Sergio Del Río-Sancho, Stephanie Christen-Zaech, David Alvarez Martinez, Jöri Pünchera, Rastine Merat, Hans Joachim Laubach
Background: The advent of ablative fractional photothermolysis has revolutionized laser dermatology by providing a method to produce well-standardized, precise, and repeatable microscopic lesions. These wounds typically heal within 1-3 weeks, depending on the body site, with a minimal risk of permanent scarring. This positions ablative fractional photothermolysis as an exemplary in vivo model for studying the skin's wound healing processes.
Objectives: This study aims to evaluate and compare the effectiveness of two noninvasive imaging techniques, reflectance confocal microscopy (RCM) and line-field confocal optical coherence tomography (LC-OCT), in assessing skin wound healing following microscopic injuries induced by ablative fractional photothermolysis.
Methods: The forearms of participating volunteers were treated and ablated with a CO2-Laser in a fractional pattern using varying power settings (2.5-10 mJ/MTZ). In vivo RCM and LC-OCT images were obtained at predefined time intervals post-laser treatment, ranging from 6 h to 14 days.
Results: Vertical visualization of the lesions through both imaging modalities revealed a healing process characterized by the upward and outward movement of microscopic epidermal necrotic debris, thereby reducing the depth of the injury while forming an external crust. LC-OCT imaging demonstrated more comprehensive results with fewer movement artifacts. Conversely, horizontal visualization with both techniques highlighted a gathering of keratinocytes around the wounds, indicating the initiation of the regenerative process. RCM provided superior image clarity in this horizontal plane.
Conclusions: RCM and LC-OCT offer valuable and complementary noninvasive alternatives to conventional biopsy methods for the assessment and characterization of the skin's wound healing process post-ablative fractional photothermolysis. These findings underscore the potential of such imaging techniques in enhancing our understanding of the wound healing process.
{"title":"Comparing Line-Field Confocal Optical Coherence Tomography and Reflectance Confocal Microscopy on the In Vivo Healing Process of Lesions Induced by Fractional Photothermolysis.","authors":"Sergio Del Río-Sancho, Stephanie Christen-Zaech, David Alvarez Martinez, Jöri Pünchera, Rastine Merat, Hans Joachim Laubach","doi":"10.1002/lsm.23841","DOIUrl":"https://doi.org/10.1002/lsm.23841","url":null,"abstract":"<p><strong>Background: </strong>The advent of ablative fractional photothermolysis has revolutionized laser dermatology by providing a method to produce well-standardized, precise, and repeatable microscopic lesions. These wounds typically heal within 1-3 weeks, depending on the body site, with a minimal risk of permanent scarring. This positions ablative fractional photothermolysis as an exemplary in vivo model for studying the skin's wound healing processes.</p><p><strong>Objectives: </strong>This study aims to evaluate and compare the effectiveness of two noninvasive imaging techniques, reflectance confocal microscopy (RCM) and line-field confocal optical coherence tomography (LC-OCT), in assessing skin wound healing following microscopic injuries induced by ablative fractional photothermolysis.</p><p><strong>Methods: </strong>The forearms of participating volunteers were treated and ablated with a CO<sub>2</sub>-Laser in a fractional pattern using varying power settings (2.5-10 mJ/MTZ). In vivo RCM and LC-OCT images were obtained at predefined time intervals post-laser treatment, ranging from 6 h to 14 days.</p><p><strong>Results: </strong>Vertical visualization of the lesions through both imaging modalities revealed a healing process characterized by the upward and outward movement of microscopic epidermal necrotic debris, thereby reducing the depth of the injury while forming an external crust. LC-OCT imaging demonstrated more comprehensive results with fewer movement artifacts. Conversely, horizontal visualization with both techniques highlighted a gathering of keratinocytes around the wounds, indicating the initiation of the regenerative process. RCM provided superior image clarity in this horizontal plane.</p><p><strong>Conclusions: </strong>RCM and LC-OCT offer valuable and complementary noninvasive alternatives to conventional biopsy methods for the assessment and characterization of the skin's wound healing process post-ablative fractional photothermolysis. These findings underscore the potential of such imaging techniques in enhancing our understanding of the wound healing process.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT05614557.</p>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154481","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}
Claus von der Burchard, Yoko Miura, Boris Stanzel, Jay Chhablani, Johann Roider, Carsten Framme, Ralf Brinkmann, Jan Tode
<div> <section> <h3> Objectives</h3> <p>Numerous laser and light therapies have been developed to induce regenerative processes in the choroid/retinal pigment epithelium (RPE)/photoreceptor complex, leaving the neuroretina undamaged. These therapies are applied to the macula for the treatment of various diseases, most prominently diabetic maculopathy, retinal vein occlusion, central serous chorioretinopathy, and age-related macular degeneration. However, the abundance of technologies, treatment patterns, and dosimetry protocols has made understanding these therapies and comparing different approaches increasingly complex and challenging. To address this, we propose a new nomenclature system with a clear categorization that will allow for better understanding and comparability between different laser and light modalities. We propose this nomenclature system as an open standard that may be adapted in future toward new technical developments or medical advancements.</p> </section> <section> <h3> Methods</h3> <p>A systematic literature review of reported macular laser and light therapies was conducted. A categorization into a standardized system was proposed and discussed among experts and professionals in the field. This paper does not aim to assess, compare, or evaluate the efficacy of different laser or dosimetry techniques or treatment patterns.</p> </section> <section> <h3> Results</h3> <p>The literature search yielded 194 papers describing laser techniques, 50 studies describing dosimetry, 272 studies with relevant clinical trials, and 82 reviews. Following the common therapeutic aim, we propose “regenerative retinal laser and light therapies (RELITE)” as the general header. We subdivided RELITE into four main categories that refer to the intended physical and biochemical effects of temperature increase (photothermal therapy, PTT), RPE regeneration (photomicrodisruption therapy, PMT), photochemical processes (photochemical therapy, PCT), and photobiomodulation (photobiomodulation therapy, PBT).</p> <p>Further, we categorized the different dosimetry approaches and treatment regimens. We propose the following nomenclature system that integrates the most important parameters to enable understanding and comparability:</p> <p><i>Pattern—Dosimetry—Exposure Time/Frequency, Duty Cycle/Irradiation Diameter/Wavelength—Subcategory—Category</i>.</p> </section> <section> <h3> Conclusion</h3> <p>Regenerative retinal laser and light therapies are widely used for different diseases and may become valu
{"title":"Regenerative Retinal Laser and Light Therapies (RELITE): Proposal of a New Nomenclature, Categorization, and Trial Reporting Standard","authors":"Claus von der Burchard, Yoko Miura, Boris Stanzel, Jay Chhablani, Johann Roider, Carsten Framme, Ralf Brinkmann, Jan Tode","doi":"10.1002/lsm.23833","DOIUrl":"10.1002/lsm.23833","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Numerous laser and light therapies have been developed to induce regenerative processes in the choroid/retinal pigment epithelium (RPE)/photoreceptor complex, leaving the neuroretina undamaged. These therapies are applied to the macula for the treatment of various diseases, most prominently diabetic maculopathy, retinal vein occlusion, central serous chorioretinopathy, and age-related macular degeneration. However, the abundance of technologies, treatment patterns, and dosimetry protocols has made understanding these therapies and comparing different approaches increasingly complex and challenging. To address this, we propose a new nomenclature system with a clear categorization that will allow for better understanding and comparability between different laser and light modalities. We propose this nomenclature system as an open standard that may be adapted in future toward new technical developments or medical advancements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic literature review of reported macular laser and light therapies was conducted. A categorization into a standardized system was proposed and discussed among experts and professionals in the field. This paper does not aim to assess, compare, or evaluate the efficacy of different laser or dosimetry techniques or treatment patterns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The literature search yielded 194 papers describing laser techniques, 50 studies describing dosimetry, 272 studies with relevant clinical trials, and 82 reviews. Following the common therapeutic aim, we propose “regenerative retinal laser and light therapies (RELITE)” as the general header. We subdivided RELITE into four main categories that refer to the intended physical and biochemical effects of temperature increase (photothermal therapy, PTT), RPE regeneration (photomicrodisruption therapy, PMT), photochemical processes (photochemical therapy, PCT), and photobiomodulation (photobiomodulation therapy, PBT).</p>\u0000 \u0000 <p>Further, we categorized the different dosimetry approaches and treatment regimens. We propose the following nomenclature system that integrates the most important parameters to enable understanding and comparability:</p>\u0000 \u0000 <p><i>Pattern—Dosimetry—Exposure Time/Frequency, Duty Cycle/Irradiation Diameter/Wavelength—Subcategory—Category</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Regenerative retinal laser and light therapies are widely used for different diseases and may become valu","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"56 8","pages":"693-708"},"PeriodicalIF":2.2,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lsm.23833","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108852","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}
Cover micrograph: The cover image is based on the article Combined CO2 Laser Vaporization and Bleomycin Injection to Treat Huge Adult Laryngeal Vascular Anomalies: Innovative Application of CO2 Laser in Otolaryngology by Xiufa Wu et al., https://doi.org/10.1002/lsm.23824.
{"title":"Cover Image: Volume 56 Issue 7","authors":"Xiufa Wu, Jing Zhang, Rui Fang, Chunsheng Wei","doi":"10.1002/lsm.23838","DOIUrl":"https://doi.org/10.1002/lsm.23838","url":null,"abstract":"<p>Cover micrograph: The cover image is based on the article Combined CO<sub>2</sub> Laser Vaporization and Bleomycin Injection to Treat Huge Adult Laryngeal Vascular Anomalies: Innovative Application of CO<sub>2</sub> Laser in Otolaryngology by Xiufa Wu et al., https://doi.org/10.1002/lsm.23824.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"56 7","pages":"i"},"PeriodicalIF":2.2,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lsm.23838","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142041521","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}
K. C. C. de Bie, R. A. A. van Kollenburg, L. A. M. J. G. van Riel, M. Almasian, J. E. Freund, P. R. Bloemen, R. Zweije, J. Crezee, B. F. Coolen, G. J. Strijkers, T. M. de Reijke, J. R. Oddens, A. G. J. M. van Leeuwen, D. M. de Bruin
<div> <section> <h3> Background</h3> <p>Focal laser ablation (FLA) serves as a targeted therapy for prostate cancer (PCa). Clinical studies have demonstrated significant variations in ablation volumes with consistent fiber configurations. Consequently, a prediction model is needed for the safe application of FLA in treating PCa.</p> </section> <section> <h3> Objective</h3> <p>This study aimed to evaluate the reproducibility of FLA–induced temperature profiles in controlled ex vivo experiments using clinical laser treatment protocols. Additionally, it sought to examine the effectiveness of the CEM43 model in predicting the zone of irreversible damage (ZID) and to compare these findings with outcomes derived from the Arrhenius model.</p> </section> <section> <h3> Methods</h3> <p>Freshly excised postmortem human prostate and porcine liver specimens were used for controlled ex vivo ablation. Tissues were secured in a Perspex sample holder for precise placement of the laser fiber and thermocouples. FLA was conducted with a 1064-nm Nd:YAG laser at 3 W in continuous-wave mode for 10 min. Pre– and post–FLA 3D T1-weighted 7 T MRI scans were obtained to assess the treatment area. Whole-mount hematoxylin and eosin histological slides were prepared and digitized. On histology, the ZID was defined as the total of vaporized, carbonized, and coagulated tissue. A 2D thermal development map was created from temperature data, using bi-cubic interpolation. The cumulative equivalent thermal isoeffect dose at 43°C in minutes (CEM43) model was applied to predict the ZID, with 240 equivalent minutes (240-CEM43) used as the damage threshold. Additionally, the Arrhenius thermal model was used for comparison of CEM43 results. Predicted ZIDs were compared to MRI and histology.</p> </section> <section> <h3> Results</h3> <p>FLA treatment was performed on ex vivo human prostate samples (<i>n</i> = 2) and porcine liver specimens (<i>n</i> = 5). For human prostate tissue, FLA did not result in an identifiable ZID upon histological macroscopic examination or a lesion on MRI. Ex vivo porcine liver samples showed a clearly demarcated oval-shaped hyperintense lesion surrounding the laser fiber tip on post–FLA MRI. The MRI lesion (range 1.6–2.1 cm<sup>2</sup>) corresponded with the shape and location of the ZID on histology, but was smaller (median 1.7 vs. 3.2, <i>p</i> = 0.02). Histological examination of porcine liver samples revealed ZIDs ranging from 2.1 to 4.1 cm<sup>2</sup>, whereas 240-CEM43–predicted ZIDs ranged from 3.3 to 3.8 cm<sup>2</sup>. Although the median 240-CEM43–pre
背景：病灶激光消融术（FLA）是一种治疗前列腺癌（PCa）的靶向疗法。临床研究表明，在光纤配置一致的情况下，消融量存在很大差异。因此，需要建立一个预测模型，以便安全应用 FLA 治疗 PCa：本研究旨在利用临床激光治疗方案，在受控体外实验中评估 FLA 诱导的温度曲线的可重复性。此外，研究还试图检验 CEM43 模型在预测不可逆损伤区（ZID）方面的有效性，并将这些结果与阿伦尼乌斯模型得出的结果进行比较：方法： 新鲜切除的死后人类前列腺和猪肝标本用于受控体外消融。组织被固定在一个 Perspex 样品支架上，以便精确放置激光光纤和热电偶。在连续波模式下使用 1064 纳米 Nd:YAG 激光器以 3 瓦功率进行 FLA，持续 10 分钟。在进行 FLA 之前和之后，均进行了 3D T1 加权 7 T MRI 扫描，以评估治疗区域。制备并数字化整张苏木精和伊红组织切片。在组织学上，ZID 被定义为汽化、碳化和凝固组织的总和。利用双立方插值法，根据温度数据绘制出二维热显影图。应用 43°C 时的累积等效热等效应剂量（CEM43）模型来预测 ZID，并以 240 等效分钟（240-CEM43）作为损伤阈值。此外，还使用阿伦尼乌斯热模型对 CEM43 结果进行比较。预测的 ZID 与核磁共振成像和组织学进行了比较：在体外人体前列腺样本（n = 2）和猪肝样本（n = 5）上进行了 FLA 处理。对于人体前列腺组织，FLA 在组织学宏观检查中未发现可识别的 ZID，在核磁共振成像中也未发现病变。活体猪肝样本在FLA后核磁共振成像上显示，激光光纤尖端周围有一个界限清晰的椭圆形高强度病变。核磁共振成像病灶（范围为 1.6-2.1 平方厘米）与组织学上 ZID 的形状和位置一致，但更小（中位数为 1.7 vs. 3.2，p = 0.02）。猪肝样本的组织学检查显示 ZID 为 2.1 至 4.1 平方厘米，而 240-CEM43 预测的 ZID 为 3.3 至 3.8 平方厘米。虽然 240-CEM43 预测的 ZID 中位数并不比组织学 ZID 大很多（3.8 对 3.2 平方厘米，p = 0.22），但在大多数实验中，它往往会高估组织学结果。Arrhenius预测的ZID中值与组织学ZID相似（3.2 vs. 3.2 cm2，p = 0.56），但在比较单个实验时，ZID的大小有所不同（范围为2.5-3.2 cm2）：结论：体外人体前列腺 FLA 在组织病理学或核磁共振成像上未显示热损伤。猪肝体外 FLA 在组织病理学上导致可识别的 ZID，在核磁共振成像上导致病变。240-CEM43 通常会高估 ZID，但与组织病理学相比，其变异性较小。阿伦尼乌斯模型的结果与组织学结果的一致性较好，但仍无法预测 FLA 诱导的单个组织学热损伤。实验之间的 ZID 变异性突出表明，有必要为 PCa 治疗中的 FLA 建立一个更全面的预测剂量模型。
{"title":"Outcomes of CEM43 in Predicting Thermal Damage Induced by Focal Laser Ablation in Controlled Ex Vivo Experiments: A Comparison to Histology and MRI","authors":"K. C. C. de Bie, R. A. A. van Kollenburg, L. A. M. J. G. van Riel, M. Almasian, J. E. Freund, P. R. Bloemen, R. Zweije, J. Crezee, B. F. Coolen, G. J. Strijkers, T. M. de Reijke, J. R. Oddens, A. G. J. M. van Leeuwen, D. M. de Bruin","doi":"10.1002/lsm.23834","DOIUrl":"10.1002/lsm.23834","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Focal laser ablation (FLA) serves as a targeted therapy for prostate cancer (PCa). Clinical studies have demonstrated significant variations in ablation volumes with consistent fiber configurations. Consequently, a prediction model is needed for the safe application of FLA in treating PCa.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to evaluate the reproducibility of FLA–induced temperature profiles in controlled ex vivo experiments using clinical laser treatment protocols. Additionally, it sought to examine the effectiveness of the CEM43 model in predicting the zone of irreversible damage (ZID) and to compare these findings with outcomes derived from the Arrhenius model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Freshly excised postmortem human prostate and porcine liver specimens were used for controlled ex vivo ablation. Tissues were secured in a Perspex sample holder for precise placement of the laser fiber and thermocouples. FLA was conducted with a 1064-nm Nd:YAG laser at 3 W in continuous-wave mode for 10 min. Pre– and post–FLA 3D T1-weighted 7 T MRI scans were obtained to assess the treatment area. Whole-mount hematoxylin and eosin histological slides were prepared and digitized. On histology, the ZID was defined as the total of vaporized, carbonized, and coagulated tissue. A 2D thermal development map was created from temperature data, using bi-cubic interpolation. The cumulative equivalent thermal isoeffect dose at 43°C in minutes (CEM43) model was applied to predict the ZID, with 240 equivalent minutes (240-CEM43) used as the damage threshold. Additionally, the Arrhenius thermal model was used for comparison of CEM43 results. Predicted ZIDs were compared to MRI and histology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>FLA treatment was performed on ex vivo human prostate samples (<i>n</i> = 2) and porcine liver specimens (<i>n</i> = 5). For human prostate tissue, FLA did not result in an identifiable ZID upon histological macroscopic examination or a lesion on MRI. Ex vivo porcine liver samples showed a clearly demarcated oval-shaped hyperintense lesion surrounding the laser fiber tip on post–FLA MRI. The MRI lesion (range 1.6–2.1 cm<sup>2</sup>) corresponded with the shape and location of the ZID on histology, but was smaller (median 1.7 vs. 3.2, <i>p</i> = 0.02). Histological examination of porcine liver samples revealed ZIDs ranging from 2.1 to 4.1 cm<sup>2</sup>, whereas 240-CEM43–predicted ZIDs ranged from 3.3 to 3.8 cm<sup>2</sup>. Although the median 240-CEM43–pre","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"56 8","pages":"723-733"},"PeriodicalIF":2.2,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lsm.23834","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142036239","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}
William Driscoll, Nicole M Golbari, Alexander Vallmitjana, Amanda F Durkin, Mihaela Balu, Christopher B Zachary
Objectives: The absorption of biostimulatory particulate matter following its application to fractional skin defects remains poorly understood, and even less is known about its in vivo impact in terms of tissue integration. The objectives of this study are twofold: (1) to evaluate the potential of calcium hydroxylapatite (CaHA) to penetrate through skin treated with a fractional laser; and (2) to assess the effectiveness of clinical laser scanning microscopy technologies in monitoring the effects of such treatment over time.
Methods: One area on a volunteer's arm was treated with a fractional erbium laser (Sciton Inc., Palo Alto, CA), while a second area received the same laser treatment followed by CaHA topical application. We used reflectance confocal microscopy (RCM) and multiphoton microscopy (MPM) to noninvasively image beneath the surface of the treated skin to study and monitor the effects of these treatments within 1 h of treatment and at four additional time points over a 6-week period.
Results: One hour posttreatment, at different depths beneath the skin surface, MPM and RCM provided similar visualizations of laser-induced channels. In skin treated by both laser and CaHA, these two imaging methods provided complementary information. RCM captured the lateral and depth distribution of CaHA microspheres and were seen as bright spheres as they became incorporated into the healing tissue. MPM, meanwhile, visualized the CaHA microparticles as dark shadow spheres within the laser-induced channels and encroaching healing tissue. Furthermore, MPM provided critical information about collagen regeneration around the microspheres, with the collagen visually marked by its distinct second harmonic generation (SHG) signal.
Conclusions: This observational pilot study demonstrates that CaHA, a collagen stimulator used as a dermal filler, can not only be inserted into the dermis after fractional laser treatment but remains in the healing skin for at least 6 weeks posttreatment. The noninvasive imaging techniques RCM and MPM successfully captured the presence of CaHA microspheres mid-dermis during the healing phase. They also demonstrated new collagen production around the microspheres, highlighting the effectiveness of these imaging approaches in monitoring such treatment over time.
{"title":"Intradermal Delivery of Calcium Hydroxylapatite With Fractionated Ablation.","authors":"William Driscoll, Nicole M Golbari, Alexander Vallmitjana, Amanda F Durkin, Mihaela Balu, Christopher B Zachary","doi":"10.1002/lsm.23830","DOIUrl":"https://doi.org/10.1002/lsm.23830","url":null,"abstract":"<p><strong>Objectives: </strong>The absorption of biostimulatory particulate matter following its application to fractional skin defects remains poorly understood, and even less is known about its in vivo impact in terms of tissue integration. The objectives of this study are twofold: (1) to evaluate the potential of calcium hydroxylapatite (CaHA) to penetrate through skin treated with a fractional laser; and (2) to assess the effectiveness of clinical laser scanning microscopy technologies in monitoring the effects of such treatment over time.</p><p><strong>Methods: </strong>One area on a volunteer's arm was treated with a fractional erbium laser (Sciton Inc., Palo Alto, CA), while a second area received the same laser treatment followed by CaHA topical application. We used reflectance confocal microscopy (RCM) and multiphoton microscopy (MPM) to noninvasively image beneath the surface of the treated skin to study and monitor the effects of these treatments within 1 h of treatment and at four additional time points over a 6-week period.</p><p><strong>Results: </strong>One hour posttreatment, at different depths beneath the skin surface, MPM and RCM provided similar visualizations of laser-induced channels. In skin treated by both laser and CaHA, these two imaging methods provided complementary information. RCM captured the lateral and depth distribution of CaHA microspheres and were seen as bright spheres as they became incorporated into the healing tissue. MPM, meanwhile, visualized the CaHA microparticles as dark shadow spheres within the laser-induced channels and encroaching healing tissue. Furthermore, MPM provided critical information about collagen regeneration around the microspheres, with the collagen visually marked by its distinct second harmonic generation (SHG) signal.</p><p><strong>Conclusions: </strong>This observational pilot study demonstrates that CaHA, a collagen stimulator used as a dermal filler, can not only be inserted into the dermis after fractional laser treatment but remains in the healing skin for at least 6 weeks posttreatment. The noninvasive imaging techniques RCM and MPM successfully captured the presence of CaHA microspheres mid-dermis during the healing phase. They also demonstrated new collagen production around the microspheres, highlighting the effectiveness of these imaging approaches in monitoring such treatment over time.</p>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004521","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> Background/Objective</h3> <p>Laser therapy has emerged as a widely favored treatment option for solar lentigines (SL). However, a significant challenge associated with this treatment, particularly among individuals with darker skin tones, is the notable risk of postinflammatory hyperpigmentation (PIH) induction. In response to these concerns, the authors conducted a prospective, self-controlled study to comprehensively evaluate the safety and effectiveness of 532-nm picosecond laser, both with and without a microlens array (MLA), for the management of SL in patients with Fitzpatrick skin types (FST) III–V.</p> </section> <section> <h3> Methods</h3> <p>Twenty-seven patients with FST III–V and bilateral SL on the face underwent randomized treatment. One side of the face was treated with a 532-nm picosecond laser coupled with an MLA, utilizing the fractional pigment toning (FPT) technique, while the other side received treatment without the MLA, following the conventional technique (CT). The FPT technique utilized a 9-mm spot size with a fluence of 0.47 J/cm<sup>2</sup> for two passes covering 40% of the area. In contrast, the CT used a 4.5-mm handpiece with fluence ranging from 0.3 to 0.7 J/cm<sup>2</sup>. Patients received a single treatment and were evaluated for pigment clearance, occurrence of PIH, and other adverse effects at 2 weeks, 1, 3, and 6 months posttreatment.</p> </section> <section> <h3> Results</h3> <p>Twenty-seven participants completed the study protocol. Analysis of pigment clearance, measured via 3D photography, showed significant improvement from 2 weeks to 6 months posttreatment for both the FPT technique (<i>p</i> < 0.001) and CT (<i>p</i> = 0.004). PIH occurred in 64%, 80%, 96%, and 88% of cases on the CT side, compared to 8%, 32%, 36%, and 16% on the FPT technique side at 2 weeks, 1, 3, and 6 months posttreatment, respectively. The incidence of PIH was significantly lower on the FPT technique side compared to the CT side throughout the follow-up periods. Additionally, transient and mild hypopigmentation occurred in one participant (4%) on the FPT technique side and in five participants (20%) on the CT side. No other adverse effects were observed during the study.</p> </section> <section> <h3> Conclusions</h3> <p>The 532-nm picosecond laser emerges as a safe and efficacious treatment modality for SL in individuals with FST III–V. Particularly noteworthy is the efficacy of the FPT technique, which demonstrates comparable effectiveness while significantly reducing the incidence of PIH compared to the CT.<
{"title":"Exploring Fractional Pigment Toning: A Novel Approach for Treating Benign Pigmented Lesions in Asian Patients With Fitzpatrick Skin Types III–V","authors":"Woraphong Manuskiatti, Thrit Hutachoke, Noldtawat Viriyaskultorn, Jayne Bernadeth Li, Thanya Techapichetvanich, Rungsima Wanitphakdeedecha","doi":"10.1002/lsm.23828","DOIUrl":"10.1002/lsm.23828","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background/Objective</h3>\u0000 \u0000 <p>Laser therapy has emerged as a widely favored treatment option for solar lentigines (SL). However, a significant challenge associated with this treatment, particularly among individuals with darker skin tones, is the notable risk of postinflammatory hyperpigmentation (PIH) induction. In response to these concerns, the authors conducted a prospective, self-controlled study to comprehensively evaluate the safety and effectiveness of 532-nm picosecond laser, both with and without a microlens array (MLA), for the management of SL in patients with Fitzpatrick skin types (FST) III–V.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty-seven patients with FST III–V and bilateral SL on the face underwent randomized treatment. One side of the face was treated with a 532-nm picosecond laser coupled with an MLA, utilizing the fractional pigment toning (FPT) technique, while the other side received treatment without the MLA, following the conventional technique (CT). The FPT technique utilized a 9-mm spot size with a fluence of 0.47 J/cm<sup>2</sup> for two passes covering 40% of the area. In contrast, the CT used a 4.5-mm handpiece with fluence ranging from 0.3 to 0.7 J/cm<sup>2</sup>. Patients received a single treatment and were evaluated for pigment clearance, occurrence of PIH, and other adverse effects at 2 weeks, 1, 3, and 6 months posttreatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-seven participants completed the study protocol. Analysis of pigment clearance, measured via 3D photography, showed significant improvement from 2 weeks to 6 months posttreatment for both the FPT technique (<i>p</i> < 0.001) and CT (<i>p</i> = 0.004). PIH occurred in 64%, 80%, 96%, and 88% of cases on the CT side, compared to 8%, 32%, 36%, and 16% on the FPT technique side at 2 weeks, 1, 3, and 6 months posttreatment, respectively. The incidence of PIH was significantly lower on the FPT technique side compared to the CT side throughout the follow-up periods. Additionally, transient and mild hypopigmentation occurred in one participant (4%) on the FPT technique side and in five participants (20%) on the CT side. No other adverse effects were observed during the study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The 532-nm picosecond laser emerges as a safe and efficacious treatment modality for SL in individuals with FST III–V. Particularly noteworthy is the efficacy of the FPT technique, which demonstrates comparable effectiveness while significantly reducing the incidence of PIH compared to the CT.<","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"56 7","pages":"642-649"},"PeriodicalIF":2.2,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lsm.23828","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792797","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}
Picosecond lasers with a microlens array can cause laser-induced optical breakdown (LIOBS) and LIC (Intradermal laser-induced cavitation) within high-fluence areas. This study aimed to describe the clinical, reflectance confocal microscopy (RCM), histopathological findings, and the characteristics of vacuoles caused by LIOBS and LIC in individuals with skin types III and IV.
Materials and Methods
This study was performed on six Chilean healthy volunteers, males and females, aged 35–65 years old with Fitzpatrick skin phototypes III–IV. The laser was applied in the inner proximal area of the nondominant arm. RCM evaluation was performed 24 h later; 48 h later, skin biopsies were performed on the laser-treated areas. Clinical, histological, and RCM findings were recorded.
Results
Every individual developed a 10 mm2 area of clinical erythema in the treated area. Under RCM, all six volunteers had hyporeflective spherical structures at the level of the epidermis, consistent with intraepidermal vacuoles. Histopathological evaluation revealed different sizes of vacuoles in both the epidermis and dermis.
Conclusion
The LIOBS and LIC processes and the secondary production of vacuoles could be highly valuable for effective dermal remodeling treatment and aid in promoting the production of new collagen, elastic fibers, and growth factors that could improve skin texture. These structures were visible under RCM and histopathological evaluation.
{"title":"In Vivo Evaluation of Laser-Induced Optical Breakdown (LIOBS) by 1064-nm Nd:YAG Fractional Picosecond Laser With Reflectance Confocal Microscopy and Precise Histopathologic Correlation","authors":"Maritza Rojas-Orrego, Nestor Carreño, Teo Feuerhake, Cristian Navarrete-Dechent","doi":"10.1002/lsm.23829","DOIUrl":"10.1002/lsm.23829","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Picosecond lasers with a microlens array can cause laser-induced optical breakdown (LIOBS) and LIC (Intradermal laser-induced cavitation) within high-fluence areas. This study aimed to describe the clinical, reflectance confocal microscopy (RCM), histopathological findings, and the characteristics of vacuoles caused by LIOBS and LIC in individuals with skin types III and IV.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This study was performed on six Chilean healthy volunteers, males and females, aged 35–65 years old with Fitzpatrick skin phototypes III–IV. The laser was applied in the inner proximal area of the nondominant arm. RCM evaluation was performed 24 h later; 48 h later, skin biopsies were performed on the laser-treated areas. Clinical, histological, and RCM findings were recorded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Every individual developed a 10 mm<sup>2</sup> area of clinical erythema in the treated area. Under RCM, all six volunteers had hyporeflective spherical structures at the level of the epidermis, consistent with intraepidermal vacuoles. Histopathological evaluation revealed different sizes of vacuoles in both the epidermis and dermis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The LIOBS and LIC processes and the secondary production of vacuoles could be highly valuable for effective dermal remodeling treatment and aid in promoting the production of new collagen, elastic fibers, and growth factors that could improve skin texture. These structures were visible under RCM and histopathological evaluation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"56 7","pages":"650-656"},"PeriodicalIF":2.2,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141784354","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}
Taryn N. Murray, Rishabh Lohray, Kelly P. Schultz, Sean Boutros, Paul M. Friedman
Background
There has been a proliferation of physicians of different levels of experience and training offering nonsurgical cosmetic procedures. Rising demand, compounded by increasing utilization of new and existing technologies by numerous physician specialties, compels discussion of adequate standardized training and patient safety.
Methods
A retrospective chart review of patients who presented to our single site dermatology clinic for managment of complications following chemical peel, laser or energy-based device treatments performed by core cosmetic physicians between the years of 2013 and 2024 was conducted. Core cosmetic physicians included plastic surgery, facial surgery/otolaryngology, oculoplastic surgery, and dermatology. Charts were reviewed for documentation of the type of complication, procedure causing the complication, and physician credentials, and referral source.
Results
Twenty-five patients were identified as having complications from chemical peeling, laser treatment or energy-based devices. Devices implicated included CO2 laser (fractional or fully ablative), chemical peels, 1064 nm long-pulsed Nd:YAG laser, 1320 nm Nd:YAG laser, intense pulsed light, 595 nm pulsed dye laser, Q-switched Nd:YAG laser, radiofrequency with and without microneedling, and 1550 nm erbium-doped fiber laser. Complications included hypertrophic scarring, atrophic scarring, post-inflammatory erythema, post-inflammatory hyperpigmentation, and post-inflammatory hypopigmentation.
Conclusions
Even in experienced hands, complications can arise. It is imperative that all physicians offering cosmetic treatments are equipped to recognize clinical endpoints, identify and manage complications, or make a timely referral to decrease the risk of a permanent and potentially devastating esthetic outcome for patients.
{"title":"Complications of Chemical Peels, Lasers, and Energy-Based Device Procedures Performed by Core Cosmetic Physicians: A Retrospective Analysis","authors":"Taryn N. Murray, Rishabh Lohray, Kelly P. Schultz, Sean Boutros, Paul M. Friedman","doi":"10.1002/lsm.23820","DOIUrl":"10.1002/lsm.23820","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There has been a proliferation of physicians of different levels of experience and training offering nonsurgical cosmetic procedures. Rising demand, compounded by increasing utilization of new and existing technologies by numerous physician specialties, compels discussion of adequate standardized training and patient safety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective chart review of patients who presented to our single site dermatology clinic for managment of complications following chemical peel, laser or energy-based device treatments performed by core cosmetic physicians between the years of 2013 and 2024 was conducted. Core cosmetic physicians included plastic surgery, facial surgery/otolaryngology, oculoplastic surgery, and dermatology. Charts were reviewed for documentation of the type of complication, procedure causing the complication, and physician credentials, and referral source.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-five patients were identified as having complications from chemical peeling, laser treatment or energy-based devices. Devices implicated included CO<sub>2</sub> laser (fractional or fully ablative), chemical peels, 1064 nm long-pulsed Nd:YAG laser, 1320 nm Nd:YAG laser, intense pulsed light, 595 nm pulsed dye laser, Q-switched Nd:YAG laser, radiofrequency with and without microneedling, and 1550 nm erbium-doped fiber laser. Complications included hypertrophic scarring, atrophic scarring, post-inflammatory erythema, post-inflammatory hyperpigmentation, and post-inflammatory hypopigmentation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Even in experienced hands, complications can arise. It is imperative that all physicians offering cosmetic treatments are equipped to recognize clinical endpoints, identify and manage complications, or make a timely referral to decrease the risk of a permanent and potentially devastating esthetic outcome for patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"56 7","pages":"619-624"},"PeriodicalIF":2.2,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759582","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}
Carolina dos Anjos, Yin Wang, Que Chi Truong-Bolduc, Paul K. Bolduc, Matthew Liu, David C. Hooper, R. Rox Anderson, Tianhong Dai, Leon G. Leanse
Objective
In this study, we evaluated the effectiveness of antimicrobial blue light (aBL; 410 nm wavelength) against β-lactamase-carrying bacteria and the effect of aBL on the activity of β-lactamases.
Methods
Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae strains carrying β-lactamases as well as a purified β-lactamase enzymes were studied. β-lactamase activity was assessed using a chromogenic cephalosporin hydrolysis assay. Additionally, we evaluated the role of porphyrins in the photoreaction, as well as protein degradation by sodium dodecyl-sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Finally, we investigated the bactericidal effect of combined aBL-ceftazidime exposure against a metallo-β-lactamase expressing P. aeruginosa strain.
Results
Our study demonstrated that aBL effectively killed β-lactamase-producing bacteria and reduced β-lactamase activity. After an aBL exposure of 1.52 J/cm2, a 50% reduction in enzymatic activity was observed in P. aeruginosa. Additionally, we found a 40% decrease in the photoreaction activity of porphyrins following an aBL exposure of 64.8 J/cm2. We also revealed that aBL reduced β-lactamase activity via protein degradation (after 136.4 J/cm2). Additionally, aBL markedly improved the bactericidal effect of ceftazidime (by >4-log10) in the metallo-β-lactamase P. aeruginosa strain.
Conclusion
Our results provide evidence that aBL compromises bacterial β-lactamase activity, offering a potential approach to overcome β-lactam resistance in bacteria.
{"title":"Blue Light Compromises Bacterial β-Lactamases Activity to Overcome β-Lactam Resistance","authors":"Carolina dos Anjos, Yin Wang, Que Chi Truong-Bolduc, Paul K. Bolduc, Matthew Liu, David C. Hooper, R. Rox Anderson, Tianhong Dai, Leon G. Leanse","doi":"10.1002/lsm.23819","DOIUrl":"10.1002/lsm.23819","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>In this study, we evaluated the effectiveness of antimicrobial blue light (aBL; 410 nm wavelength) against β-lactamase-carrying bacteria and the effect of aBL on the activity of β-lactamases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p><i>Pseudomonas aeruginosa</i>, <i>Escherichia coli</i>, and <i>Klebsiella pneumoniae</i> strains carrying β-lactamases as well as a purified β-lactamase enzymes were studied. β-lactamase activity was assessed using a chromogenic cephalosporin hydrolysis assay. Additionally, we evaluated the role of porphyrins in the photoreaction, as well as protein degradation by sodium dodecyl-sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Finally, we investigated the bactericidal effect of combined aBL-ceftazidime exposure against a metallo-β-lactamase expressing <i>P. aeruginosa</i> strain<i>.</i></p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our study demonstrated that aBL effectively killed β-lactamase-producing bacteria and reduced β-lactamase activity. After an aBL exposure of 1.52 J/cm<sup>2</sup>, a 50% reduction in enzymatic activity was observed in <i>P. aeruginosa</i>. Additionally, we found a 40% decrease in the photoreaction activity of porphyrins following an aBL exposure of 64.8 J/cm<sup>2</sup>. We also revealed that aBL reduced β-lactamase activity via protein degradation (after 136.4 J/cm<sup>2</sup>). Additionally, aBL markedly improved the bactericidal effect of ceftazidime (by >4-log<sub>10</sub>) in the metallo-β-lactamase <i>P. aeruginosa</i> strain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our results provide evidence that aBL compromises bacterial β-lactamase activity, offering a potential approach to overcome β-lactam resistance in bacteria.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"56 7","pages":"673-681"},"PeriodicalIF":2.2,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748514","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}
Ajay N. Sharma, Nicole M. Golbari, Solomiya Grushchak, Adriana Ribas Andrade, Christopher B. Zachary
<div> <section> <h3> Objectives</h3> <p>Iatrogenic cutaneous siderosis is a well-recognized dermatologic complication after parenteral iron infusion. The condition manifests as discrete, hyperpigmented patches near the site of injection. Most cases do not resolve spontaneously, leading to significant aesthetic and psychological distress to patients. A recent case of iatrogenic cutaneous siderosis at our institution prompted a systematic review of the efficacy of energy-based devices previously reported in the treatment of this condition.</p> </section> <section> <h3> Methods</h3> <p>PubMed and Cochrane databases were searched for all peer-reviewed articles published using the following search terms: “iron OR heme OR hemosiderosis OR siderosis” and “hyperpigmentation OR staining OR tattoo.” Articles reporting on energy-based devices in the treatment of iron-induced hyperpigmentation were included.</p> </section> <section> <h3> Results</h3> <p>A total of seven articles and 54 total patients were included in this review. All patients, including the patient treated at our institution, were female, with an average age of 44 years. Hyperpigmentation was most commonly associated with intravenous iron infusion (48/54, 89%), on the arm or forearm (44/54, 81%), and used for the treatment of underlying iron deficiency anemia (54/54, 100%). The application of six different nanosecond or picosecond quality-switched laser systems was reported in the treatment of cutaneous siderosis, with wavelengths ranging from 532 to 1064 nm. Spot sizes varied between 2 and 7 mm, with energy fluences spanning 0.5–40 J/cm<sup>2</sup> depending on both the device and spot size. Outcomes were measured after an average of 5.4 laser treatments and 10.4 months, with over half of all reported patients experiencing complete clearance (27/50, 54%). Our patient received treatment in three test areas with picosecond alexandrite 785 nm, nanosecond Nd:YAG 532 nm, and picosecond Nd:YAG 532 nm devices. The nanosecond Nd:YAG 532 nm treated area demonstrated the greatest improvement, and the entire arm was subsequently treated with this device.</p> </section> <section> <h3> Conclusions</h3> <p>Despite the often intractable nature of iatrogenic cutaneous siderosis, laser surgery is a reasonable and safe treatment modality for patients seeking cosmetic improvement of this dyschromia. Dermatologists should be aware of this entity and the efficacy of the energy-based devices currently in our armamentarium. A combination approach may need to be utilized with different wavelengths and pulsed widths to target iron pigment in both dermal and subcutaneous layers.</p> </sec
{"title":"Treatment of Iron-Induced Cutaneous Hyperpigmentation With Energy-Based Devices","authors":"Ajay N. Sharma, Nicole M. Golbari, Solomiya Grushchak, Adriana Ribas Andrade, Christopher B. Zachary","doi":"10.1002/lsm.23825","DOIUrl":"10.1002/lsm.23825","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Iatrogenic cutaneous siderosis is a well-recognized dermatologic complication after parenteral iron infusion. The condition manifests as discrete, hyperpigmented patches near the site of injection. Most cases do not resolve spontaneously, leading to significant aesthetic and psychological distress to patients. A recent case of iatrogenic cutaneous siderosis at our institution prompted a systematic review of the efficacy of energy-based devices previously reported in the treatment of this condition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed and Cochrane databases were searched for all peer-reviewed articles published using the following search terms: “iron OR heme OR hemosiderosis OR siderosis” and “hyperpigmentation OR staining OR tattoo.” Articles reporting on energy-based devices in the treatment of iron-induced hyperpigmentation were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of seven articles and 54 total patients were included in this review. All patients, including the patient treated at our institution, were female, with an average age of 44 years. Hyperpigmentation was most commonly associated with intravenous iron infusion (48/54, 89%), on the arm or forearm (44/54, 81%), and used for the treatment of underlying iron deficiency anemia (54/54, 100%). The application of six different nanosecond or picosecond quality-switched laser systems was reported in the treatment of cutaneous siderosis, with wavelengths ranging from 532 to 1064 nm. Spot sizes varied between 2 and 7 mm, with energy fluences spanning 0.5–40 J/cm<sup>2</sup> depending on both the device and spot size. Outcomes were measured after an average of 5.4 laser treatments and 10.4 months, with over half of all reported patients experiencing complete clearance (27/50, 54%). Our patient received treatment in three test areas with picosecond alexandrite 785 nm, nanosecond Nd:YAG 532 nm, and picosecond Nd:YAG 532 nm devices. The nanosecond Nd:YAG 532 nm treated area demonstrated the greatest improvement, and the entire arm was subsequently treated with this device.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite the often intractable nature of iatrogenic cutaneous siderosis, laser surgery is a reasonable and safe treatment modality for patients seeking cosmetic improvement of this dyschromia. Dermatologists should be aware of this entity and the efficacy of the energy-based devices currently in our armamentarium. A combination approach may need to be utilized with different wavelengths and pulsed widths to target iron pigment in both dermal and subcutaneous layers.</p>\u0000 </sec","PeriodicalId":17961,"journal":{"name":"Lasers in Surgery and Medicine","volume":"56 7","pages":"625-631"},"PeriodicalIF":2.2,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620356","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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