Flash-lamp pulsed-dye laser treatment of keloids: results of an observational study.

OBJECTIVE: Flash lamp pulsed dye laser (FPDL) was used in a selected group of patients with hypertrophic scars and keloids. Objective of the study was to assess the efficacy on a large number of cases. BACKGROUND DATA: FPDL is a nonablative technology, typically used in vascular malformation therapy because of its specificity for hemoglobin. METHODS: A total of 59 patients (33 males and 26 females, mean age 37.5 years) affected by hypertrophic postsurgical scars and keloids, underwent from four to six treatment sessions with a flash lamp pumped pulsed dye laser. Clinical follow-up was performed 6 months after the last treatment. Results were judged by blind observers. RESULTS: A total of 29 patients out of 59 (49.1%) achieved excellent clearance, 15 patients (25.4%) achieved good to moderate clearance, and 12 patients (20.4%) obtained slight improvement. Only three subjects (5%) had little or no removal of their lesion. Treatment was well tolerated with minor and transient side effects. CONCLUSIONS: FPDL is known as a safe and effective treatment for different dermatological lesions in which skin microvessels play a key role in pathogenesis or development. This laser was effective when applied to hypertrophic scars and keloids. Further studies in a larger set of patients, however, are required to assess a standardized and reproducible method for treating these lesions.

Deep pulse fractional CO2 laser combined with a radiofrequency system: results of a case series.

OBJECTIVE: The purpose of this study was evaluation of the safety and efficacy of this new combined technology that adds deep ablation to thermal stimulation. BACKGROUND DATA: Minimally ablative or subablative lasers, such as fractional CO2 lasers, have been developed in an attempt to achieve the same clinical results observed with traditional ablative lasers, but with fewer side effects. Despite being an ablative laser, the system used in this study is able to produce a fractional supply of the beam of light. Fractional ablation of skin is performed through the development of microscopic vertical columns surrounded by spared areas of epidermis and dermis, ensuring rapid wound healing and minimum down time. Simultaneous synchronized delivery of a radiofrequency (RF) current to the deeper layers of the skin completes the therapeutic scenario, ensuring an effective skin tightening effect over the entire treated area. METHODS: Nine adult patients were treated for wrinkles and acne scars using this new laser technology. An independent observer evaluated the improvement using a five point scale. RESULTS: All patients had good results in terms of improvement of skin texture, with mild and transitory side effects. CONCLUSIONS: This novel combined system produced improvement in wrinkles and acne scars, with progressive enhancement of skin tone and elasticity.

In vivo non-invasive monitoring of collagen remodelling by two-photon microscopy after micro-ablative fractional laser resurfacing.

Non-linear optical microscopy is becoming popular as a non-invasive in vivo imaging modality in dermatology. In this study, combined TPF and SHG microscopy were used to monitor collagen remodelling in vivo after micro-ablative fractional laser resurfacing. Papillary dermis of living subjects, covering a wide age range, was imaged immediately before and forty days after treatment. A qualitative visual examination of acquired images demonstrated an age-dependent remodelling effect on collagen. Additional quantitative analysis of new collagen production was performed by means of two image analysis methods. A higher increase in SHG to TPF ratio, corresponding to a stronger treatment effectiveness, was found in older subjects, whereas the effect was found to be negligible in young, and minimal in middle age subjects. Analysis of collagen images also showed a dependence of the treatment effectiveness with age but with controversial results. While the diagnostic potential of in vivo multiphoton microscopy has already been demonstrated for skin cancer and other skin diseases, here we first successfully explore its potential use for a non-invasive follow-up of a laser-based treatment.