG laser. He was offered 10 sessions of treatment, and the right thumbnail showed good response and the left thumbnail showed fair response. He experienced severe pain during the treatment (Numerical rating scale (NRS) 8) and was satisfied moderately with the results (NRS 6.5). We report a case of treatment of MCND with 1064-nm quasi-long pulsed Nd:YAG laser with excellent clinical improvement.

Treatment of Persistent Facial Postinflammatory Hyperpigmentation With Novel Pulse-in-Pulse Mode Intense Pulsed Light.

BACKGROUND: Postinflammatory hyperpigmentation (PIH) is an acquired hypermelanosis induced by various causes including inflammatory dermatoses, injury, or cosmetic procedures, such as lasers or chemical peels, and it tends to affect dark-skinned people with greater frequency and severity. There are a variety of treatment options for PIH, including topical agents, chemical peels, laser, and light therapy. However, the results are not up to expectation. OBJECTIVE: The purpose of this study was to examine the clinical efficacy and safety of novel pulse-in-pulse mode intense pulsed light (IPL) for the treatment of persistent facial PIH in Korean patients. MATERIALS AND METHODS: Twenty-five Korean female patients (Fitzpatrick skin types III-V) with persistent facial PIH were enrolled in the study. The patients were treated with novel pulse-in-pulse mode IPL for 4 sessions at 1-week interval and 4 sessions at 2-week intervals. Treatment efficacy and patient satisfaction were evaluated using photographs and questionnaires. RESULTS: After 2 months of all treatments, 23 patients (92%) had more than 50% improvement and 22 patients (88%) were satisfied with the treatments. No adverse effects or aggravations were reported. CONCLUSION: The pulse-in-pulse mode IPL treatment is effective and safe for persistent facial PIH in dark-skinned patients.

Adjunctive 830 nm light-emitting diode therapy can improve the results following aesthetic procedures.

BACKGROUND: Aggressive, or even minimally aggressive, aesthetic interventions are almost inevitably followed by such events as discomfort, erythema, edema and hematoma formation which could lengthen patient downtime and represent a major problem to the surgeon. Recently, low level light therapy with light-emitting diodes (LED-LLLT) at 830 nm has attracted attention in wound healing indications for its anti-inflammatory effects and control of erythema, edema and bruising. RATIONALE: The wavelength of 830 nm offers deep penetration into living biological tissue, including bone. A new-generation of 830 nm LEDs, based on those developed in the NASA Space Medicine Laboratory, has enabled the construction of planar array-based LED-LLLT systems with clinically useful irradiances. Irradiation with 830 nm energy has been shown in vitro and in vivo to increase the action potential of epidermal and dermal cells significantly. The response of the inflammatory stage cells is enhanced both in terms of function and trophic factor release, and fibroblasts demonstrate superior collagenesis and elastinogenesis. CONCLUSIONS: A growing body of clinical evidence is showing that applying 830 nm LED-LLLT as soon as possible post-procedure, both invasive and noninvasive, successfully hastens the resolution of sequelae associated with patient downtime in addition to significantly speeding up frank wound healing. This article reviews that evidence, and attempts to show that 830 nm LED-LLLT delivers swift resolution of postoperative sequelae, minimizes downtime and enhances patient satisfaction.

Treatment of nevus of Ota using low fluence Q-switched Nd:YAG laser.

BACKGROUND: Nevus of Ota, caused by dermal melanocytosis, is cosmetically troublesome in Asian patients. The destruction of dermal melanocytosis using Q-switched laser systems carries a high risk of postinflammatory hyperpigmentation/hypopigmentation. METHODS: To determine the usefulness, safety, and adverse problems of low fluence 1064 nm Q-switched Nd:YAG laser in the treatment of nevus of Ota, 19 Korean patients (five male and 14 female; Fitzpatrick skin type IV) who were clinically diagnosed as having nevus of Ota were enrolled in the present study. Low fluence laser treatments were performed with a collimated Q-switched Nd:YAG laser at intervals of two weeks. The fluence of laser treatments was set at 2.5 J/cm(2) and adjusted based on patient response to the previous treatment session and sensitivity to pain. Treatment was applied until the lesions showed mild erythema. RESULTS: The mean number of total treatment sessions was 17.1 (range 6-32). Among the 19 patients, 18 reached near total improvement, while one patient failed to reach near total improvement after 11 treatment sessions. The mean fluence of treatment was 2.5 J/cm(2) (range 2.0-5.0 J/cm(2) ). Five patients complained of delayed eyelid response. Post-therapy hyperpigmentation was observed in one patient. CONCLUSION: Low fluence 1064 nm Q-switched Nd:YAG laser is an effective modality for the treatment of nevus of Ota with a low incidence of side effects. It is an easy to perform treatment with low downtime.

Wound-healing effect of ginsenoside Rd from leaves of Panax ginseng via cyclic AMP-dependent protein kinase pathway.

Panax ginseng is considered as one of the most valuable medicinal herbs in traditional medicine, and ginsenoside Rd is one of the main active ingredients in P. ginseng leaf. Although there is significant number of evidences implicated on the beneficial effects of the ginsenosides with diverse associated mechanisms, reports on the skin regeneration by the ginsenoside Rd are not sufficient. Therefore, we examined the mitogenic and protective effects of the ginsenoside Rd in the keratinocyte progenitor cells (KPCs) and human dermal fibroblasts (HDFs). Furthermore, the signaling pathways involved in the activation of KPCs and HDFs were investigated, and wound-healing effect is evaluated in vivo through animal wound models. We found that the ginsenoside Rd significantly increased the proliferation and migration level of KPCs and HDFs in a dose-dependent manner. Additionally, the cell survival was significantly increased in H2O2 treated KPCs. Moreover, the ginsenoside Rd effectively induced collagen type 1 and down-regulated matrix metalloprotinase-1 (MMP-1) in a dose-dependent manner. All of these beneficial effects are associated with an induction of intracellular cAMP levels and phosphorylated cAMP response element-binding protein expression in nucleus, which both attenuated by adenine 9-ß-d-arabinofuranoside, an adenylate cyclase inhibitor. Application of the ginsenoside Rd to an excision wound in mice showed an effective healing process. As skin regeneration is mainly associated with the activation of HDFs and KPCs, P. ginseng leaf, an alternative source of the ginsenoside Rd, can be used as a natural source for skin regeneration.

Extract of Aneilema keisak inhibits transforming growth factor-ß-dependent signalling by inducing Smad2 downregulation in keloid fibroblasts.

Keloids are characterised by the excessive accumulation of extracellular matrix (ECM), especially overabundant collagen formation. In keloid fibroblasts (KFs), transforming growth factor (TGF)-ß-dependent signalling is closely associated with a variety of keloid pathologic responses such as ECM production and fibroblast overgrowth. Thus, inhibition of TGF-ß signalling would be a potential therapeutic approach to prevent keloid scar formation. Thereby, we aimed to identify a novel TGF-ß signalling blocker among natural products using a simplified screening approach. We discovered that the extract of Aneilema keisak (A.K-Ex) lowered TGF-ß-dependent signalling by reducing Smad2 protein levels. Given that KFs showed altered dependency on TGF-ß for survival and proliferation, A.K-Ex-mediated reduction in Smad2 protein levels significantly inhibited the major characteristics of KFs such as cell growth, migration and collagen synthesis, suggesting that A.K-Ex exhibits possible therapeutic activity on keloids.

The systemic effect of 830-nm LED phototherapy on the wound healing of burn injuries: A controlled study in mouse and rat models.

BACKGROUND: The present controlled study assessed the systemic effect of 830-nm LED phototherapy in rodent models. MATERIALS AND METHODS: Two HR-1 hairless mice and 3 HWY/Slc hairless rats were divided into two groups: the treatment group (Tx Group, one mouse, two rats) and the control group (Con Group, one mouse, one rat). All animals received an identical 12 mm × 12 mm control burn over three sites on the dorsum with a fractional ablative CO(2) laser. Wounds were protected with a film-type dressing. The abdomen of the Tx Group subjects was irradiated with an 830-nm LED array immediately post CO(2) treatment and then at 1, 5 and 6 days post laser irradiation. Wound healing was assessed macroscopically from the clinical photography. RESULTS: At the 2-day post-laser assessment, the healing process in the wounds in the Tx Group was already apparent compared with the Con Group. At the final evaluation (post-burn day 7), no site on the Con Group (six wounds) showed 100% healing, recovery was over 70% in four and lower than 50% in two sites. Of the nine Tx Group sites, 100% recovery was seen in three sites, over 70% in five sites and one wound was exacerbated through trauma. CONCLUSIONS: LED phototherapy on the abdomen produced faster wound healing of the uniform burn wounds than in animals with the same burn wounds that did not receive LED phototherapy, strongly suggesting the systemic effect of phototherapy.

Prevention of thyroidectomy scars in Asian adults using a 532-nm potassium titanyl phosphate laser.

BACKGROUND: Prediction of whether postoperative wound healing will result in a hypertrophic scar or keloid is difficult. Diverse treatment options have been developed in an effort to prevent excessive scar formation. OBJECTIVE: To evaluate the efficacy and safety of a 532-nm potassium titanyl phosphate (KTP) laser in the prevention of scar formation after total thyroidectomy. MATERIALS AND METHODS: Twenty-eight individuals with Fitzpatrick skin types IV and V and linear surgical suture lines after total thyroidectomy by the same surgeon were enrolled. Twenty participants were treated using a 532-nm KTP laser two times at 2-week intervals. Eight participants were assigned to the control group. The Vancouver Scar Scale (VSS), global assessment score (GAS), and participants' subjective satisfaction were used to determine the effect of scar prevention. These results were compared with those of the control group. RESULTS: The average VSS score was remarkably lower in the KTP laser treatment group. Average GASs indicated better cosmetic outcomes in the treatment group. Participant satisfaction was also higher in the treatment group. No significant side effects were observed during follow-up. CONCLUSION: A 532-nm KTP laser can be used safely and efficiently on Asian skin to reduce scar formation after thyroidectomy. The authors have indicated no significant interest with commercial supporters.

Is light-emitting diode phototherapy (LED-LLLT) really effective?

BACKGROUND: Low level light therapy (LLLT) has attracted attention in many clinical fields with a new generation of light-emitting diodes (LEDs) which can irradiate large targets. To pain control, the first main application of LLLT, have been added LED-LLLT in the accelerated healing of wounds, both traumatic and iatrogenic, inflammatory acne and the patient-driven application of skin rejuvenation. Rationale and Applications: The rationale behind LED-LLLT is underpinned by the reported efficacy of LED-LLLT at a cellular and subcellular level, particularly for the 633 nm and 830 nm wavelengths, and evidence for this is presented. Improved blood flow and neovascularization are associated with 830 nm. A large variety of cytokines, chemokines and macromolecules can be induced by LED phototherapy. Among the clinical applications, non-healing wounds can be healed through restoring the collagenesis/collagenase imbalance in such examples, and 'normal' wounds heal faster and better. Pain, including postoperative pain, postoperative edema and many types of inflammation can be significantly reduced. Experimental and clinical evidence: Some personal examples of evidence are offered by the first author, including controlled animal models demonstrating the systemic effect of 830 nm LED-LLLT on wound healing and on induced inflammation. Human patients are presented to illustrate the efficacy of LED phototherapy on treatment-resistant inflammatory disorders. CONCLUSIONS: Provided an LED phototherapy system has the correct wavelength for the target cells, delivers an appropriate power density and an adequate energy density, then it will be at least partly, if not significantly, effective. The use of LED-LLLT as an adjunct to conventional surgical or nonsurgical indications is an even more exciting prospect. LED-LLLT is here to stay.