Effect of CO2 fractional laser combined with recombinant human epidermal growth factor gel on skin barrier.

To evaluate the impact of CO2 fractional laser combined with recombinant human epidermal growth factor (rhEGF) gel on skin barrier in acne scar patients. In a retrospective analysis, we examined 105 acne scar patients admitted between July 2018 and August 2021. Of these, 51 received only CO2 fractional laser (control group), while 54 underwent a combination of CO2 fractional laser and rhEGF gel (observation group). We assessed treatment efficacy, symptom relief, skin barrier parameters, pre- and posttreatment inflammatory factors, adverse reactions, posttreatment quality of life, and patient satisfaction. The observation group exhibited a higher overall response rate, significantly shorter wound healing, scab formation, and scab detachment times. Additionally, this group showed increased stratum corneum water content, decreased pH, and transdermal water loss (TEWL), and reduced hypersensitive C-reactive protein and interleukin-6 expression posttreatment. Quality of life scores were higher, with fewer adverse reactions and greater treatment satisfaction. Combining CO2 fractional laser with rhEGF gel markedly improves acne scar treatment efficacy, enhances skin barrier function, reduces inflammation, and elevates quality of life. Its safety profile supports its broader clinical adoption.

Láser CO2 vaginal, indicaciones y aplicaciones / Vaginal CO2 laser, indications and applications

El síndrome genitourinario es una entidad hoy en día cada vez más frecuente en la mujer posmenopáusica, con signos y síntomas muy característicos que llevan a la pérdida de calidad de vida de las pacientes, generados por la disminución de estrógenos. Su diagnóstico se realiza mediante una buena historia clínica, exámenes hormonales, estudios urodinámicos y de pH vaginal. Su clínica varía desde sequedad vaginal, atrofia de la misma, vaginitis a repetición, pérdida de orina al esfuerzo, nicturia y dispareunia. A los largo de los años se han protocolizado diferentes tratamientos como reemplazos hormonales, lubricantes y cirugías invasivas vaginales. Pero en los últimos años ha aparecido una nueva terapéutica de láser CO2 fraccionado. Materiales y método. Se realizó un estudio retrospectivo de seis años de evolución, entre los años 2017 y 2023, con más de 300 pacientes tratadas con tecnología láser CO2 fraccionado, con criterios de inclusión y exclusión, protocolizando 3 sesiones cada 30 días y controles hasta los 6 meses. Resultados. Para evaluar los resultados se diseñó una encuentra de satisfacción de 5 puntos, la cual fue presentada luego de cada sesión, encontrando un alto grado de satisfacción en la mejoría clínica a medida que transcurrían las sesiones, con un muy bajo índice de complicaciones. También biopsias con mejorías histológicas que demuestran resultados. Discusión. La aplicación de esta nueva tecnología láser nos abre una posibilidad terapéutica segura, rápida y efectiva para mejorar la sintomatología y calidad de vida de nuestras pacientes con síndrome genitourinario, sumando una nueva terapéutica a todo el arsenal de tratamientos médico-quirúrgicos disponibles a la fecha. Conclusiones. El síndrome genitourinario es una entidad prácticamente inevitable, con síntomas desde leves a graves, que afecta la calidad de vida personal, sexual y social. Los tratamientos hasta la fecha hormonales, tópicos o quirúrgicos han dado mediocres resultados sin estar exentos de complicaciones, por lo que la aparición de la tecnología láser CO2 fraccionada nos ha dado el plus necesario para aportar un tratamiento seguro, eficaz, con mínimas complicaciones y una curva de aprendizaje pequeña

Genitourinary syndrome is an increasingly frequent entity in postmenopausal women today, with very characteristic signs and symptoms that lead to a loss of quality of life in patients, generated by estrogen depletion, whose diagnosis is made through a good clinical history, hormonal tests, urodynamic and vaginal pH studies. Its symptoms vary from vaginal dryness, vaginal atrophy, repeated vaginitis, loss of urine on exertion, nocturia and dyspareunia. Over the years, different treatments have been protocolized, such as hormone replacements, lubricants, and invasive vaginal surgeries. But in recent years a new fractionated CO2 laser therapy has appeared. Materials and method. A retrospective study of six years of evolution was carried out, between the years 2017 and 2023, with more than 300 patients treated with fractionated CO2 laser technology, with inclusion and exclusion criteria, protocolizing 3 sessions every 30 days and controls until the 6 months. Results. To evaluate the results, a 5-point satisfaction score was designed, which was presented after each session, finding a high degree of satisfaction in the clinical improvement as the sessions progressed with a very low indication of complications. Also biopsies with histological improvements that demonstrate results. Discussion. The application of this new laser technology opens up a safe, fast and effective therapeutic possibility to improve the symptoms and quality of life of our patients with genitourinary syndrome, adding a new therapeutic option to the arsenal of medical-surgical treatments available to date. Conclusions. Genitourinary syndrome is a practically inevitable entity, with symptoms ranging from mild to severe, affecting the quality of personal, sexual and social life. The hormonal, topical or surgical treatments to date have given mediocre results, not being free of complications, so the appearance of fractionated CO2 laser technology has given us the necessary extra to provide a safe, effective treatment, with minimal complications. and a small learning curve.

Evaluation of combining ultrapulse CO2 with fractional CO2 laser for the treatment of atrophic scars in Asians.

Various treatment modalities have been applied to atrophic scars. Fractional CO2 laser treatment has attracted increasingly more attention because of its quicker recovery time and fewer side effects. However, its limitation of sculpting the edge is an urgent shortcoming. In order to achieve a more effective result with fewer complications, we have integrated ultrapulse CO2 and fractional CO2 lasers to for the treatment of facial atrophic scars. The study included 25 patients (10 males and 15 females) diagnosed with moderate to severe atrophic scars between August 2020 and July 2022. All subjects underwent the same surgical treatment. The effects were assessed at baseline, 1 week, 1 month, and 3 months using photographic evidence. Objective evaluation of the results was conducted using a quartile grading scale, while the subjects' satisfaction and any adverse events were also recorded. The patients in the study underwent more than two laser sessions (2-5), resulting in substantial improvement in their appearance. The time interval between each session was 3-6 months. The majority of the patients (19/25, 76%) had a significant or even excellent improvement. Any adverse events observed, such as erythema, superficial crusting, and PIH, were of a mild nature and temporary in duration. This treatment combined two CO2 lasers is an effective and safe choice for atrophic scars in Asians.

Early intervention of carbon dioxide fractional laser in hypertrophic scar through TGFß-1/ Smad3 signaling pathway.

Hypertrophic scars are usually the result of surgical trauma or burn,and more common in individuals with a darker skin color. They appear as red and raised lesions around the wound that continually expand over a period of weeks or months, causing itching, pain, burning sensation and discomfort. Severe scarring affects interpersonal and social relationships, and decreases the quality of life of the patients.The aim of this study was to evaluate the effect of carbon dioxide fractional laser as an early intervention against hypertrophic scars using a rabbit ear scar model, and explore the role of the TGFß-1/ Smad3 signaling pathway in scar hyperplasia. Four wounds were made into each ear of rabbits, and divided into the untreated control and three laser-treatment groups. The experimental groups received laser intervention once, twice and thrice respectively. laser treatment significantly inhibited the formation of hypertrophic scars, and maximum benefits were seen in the wounds that received three laser treatments. Immunohistochemical staining showed that the in situ expression of TGFß-1 and Smad3 in the scars decreased by varying degrees after laser intervention, and was most obvious after three laser interventions. Furthermore, the expression levels were the lowest at the end of 6 months after modeling. Therefore, we can assume that early intervention with carbon dioxide fractional laser can prevent formation of hypertrophic scars by regulating the TGF-ß1/Smad3 pathway.

Fractional CO2 Laser for Vulvar Tissue Rejuvenation: A Prospective Study.

Objective: Aging and changes in hormone levels influence the appearance of the vulva, including the texture, pigmentation, and other manifestations, all of which may largely affect the physical and mental health of women. This study aimed to evaluate the efficacy and safety of fractional carbon dioxide (CO2) laser treatment for vulvar rejuvenation in Chinese women. Background: The limited options currently available for vulvar rejuvenation raise concerns. There is insufficient evidence to determine whether the fractional CO2 laser can safely and effectively rejuvenate the vulvar area for women of various ages and races. Methods: The study included 17 patients (mean age = 36.4 years) treated three times by continuous fractional CO2 laser with an interval of 1 month between each session. The primary outcomes were changes in vulva texture and pigmentation. Treatment was evaluated using images of the patients. Baseline and posttreatment images were collected and evaluated using a scoring system from 0 to 3 to grade the vulvar texture and pigmentation changes. In addition, patients rated their degree of vaginal rejuvenation after the treatment using a scoring system from 0 to 3. Results: Fractional CO2 laser treatment effectively and significantly increased vulvar texture and decreased vulvar pigmentation after three sessions (p < 0.05). Patients also self-reported noticeable improvement. There were no adverse reactions during the treatment and follow-up. Conclusions: Fractional CO2 laser treatment is a safe and effective method for vulvar rejuvenation in women.

Fractional CO2 laser for genitourinary syndrome of menopause: evaluating the evidence.

The fractionated CO2 laser has been marketed to women for a variety of gynecologic symptoms and conditions, including the genitourinary syndrome of menopause (GSM). The evidence has been limited, precluding conclusions regarding the efficacy and safety of the therapy. However, data from randomized, controlled trials evaluating this technology for GSM are now available. This Practice Pearl addresses the latest data concerning the use of the fractionated CO2 laser for the treatment of GSM.

Clinical efficacy of CO2 fractional laser in treating post-burn hypertrophic scars in children: A meta-analysis: CO2 fractional laser in treating post-burn hypertrophic scars in children.

OBJECTIVE: To evaluate and explore the efficacy of CO2 fractional laser in treating post-burn hypertrophic scars in children through Meta-analysis. METHODS: English databases (PubMed, Web of Science and The National Library of Medicine), as well as Chinese databases (China National Knowledge Infrastructure and Wanfang Data) were searched. RevMan 5.3 software was used to data analysis. RESULTS: A total of 10 pieces of literature were included, involving 413 children. Meta-analysis showed that: (1) The average Vancouver Scar Scale after surgery was significantly lower than that before surgery [weight mean difference (WMD) = -3.56, 95% confidence interval (CI):-4.53,-2.58, p < 0.001]; (2) After CO2 fractional laser, pigmentation [WMD = -0.74, 95% CI:-1.10,-0.38, p < 0.001], pliability [WMD = -0.92, 95% CI:-1.20,-0.65, p < 0.001], vascularity [WMD = -0.77, 95% CI:-1.09,-0.46, p < 0.001], height [WMD = -0.57, 95% CI:-0.95,-0.19, p < 0.001] were improved compared with those before surgery. (3) The average Visual Analogue Scale (VAS) after surgery was significantly lower than that before surgery [WMD = -3.94, 95% CI:-5.69,-2.22, p < 0.001]. (4) Both Patient and Observer Scar Assessment Scale (POSAS)-Observer [WMD = -3.98, 95% CI:-8.44,0.47, p < 0.001] and POSAS-Patient [WMD = -4.98, 95% CI:-8.09,-1.87, p < 0.001] were significantly lower than those before surgery. (5) Erythema and vesicles were the most common complications after CO2 fractional laser therapy, with an incidence of 4.09%. CONCLUSION: CO2 fractional laser is beneficial to the recovery of hypertrophic scar after burn in children, and can effectively improve the scar symptoms and signs in children, with desirable clinical efficacy.

Different effects of CO2 laser and estrogen treatment on vaginal mucosa microbiota and function in genitourinary syndrome of menopause patients.

AIM: To characterize the effects of CO2 laser treatment and estrogen treatment on vaginal microbiota in patients with genitourinary syndrome of menopause (GSM). METHODS: Sixty-four patients with genitourinary syndrome were divided into the estrogen group, the CO2 laser group, and the control group. The control group did not receive any treatment. Vaginal mucosa was collected after 3 and 12 months of treatment. The former was used for 16S rRNA sequencing, and the latter was used for pathological evaluation. Vaginal health and voiding function were assessed using the vaginal health index (VHI) scale and the UDI-6 scale at 3 and 12 months after treatment. RESULTS: The results showed that both treatments reduced alpha diversity in the vaginal flora. Additionally, the abundance of 65 genera differed significantly between the treatment and control groups, with an increase in potentially beneficial bacteria such as Lactobacillus, IheB3_7, Mycoplasma urealyticum, and Streptococcus. In addition, the VHI and UDI-6 scores improved in both treatment groups compared to the control group after 3 months. Whereas VHI and UDI-6 scores were close to baseline in the estrogen group, and remained significantly improved in the CO2 laser group after 12 months. Pathological results showed that both methods improved the vaginal health status of patients with GSM after 12 months of treatment. However, the CO2 group exhibited a more significant increase in type III collagen. CONCLUSIONS: Both CO2 laser and estrogen therapies can regulate the vaginal flora imbalance of GSM and improve the corresponding symptoms. However, the long-term efficacy of CO2 laser therapy is superior compared to estrogen therapy.

Impact of ultra-pulse carbon dioxide laser on the treatment of chronic refractory ulcer with bone exposure.

BACKGROUND: Chronic refractory ulcers with bone exposure present significant challenges in wound management and necessitate effective treatment strategies to facilitate healing and alleviate patient discomfort. This study aimed to investigate the impact of ultra-pulse carbon dioxide laser on treating chronic refractory ulcers with bone exposure. METHODS: This retrospective observational study enrolled patients diagnosed with chronic refractory ulcers with bone exposure admitted to the wound repair clinic of the Affiliated Hospital of Southwest Medical University between July 2018 and July 2019. RESULTS: A total of 64 patients with chronic refractory ulcers and bone exposure were included, of which 32 patients underwent ultra-pulse carbon dioxide laser drilling. Compared with patients who did not receive ultra-pulse carbon dioxide laser treatment, those who experienced the procedure demonstrated significantly higher wound healing rates on the fourth, eighth, 12th, 16th, and 20th days after treatment (all P < .001), lower scores on the visual analog scale for pain after 20 days of debridement (0.24 ± 0.05 vs 0.58 ± 0.12, P < .001), lower granulation color observation scores on the 12th, 16th, and 20th days (all P = .001), as well as reduced treatment costs (8200 ± 1600 yuan vs 15400 ± 3800 yuan, P < .001). CONCLUSION: Ultra-pulse carbon dioxide laser treatment may enhance the growth of granulation tissue, improve wound healing rates, reduce pain, and lower treatment costs for patients with chronic bone exposure wounds compared to those without such treatment.

A triple combination of latanoprost, fractional CO2 laser, and platelet-rich plasma in localized vitiligo: A clinical and histopathologic study.

BACKGROUND: Several treatment modalities are available for the treatment of vitiligo due to the lack of a uniformly effective therapy. Topical latanoprost 0.005% is an effective topical treatment. Fractional CO2 laser alone or combined with platelet-rich plasma (PRP) has been proposed as effective adjunctive therapies. OBJECTIVES: We aimed to compare the efficacy of topical latanoprost 0.005% (Ioprost®, Orchidia, Egypt) combined with either add-on fractional CO2 laser or fractional CO2 -PRP versus topical latanoprost monotherapy in the treatment of localized stable vitiligo. PATIENTS/METHODS: The study included 60 patients randomly assigned into three equal groups. Group A patients received topical latanoprost drops only. Group B patients received topical latanoprost drops and fractional CO2 laser sessions at 2-week interval for 3 months. Group C patients received topical latanoprost drops and fractional CO2 laser sessions combined with PRP at a 2-week interval for 3 months. The mean improvement score by the physician was calculated 4 months after the start of the study. Punch skin biopsies were obtained before treatment and 4 months from the beginning of the study and stained with H&E and HMB-45 antibody for evaluation of pigmentation. RESULTS: Significant clinical improvement of vitiligo lesions with significant increase of re-pigmentation were reported in the three treated groups. Latanoprost in combination with fractional CO2 and PRP was associated with more significant therapeutic outcomes than either combined latanoprost and fractional CO2 or latanoprost alone. CONCLUSION: Fractional CO2 laser-PRP enhances the therapeutic efficacy of latanoprost 0.005% in the treatment of localized stable vitiligo.

Efficacy and safety of fractional carbon dioxide laser followed by 5-aminolevulinic acid photodynamic therapy for keloids.

BACKGROUND: Keloids are aggressive fibroproliferative disorders that cause aesthetic and functional damage. Photodynamic therapy (PDT) has shown promise as a novel treatment for keloids. However, the limited penetration of 5-aminolevulinic acid (ALA) and unsatisfactory outcomes in dense scars hinder its effectiveness as a monotherapy. The objective of this study is to assess the efficacy and safety of fractional CO2 laser followed by 5-ALA PDT for keloids. METHODS: A total of 12 patients with keloid were included in our study. Each lesion was pretreated by fractional CO2 laser with 26-28 W to create microthermal zones. After topical application of 5-ALA solution, an irradiation of 635 nm red light with 120 J/cm2 was performed. The treatment was repeated at least every 2 weeks. Efficacy and safety were evaluated using the Vancouver Scar Scale (VSS), the Visual Analogue Scale (VAS) for keloid-related symptoms and documentation of postoperative complications. Statistical analysis was performed to compare VSS and keloid-related symptom VAS scores of the baseline and final treatment sessions. RESULTS: The final treatment resulted in a statistically significant decrease in all parameters of VSS and VAS for pruritus and pain compared to the baseline. Except for postoperative hyperpigmentation, no infections, scar aggravation, or recurrence were observed during at least 6 months of follow-up. Overall, patients expressed a high level of satisfaction with the treatment outcome. CONCLUSIONS: Fractional CO2 laser followed by 5-ALA PDT is a promising method for treating keloids. However, its synergetic effects need to be validated through clinical trials involving larger patient cohorts.

Photodynamic therapy combined with CO2 laser for the treatment of seborrheic keratosis in the auricle: A case report.

Seborrheic keratosis(SK) is a very common skin tumor which is mostly frequently observed in the trunck, head, neck. SK in the auricle is rare and this condition should be excluded the possibility of malignancy by pathologic diagnosis. We report a case of 66-year-old man who presented with a brownish, papillomatous, verrucous mass in the auricle for the past seven years, which began to growing faster during the previous year. Dermoscopy and histopathological examination were performed and the patient was diagnosed with SK. He was treated with the carbon dioxide(CO2) laser and aminolevulinate photodynamic therapy (ALA-PDT). The CO2 laser was used for the removal of the thick hypertrophic lesions and to enhance the transdermal absorption efficiency of ALA. A 20% ALA cream(118 mg/cm2) was applied to his lesion and sealed for 3 h without light, followed by irradiation with 630-nm LED light (96 J/cm2, 80 mw/cm2). We use fluorescent diagnosis with aminolevulinic acid to define the tumor margins at the first session of ALA-PDT. After 4 sessions of ALA-PDT, the lesion was completely removed and did not recur. Therefore, we consider that ALA-PDT combined with CO2 laser is a safe and effective choice for the treatment of seborrheic keratosis in the auricle.

Novel 40 µm spot size 3050/3200 nm DFG laser versus CO2 laser for laser-assisted drug delivery.

BACKGROUND AND OBJECTIVES: The use of ablative fractional lasers to enhance the delivery of topical drugs through the skin is known as laser-assisted drug delivery. Here, we compare a novel 3050/3200 nm difference frequency generation (DFG) fiber laser (spot size: 40 µm) to a commercially used CO2 laser (spot size: 120 µm). The objective is to determine whether differences in spot size and coagulation zone (CZ) thickness influence drug uptake. MATERIALS AND METHODS: Fractional ablation was performed on ex-vivo human abdominal skin with the DFG (5 mJ) and CO2 (12 mJ) lasers to generate 680 µm deep lesions. To evaluate drug delivery, 30 kDa encapsulated fluorescent dye was topically applied to the skin and histologically analyzed at skin depths of 100, 140, 200, 400, and 600 µm. Additionally, transcutaneous permeation of encapsulated and 350 Da nonencapsulated dye was assessed using Franz Cells. RESULTS: The DFG laser generated smaller channels (diameter: 56.5 µm) with thinner CZs (thickness: 22.4 µm) than the CO2 laser (diameter: 75.9 µm, thickness: 66.8 µm). The DFG laser treated group exhibited significantly higher encapsulated dye total fluorescence intensities after 3 h compared to the CO2 laser treated group across all skin depths (p < 0.001). Permeation of nonencapsulated dye was also higher in the DFG laser treated group vs the CO2 laser treated group after 48 h (p < 0.0001), while encapsulated dye was not detected in any group. CONCLUSION: The DFG laser treated skin exhibited significantly higher total fluorescence uptake compared to the CO2 laser. Additionally, the smaller spot size and thinner CZ of the DFG laser could result in faster wound healing and reduced adverse effects while delivering similar or greater amount of topically applied drugs.

A focused review on laser- and energy-assisted drug delivery for nail disorders.

The purpose of this review is to consolidate and summarize laser-assisted drug delivery (LADD) for nail diseases, particularly onychomycosis and psoriasis. A PubMed search was conducted in June 2023 using search terms (1) "laser assisted drug delivery" AND "nail," (2) "laser" AND "nail," and (3) "nail disorder" AND "laser treatment." References of papers were also reviewed, yielding 15 papers for this review. Fractional ablative CO2 laser (FACL) and Er:YAG laser can be used for LADD of topical medications such as amorolfine, terbinafine, and tioconazole to treat onychomycosis. A fungal culture should be performed to determine the type of dermatophyte, which will help determine which topical will be most effective. Laser settings varied between studies, but overall LADD tended to be more effective than topical treatments alone. Laser-assisted photodynamic therapy (PDT) was also found to be effective in treating onychomycosis. For psoriatic nails, LADD was used to deliver calcipotriol-betamethasone dipropionate foam, tazarotene, triamcinolone, or methotrexate into the nail. Again, LADD was found to be significantly more effective than topical treatment alone. FACL was the only laser noted for use for LADD in both diseases. Laser-assisted drug delivery for nail disease is a newer approach for onychomycosis and nail psoriasis with several benefits and drawbacks. Dermatologists should discuss the option of LADD with their patients who have recalcitrant onychomycosis or nail psoriasis.

[Treatment of therapy-resistant verruca plantaris with laser-assisted photodynamic therapy (PDT) with methyl aminolevulinate (MAL)]. / Therapie von behandlungsresistenten Mosaikwarzen mittels laserassistierter photodynamischer Therapie (PDT) mit Methylaminolävulinat (MAL).

Mosaic warts are a type of verruca vulgaris that occur almost exclusively on the soles of the feet. They are particularly known for their treatment resistance and high recurrence rate. Laser-assisted drug delivery (LADD) photodynamic therapy (PDT) with methyl aminolevulinate (MAL) offers a low pain treatment option with hardly any side effects in therapy-resistant cases of verruca plantaris. Pretreatment with an ablative fractional laser is especially important to obtain penetration of MAL through the human papillomavirus (HPV)-infected skin layer.

Impact of skin hydration on patterns of microthermal injury produced by fractional CO2 laser.

OBJECTIVES: The impact of skin hydration on patterns of thermal injury produced by ablative fractional lasers (AFLs) is insufficiently examined under standardized conditions. Using skin with three different hydration levels, this study assessed the effect of hydration status on microchannel dimensions generated by a fractional CO2 laser. METHODS: A hydration model (hyperhydrated-, dehydrated- and control) was established in ex vivo porcine skin, validated by changes in surface conductance and sample mass. After, samples underwent AFL exposure using a CO2 laser (10,600 nm) at two examined pulse energies (10 and 30 mJ/mb, fixed 10% density, six repetitions per group). Histological assessment of distinct microchannels (n = 60) determined three standardized endpoints in H&E sections: (1) depth of microthermal treatment zones (MTZs), (2) depth of microscopic ablation zones (MAZs), and (3) coagulation zone (CZ) thickness. As a supplemental in vivo assessment, the same laser settings were applied to hyperhydrated- (7-h occlusion) and normohydrated forearm skin (no pretreatment) of a human volunteer. Blinded measurement of MAZ depth (n = 30) was performed using noninvasive optical coherence tomography (OCT). RESULTS: Modest differences in microchannel dimensions were shown between hyperhydrated, dehydrated and control skin at both high and low pulse energy. Compared to controls, hyperhydration led to median reductions in MTZ and MAZ depth ranging from 5% to 8% (control vs. hyperhydrated at 30 mJ/mb; 848 vs. 797 µm (p < 0.003) (MAZ); 928 vs. 856 µm (p < 0.003) (MTZ)), while 14%-16% reductions were shown in dehydrated skin (control vs. dehydrated at 30 mJ/mb; MAZ: 848 vs. 727 µm (p < 0.003); MTZ: 928 vs. 782 µm (p < 0.003)). The impact of skin hydration on CZ thickness was in contrast limited. Corresponding with ex vivo findings, hyperhydration was similarly associated with lower ablative depth in vivo skin. Thus, median MAZ depth in hydrated skin was 10% and 14% lower than in control areas at 10 and 30 mJ/mb pulse energy, respectively (10 mJ: 210 vs. 180 µm (p < 0.001); 30 mJ: 335 vs. 300 µm (p < 0.001)). CONCLUSION: Skin hydration status can exert a minimal impact on patterns of microthermal injury produced by fractional CO2 lasers, although the clinical implication in the context of laser therapy requires further study.

Fractional ablative CO2 laser and oral isotretinoin-A prospective randomized controlled split-face trial comparing concurrent versus delayed laser treatment for acne scars.

BACKGROUND: Therapeutic dogma has been to treat acne scars with ablative fractional laser no less than 6 months after isotretinoin (ITN) cessation. OBJECTIVE: To evaluate the safety and efficacy of fractional ablative CO2 laser (FACL) in patients treated concurrently with ITN. METHODS: We conducted a prospective split-face randomized control trial in patients treated with FACL concurrently with ITN versus patients treated with FACL 6 months post-ITN treatment. Patients received 3 monthly sessions of FACL with concurrent ITN treatment on half of the face; the other side of the face received the same FACL treatment regimen 6 months post-ITN cessation. Patients were followed for adverse effects up to 6 months post-FACL treatment. Final cosmesis was scored using the Quantitative Global Acne Scarring Grading System (GASGS) by three independent dermatologists. RESULTS: The GASGS of the concurrent ITN-FACL treated side of the face was significantly lower than the side treated with delayed laser therapy (4.7 ± 2.5 vs. 7.7 ± 2.9, respectively, p < 0.001). LIMITATIONS: The laser's settings were standardized, and not adjusted per patient skin type. CONCLUSION: Per our prospective trial, concurrent treatment of FACL -ITN is superior to delayed FACL treatment 6 months post-ITN cessation. Fractional ablative laser treatment is effective in improving acne scars, which persist despite isotretinoin therapy.

3D-4K Exoscope-Assisted CO2 Laser Supraglottoplasty for Severe Laryngomalacia in a Pediatric Patient.

Laryngomalacia is the most frequent congenital laryngeal anomaly. Surgery is possible by means of cold knife, carbon dioxide (CO2 ) laser, microdebrider and coblation, traditionally under microscopic view. We here describe the use of the 3D-4K exoscope assisted CO2 laser supraglottoplasty in tubeless general anesthesia in spontaneous breathing in a 5 month-old patient with severe laryngomalacia. Laryngoscope, 134:1359-1362, 2024.