Vy X Pham, Bobak T Pousti, Gerd Gauglitz, Peter R Shumaker
Objectives: A substantial and expanding body of literature addresses the safety and efficacy of fractional ablative laser therapy for traumatic scarring resulting from burns and other trauma. However, available scar research commonly employs standardized assessment scales that generally do not directly address the impact on function and overall quality of life. Unlike past reviews, this manuscript will explore available evidence with a focus explicitly on function and quality of life (QoL) outcomes and de-emphasize surrogate outcome measures that rely primarily on visual characteristics.
Methods: Through literature review conducted up to January 2024, the authors examined relevant studies focusing on function and quality of life outcomes in traumatic and burn scar management with fractional ablative laser therapy. PubMed, EMBASE, MEDLINE, and Cochrane Library were utilized as primary databases. Reference lists were secondarily reviewed to supplement the literature review process. Studies that did not highlight functional or QoL endpoints or were not in the English language were excluded.
Results: The reviewed studies demonstrated that fractional ablative therapy led to consistent significant and meaningful improvements in functional outcomes, relief from pruritus and pain, and overall enhancements in quality of life for patients with traumatic scarring. Adverse events associated with fractional ablative therapy were infrequent and generally of mild severity, indicating a favorable safety profile.
Conclusions: The findings from this literature review document ample existing evidence supporting the efficacy and safety of fractional ablative therapy to enhance function, mobility, reduce pruritus and pain, and improve overall QoL. Fractional ablative laser therapy should be integrated more widely into standard management protocols. Given the previous reliance on standardized scar assessment tools that heavily integrate visual characteristics, future studies should prioritize functional and QoL outcomes to further advance scar management protocols and optimize patient care.
目的：大量文献探讨了点阵消融激光疗法治疗烧伤和其他创伤导致的外伤性瘢痕的安全性和有效性，而且这种疗法的范围还在不断扩大。然而，现有的疤痕研究通常采用标准化的评估量表，一般不会直接涉及对功能和整体生活质量的影响。与以往的综述不同，本稿件将探讨现有的证据，明确关注功能和生活质量（QoL）结果，而不再强调主要依赖视觉特征的替代性结果测量：通过对截至 2024 年 1 月的文献进行回顾，作者研究了以点阵消融激光疗法治疗创伤和烧伤疤痕的功能和生活质量为重点的相关研究。主要数据库包括 PubMed、EMBASE、MEDLINE 和 Cochrane Library。参考文献列表是对文献综述过程的补充。未强调功能或 QoL 终点或非英语的研究被排除在外：综述研究表明，点阵消融疗法可持续显著改善外伤性瘢痕患者的功能预后、缓解瘙痒和疼痛，并全面提高生活质量。与点阵消融疗法相关的不良事件并不常见，且一般程度较轻，这表明该疗法具有良好的安全性：本次文献综述的研究结果提供了大量现有证据，支持点阵消融疗法在增强功能、提高活动能力、减轻瘙痒和疼痛以及改善整体生活质量方面的有效性和安全性。应将点阵消融激光疗法更广泛地纳入标准管理方案。鉴于以往对标准化疤痕评估工具的依赖严重依赖视觉特征，未来的研究应优先考虑功能和 QoL 结果，以进一步推进疤痕管理方案并优化患者护理。
{"title":"Impact of Fractional Ablative Laser Therapy on Function, Symptoms, and Quality of Life in the Management of Traumatic Scars: A Review.","authors":"Vy X Pham, Bobak T Pousti, Gerd Gauglitz, Peter R Shumaker","doi":"10.1002/lsm.23858","DOIUrl":"https://doi.org/10.1002/lsm.23858","url":null,"abstract":"<p><strong>Objectives: </strong>A substantial and expanding body of literature addresses the safety and efficacy of fractional ablative laser therapy for traumatic scarring resulting from burns and other trauma. However, available scar research commonly employs standardized assessment scales that generally do not directly address the impact on function and overall quality of life. Unlike past reviews, this manuscript will explore available evidence with a focus explicitly on function and quality of life (QoL) outcomes and de-emphasize surrogate outcome measures that rely primarily on visual characteristics.</p><p><strong>Methods: </strong>Through literature review conducted up to January 2024, the authors examined relevant studies focusing on function and quality of life outcomes in traumatic and burn scar management with fractional ablative laser therapy. PubMed, EMBASE, MEDLINE, and Cochrane Library were utilized as primary databases. Reference lists were secondarily reviewed to supplement the literature review process. Studies that did not highlight functional or QoL endpoints or were not in the English language were excluded.</p><p><strong>Results: </strong>The reviewed studies demonstrated that fractional ablative therapy led to consistent significant and meaningful improvements in functional outcomes, relief from pruritus and pain, and overall enhancements in quality of life for patients with traumatic scarring. Adverse events associated with fractional ablative therapy were infrequent and generally of mild severity, indicating a favorable safety profile.</p><p><strong>Conclusions: </strong>The findings from this literature review document ample existing evidence supporting the efficacy and safety of fractional ablative therapy to enhance function, mobility, reduce pruritus and pain, and improve overall QoL. Fractional ablative laser therapy should be integrated more widely into standard management protocols. Given the previous reliance on standardized scar assessment tools that heavily integrate visual characteristics, future studies should prioritize functional and QoL outcomes to further advance scar management protocols and optimize patient care.</p>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Objectives: Commonly adopted in cosmetic dermatology, nonablative radiofrequency (RF) devices convert high-frequency electromagnetic energy into thermal energy to induce a wound-healing response in skin tissue. However, differences in the electrical properties of different skin layers raise questions about the impact of different RF frequencies and target temperatures on treatment effectiveness. This paper presents a finite element analysis (FEA)-based computational study aimed at simulating and optimizing the effects of a proportional integral derivative (PID)-controlled RF cosmetic devices under different combinations of these two parameters during treatment.
Study Design/Materials and Methods: A 3D physical model for the application of a nonablative RF device was constructed using COMSOL, which included the human tissue and RF electrodes, electromagnetic and thermal boundary conditions, as well as the PID controller. FEA was performed for each of the twelve models with parameter combinations of three RF frequencies (0.1, 0.5, and 1 MHz) and three PID-controlled target temperatures (60°C, 65°C, and 70°C) plus one group without PID control. Treatment effectiveness was quantitatively assessed using the integration of tissue thermal damage fraction, i.e., thermal damage volume.
Results: In the earlier stage of heating (0–10 s), higher RF frequency resulted in a larger thermal damage volume. At 10 s, among models with a temperature target of 70°C, there is a 6.04% difference between the thermal damage volume at RF frequencies of 1.0 and 0.1 MHz. In the later stage of heating(11–80 s), the impact of RF frequency decreases. The difference in thermal damage volume caused by higher temperature targets is more significant, at 80 s, among models with an RF frequency of 1.0 MHz, the 70°C model produces 1.15 and 1.36 times more tissue thermal damage than the 65°C and 60°C models.
Conclusion: PID controller has ensured treatment safety and uniformity, in exchange for some efficiency. Among 12 parameter combinations, the one with a temperature of 70°C and RF frequency of 1.0 MHz achieved the highest thermal damage volume, which could potentially result in the best esthetic effect. Considering users' different susceptibility to heat, engineers or physicians can select better temperature targets and RF frequencies to bring the desired cosmetic results based on thermal damage volume curves from this study.
{"title":"A Computational Study on Effects of PID Temperature Target and RF Frequency for PID-Controlled Nonablative RF Cosmetic Systems","authors":"Lu-Xiao Wang, Xiang-Yong Kong, Tong-Juan Zhou","doi":"10.1002/lsm.23855","DOIUrl":"10.1002/lsm.23855","url":null,"abstract":"<div>\u0000 \u0000 <p><b>Background and Objectives:</b> Commonly adopted in cosmetic dermatology, nonablative radiofrequency (RF) devices convert high-frequency electromagnetic energy into thermal energy to induce a wound-healing response in skin tissue. However, differences in the electrical properties of different skin layers raise questions about the impact of different RF frequencies and target temperatures on treatment effectiveness. This paper presents a finite element analysis (FEA)-based computational study aimed at simulating and optimizing the effects of a proportional integral derivative (PID)-controlled RF cosmetic devices under different combinations of these two parameters during treatment.</p>\u0000 <p><b>Study Design/Materials and Methods:</b> A 3D physical model for the application of a nonablative RF device was constructed using COMSOL, which included the human tissue and RF electrodes, electromagnetic and thermal boundary conditions, as well as the PID controller. FEA was performed for each of the twelve models with parameter combinations of three RF frequencies (0.1, 0.5, and 1 MHz) and three PID-controlled target temperatures (60°C, 65°C, and 70°C) plus one group without PID control. Treatment effectiveness was quantitatively assessed using the integration of tissue thermal damage fraction, i.e., thermal damage volume.</p>\u0000 <p><b>Results:</b> In the earlier stage of heating (0–10 s), higher RF frequency resulted in a larger thermal damage volume. At 10 s, among models with a temperature target of 70°C, there is a 6.04% difference between the thermal damage volume at RF frequencies of 1.0 and 0.1 MHz. In the later stage of heating(11–80 s), the impact of RF frequency decreases. The difference in thermal damage volume caused by higher temperature targets is more significant, at 80 s, among models with an RF frequency of 1.0 MHz, the 70°C model produces 1.15 and 1.36 times more tissue thermal damage than the 65°C and 60°C models.</p>\u0000 <p><b>Conclusion:</b> PID controller has ensured treatment safety and uniformity, in exchange for some efficiency. Among 12 parameter combinations, the one with a temperature of 70°C and RF frequency of 1.0 MHz achieved the highest thermal damage volume, which could potentially result in the best esthetic effect. Considering users' different susceptibility to heat, engineers or physicians can select better temperature targets and RF frequencies to bring the desired cosmetic results based on thermal damage volume curves from this study.</p>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"56 10","pages":"865-879"},"PeriodicalIF":2.2,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sifan Dong, Shiqi An, Qifan Liu, Xujia Wang, Yongmei Hu, An Jiang
Background
Photodynamic therapy (PDT) induced lipid peroxidation reaction can lead to necrosis and apoptosis of extrahepatic cholangiocarcinoma (ECC) cells, reducing the tumor load. However, the depth of action of PDT is shallow, and its therapy efficacy is weak, making it difficult to achieve eradication even with multiple treatments.
Objectives
This study aims to investigate the mechanism and main pathways of ferroptosis in cholangiocarcinoma under Hematoporphyrin-mediated photodynamic therapy, and to compare the effects of different ferroptosis inducers on photodynamic therapy-induced ferroptosis in cholangiocarcinoma. To provide an experimental basis for selecting appropriate ferroptosis-inducing agents and synergizing with photodynamic therapy during the clinical perioperative period.
Methods
The Cell Counting Kit-8 (CCK-8) was used to examine the cytotoxicity of cholangiocarcinoma cells following PDT. Flow cytometry was used to detect apoptotic cell percentage and cell cycle changes to assess the enhanced photodynamic production of reactive oxygen species (ROS) by different ferroptosis inducers, confocal imaging was used to de-assay ROS content. Western blot analysis was employed to detect the expression of GPX4 、FSP1、ASCL4 and SLC7A11. Furthermore, a fluorescence spectrophotometric assay was used to quantify the alterations in lipid peroxides (MDA, LPO, GSH, and Fe2+).
Results
The combination of PDT with Lenvatinib or Erastin resulted in increased ROS levels, and decreased GSH content, tumor cells were inhibited in the G2 phase, and the proportion of apoptotic cells increased. Additionally, GPX4, FSP1, and SLC7A11 protein expression decreased, whereas ASCL4 increased This was accompanied by heightened levels of Fe2+, LPO, and MDA. Induction of the ferroptosis pathway was observed to enhance the therapeutic efficacy of PDT.
Conclusion
Our findings suggest that Erastin or Lenvatinib can enhance the induction of ferroptosis in cholangiocarcinoma cells by photodynamic therapy by increasing intracellular ROS and inhibiting intracellular antioxidant pathways.
{"title":"Study on the Synergistic Mechanism of Photodynamic Therapy Combined With Ferroptosis Inducer to Induce Ferroptosis in Cholangiocarcinoma","authors":"Sifan Dong, Shiqi An, Qifan Liu, Xujia Wang, Yongmei Hu, An Jiang","doi":"10.1002/lsm.23857","DOIUrl":"10.1002/lsm.23857","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Photodynamic therapy (PDT) induced lipid peroxidation reaction can lead to necrosis and apoptosis of extrahepatic cholangiocarcinoma (ECC) cells, reducing the tumor load. However, the depth of action of PDT is shallow, and its therapy efficacy is weak, making it difficult to achieve eradication even with multiple treatments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aims to investigate the mechanism and main pathways of ferroptosis in cholangiocarcinoma under Hematoporphyrin-mediated photodynamic therapy, and to compare the effects of different ferroptosis inducers on photodynamic therapy-induced ferroptosis in cholangiocarcinoma. To provide an experimental basis for selecting appropriate ferroptosis-inducing agents and synergizing with photodynamic therapy during the clinical perioperative period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Cell Counting Kit-8 (CCK-8) was used to examine the cytotoxicity of cholangiocarcinoma cells following PDT. Flow cytometry was used to detect apoptotic cell percentage and cell cycle changes to assess the enhanced photodynamic production of reactive oxygen species (ROS) by different ferroptosis inducers, confocal imaging was used to de-assay ROS content. Western blot analysis was employed to detect the expression of GPX4 、FSP1、ASCL4 and SLC7A11. Furthermore, a fluorescence spectrophotometric assay was used to quantify the alterations in lipid peroxides (MDA, LPO, GSH, and Fe<sup>2+</sup>).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The combination of PDT with Lenvatinib or Erastin resulted in increased ROS levels, and decreased GSH content, tumor cells were inhibited in the G2 phase, and the proportion of apoptotic cells increased. Additionally, GPX4, FSP1, and SLC7A11 protein expression decreased, whereas ASCL4 increased This was accompanied by heightened levels of Fe<sup>2+</sup>, LPO, and MDA. Induction of the ferroptosis pathway was observed to enhance the therapeutic efficacy of PDT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings suggest that Erastin or Lenvatinib can enhance the induction of ferroptosis in cholangiocarcinoma cells by photodynamic therapy by increasing intracellular ROS and inhibiting intracellular antioxidant pathways.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"56 10","pages":"845-853"},"PeriodicalIF":2.2,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chris W. Robb, Jan Bernardy, Rea Jarosova, Nikola Hodkovicova
Objectives
Submental fullness has been associated with being perceived as unattractive. Technology combining radiofrequency and muscle stimulation offers submental contouring through fat reduction, muscle stimulation, and skin tightening. This study aims to demonstrate the effectiveness and safety of fat reduction aspect with a novel submentum applicator delivering HIFES and synchronized radiofrequency+ (RF+) energies.
Materials and Methods
Six white pigs (sus scrofa domesticus, n = 6, 60–80 kg) were recruited for this study, five in the active group (n = 5) received four treatments on the abdominal area, one sow served as a control (n = 1). Ultrasound, histological, and RT-qPCR methods were used as evaluation methods.
Results
Fat thickness decreased at 1 month by −17.35% and at 2 month by 31.40%. Proapoptotic caspase-9 gene expression increased (at 1 h, 6 h, 24 h to +43.45%, +21.22%, −8.36%), as well as caspase-3 (+15.28%, +21.77%, −6.71%), while bcl2l1 activity decreased (−11.46% at 1 h, −17.02% at 6 h, −3.9% at 24 h). While the AI in the control animal had minimal change (at 1 h −0.08%, at 6 h −0.09%, and at 24 h −0.025%), the active group's AI increased from the baseline of 9.14 to 44.85 at 1 h (+391%), peaked at 6 h to 53.50 (+485%), and at 24 h to 38.17 (+318%).
Conclusion
The study results indicate the efficacy and safety of subcutaneous fat reduction following the novel technology combining HIFES and RF+ energies, designed to target small localized areas.
{"title":"Novel Applicator Utilizing HIFES and Enhanced Synchronized Radiofrequency+ for Subcutaneous Fat Reduction: Porcine Model Study","authors":"Chris W. Robb, Jan Bernardy, Rea Jarosova, Nikola Hodkovicova","doi":"10.1002/lsm.23854","DOIUrl":"10.1002/lsm.23854","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Submental fullness has been associated with being perceived as unattractive. Technology combining radiofrequency and muscle stimulation offers submental contouring through fat reduction, muscle stimulation, and skin tightening. This study aims to demonstrate the effectiveness and safety of fat reduction aspect with a novel submentum applicator delivering HIFES and synchronized radiofrequency+ (RF+) energies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Six white pigs (<i>sus scrofa domesticus</i>, <i>n</i> = 6, 60–80 kg) were recruited for this study, five in the active group (<i>n</i> = 5) received four treatments on the abdominal area, one sow served as a control (<i>n</i> = 1). Ultrasound, histological, and RT-qPCR methods were used as evaluation methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fat thickness decreased at 1 month by −17.35% and at 2 month by 31.40%. Proapoptotic caspase-9 gene expression increased (at 1 h, 6 h, 24 h to +43.45%, +21.22%, −8.36%), as well as caspase-3 (+15.28%, +21.77%, −6.71%), while <i>bcl2l1</i> activity decreased (−11.46% at 1 h, −17.02% at 6 h, −3.9% at 24 h). While the AI in the control animal had minimal change (at 1 h −0.08%, at 6 h −0.09%, and at 24 h −0.025%), the active group's AI increased from the baseline of 9.14 to 44.85 at 1 h (+391%), peaked at 6 h to 53.50 (+485%), and at 24 h to 38.17 (+318%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study results indicate the efficacy and safety of subcutaneous fat reduction following the novel technology combining HIFES and RF+ energies, designed to target small localized areas.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"56 10","pages":"803-810"},"PeriodicalIF":2.2,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142503129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tal Levy, Ilana Lerman, Jill Waibel, Gerd G Gauglitz, Matteo T Clementoni, Daniel P Friedmann, Kevin Duplechain, Peter Peng, Davin Lim, Firas Al-Niaimi, Shangli Lin, Gilly Munavalli, Brian S Biesman, Greg J Goodman, Alina Fratila, Thomas M Beachkofsky, E Victor Ross, Asif Hussein, Arielle Kauvar, Suzanne L Kilmer, Robert Langdon, Ronald L Moy, Ofir Artzi
Background: For three decades, fractional ablative CO2 lasers have been used for skin rejuvenation. With breakthroughs in laser technology and expanding popularity, new recommendations and suggestions arise on a regular basis.
Objective: To develop up-to-date clinical recommendations on safety measures, therapeutic framework, and techniques to improve treatment outcomes.
Methods: Using Google Forms, a questionnaire with 188 questions was given to a varied sample of 21 dermatologists and plastic surgeons from various countries and practice contexts. A second questionnaire with 11 items was created to resolve any gaps or discrepancies.
Results: Active face infections are considered a treatment contraindication by 95% of panelists. Burns, recent sun exposure, and pregnancy or breastfeeding were also considered contraindications (according to 67% of panelists). Over 90% employ bacterial and viral prophylaxis, however the majority (67%) do not prescribe antifungal prophylaxis. The most often stated anesthetic treatments by panelists are topical anesthetic cream, nerve blocks, and oral analgesics (according to 95%, 81%, and 62% of panelists respectively). Over 90% of panel members suggested treatment setting alterations for individuals with Fitzpatrick skin types III-IV. Following reepithelization, which happens between 8 and 42 days after the treatment, the majority (76%) of panelists advocate continuing standard skin care routines including active ingredients. Eighty-one percent of panelists recommend using supplementary treatment to maximize results. Supplementary treatment recommendations included use of neuromodulators (76% of panelists), Intense Pulsed Light Therapy treatments pre and postprocedure (61% of panelists), and injection-based therapies such as (Hyaluronic Acid fillers, and biostimulatory fillers) (recommended by 48% of panelists). 60% of panelists perform FACL to improve skin laxity treatment in nonfacial areas and adjust their settings accordingly.
Limitations: Our results reflect only a modest panel size; with a focus on a specific device. Although experienced, the small number of panelists, recommendations, and personal adverse reactions encounters for resurfacing indication, might be biased.
Conclusion: Fractional CO2 laser is a popular and effective skin rejuvenation treatment with minimal downtime and side effects. This study presents new therapy recommendations to resolve treatment uncertainty and provide complete care suggestions for best results.
{"title":"Expert Consensus on Clinical Recommendations for Fractional Ablative CO<sub>2</sub> Laser, in Facial Skin Rejuvenation Treatment.","authors":"Tal Levy, Ilana Lerman, Jill Waibel, Gerd G Gauglitz, Matteo T Clementoni, Daniel P Friedmann, Kevin Duplechain, Peter Peng, Davin Lim, Firas Al-Niaimi, Shangli Lin, Gilly Munavalli, Brian S Biesman, Greg J Goodman, Alina Fratila, Thomas M Beachkofsky, E Victor Ross, Asif Hussein, Arielle Kauvar, Suzanne L Kilmer, Robert Langdon, Ronald L Moy, Ofir Artzi","doi":"10.1002/lsm.23850","DOIUrl":"https://doi.org/10.1002/lsm.23850","url":null,"abstract":"<p><strong>Background: </strong>For three decades, fractional ablative CO<sub>2</sub> lasers have been used for skin rejuvenation. With breakthroughs in laser technology and expanding popularity, new recommendations and suggestions arise on a regular basis.</p><p><strong>Objective: </strong>To develop up-to-date clinical recommendations on safety measures, therapeutic framework, and techniques to improve treatment outcomes.</p><p><strong>Methods: </strong>Using Google Forms, a questionnaire with 188 questions was given to a varied sample of 21 dermatologists and plastic surgeons from various countries and practice contexts. A second questionnaire with 11 items was created to resolve any gaps or discrepancies.</p><p><strong>Results: </strong>Active face infections are considered a treatment contraindication by 95% of panelists. Burns, recent sun exposure, and pregnancy or breastfeeding were also considered contraindications (according to 67% of panelists). Over 90% employ bacterial and viral prophylaxis, however the majority (67%) do not prescribe antifungal prophylaxis. The most often stated anesthetic treatments by panelists are topical anesthetic cream, nerve blocks, and oral analgesics (according to 95%, 81%, and 62% of panelists respectively). Over 90% of panel members suggested treatment setting alterations for individuals with Fitzpatrick skin types III-IV. Following reepithelization, which happens between 8 and 42 days after the treatment, the majority (76%) of panelists advocate continuing standard skin care routines including active ingredients. Eighty-one percent of panelists recommend using supplementary treatment to maximize results. Supplementary treatment recommendations included use of neuromodulators (76% of panelists), Intense Pulsed Light Therapy treatments pre and postprocedure (61% of panelists), and injection-based therapies such as (Hyaluronic Acid fillers, and biostimulatory fillers) (recommended by 48% of panelists). 60% of panelists perform FACL to improve skin laxity treatment in nonfacial areas and adjust their settings accordingly.</p><p><strong>Limitations: </strong>Our results reflect only a modest panel size; with a focus on a specific device. Although experienced, the small number of panelists, recommendations, and personal adverse reactions encounters for resurfacing indication, might be biased.</p><p><strong>Conclusion: </strong>Fractional CO<sub>2</sub> laser is a popular and effective skin rejuvenation treatment with minimal downtime and side effects. This study presents new therapy recommendations to resolve treatment uncertainty and provide complete care suggestions for best results.</p>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div> <section> <h3> Objectives</h3> <p>Photodynamic inactivation (PDI) is a powerful technique for eradicating microorganisms, and our group previously demonstrated its effectiveness against planktonic cultures of Staphylococcus aureus bacteria using 5,10,15,20-tetrakis[4-(3-<i>N,N</i>-dimethylaminopropoxy)phenyl]porphyrin (TAPP) and visible light irradiation. However, biofilms exhibit a lower sensitivity to PDI, mainly due to limited penetration of the photosensitizer (PS). In the context of emerging antibacterial strategies, near-infrared treatments (NIRTs) have shown promise, especially for combating resistant strains. NIRT can act either through photon absorption by water, causing a thermal effect on bacteria, or by specific chromophores without a significant temperature increase. Our objective was to enhance biofilm sensitivity to TAPP-PDI by pretreatment with NIRT. This combined approach aims to disrupt biofilms and increase the efficacy of TAPP-PDI against bacterial biofilms.</p> </section> <section> <h3> Materials and Methods</h3> <p>In vitro biofilm models of <i>S. aureus</i> RN6390 were utilized. NIRTs involved a 980 nm laser (continuous mode, 7.5 W/cm<sup>2</sup>, 30 s, totaling 225 J/cm<sup>2</sup>) post-TAPP exposure to enhance photosensitizer accumulation. Subsequent visible light irradiation at 180 J/cm<sup>2</sup> was employed to perform PDI. Colony-forming unit counts evaluated the synergistic effect on bacterial viability. Scanning electron microscopy visualized the architectural changes in the biofilm structure. TAPP was extracted from bacteria to estimate the impact of NIRT on biofilm penetration.</p> </section> <section> <h3> Results</h3> <p>Using in vitro biofilm models, NIRT application following biofilm exposure to TAPP increased PS accumulation per bacteria. Under these conditions, NIRT induced a transient increase in the temperature of PBS to 46.0 ± 2.6°C (Δ<i>T</i> = 21.5°C). Following exposure to visible light, a synergistic effect emerged, yielding a substantial 4.4 ± 0.1-log CFU reduction. In contrast, the PDI and NIRT treatments individually caused a decrease in viability of 0.9 ± 0.1 and 0.8 ± 0.2-log respectively. Interestingly, preheating TAPP-PBS to 46°C had no significant impact on TAPP-PDI efficacy, suggesting the involvement of thermal and nonthermal effects of NIR action. In addition to the enhanced TAPP penetration, NIRT dispersed the biofilms and induced clefts in the biofilm matrix.</p> </section> <section> <h3> Conclusion</h3> <p>Our findings suggest that NIR irradiation serves as a complementary treatment to PDI. This combined strategy reduces bacterial numbers at lower PS concentration
{"title":"Laser NIR Irradiation Enhances Antimicrobial Photodynamic Inactivation of Biofilms of Staphylococcus aureus","authors":"Leandro Mamone, Roberto Tomás, Gabriela Di Venosa, Lautaro Gándara, Edgardo Durantini, Fernanda Buzzola, Adriana Casas","doi":"10.1002/lsm.23847","DOIUrl":"10.1002/lsm.23847","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Photodynamic inactivation (PDI) is a powerful technique for eradicating microorganisms, and our group previously demonstrated its effectiveness against planktonic cultures of Staphylococcus aureus bacteria using 5,10,15,20-tetrakis[4-(3-<i>N,N</i>-dimethylaminopropoxy)phenyl]porphyrin (TAPP) and visible light irradiation. However, biofilms exhibit a lower sensitivity to PDI, mainly due to limited penetration of the photosensitizer (PS). In the context of emerging antibacterial strategies, near-infrared treatments (NIRTs) have shown promise, especially for combating resistant strains. NIRT can act either through photon absorption by water, causing a thermal effect on bacteria, or by specific chromophores without a significant temperature increase. Our objective was to enhance biofilm sensitivity to TAPP-PDI by pretreatment with NIRT. This combined approach aims to disrupt biofilms and increase the efficacy of TAPP-PDI against bacterial biofilms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>In vitro biofilm models of <i>S. aureus</i> RN6390 were utilized. NIRTs involved a 980 nm laser (continuous mode, 7.5 W/cm<sup>2</sup>, 30 s, totaling 225 J/cm<sup>2</sup>) post-TAPP exposure to enhance photosensitizer accumulation. Subsequent visible light irradiation at 180 J/cm<sup>2</sup> was employed to perform PDI. Colony-forming unit counts evaluated the synergistic effect on bacterial viability. Scanning electron microscopy visualized the architectural changes in the biofilm structure. TAPP was extracted from bacteria to estimate the impact of NIRT on biofilm penetration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Using in vitro biofilm models, NIRT application following biofilm exposure to TAPP increased PS accumulation per bacteria. Under these conditions, NIRT induced a transient increase in the temperature of PBS to 46.0 ± 2.6°C (Δ<i>T</i> = 21.5°C). Following exposure to visible light, a synergistic effect emerged, yielding a substantial 4.4 ± 0.1-log CFU reduction. In contrast, the PDI and NIRT treatments individually caused a decrease in viability of 0.9 ± 0.1 and 0.8 ± 0.2-log respectively. Interestingly, preheating TAPP-PBS to 46°C had no significant impact on TAPP-PDI efficacy, suggesting the involvement of thermal and nonthermal effects of NIR action. In addition to the enhanced TAPP penetration, NIRT dispersed the biofilms and induced clefts in the biofilm matrix.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings suggest that NIR irradiation serves as a complementary treatment to PDI. This combined strategy reduces bacterial numbers at lower PS concentration","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"56 9","pages":"783-795"},"PeriodicalIF":2.2,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Briana R Halle, Nicole M Golbari, Janellen Smith, Christopher Zachary
Objectives: Agminated nevi are rare, grouped lesions, which are confined to one anatomic area. Herein, we report a case of successful cosmetic treatment of bilateral, acquired agminated nevi with a picosecond 532 nm Nd:YAG laser device.
Materials and methods: Literature search was completed on acquired agminated nevi. A healthy 21-year-old woman presented with numerous, grouped 1-mm brown-to-dark brown macules in the axillae bilaterally. Biopsies revealed lentiginous junctional nevi with mild atypia, leading to the diagnosis of agminated nevi. She was referred for laser treatment to improve cosmetic appearance. Two different laser devices were utilized initially, a picosecond 532 nm Nd:YAG laser on the left axilla and a millisecond domain 532 nm laser on the right. Greater improvement was noted with the picosecond 532 nm device. Three additional treatments were completed with the picosecond laser with significant improvement in pigmentation of melanocytic nevi.
Results: Various pigmented and melanocytic lesions have been noted to occur in an agminated pattern although their pathway of development remains unknown. While various devices have demonstrated efficacy for pigmented lesions, treatment of agminated nevi specifically is less reported or established. Our patient's presentation is novel because of the axillary location and bilateral distribution of multiple acquired agminated nevi, neither of which have been previously reported in the literature. We also report successful treatment utilizing a picosecond 532 nm laser. While laser can help improve the cosmetic appearance of pigmented lesions, most lasers do not remove all melanocytes, highlighting the need for close monitoring, as atypia and melanoma have been reported to develop in acquired agminated nevi.
Conclusion: Thus, we present a case of acquired agminated nevi in a novel bilateral distribution in a healthy female successfully treated with a picosecond 532 nm laser.
{"title":"Picosecond 532 nm Laser: An Optimal Device for the Reduction of Acquired Agminated Nevi.","authors":"Briana R Halle, Nicole M Golbari, Janellen Smith, Christopher Zachary","doi":"10.1002/lsm.23851","DOIUrl":"https://doi.org/10.1002/lsm.23851","url":null,"abstract":"<p><strong>Objectives: </strong>Agminated nevi are rare, grouped lesions, which are confined to one anatomic area. Herein, we report a case of successful cosmetic treatment of bilateral, acquired agminated nevi with a picosecond 532 nm Nd:YAG laser device.</p><p><strong>Materials and methods: </strong>Literature search was completed on acquired agminated nevi. A healthy 21-year-old woman presented with numerous, grouped 1-mm brown-to-dark brown macules in the axillae bilaterally. Biopsies revealed lentiginous junctional nevi with mild atypia, leading to the diagnosis of agminated nevi. She was referred for laser treatment to improve cosmetic appearance. Two different laser devices were utilized initially, a picosecond 532 nm Nd:YAG laser on the left axilla and a millisecond domain 532 nm laser on the right. Greater improvement was noted with the picosecond 532 nm device. Three additional treatments were completed with the picosecond laser with significant improvement in pigmentation of melanocytic nevi.</p><p><strong>Results: </strong>Various pigmented and melanocytic lesions have been noted to occur in an agminated pattern although their pathway of development remains unknown. While various devices have demonstrated efficacy for pigmented lesions, treatment of agminated nevi specifically is less reported or established. Our patient's presentation is novel because of the axillary location and bilateral distribution of multiple acquired agminated nevi, neither of which have been previously reported in the literature. We also report successful treatment utilizing a picosecond 532 nm laser. While laser can help improve the cosmetic appearance of pigmented lesions, most lasers do not remove all melanocytes, highlighting the need for close monitoring, as atypia and melanoma have been reported to develop in acquired agminated nevi.</p><p><strong>Conclusion: </strong>Thus, we present a case of acquired agminated nevi in a novel bilateral distribution in a healthy female successfully treated with a picosecond 532 nm laser.</p>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pigmented actinic keratoses (PAKs), a pigmented variant of actinic keratosis, present diagnostic challenges due to their resemblance to both benign and malignant lesions. Conventional therapies have inconsistent outcomes and may cause undesirable side effects. This study investigates the efficacy of the Alexandrite laser, a pulsed laser with selective melanin absorption, for PAK treatment. Through dermoscopic analysis pretreatment, it aims to identify predictive patterns for better treatment outcomes.
Materials and Methods
Patients with PAKs were enrolled in a multicenter study, receiving standardized Alexandrite laser therapy. Detailed dermoscopic evaluations were conducted pretreatment. The Physician's Global Assessment (PGA) and Target Lesion Pigmentation (TLP) scales measured treatment efficacy.
Results
The study included 50 patients with 60 PAKs. Following treatment, there was a statistically significant reduction in TLP scores, particularly in lesions with pigmented pseudo-networks and gray-brownish dots, which were linked to improved outcomes. No adverse effects were reported, suggesting the safety and tolerability of the laser treatment.
Conclusion
The Alexandrite laser emerges as a promising modality for the management of PAK pigmentation, with specific dermoscopic patterns being indicative of a favorable response. This study reinforces the critical importance of dermoscopic expertise in the selection and optimization of treatment for PAKs. Future research should focus on comparative studies with different lasers or combination therapies to develop a more comprehensive treatment framework for PAKs.
目的：色素性光化性角化病（PAKs）是光化性角化病的一种色素变异型，由于与良性和恶性病变相似，给诊断带来了挑战。传统疗法疗效不一，而且可能会产生不良副作用。本研究探讨了选择性吸收黑色素的脉冲激光 Alexandrite 激光治疗 PAK 的疗效。通过对治疗前的皮肤镜分析，该研究旨在确定预测模式，以获得更好的治疗效果：一项多中心研究招募了PAK患者，让他们接受标准化的亚历山大激光治疗。治疗前进行了详细的皮肤镜评估。医生总体评估（PGA）和目标病变色素沉着（TLP）量表衡量治疗效果：研究包括 50 名患者，60 个 PAK。治疗后，TLP评分明显降低，尤其是在有色素假性网状结构和灰褐色小点的病变中，这与治疗效果的改善有关。没有不良反应报告，这表明激光治疗的安全性和耐受性：结论：亚历山大激光是治疗PAK色素沉着的一种很有前途的方法，其特定的皮肤镜模式表明治疗效果良好。这项研究加强了皮肤镜专业知识在选择和优化 PAK 治疗中的重要性。未来的研究应侧重于不同激光或联合疗法的比较研究，以制定更全面的PAK治疗框架。
{"title":"Efficacy of Alexandrite Laser in the Treatment of Pigmented Actinic Keratoses: A Pivotal Study","authors":"Stefano Bighetti, Cristina Zane, Nicola Zerbinati, Mariachiara Arisi, Simone Caravello, Vincenzo Maione, Piergiacomo Calzavara-Pinton, Luca Bettolini","doi":"10.1002/lsm.23849","DOIUrl":"10.1002/lsm.23849","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Pigmented actinic keratoses (PAKs), a pigmented variant of actinic keratosis, present diagnostic challenges due to their resemblance to both benign and malignant lesions. Conventional therapies have inconsistent outcomes and may cause undesirable side effects. This study investigates the efficacy of the Alexandrite laser, a pulsed laser with selective melanin absorption, for PAK treatment. Through dermoscopic analysis pretreatment, it aims to identify predictive patterns for better treatment outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Patients with PAKs were enrolled in a multicenter study, receiving standardized Alexandrite laser therapy. Detailed dermoscopic evaluations were conducted pretreatment. The Physician's Global Assessment (PGA) and Target Lesion Pigmentation (TLP) scales measured treatment efficacy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 50 patients with 60 PAKs. Following treatment, there was a statistically significant reduction in TLP scores, particularly in lesions with pigmented pseudo-networks and gray-brownish dots, which were linked to improved outcomes. No adverse effects were reported, suggesting the safety and tolerability of the laser treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The Alexandrite laser emerges as a promising modality for the management of PAK pigmentation, with specific dermoscopic patterns being indicative of a favorable response. This study reinforces the critical importance of dermoscopic expertise in the selection and optimization of treatment for PAKs. Future research should focus on comparative studies with different lasers or combination therapies to develop a more comprehensive treatment framework for PAKs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"56 9","pages":"776-782"},"PeriodicalIF":2.2,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lsm.23849","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: This study aimed to evaluate the efficacy and safety of nanosecond laser treatment of pigmented lesions in silico using a model of melanosome disruption threshold fluence (MDTF) based on skin optical properties.
Methods: Particle size analysis and scanning electron microscopy were performed to determine the threshold fluence for melanosome disruption using a nanosecond laser. By inputting the obtained threshold fluence into the MDTF model and considering the variability in skin optical properties, irradiation parameters were calculated and compared with the results from clinical studies.
Results: The threshold fluences for 532 and 755 nm nanosecond laser irradiation were determined to be 3.0 and 15.0 J/cm2, respectively. In silico analysis showed that the incident fluence for moderately pigmented skin should be 1.2 times that for lightly pigmented skin, whereas it should be 50% lower than that for lightly pigmented skin to achieve the same level of energy deposition. Clinically applied fluences for moderately pigmented skin are at the low end of the calculated range of values, suggesting that the clinical fluence is chosen to minimize energy deposition in normal tissues.
Conclusions: Our results showed that the MDTF model can be used to evaluate nanosecond laser treatments and provide clinical guidance on fluence settings based on laser-tissue interactions in moderately pigmented skin. The in silico method can, therefore, provide a robust and quantitative retrospective evaluation of the treatment effects that accounts for variation in irradiation parameters among patients by combining the MDTF model with the in vivo optical properties of individual skin types.
{"title":"In Silico Evaluation of Nanosecond Laser Treatment of Pigmented Lesions Based on Skin Optical Properties Using a Model of Melanosome Disruption Threshold Fluence.","authors":"Yu Shimojo, Takahiro Nishimura, Daisuke Tsuruta, Toshiyuki Ozawa, Taro Kono","doi":"10.1002/lsm.23848","DOIUrl":"https://doi.org/10.1002/lsm.23848","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the efficacy and safety of nanosecond laser treatment of pigmented lesions in silico using a model of melanosome disruption threshold fluence (MDTF) based on skin optical properties.</p><p><strong>Methods: </strong>Particle size analysis and scanning electron microscopy were performed to determine the threshold fluence for melanosome disruption using a nanosecond laser. By inputting the obtained threshold fluence into the MDTF model and considering the variability in skin optical properties, irradiation parameters were calculated and compared with the results from clinical studies.</p><p><strong>Results: </strong>The threshold fluences for 532 and 755 nm nanosecond laser irradiation were determined to be 3.0 and 15.0 J/cm<sup>2</sup>, respectively. In silico analysis showed that the incident fluence for moderately pigmented skin should be 1.2 times that for lightly pigmented skin, whereas it should be 50% lower than that for lightly pigmented skin to achieve the same level of energy deposition. Clinically applied fluences for moderately pigmented skin are at the low end of the calculated range of values, suggesting that the clinical fluence is chosen to minimize energy deposition in normal tissues.</p><p><strong>Conclusions: </strong>Our results showed that the MDTF model can be used to evaluate nanosecond laser treatments and provide clinical guidance on fluence settings based on laser-tissue interactions in moderately pigmented skin. The in silico method can, therefore, provide a robust and quantitative retrospective evaluation of the treatment effects that accounts for variation in irradiation parameters among patients by combining the MDTF model with the in vivo optical properties of individual skin types.</p>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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