Lasers in Surgery and Medicine最新文献

Objectives: To evaluate the effectiveness of laser therapy, such as non-ablative fractional laser and pulse-dye laser therapy in reducing scar hypertrophy and erythema in patients with healed pyoderma gangrenosum lesions following successful control of systemic inflammation.

Materials and methods: A retrospective case series was conducted of six female patients who underwent non-ablative and pulse-dye laser therapy to treat scarring secondary to healed pyoderma gangrenosum lesions. Treatment courses varied by patient and are detailed in the full case descriptions. Clinical photographs and chart documentation were retrospectively reviewed to assess patient outcomes. The authors obtained written consent from patients for their photographs and medical information to be published in print and online, and with the understanding that this information may be publicly available.

Results: All six patients demonstrated visible improvement in scar appearance, such as hypertrophy and erythema, documented by clinical examination and serial photography. Although no standardized assessment scales were applied, all patients reported subjective improvement in pain, texture, or appearance. No disease recurrence or signs of pathergy were observed following treatment.

Conclusion: This case series highlights the potential utility of non-ablative fractional laser and pulse-dye laser therapy to improve scar hypertrophy, pain, erythema, and appearance in healed pyoderma gangrenosum lesions. When initiated after systemic inflammatory disease is adequately controlled, the risk of pathergy appears minimized. Although larger studies are needed, this series highlights a promising approach to scar reduction in pyoderma gangrenosum.

Importance: Acquired digital arteriovenous malformations (ADAVMs) are rare vascular anomalies traditionally managed with surgery, which may lead to morbidity, recurrence, and functional impairment. Evidence regarding laser therapy-historically considered contraindicated in arteriovenous malformations-is extremely limited, and no large cohort has been reported to date.

Objectives: To report the largest cohort of ADAVMs treated with laser therapy and to determine whether dual sequential pulsed dye (595 nm) and Nd:YAG (1064 nm) laser therapy is an effective and safe alternative to surgery for Schöbinger stage I ADAVMs.

Methods: A retrospective case series (2010-2025) including 26 patients with ADAVMs was conducted. Schöbinger stage I lesions were treated using dual sequential 595-nm pulsed dye and 1064-nm Nd:YAG laser (Multiplex mode). Clinical characteristics, treatment parameters, outcomes, and satisfaction were analyzed.

Results: Laser therapy achieved complete lesion clearance after a mean of 1.5 sessions, with a median clinical improvement of 100% and no recurrences over a median follow-up of 85.5 months. Three patients with previous surgical failure also achieved full resolution. No bleeding episodes, adverse effects, or procedural complications were observed. The most commonly used parameters included a 7-mm spot size, 595 nm PDL at 6-8 J/cm² and 10 ms, followed by 1064 nm Nd:YAG at 70-100 J/cm² and 15 ms.

Conclusions and relevance: Dual sequential PDL/Nd:YAG laser therapy appears to be a highly effective, safe, and minimally invasive alternative to surgery for Schöbinger stage I ADAVMs, supporting its potential role as a first-line therapeutic option.

Background and objective: Oral isotretinoin is the standard therapy for severe acne. However, scarring may persist. Fractional microneedling radiofrequency (FMRF) improves both inflammatory lesions and scars with minimal downtime. In this study, we compare isotretinoin monotherapy and concurrent isotretinoin and FMRF for active acne regarding clinical outcomes.

Methods: In this parallel two-group comparative study, patients received either low-dose isotretinoin monotherapy for 20 weeks (n = 34) or low-dose isotretinoin concurrently with 5 monthly FMRF sessions (n = 36). Outcomes were assessed at baseline and weeks 12, 20, 24, 32, and 44. The primary endpoints were Global Acne Grading System (GAGS) scores and inflammatory/non-inflammatory lesion counts. Secondary endpoints were hemoglobin indices and skin roughness.

Results: The GAGS scores of isotretinoin and FMRF were significantly lower than those of isotretinoin monotherapy from weeks 12-44 (-79.69% vs. -60.34% at week 44, respectively; p < 0.001). Isotretinoin and FMRF showed significantly greater lesion count reductions than isotretinoin monotherapy at follow-up visits from weeks 12-44. Isotretinoin and FMRF showed significantly lower hemoglobin levels than isotretinoin monotherapy at weeks 32 and 44 (p = 0.029 and p < 0.001, respectively). Skin surface roughness improved substantially and persistently from week 12-44.

Conclusions: Early active treatment with isotretinoin and FMRF is safe and better than isotretinoin monotherapy over 44 weeks regarding severity, reduced erythema, and improved surface roughness in moderate-to-severe acne vulgaris. This encourages early and effective treatment of acne to mitigate acne scarring and improve patients' quality of life.

Clinicaltrials: gov (Or Equivalent) Listing: Thai Clinical Trials Registry (TCTR20250202008).

Background: Vulvar lichen simplex chronicus (VLSC) is a chronic inflammatory dermatosis that remains difficult to manage long term. Fractional CO₂ laser (FxCO₂) combined with topical corticosteroids (TCs) has emerged as a potential therapeutic strategy; however, high-quality long-term evidence remains limited.

Objective: To evaluate the long-term efficacy and safety of FxCO₂ combined with TC in patients with VLSC.

Study design: This retrospective single-center study included 172 patients with biopsy-confirmed VLSC treated between 2016 and 2024. All patients received at least one FxCO₂ + TC treatment session. Primary outcomes included pruritus improvement, recurrence, and subjective symptom relief. Secondary outcomes assessed patient satisfaction, treatment adherence, and adverse events.

Results: FxCO₂ combined with TC treatment was effective, achieving an initial pruritus improvement rate of 90.12% (155/172). Subjective symptom improvement was reported by 91.86% (158/172) of patients, and patient satisfaction was 88.95% (153/172). Among those who improved, 50.58% (80/155) achieved improvement after 3 treatments, and the median duration of improvement was 18.0 months (range, 12-54 months). The recurrence rate was 14.84% (23/155), with a median time to recurrence of 36.0 months (range, 12-60 months). Adverse events occurred in 15.70% (27/172) of patients, with dryness being the most common (6.40%, 11/172). No clinical signs of deterioration or atypical progression were noted throughout the follow-up.

Conclusion: FxCO₂ combined with TC treatment is effective and well tolerated in women with VLSC, providing long-term symptom relief with low recurrence and acceptable safety. This combined approach may represent a promising therapeutic option for managing intense pruritus associated with VLSC.

Background and objectives: Accurate visualization of thermal damage zone (TDZ) in the dermis is critical for energy-based device (EBD) and burn research. While nitroblue tetrazolium chloride (NBTC) staining and birefringence imaging are commonly used, both rely on detecting loss-of-signal, thereby only inferring TDZ indirectly. Other methods, such as hematoxylin and eosin and Masson's trichrome, are protocol-sensitive and limited in sufficiency and consistency for TDZ visualization. This study aims to validate a novel staining protocol optimized for direct and selective visualization of thermally denatured collagen, termed Ahn-van Gieson stain (AVG).

Methods: Protocol analysis was performed to identify sources of inconsistency in the iron hematoxylin-based Verhoeff-van Gieson stain, followed by comparison of multiple versions of modifications for optimization. Horizontal sections of the human dermis were irradiated with a defocused CO₂ laser beam under thermal recording with a 10.6 μm notch filter. Thermal data were processed to generate peak temperature and Arrhenius integral maps for collagen denaturation. Slides stained with the optimized AVG protocol were overlaid with thermal maps for validation.

Results: Iron-hematoxylin stained both TDZ and surrounding collagen regions, but subsequent differentiation using FeCl₃ led to partial loss of staining within TDZ, contributing to inconsistent results. Replacing the FeCl₃ differentiation step with 1 min 1% acid alcohol treatment produced the most consistent and high-contrast visualization of TDZ. The protocol required approximately 40 min, functioned reliably on both frozen and paraffin-embedded samples, and was compatible with birefringence imaging. The stained areas corresponded well with thermal maps for collagen denaturation, supporting the specificity of AVG for thermally denatured collagen.

Conclusions: The novel protocol enables direct, high-contrast, and reproducible visualization of thermally denatured collagen using standard equipment in a short time. It holds promise as a practical histological tool in EBD and burn research, where precise collagen damage visualization is essential.

Introduction: Burn injuries are extremely common, and burn wounds can be associated with prolonged healing due to their inherent biofilm formation on the surface, further increasing the risk of complications such as infection and slow healing. This severely affects the patient's life and represents a socioeconomic burden for the patients and for the healthcare system. Photobiomodulation (PBM) has been introduced in wound management since the 1980s and has shown satisfactory outcomes, with no reported negative outcomes. The effects of PBM on the microbial load of burn wounds were assessed in the burn's outpatient dressing clinic.

Methodology: During routine outpatient dressing changes, wounds were standardly cleansed and a baseline burn wound swab obtained, followed by 2 min of noncontact PBM over the wound bed and peri-wound margin. A repeat wound swab was taken immediately after irradiation, and the wound was redressed with the appropriate dressing for the clinical appearance of the wound. The colony-forming units were counted and compared pre- versus post-treatment bacterial load.

Results: Ninety-six paired swabs from acute burn wounds were analyzed. After a single PBM session, the bacterial load decreased in 42 out of 96 wounds, and increased in nine wounds swabbed out of 96. No bacterial growth was present both before and after PBM in 45 out of 96 wounds. One PBM session on an acute burn wound led to an average of 64.4% decrease in the bacterial load on the burn wound surface. Overall, PBM reduces, or does not increase, the microbial load on 91% of the burn wounds.

Conclusion: PBM is a valuable adjunct in burn wound care by decreasing the microbial load, being noncontact, easy to implement, and conserving the same outpatient clinic settings and length of appointment.

Objective: Given that the therapeutic evidence for doxycycline in rosacea has predominantly been derived from studies on papulopustular rosacea (PPR), this study aimed to evaluate the efficacy and safety of combined oral doxycycline, topical calcineurin inhibitor (TCI), and pulsed dye laser (PDL) therapy in erythematotelangiectatic rosacea (ETR) and to identify clinical predictors of treatment response.

Materials and methods: Medical photographs of patients with ETR treated with oral doxycycline, TCI, and two subsequent PDL sessions were retrospectively reviewed. Erythema on the right cheek was quantitatively measured using computer-aided image analysis.

Results: Of the 79 included patients, 47 had the ETR subtype and 32 had the mixed ETR/PPR subtype. Erythema significantly improved after oral doxycycline and TCI treatment (p < 0.001) and further PDL treatment (p < 0.001). Particularly, in patients with moderate-to-severe ETR, background erythema improved to a level comparable to that observed in patients with mild ETR after treatment (p = 0.307). Post-treatment erythema did not differ by age (p = 0.963) or Fitzpatrick skin type (p = 0.277); however, it was significantly lower among males (p = 0.008) and in patients without prior steroid treatment (p = 0.046). No serious adverse events, including photosensitivity, were observed.

Conclusion: Combined oral doxycycline, TCI, and PDL therapy is effective and safe for ETR, especially in patients with higher severity. Prompt diagnosis and avoidance of steroid misuse may improve treatment responses.

Background: Although effective for atrophic acne scars, ablative fractional CO₂ laser (AFCL) causes unavoidable downtime and carries the potential for post-inflammatory hyperpigmentation (PIH).

Objectives: To evaluate the efficacy and safety of hydroxybutyl chitosan (HBC) in wound healing and to investigate the possible molecular mechanisms of HBC.

Methods: Eighteen participants were enrolled in a split-face study, with each hemiface randomly assigned to receive either HBC or positive control therapy (PC: desonide cream, epidermal growth factor gel, and fusidic acid cream in combination) following AFCL. Clinical assessments included erythema, edema, pain, the time to decrustation, the skin barrier function, and melanin were assessed. In parallel, a mouse skin wound healing model was employed to investigate the effects of HBC. The expression of interferon regulatory factor 7 (IRF7) and cathepsin S (Ctss), as well as M1 and M2 macrophage polarization, was evaluated by immunohistochemistry and Western blot analysis of mouse skin tissues.

Results: Although HBC exhibited a slightly delayed onset of wound healing compared to the PC protocol, it achieved comparable outcomes by Days 7 and 28 between the groups. HBC showed more early pain but no steroid-related irritation and better moisturization. In mice, HBC demonstrated effects comparable to PC drugs, promoting macrophage M2 polarization and upregulating IRF7 and Ctss expression.

Conclusions: HBC is effective and safe for promoting wound healing post AFCL. HBC upregulates IRF7 and Ctss expression and promotes macrophage M2 polarization. The expression of IRF7/CTSS may be correlated with M2 polarization of macrophages.

Clinical trial registration no: ChiCTR2200063765.

Aim: This study aims to perform optical dosimetry in the patient's chest using Monte Carlo simulation, quantifying absorbed optical energy and photon fluence as a function of depth in biological tissue during arthritis rheumatoid photo-treatment.

Method: The MCLTmx code was employed to simulate light transport. A 532, 630, 660, and 850 nm external monoenergetic light source was simulated. The optical energy deposited and photon fluence as a function of depth were calculated under the structural arrangement: source-air-skin-fat-muscle.

Results: Experimental validation was successful. The results indicate that the skin receives, on average, three orders of magnitude more optical energy than fat and muscle for all wavelengths.

Conclusion: The dosimetry developed in this manuscript will serve as a valuable tool to correlate the power of the light source with dosimetric quantities, such as absorbed optical energy and photon fluence, and subsequently with the response to phototreatment. Once this correlation is established, the required irradiation time and power to produce favorable effects in patients suffering from RA can be calculated.

Background and objectives: Skin aging, characterized by wrinkles, pigment disorders, and enlarged pores, is driven primarily by photoaging. While a 1064 nm fractional picosecond laser shows efficacy in skin rejuvenation, comparative studies with intense pulsed light (IPL) remain limited. This randomized controlled trial (RCT) aimed to compare the efficacy and safety of the 1064 nm fractional picosecond laser with IPL in Asian women.

Methods: In this single-center RCT, 38 Asian women (30-60 years) were randomized to receive 1064 nm Nd:YAG picosecond laser with a fractional optic (1064 nm Ps) (n = 19) or IPL (n = 19) therapy for three treatments. Baseline and post treatments Global Score for Photoaging (GSP), fine lines and pigmented spots scores were assessed by two blinded dermatologists based on VISIA photographs. Skin texture, T-zone pores and skin tone were measured with VISIA, C-Cube and Delfin Skin Color Catch. Transepidermal water loss (TEWL) was measured before and after a single treatment by Delfin Vapometer. All adverse events were documented.

Results: 1064 nm Ps outperformed IPL in the periorbital fine lines (p = 0.0315) and T-zone pore counts (p = 0.0473). GSP, infraorbital texture area, pigmented spots and lightness (L*), compared to baseline, significantly improved after treatments in each group, while there was no difference between two groups. Regarding safety, erythema was the most frequent transient response in both groups.

Conclusions: Both 1064 nm fractional picosecond laser and IPL were effective and safe in treatments of facial rejuvenation. Compared to IPL, 1064 nm fractional picosecond laser excelled in periorbital fine lines and T-zone pores.

Clinical trial registration: This trial was registered at ClinicalTrials.gov (identifier: NCT07122310).