Fractional photothermolysis for the treatment of facial wrinkle in Asians.

BACKGROUND: Fractional photothermolysis is a novel aesthetic-laser-surgical modality for the treatment of facial wrinkle in Caucasians apart from other conventional treatments. However there are limited reports regarding the effectiveness and side effects of this treatment in Asians' skin. OBJECTIVE: To evaluate the effectiveness and side effects of 1550 nm Erbium fiber Laser as a treatment for facial wrinkle in Asians'skin (Fitzpatrick's skin type III-V). MATERIAL AND METHOD: Twenty patients with mild to moderate facial wrinkle were included in the study. Half of the forehead in each patient was randomized to receive the treatment and the other half served as control. The treatment was done with FINE SCAN 1550 (TNC SPECTRONICS, Bangkok, Thailand), 1550 nm Erbium fiber laser once a week for 8 successive treatments. Photographs had been taken by VISIA at 0, 4 weeks and 12 weeks after the treatment and were evaluated by three experienced dermatologists using a quartile grading scale. Patient satisfaction score and side effects during each treatment were also recorded. RESULTS: At 4 weeks after the treatment, mean wrinkle, dyspigmentation, irregularities and the overall improvement scores were 0.35, 0.10, 0.20 and 0.50 respectively. At 12 weeks post treatment, the score decreased to 0.20, 0.05, 0.10 and 0.20. All of the improvement scores were significantly higher (p < 0.05) in the treatment group than the control group except for the dyspigmentation improvement score. Patients' satisfaction score was graded as 2 (good) in 35% (7/20) of the patients. Side effects included transient erythema and edema which were mild and self-limited. Mean pain score using visual analog scale was 1.32. No serious side effect was observed. CONCLUSION: Fractional photothermolysis with 1550 nm Erbium fiber Laser is one of the effective treatments for facial wrinkle. However; the improvement score decreased with time. Side effects are few and tolerable, even in patients with Fitzpatrick's skin type III-V

Lidocaine iontophoresis versus EMLA cream for CO2 laser treatment in seborrheic keratosis.

BACKGROUND: Topical anesthesia for skin surgery has widely been used for a long time. Various preparations are used. The EMLA cream is the most popular one. OBJECTIVE: The authors compared the local analgesic effect of topical lidocaine iontophoresis and EMLA cream in a crossover study design. METHOD: After informed consent, 16 patients with seborrheic keratosis, who required CO2 laser surgery, were enrolled. Two lesions on the opposite side of the body with a comparable size, shape and location were selected from each patient. The lidocaine iontophoresis was done on one lesion and the EMLA cream was applied on the other The CO2 laser surgery was performed after 10 min of lidocaine iontophoresis and 60 min after EMLA cream. The level of pain was recorded using a 100-mm visual analog scale. Ratings of patient satisfaction were also assessed. RESULTS: There were no significant differences in pain scores between the two groups (p=0.968), but significantly higher in satisfaction scores (1-5 scale) in the iontophoretic group than the EMLA group (p=0.005). Fifteen patients preferred lidocaine iontophoresis (93.8%), none preferred EMLA cream. All patients in the present study tolerated the tingling and burning sensations. No severe adverse events and side effects were detected. CONCLUSION: Lidocaine iontophoresis provides effective pain relief for CO2 laser surgery of seborrheic keratosis as well as the EMLA cream. The effect is as fast as 10 min after application. There is no significant side effect. Most of the patients were satisfied. Lidocaine iontophoresis is a useful, noninvasive local anesthesia for CO2 laser surgery of superficial skin lesions.