Journal of Cutaneous and Aesthetic Surgery
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FROM THE LITERATURE Table of Contents   
Year : 2010  |  Volume : 3  |  Issue : 1  |  Page : 53-54
From the Literature


Venkat Charmalaya, Centre for Advanced Dermatology, Bangalore, Karnataka, India

Click here for correspondence address and email

Date of Web Publication15-May-2010
 

How to cite this article:
Anitha B S. From the Literature. J Cutan Aesthet Surg 2010;3:53-4

How to cite this URL:
Anitha B S. From the Literature. J Cutan Aesthet Surg [serial online] 2010 [cited 2019 Jul 20];3:53-4. Available from: http://www.jcasonline.com/text.asp?2010/3/1/53/63223


The Efficacy and Safety of the 10,600-nm Carbon Dioxide Fractional Laser for Acne Scars in Asian Patients

Cho SB, Lee SJ, Kang JM, Kim YK, Chung WS, Oh SH

Dermatol Surg 2009;35:1955-61

Acne scars can be disfiguring and cause social problem to many youngsters. The treatment of these scars plays a very important role in the aesthetic practice. Different types of procedures have become available for the management of these scars, and among them in recent times, fractional laser has become prominent.

This article is a prospective study dealing with the efficacy and safety of the 10,600-nm ablative CO 2 fractional laser in the treatment of acne scars in Korean patients.

The study was conducted on 20 Korean patients with Fitzpatrick skin type IV with mild to severe atrophic acne scars. They were offered a single session of ablative 10,600-nm CO 2 fractional laser combining two treatment modes (deep FX mode with spot size of 0.12 mm for the scars and active FX mode with spot size of 1.25 mm throughout the face).

An evaluation was done after 3 months of treatment by two blinded dermatologists, using a quartile grading scale. Five percent of the total patients had 76-100% improvement, 45% had 51-75%, 35% had 26-50%, and 15% had no improvement. There was no difference in the results or improvement with respect to any particular scar type.

Common side effects noted were pain, post-treatment erythema, oedema, scaling, which lasted for few more days than what was seen in the case of non-ablative fractional laser.

To conclude, this laser promises to be an effective tool in the everadvancing technologies for the acne scar treatment, but further substantial studies are necessary.

Split-Skin Grafting from the Scalp: The Hidden Advantage

Gerhard HW, Boris B, Nikolaus B, Henning H, Eva-BB

Dermatol Surg 2009;35:1873-79

To cover chronic leg ulcers or large skin defects, skin harvesting is traditionally done usually from either of the thigh/buttock/abdomen, mainly because of the easy accessibility. Recently, posterior scalp has been suggested to be a better donor site for this purpose because of easy and rapid preparation, rapid wound healing, minimal post-operative care, low chance of infection, excellent cosmetic output, and minimal interference with routine activities.

This was a prospective study involving 166 (85 male and 81 female) patients, who underwent split-skin (0.2-0.3 mm in thickness) grafting for either chronic leg ulcers or other skin defects, donor site being the occipital scalp area. It required head shaving and the procedure was done under tumescent local anaesthesia. Post-operatively, the wound-healing time, complications, and cosmetic outcome were recorded.

The mean size of the graft was 4.5 cm 2 . The mean healing time was about 5 days. A total of 95% of the patients reported complete regrowth of hairs with an excellent cosmetic coverage on the donor area. There were only minimal side effects like pruritus, patchy alopecia in few patients, and almost no one complained of post-operative pain.

The study suggests that scalp can serve as a good site to achieve an excellent cosmetic coverage both at the donor and recipient site with rapid wound healing, easy pre-operative and post-operative care, and also avoids the patient from the trauma of immobilization. However, further studies are needed to prove the efficacy and patient compliance in such cases.

Radiofrequency Ablation of Facial Nerve Branches Controlling Glabellar Frowning

Foster KW, Fincher EF, Moy RL

Dermatol Surg 2009;35:1908-17

Glabellar frowning results mainly due to the hyperactivity of the corrugator supercilli muscle and to a lesser extent due to the procerus muscle. These muscles are innervated by branches of the facial nerve. The most preferred current treatment is injection of the botulinum toxin into the representative muscle to produce temporary muscle inactivity, resulting in flattening of the furrows.

The authors of this article have used a different approach to treat this common aesthetic problem. They used bipolar radiofrequency energy transmitted with the help of a probe to ablate the efferent motor nerves innervating these two muscles, namely, temporal and angular nerves through a percutaneous approach on both sides.

A total of 29 patients with mild to moderate glabellar frowning underwent this study, of whom 90% (26 out of 29) had highly satisfying results. The effect of the ablation lasted for a varying period, ranging from 4 months (69%) to 12 months (10%). There were no major side effects encountered.

However, this is a preliminary study and this alternate technique needs further evaluation through a controlled study for its safety, and benefits over and above those of the botulinum toxin therapy.

Low-Energy Helium-Neon Laser Induces Melanocyte Proliferation via an Interaction with Type IV Collagen: Visible Light as a Therapeutic Option for Vitiligo

Lan CC, Wu CS, Chiou MH, Chiang TY, Yu HS

Br J Dermatol 2009;161:273-80

Vitiligo is a common disease causing serious cosmetic disability and social stigma. Though several modalities exist, such as medical therapy, phototherapy, and surgery, treatment is not satisfactory in all cases. This article explores the possible role of the helium-neon laser (He-Ne), a low-energy laser with the wavelength in the visible light spectrum (632.8 nm).

In the study, the melanocytes obtained from the normal human foreskin were irradiated with 0 and 1 J/cm 2 of the He-Ne laser light and the effects on the skin were studied by different assays. The results were as follows:

  1. Increased attachment of melanocytes to type IV collagen with the resulting decreased mobility of melanocytes on the collagen
  2. Upregulation of α2β1 integrin expression on the melanocytes which mediates melanocyte growth
  3. Increase in the number of melanocytes , mitochondrial activity of melanocytes , and the resultant increased melanin turnover-these effects explain the photostimulatory effect of the He-Ne laser
  4. Increased expression of the phosphorylated cAMP response element binding (CREB) protein that regulates the melanocyte growth
  5. Increased synthesis and secretion of growth factors from keratinocytes and fibroblasts that influence the melanocyte growth.


It is now known that the repigmentation of the vitiliginous skin involves not just melanocytes, but also other cells like keratinocytes, fibroblasts, and melanoblasts operating through their growth factors, and also extracellular matrix (ECM) like type IV collagen. In this study, the He-Ne laser has been shown to influence repigmentation both directly (by its effects on melanocytes) and indirectly (through effects on other cells and ECM). Thus, the low-energy He-Ne laser shows promise in the treatment of vitiligo in vitro. These in vitro findings however need to be confirmed by proper controlled clinical trials to establish the efficacy of this laser.

Helium-Neon Laser Irradiation Stimulates Migration and Proliferation in Melanocytes and Induces Repigmentation in Segmental Type Vitiligo

Yu HS, Wu CS, Yu CL, Kao YH, Chiou MH

J Invest Dermatol 2003;120:56-64.

Segmental vitiligo is a distinct type of vitiligo which affects only a particular segment of the skin supplied by a specific dermatome. This type of vitiligo is associated with dysfunction of the sympathetic nerves in the affected patch. Though all the conventional medical modalities are tried for the treatment of this unique type of vitiligo, but none of them yield satisfactory results, whereas surgical grafting provides good improvement.

This is an in vivo study demonstrating the effectiveness of the low-energy helium-neon laser treatment in patients with segmental vitiligo. The study involved 30 patients with white patches over the head and neck region. They were treated with a continuous wave of the He-Ne laser once/twice a week.

Repeated photographs were taken for the comparison of the results and statistical analysis was done with Student's " t" test. About 10% of them had 100% repigmentation after 20 treatment sessions. After about 140 sessions, 40% had results varying from 50% to 75%. In those who showed an initial response, laser irradiation was continued as a maintenance therapy once/twice a month to avoid depigmentation. It was found that the size of the lesion and the duration of the lesion were inversely related to the response.

To conclude, the He-Ne laser therapy offers almost the same results as those of the conventional modes of treatment in vitiligo, and at the same time it is less expensive with no side effects.

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Correspondence Address:
B S Anitha
Venkat Charmalaya, Centre for Advanced Dermatology, Bangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


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