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BACKGROUND The authors previously reported the safety and short-term efficacy of ablative fractional laser (AFXL)-assisted delivery of topical fluorouracil in the treatment of superficial basal cell carcinoma (sBCC) and squamous cell carcinoma in situ (SCCis). OBJECTIVE This follow-up study was conducted to assess whether tumor clearance was sustained in this cohort of patients at >9 months post-treatment. METHODS Thirty primary sBCC or SCCis <2 cm on the trunk or extremities were treated with AFXL and a single application of topical 5-fluorouracil 5% under occlusion for 7 days. Among the 26 patients who achieved tumor clearance at 4 to 8 weeks post-treatment, 20 patients presented for this follow-up study and underwent shave biopsy to confirm histologic clearance. Mean follow-up time was 15 months. RESULTS Considering those who had persistent tumor at 4 to 8 weeks post-treatment and those who presented for follow-up at >9 months post-treatment, overall treatment success was 79% (95% confidence interval: 67%-96%), with 92% (11/12) for SCCis and 67% (8/12) for sBCC. Neither the tumor location nor size significantly impacted treatment outcome (p = .96 and 0.87, respectively). CONCLUSION Ablative fractional laser-assisted topical fluorouracil is a reasonable noninvasive treatment option for primary SCCis and sBCC, especially for lesions located in areas where self-application is not possible, or when clinician-administered therapy is preferred. [ABSTRACT FROM AUTHOR]

BACKGROUND Although ablative fractional laser is the gold standard for acne scars, evidence is still lacking for other types of scars. OBJECTIVE To evaluate the efficacy and safety of the ablative fractional 10,600-nm CO2 laser in the treatment of various scar types. MATERIALS AND METHODS The authors performed an intraindividual single-blinded randomized controlled split-lesion trial. Adult patients received 3 laser treatments at 8-week intervals for scars existing at least 1 year. Primary end points were the Physician Global Assessment (PhGA) and the assessment of adverse effects. RESULTS Twenty-five consecutive patients with atrophic (52%) or hypertrophic (48%) scars located mainly on the body (84%) were included in the study. At 6-month follow-up of 21 patients, the PhGA showed no statistically significant difference between the treated and untreated side of the scar (p = .70). Persistent erythema, postinflammatory pigmentary changes, and scarring after ulceration (n = 3) were observed as side effects. CONCLUSION In this trial involving various types of scars, the efficacy of ablative fractional CO2 laser could not be confirmed. The authors presume that different types of scars have a different response to treatment. Future studies should aim to identify the type of scars that may benefit from ablative fractional laser therapy. [ABSTRACT FROM AUTHOR]

BACKGROUND Microfocused ultrasound (MFU) and ablative fractionated laser (AFL) resurfacing techniques have been used separately to noninvasively improve skin laxity and rhytides on the face and neck. Simultaneous combination treatment would be anticipated to provide further improvement but has not previously studied. METHODS A retrospective analysis of 100 combination face and neck treatments from 3 centers was performed, including collective treatment protocols, postoperative recovery, side effect profile, and clinical results. RESULTS Skin laxity and photodamage (rhytides and texture) showed significant improvement with combination MFU + AFL treatment. Except for increased facial swelling in a small percentage of patients, postoperative recovery and side effects were comparable with those obtained after application of individual treatments. CONCLUSION Combination MFU–AFL on the face and neck is a safe and effective method for targeting multiple facets of facial and neck skin aging and can be safely performed in a single treatment session. [ABSTRACT FROM AUTHOR]

BACKGROUND With patients more resistant to invasive treatments and those that result in significant downtime, there has been a rise in using lasers to improve skin laxity and induce tissue tightening as an alternative to surgery. Traditional and fractional ablative resurfacing induces skin tightening through precise dermal heating and a wound-healing effect. OBJECTIVE The purpose of this review was to discuss the mechanism of action of using ablative lasers to induce skin tightening and compare traditional versus fractional technologies. MATERIALS AND METHODS A review of the literature was performed. RESULTS The authors discuss traditional and fractional ablative lasers for achieving skin tightening. CONCLUSION Neocollagenesis and dermal remodeling seen after ablative resurfacing contributes to the clinical improvement seen in tissue tightening. Fractional photothermolysis may enhance tissue tightening effects of ablative lasers because of its ability to ablate deeper into the reticular dermis without significant risk for scarring. [ABSTRACT FROM AUTHOR]

Background The effective delivery of therapeutic molecules to varied targets in the skin and elsewhere has been an area of ongoing research and development. Objective To review the structure of the skin with an emphasis on topical drug delivery and to present the rationale for the use of ablative and nonablative fractional resurfacing in assisted drug delivery. Methods and Materials Review of the currently available scientific literature on laser-assisted drug delivery. Results A number of strategies can be employed to enhance topical drug delivery. Ablative fractional resurfacing ( AFR) has been demonstrated to be effective in enhancing drug delivery. Further studies are needed to assess the use of nonablative fractional resurfacing in assisted drug delivery. Conclusion AFR-assisted drug delivery is a promising tool for the future of dermatology. We expect to see a number of agents to be paired with AFR for enhanced drug delivery. Further investigation is necessary to evaluate appropriate drug specific channel density and depth parameters. Factors that must be considered include the physicochemical properties of the drug, the target tissue, skin wounding, and cost when evaluating the drugs and conditions that will most benefit from this promising new drug delivery system. [ABSTRACT FROM AUTHOR]

BACKGROUND Ablative resurfacing lasers are effective for treatment of acne scars, but they have a high risk of complications. Fractional lasers have less severe side effects but more moderate efficacy than ablative devices. Studies were performed in individuals with Fitzpatrick skin type I to VI. OBJECTIVE To determine the efficacy and safety of an erbium 1,550-nm fractional laser in the treatment of facial acne scars in Fitzpatrick skin types IV to VI. METHODS We conducted a prospective, single-blind, randomized trial in patients with acne scars ( n=15), skin type IV to VI, with a 1,550-nm erbium fractionated laser. Patients were divided into two groups; one was treated with 10 mJ and the other with 40 mJ. Five monthly laser sessions were performed. A patient questionnaire was distributed. RESULTS There was a significant improvement in the acne scarring and overall appearance ( p<.001). No significant difference was found between 10 and 40 mJ. Patients were highly satisfied with their results. Significant postinflammatory hyperpigmentation was seen; pain was significantly higher in darker skin. CONCLUSIONS Fractional photothermolysis is effective for the treatment of acne scars, but practition-ers should be aware of the higher incidence of pain and postinflammatory hyperpigmentation in individuals with skin types IV to VI. The study was funded by Reliant Technologies, Inc., which participated in the study design. Galderma (Ft. Worth, TX) provided Tri-luma cream and GlaxoSmithKline (Research Triangle Park, NC) provided valacyclovir (Valtrex). [ABSTRACT FROM AUTHOR]

BACKGROUND The treatment standard for laser skin resurfacing (LSR) includes aggressively wiping away the char with moist gauze before and after each pass to prevent heat buildup and lateral tissue damage from existing char. No published study has addressed not debriding between passes with traditional higher fluence, high-density, multipass CO2 LSR in humans. PURPOSE The objective was to disprove the dogma that wiping away the laser char between treatment passes is necessary. MATERIALS AND METHODS A total of 158 patients were treated over a 23-month period with multipass, nondebrided CO2 laser resurfacing (6 J/cm2, density 6). A small series of split-face studies were performed by debriding one side and not debriding the other side after each pass, and 89 full-face patients were treated without debriding any char between two or three passes. Histologic and photographic studies were performed in selected patients to determine the differences between debrided and nondebrided techniques. RESULTS None of the nondebrided patients experienced significant complications. Operative times were shortened as was postlaser pain and erythema. CONCLUSION Histologic analysis showed that three passes of 6 J/cm2 with a density of 6 produces extremely similar epidermal and dermal changes regardless of debriding between passes or not. This is the first study in humans using high-energy, high-density, multipass LSR without debriding between passes. [ABSTRACT FROM AUTHOR]

The author discusses the microarray studies on the early effects of ablative fractional carbon dioxide laser treatment on human skin. He states that the growth of the number of research conducted on the molecular mechanisms underlying ablative fractional resurfacing is due to the difficulty in achieving successive patient follow-up before an elective procedure. The significance of taking notice of the laboratory changes in the patients for astute physicians is also tackled.

The authors have indicated no significant interest with commercial supporters. [ABSTRACT FROM AUTHOR]

Sorin Eremia, MD, has indicated no significant interest with commercial supporters. [ABSTRACT FROM AUTHOR]

Dr. Dover has received funds for research from Solta, Lumenis, and Cutera and is a consultant to Solta and Lumenis. [ABSTRACT FROM AUTHOR]