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Objective:To evaluate the efficacy and patients＇ satisfaction of the intense pulse light (IPL) and M22-Resur Fx non-ablative fractional laser (NAFL) for the treatment of lateral static crow＇s feet.Methods:A prospective split-face, randomized, controlled study of 60 consecutive patients with lateral static crow＇s feet was performed. The patients aged 30 to 55 years, who were enrolled in the Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University from January 2018 to January 2020. The two sides of each patient＇s face were randomized to receive different treatment, and according to their treatment, the patients were divided into 3 groups with 20 cases each: Group A, in which 20 patients＇ one side face was treated with IPL, and other side was treated with NAFL; Group B, in which one side face was treated with IPL, and another side was treated with IPL immediately followed by NAFL; Group C, in which one side face was treated with NAFL, and another side was treated with IPL immediately followed by NAFL. The improvements including the water content of stratum corneum of skin and the patients＇ satisfaction, as well as the improvement of the lateral static crow＇s feet were evaluated.Results:The IPL plus NAFL combined treatment group and the NAFL treatment group showed the effective rate of the improvement for lateral static crow＇s feet of patients on days 60 and 90 was statistically significant ( P<0.05) compared with that before the treatment. And the improvement for lateral static crow＇s feet of patients on days 60 and 90 in combined treatment side was significantly different from either NAFL side ( P<0.05). 60 days and 90 days after treatment, the satisfaction of combined treatment side was significantly higher than that of either NAFL side or IPL side ( P<0.05). Conclusions:The treatment with an optimized IPL immediately followed by a NAFL is clinically superior to those with the NAFL or IPL alone for improving the lateral static crow＇s feet of patients. The satisfaction treated by NAFL combined with IPL is higher than using the NAFL or IPL alone.
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Objective:To evaluate the clinical efficacy and safety of a cream containing madecassoside, 5% panthenolon skin repairing after nonablative fractional 1 565 nm laser therapy.Methods:A total of 84 patients who received nonablative fractional laser surgery in our hospital from April 2017 to April 2018 were included as research objects. The patients were divided into observation group and control group by random number table method, 42 cases in each group. The control group was treated with routine facial intervention after operation, while the observation group was treated with a cream containing madecassoside, 5% panthenolon skin repairing on the basis of routine intervention. The postoperative skin barrier function of the two groups were recorded and compared through skin property system and VISIA complexion analysis system.Results:At 1 and 2 weeks after operation, the sebum content and cuticle water content in the observation group were higher than those in the control group, and the transdermal water loss in the observation group was less than that in the control group, and the differences were statistically significant ( t=4.927, 7.833, 12.430, 4.538, 10.083, 8.017, P<0.05). The erythema index (EI) and melanin index (MI) of the observation group were lower than those of the control group at 1 and 2 weeks after operation, and the incidence of complications was significantly lower than that of the control group ( t=2.392, 2.807, 3.485, 3.009, P<0.05). Conclusions:The application of a cream containing madecassoside, 5% panthenolon in skin repairing is helpful to enhance the moisturizing effect, reduce the complications and promote the early recovery of patients with skin trauma after fractional laser operation.
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Objective@#To explore the effect and safety of fractional 1565 nm laser on white striae gravidarum (SG) in abdomen and observe the influencing factors of treatment effect.@*Methods@#Thirty-six patients, aged 24-39 years old, were randomly divided into two groups(group A, n=16, group B, n=20): patients in group A underwent two passes of laser treatment: striae were locally scanned at moderate level energy(35 mJ/μb) with high density(300 dot/cm2), and high level energy (45 mJ/μb)with low density(150 dot/cm2)was adopted for the whole area.Group B received one pass of treatment at moderate energy with high density 35 mJ/μb, 300 dot/cm2). All patients received three laser treatments at a 6 weeks interval. Improvement of SG appearance was assessed by blinded reviewers, 3 months after the last treatment, using a percentage category scale. Meanwhile, patients satisfaction was evaluated. The impact of skin aging on laser treatment was evaluated. Patient satisfaction scores and side effects were evaluated.@*Results@#All patients completed the overall trial. The average improvement of scores was 1.69±0.95, which contributed to a fairly good response rate of 88.89%. The patients satisfactory and very satisfactory rate was 58.3%(21/36). There was no significant difference in improvement score between group A(1.88±0.89) and group B(1.55±1.00) (P< 0.01). The operation duration of group B was shorter than group A, (29.6±4.9)min vs.(53.7±5.5)min, P<0.05. There was a moderate negative correlation between aging and laser treatment effect (r=-0.553). The abnormal color of skin(erythema and post-inflammatory hyperpigmentation) in group A lasted longer than group B, (9.17±4.03)d vs. (6.73±2.29)d, P<0.05.The pain score during treatment was tolerable, with the score of 2.61±0.76.@*Conclusions@#The treatment with fractional 1565 nm laser can improve the appearance of SG. It is more timesaving when the entire implicated area treated by one pass at moderate level energy with high density. Skin aging will discount the effect.
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Objective To explore the application of Lux1540 nm non-stripping array laser in fa-cial rejuvenation .Methods A total of 100 patients were collected for Lux1540 nm non stripped lattice laser treatment in patients with facial skin aging ,once a month ,totally four times treatment ;1 month after the treatment ,the skin of patients was analyzed by skin image analyzer VISIA for quantitative e-valuation .Results After 4 treatments ,the skin wrinkles ,texture ,pores ,skin roughness ,brown spots ,erythrocyte and purple spots were all improved ,with statistically significant differences (P <0 .05) ,while the changes of ultraviolet spots were not obvious ,and the differences were not statistical-ly significant (P > 0 .05) .After treatment ,80 patients were satisfied ,17 were comparatively satisfied , and 3 were dissatisfied ,with a satisfactory rate of 97％ .All patients had needle-like pain during the treatment ,which could be tolerated without local anesthesia ointment .Ice compress was given after treatment ,which significantly alleviated the discomfort after treatment .Only 3 cases had mild pig-mentation .During the treatment and follow-up ,no adverse events such as skin redness and swelling , pigmentation and pruritus were found .Conclusions Lux1540 nm non-ablative dot array laser has posi-tive efficacy ,high safety and few side effects in facial rejuvenation ,and it is an effective method to treat facial skin aging .
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O uso do laser não ablativo no tratamento do melasma tem sido abordado em diversos estudos, porém, não há consenso na literatura quanto aos parâmetros e feitos de intervenções baseadas neste recurso. O objetivo deste estudo foi identificar e descrever parâmetros e efeitos do laser não ablativo no tratamento de hiperpigmentação de pele (melasma). Trata-se de uma revisão sistemática da literatura baseada no Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A busca eletrônica compreendeu as seguintes bases de dados: PubMed, Physiotherapy Evidence Database (PEDro), Science Direct e SciELO. Foram identificados inicialmente 641 documentos nas bases de dados eletrônicas, enquanto na busca manual 26 artigos foram encontrados, após leitura e análise 7 artigos foram selecionados. Foram analisados 7 artigos correspondentes as bases de dados PubMed e Science Direct, todos na língua inglesa e publicados a partir do ano de 2010. Apenas um estudo utilizou uma amostra maior que 30 indivíduos, os demais utilizaram em média 16 participantes, com predomínio do sexo feminino e classificação segundo Fitzpatrick entre III-V. O comprimento de onda variou entre 1064 nm a 1550 nm e a energia máxima não ultrapassou 4 J/cm². De acordo com as variáveis avaliadas, os protocolos testados demonstraram que o laser não ablativo foi ineficaz no tratamento de melasma facial, sobretudo após a interrupção da terapia. (AU)
The use of non-ablative laser in the treatment of melasma has been used in several studies, however, there is no consensus in the literature regarding the parameters and interventions based on this resource. The objective of this study was to identify and describe parameters and effects of nonablative laser in the treatment of skin hyperpigmentation (melasma). This is a systematic review of the literature based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). The study included the following databases: PubMed, Physiotherapy Evidence Database (PEDro), Science Direct and SciELO. We initially identified 641 documents in the electronic databases, while in the manual search 26 articles were found, and after reading and analyzing 7 articles were selected. We analyzed these 7 articles corresponding to the PubMed and Science Direct databases, all in the English language and published after the year 2010. Only one study used a sample > 30 individuals, the others used on average 16 participants, with a predominance of female gender and Fitzpatrick classification according to III-V. The wavelength ranged from 1064 nm to 1550 nm and the maximum energy did not exceed 4 J/cm². According to the variables evaluated, the protocols tested demonstrated that the non-ablative laser was ineffective in the treatment of facial melasma, especially after the end of the therapy. (AU)
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Humanos , Masculino , Femenino , Historia del Siglo XXI , Hiperpigmentación , Terapia por Láser , Dermatología , Especialidad de Fisioterapia , RevisiónRESUMEN
Objective To evaluate the safety and efficacy of the combined treatment with an optimized intense pulsed light (IPL) and a non-ablative fractional laser (NAFL) for facial rejuvenation.Methods A prospective,split-face,randomized,controlled study was conducted.A total of 22 testees with facial photoaging,who aged from 35 to 55 years,were enrolled into this study from the Department of Dermatology of Peking University First Hospital between March and June in 2017.By a random number table,the two sides of each testee's face were randomized to receive combined treatment with optimized IPL immediately followed by non-ablative 1 565 nm Erbium:Glass fractional laser (combined treatment group) or non-ablative 1 565 nm Erbium:Glass fractional laser alone (NAFL group) once every month for 3 sessions.Before the treatment,60 and 90 days after the treatment (1 month after the second and third treatment respectively),photos of the treatment regions were taken,skin physiology parameters (including skin melanin,erythema indices,water content of the stratum corneum,transepidermal water loss [TEWL],skin flexibility and glossiness) were measured,and subjective and objective clinical evaluation was carried out.After each treatment,adverse reactions were assessed by two dermatologists independently,including facial erythema,swelling and crusting,desquamation,pigmentation and pains.Results During the treatment course,1 testee dropped out due to pains,another 1 testee dropped out for personal reasons,and 20 testees completed the treatment and follow-up.The combined treatment group showed significantly decreased melanin indices on days 60 and 90 (152.9 ± 36.9 and 155.0 ± 38.1,respectively) compared with that before the treatment (168.4 ± 41.3,F =5.321,P ＜ 0.05).On day 60,the melanin index was significantly lower in the combined treatment group than in the NAFL group (159.4 ± 35.3,P ＜ 0.05).However,the melanin indices on days 60 and 90 in the NAFL group (159.4 ± 35.3,156.7 ± 36.3) did not significantly differ from that before the treatment (165.9 ± 35.4,P ＞ 0.05).No significant difference was observed between the pre-and post-treatment erythema indices in either of the two groups (both P ＞ 0.05).The water content of the stratum corneum on days 60 and 90 significantly increased compared with that before the treatment in both the combined treatment group (F =21.795,P ＜ 0.001) and NAFL group (F =21.798,P ＜ 0.001),while the TEWL on days 60 and 90 significantly decreased compared with that before the treatment in both the combined treatment group (F =8.848,P =0.001) and NAFL group (F =5.833,P ＜ 0.05).However,there were no significant differences in either of the water content of the stratum corneum or TEWL on days 60 and 90 between the two groups (P ＞ 0.05).On days 60 and 90,the combined treatment group and NAFL group both showed significantly increased skin flexibility (P＜ 0.05,0.001,respectively) and glossiness (both P ＜ 0.001) compared with those before the treatment.On day 90,the skin glossiness in the combined treatment group was higher than that in the NAFL group (P ＜ 0.05).The short-term adverse reactions included transient pain,erythema and swelling which lasted 2-3 days,and slight desquamation.The main adverse reaction was mild local pigmentation,which lasted 2-3 months and then subsided gradually.Conclusion The 3 sessions of treatment with an optimized IPL immediately followed by a 1 565 nm NAFL is clinically superior to those with the NAFL alone for improving the facial pigmentation and skin glossiness,and the adverse reactions are usually transient and mild.
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Objective Xanthelasma palpebrarum presents a therapeutic and aesthetic challenge because of its high visibility and frequent rate of recurrence with a wide variety of treatments.Many patients were disappointed by an initial unsuccessful treatment and fail to return for further therapy until the problem had become quite conspicuous.So a simple treatment with few side effects and good acceptance remains an important goal.Methods Eleven patients with xanthelasma lesions were treated with the 1540nm erbium:glass laser.We could see erythema and swell around the skin lesion immediately.It needed irradiate again after one month if there was residual lesion.The end point was the lesions completely removed.The therapeutic effect of 1540nm erbium laser,the adverse reaction and the satisfaction of patients were observed.Results All lesions were removed without hyperpigmentation or scarring.Conclusions The 1540 nm erbium:glass laser represents an effective means for treating xanthelasmas with few side effects and good acceptance.
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Objective To evaluate the efficacy and safety of nonablative radiofrequency in facial rejuvenation.Methods A total of 198 patients with facial skin relaxing or wrinkles in the 153rd Central Hospital of PLA from July 2010 to March 2015 were treated with nonablative radiofrequency,of which 42 cases were male,156 cases were female,the ages were from 30 to 60 years old,Fitzpatrick skin type was Ⅲ~Ⅳ.The nonablative radiofrequency were performed in all the patients.Output:Monopolar RF 90~110W,Bipolar RF 40~45W,Periorbital RF 40~50W.The total course of treatment had 6 times with a fixed 10-day interval after each therapy.Results In 198 facial skin aging patients,the total effective rate was more than 90%,the half-year effective maintenance rate was more than 70%.Complications included slight oedema and mild erythema that were minor and transitory.Side effects such as post-inflammatory hyperpigmentation,epidermal burns and scar formation were not observed.Conclusion The nonablative radiofrequency is safe and effect on facial rejuvenation with less complications.
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BACKGROUND: Multiple therapies involving ablative and nonablative techniques have been developed for the rejuvenation of photodamaged skin. Radiofrequency (RF) is emerging as a gentler, nonablative skin-tightening device that delivers uniform heat to the dermis at a controlled depth. OBJECTIVE: To compare the efficacy of bipolar radiofrequency (Polaris™) and 1,550-nm fractional erbium-glass laser (Mosaic™) for the treatment of photoaging using a randomized, split-face, patient- and evaluator-blind study. METHODS: We evaluated the clinical effects after the treatment of photoaging. Ten Asian women (Fitzpatrick skin type III to IV) underwent 9 weeks of treatment (3 sessions at 3-week intervals) with monotherapy (Polaris™) on one side of the face and combination therapy with non-ablative bipolar radiofrequency (Polaris™) and 1,550-nm fractional erbium-glass laser (Mosaic™) on the other side. RESULTS: Among 10 patients, 4 were male and 6 were female. Subjective and objective assessments showed that the combination therapy was more effective. As the number of the treatment sessions increased, there was an accompanying increase in the satisfaction level and efficacy. CONCLUSION: This study suggests that bipolar radiofrequency combined with 1,550-nm fractional erbium-glass laser could be effective treatment for photoaging.
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Femenino , Humanos , Masculino , Pueblo Asiatico , Vestuario , Dermis , Calor , Rejuvenecimiento , PielRESUMEN
There are many therapeutic methods for treating vitiligo, including narrow-band UVB, topical corticosteroids, calcineurin inhibitors, excimer laser, and surgical methods, such as autologous epidermal grafting and dermabrasion. However, although various treatments have been tried, there is still no reliable treatment. Recently, there were several reports about the use of fractional laser combined with narrow-band (NB) UVB to treat vitiligo. A 33-year-old male patient presented with hypopigmented patch on lower right abdominal area. After being diagnosed with vitiligo, the patient underwent NB-UVB treatment and application of a topical agent for two years but failed to show response. To evaluate the efficacy of non-ablative fractional laser, a 1550-nm erbium:glass (Er:Glass) fractional laser was applied to whole area of the lesion. The area showed erythema and brown microscopic epidermal necrotic debris. Five days after the laser procedure, NB-UVB treatment with application of a topical agent was initiated once or twice a week, followed by pigmentation of the treated area . The fractional laser was reapplied three months later, and the patient is currently under observation and is still being treated with NB-UVB. We observed successful treatment of refractory vitiligo with the combination of non-ablative 1550-nm Er:Glass fractional laser, NB-UVB, and a topical agent. We consider non-ablative Er:Glass fractional laser as a favorable choice of treatment for refractory vitiligo.
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Adulto , Humanos , Masculino , Corticoesteroides , Inhibidores de la Calcineurina , Dermabrasión , Eritema , Láseres de Excímeros , Pigmentación , Trasplantes , VitíligoRESUMEN
Objective To evaluate the clinical efficacy of the non-ablative 1550 nm fractional laser on post-acne atrophic scarring and post-acne erythema.By following up,the correlative factors were analyzed to guide the further use of the non-ablative 1550 nm fractional laser.Methods Twentyseven patients who received the non-ablative 1550 nm fractional laser therapy from Dec.2011 to June 2013 were enrolled in this retrospective study.We used a quartile grading scale for evaluation of postacne atrophic scarring and post-acne erythema.Results The effective rate was 13.0％ (3/23) for post-acne atrophic scarring and 44.0％ (11/25) for post-acne erythema.Nonparametric test showed that there was no statistical correlation of the efficacy with gender,age and courses of disease.But there was positive correlation between efficacy and treatment frequencies on post-acne erythema (r=0.619,P＜0.05).No severe adverse effect was observed.Conclusions We suggest that the nonablative 1550 nm fractional laser may provide a new treatment algorithm in some cases of post-acne atrophic scar and post-acne erythema.
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Background: As the demand for noninvasive procedures for skin rejuvenation is increasing, combined diode laser and radiofrequency and combined infrared and radiofrequency devices have recently emerged. Aim: To compare Polaris WRA TM , a combination device of diode light and RF, and ReFirme ST TM , a combination device of infrared and bipolar RF, in terms of safety and efficacy on skin rejuvenation. Methods: Fourteen Korean volunteers of skin type II-IV, with facial laxity and periorbital rhytids, received three treatments at 3-week intervals with combined diode laser and bipolar radiofrequency (laser fluence 30 J/cm 2 , RF fluence 90 J/cm 3 ) on the right half of their faces and combined infrared light and bipolar radiofrequency (RF fluence 120 J/cm 3 ) on the left half of their faces. Clinical photos of front and bilateral sides of the subjects' faces were taken at baseline and at 6, 9, 12 weeks after the treatment initiation. The investigators' and the subjects' global assessments were performed. Results: There is no statistically significant difference in the overall outcome between Polaris WRA TM and Refirme ST TM based on pre- and post-treatment objective measurements. Polaris WRA TM was more effective than Refirme ST TM at reducing wrinkles when therapeutic results of the two appliances were compared based on the patient satisfaction measurements. After the treatment with both instruments, histological increase in the production and rearrangement of collagen fibers at the dermal layer was observed. The density of the collagen fibers was more increased with the Polaris WRA TM -treated facial area than that of Refirme ST TM . Treatment was generally well tolerated, and there was no serious complication. Conclusion: In this study, both the lasers appeared to be safe, and effective methods for treating skin laxity and facial wrinkles. Combined diode laser and radiofrequency was more effective than combined infrared and radiofrequency at reducing wrinkles and pores when the therapeutic results of both the appliances were compared.
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Objective To evaluate the change of the amount of collagen in the viemedic RF ASC01IC non-ablative photorejuveantion,in order to provide reference for effective clinical treatment.Methods Twenty rats were randomly divided into two groups,with ten rats in each group.The rats'skin was dividied into two areas by spine.The left side was used as control,and the right side was experiment side,which was treated with RF by viemedic RF ASC011C for five times at interval of seven days,and ten minutes in each time.The content of collagen in the dermis was measured by immunohistochemical method,the thickness of collagen bundles in the dermis was measured under HE staining and the quantity of collagen fibers was compared by collagen fibers staining.Results Epidermis was more smooth,the collagen fiber was thicker and the content of fibroblasts,collagen was higher in experiment side.Image quantitative analysis showed significant improvement in area density of collagen fibers.Conclusions RF is a very safe and effective method for non-ablative photorejuvnation.
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BACKGROUND: Striae distensae are atrophic dermal scars with overlying epidermal atrophy causing significant cosmetic concern. Although a variety of laser and light sources have been used for the treatment of striae distensae, to date no definite 'gold standard' treatment modality has been determined. OBJECTIVE: To assess and compare the efficacy and safety of nonablative fractional photothermolysis and ablative CO2 fractional laser resurfacing in the treatment of striae distensae. METHODS: Twenty-four ethnic South Korean patients with varying degrees of atrophic striae alba in the abdomen were enrolled in a randomized blind split study. The patients were treated with 1,550 nm fractional Er:Glass laser and ablative fractional CO2 laser resurfacing. Each half of the abdominal lesion was randomly selected and treated three times at intervals of 4-weeks using the same parameters. Digital photography was conducted and skin elasticity and the width of the widest striae in each subject were measured at the baseline and 4 weeks after the final treatment. Clinical improvement was assessed by comparing pre- and post-treatment clinical photographs by two blinded physicians and participant satisfaction rates were evaluated. Skin biopsies were taken from three participants. All adverse effects were reported during the study. RESULTS: Although they do not statistically differ, both treatments with nonablative fractional laser and ablative CO2 fractional laser showed a significant clinical and histopathologic improvement of striae distensae over pretreatment sites. CONCLUSION: These results support the use of nonablative fractional laser and ablative CO2 fractional laser as effective and safe treatment modalities for striae distensae of Asian skin. However, neither treatment showed any greater clinical improvement than the other treatment.
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Humanos , Abdomen , Pueblo Asiatico , Atrofia , Biopsia , Cicatriz , Cosméticos , Elasticidad , Láseres de Gas , Luz , Fotograbar , Piel , Estrías de DistensiónRESUMEN
BACKGROUND: Topical and systemic drugs have been successfully used in the treatment of acne. However, many people are concerned about the side effects of these medicines, especially the childbearing women. Recent reports demonstrated that sequential treatment with laser- and light-based devices lead to a clinical improvement in acne. Recently, we witnessed experienced a case of improvement of inflammatory acne lesions during the treatment of acne scars using a 1,550-nm non-ablative fractional erbium-glass laser. OBJECTIVE: This study was designed to investigate the efficacy and safety of 1,550-nm non-ablative fractional erbium-glass laser in the treatment of facial inflammatory acne vulgaris. METHODS: 11 patients with facial inflammatory acne vulgaris were recruited. These patients received three treatment sessions at a 3-week interval. Inflammatory lesions were counted before and after treatment. The sebum production was quantified using the Sebumeter(R). We graded the patients' self-assessment and the investigator's global assessment using a five-point scale used by the dermatologist. We also investigated the histological changes after the treatment sessions, and the adverse effects during the study. RESULTS: Treatment with 1,550-nm non-ablative fractional erbium-glass laser was well tolerated, resulting in the reduction of inflammatory lesions by 61% (p<0.05). However, the reduction in sebum production from the baseline was not statistically significant. Histopathologic examination of the inflammatory lesions showed a marked decrease in the dermal inflammatory cell infiltration around the perivascular and periappendageal area and the sebaceous glands became smaller after laser treatments. Side-effects were minimal, and were resolved within a few days. CONCLUSION: 1,550-nm non-ablative fractional erbium-glass laser was safe and effective for the treatment of facial inflammatory acne lesions.
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Femenino , Humanos , Acné Vulgar , Cicatriz , Glándulas Sebáceas , Sebo , Autoevaluación (Psicología) , Ingenio y Humor como AsuntoRESUMEN
Objective To observe the histological change of different waves in treating SD rats of the long-pulse 1064nm Nd:YAG laser and the 560～1200 nm intense pulse light,in order to provide the theory bases of non-ablative rejuvenation.Methods Two waves were used on experimental mice.The dermic thickness and the expression of collagen typesⅠand Ⅲwere detected by HE stain and immunohistochemical methods. Semiquantitative analysis was used to determine the mean of absorbance.Results Thedermal thicknesses and the mean of absorbance of collagen typesⅠandⅢin two different waves were higher than those in common control groups(P＜0.05).The effect of Nd:YAG laser groups were higher than IPL groups(P＜0.05).The expression of collagen typeⅠwas higher than that of collagen type Ⅲ(P＜0.001).Conclusion After Nd:YAG laser or IPL irradiation,the dermal thickness and collagen typesⅠandⅢof SD rats are increased.The effects of Nd:YAG laser are better than those of 560～1 200 nm IPL.The expression of collagen type Ⅲ is obviously more than that of collagen typeⅠin the early,whereas the expression of collagen typeⅠis obviously more than that of collagen type Ⅲin the later.It proves that the mechanism of dermal remodeling of non-ablative skin rejuvenation is mainly correlation with raising range and time of collagen typeⅠ.
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Os lasers ablativos, como o laser de CO2 (10.600 nm) e o erbium:YAG (Er:YAG-2.940 nm), removem a epiderme e provocam dano térmico residual na derme. Apresentam algumas desvantagens, como tempo de recuperação prolongado, não podem ser usados fora do rosto e têm risco significativo de efeitos colaterais. Para reduzir esses efeitos colaterais, surgiram os lasers não ablativos, que penetram profundamente na pele e aquecem a derme, poupando a epiderme. Seus efeitos colaterais e o tempo de recuperação são mínimos porém, comparado ao resurfacing ablativo, têm eficácia modesta e requerem múltiplos tratamentos. Lasers fracionados não ablativos foram desenvolvidos para rejuvenescimento cutâneo semelhante ao do laser de CO2, sem os inconvenientes e o pós-operatório deste. O princípio do laser fracionado é poupar áreas de pele sãs entre as áreas tratadas, facilitando e promovendo uma cicatrização mais rápida a partir das áreas poupadas. O resurfacing fracionado não ablativo apresenta bons resultados para o tratamento de rugas finas a moderadas e outros sinais do fotoenvelhecimento cutâneo. Outras indicações são cicatrizes atróficas, cicatrizes de acne, cicatrizes cirúrgicas e há relatos da eficácia no melasma. O tempo de recuperação é rápido, mas os resultados são inferiores aos obtidos com os tratamentos ablativos. Recentemenente surgiram os lasers fracionados ablativos de CO2 (10.600 nm) e érbio (Er:YAG 2.940 nm), com o intuito de se alcançar um resultado semelhante ao dos lasers ablativos, porém com recuperação e risco de efeitos colaterais mais próximos ao dos lasers fracionados não ablativos, já que também poupam áreas de pele sãs entre as áreas tratadas.
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In two institutions in México, twelve patients were given a second allogeneic stem cell transplantation, using the "Mexican" non-myeloablative preparative regimen. Eight had a malignant condition (six acute leukemias, one myelofibrosis and one myelodysplasia), eleven individuals were allografted twice from the same donor and in one case, cells from two different umbilical cords were used. The median time to conduct the second allograft after the first one was 6 months (range 1-41). The five patients who failed to engraft after the first transplant failed also to engraft after the second one; all of them had been heavily transfused. Only three patients were successfully rescued with the second transplant, two with acute leukemia and one with aplastic anemia. Seven patients are alive 10-41 months (median 35) after the second transplant, but only three (25%) remain disease-free. The 52-month overall survival (SV) of the patients is 58%, whereas the median overall SV has not been reached, being above 52 months. Conducting a second allograft may be useful to rescue some individuals relapsing after a first hematopoietic allotransplant.
En dos instituciones en México se llevaron a cabo doce segundos trasplantes de células hematopoyéticas usando el "método mexicano" de acondicionamiento no mieloablativo. Ocho pacientes tenían una enfermedad maligna (seis leucemias agudas, una mielofibrosis y una mielodisplasia). Once sujetos se retrasplantaron del mismo donador y en un caso se emplearon células hematopoyéticas de dos diferentes cordones umbilicales. La mediana del tiempo transcurrido entre los dos trasplantes fue de seis meses (rango 1 a 41). Los cinco pacientes que no se injertaron con el primer trasplante tampoco se injertaron con el segundo; todos ellos habían sido multitransfundidos antes de los trasplantes. Sólo tres pacientes se pudieron rescatar con el segundo trasplante, dos con leucemia aguda y uno con anemia aplástica. Siete pacientes están vivos 10 a 41 meses (mediana 35) después del segundo trasplante, pero sólo tres (25%) se encuentran libres de enfermedad. La supervivencia (SV) global a 52 meses es de 58%, en tanto que la mediana de SV no se ha alcanzado y es mayor de 52 meses. Hacer un segundo trasplante hematopoyético puede rescatar a algunos pacientes quienes recaen después de un trasplante de médula ósea.