Journal Of Cutaneous And Aesthetic Surgery [J Cutan Aesthet Surg] 2019 Jan-Mar; Vol. 12 (1), pp. 8-16.
Laser hair removal since its availability has been primarily used for aesthetic purposes. Over the years, it has emerged as an important therapeutic modality in various dermatological and surgical disorders, both as an adjuvant and as a monotherapy. Depending on the skin type, all laser hair removal systems have been used with good results and minimal complications. We hereby review the diverse range of unconventional indications of laser hair removal.
Bhat YJ, Hassan I, Sajad P, Yaseen A, Mubashir S, Akhter S, and Wani R
Journal Of Cutaneous And Aesthetic Surgery [J Cutan Aesthet Surg] 2016 Jul-Sep; Vol. 9 (3), pp. 183-187.
Background: Epidermal naevi are benign hamartomatous growths of the skin which are generally asymptomatic with a benign course but are cosmetically disagreeable. Topical treatments such as steroids, calcipotriol, 5 fluorouracil, podophyllin, retinoids and cryotherapy are ineffective and surgical excision results in scar formation. Therapy is often challenging. Aim Of the Study: To study the response of carbon dioxide (CO2) laser in the management of epidermal naevi. Subjects and Methods: We conducted a study of CO2 laser treatment on 15 patients of epidermal naevi, eight with verrucous epidermal naevi and seven with sebaceous naevi. A thorough history and examination was done to rule out any epidermal naevus syndrome. The diagnosis was confirmed by histopathology. The number of treatment sessions varied from 1 to 8. Results: Response was excellent (>90% reduction in lesion size) in three patients, very good (>75% reduction) in five, good (>50% reduction in lesion size) in five and poor (<50% reduction in lesion size) in two patients. The side effects were hyperpigmentation and scarring. Long-term follow-up over a period of 10 months showed a recurrence rate of 20%. Conclusion: We conclude that CO2 laser treatment might be an effective option with long-term safety, minimal discomfort and rapid recovery.
Journal Of Cutaneous And Aesthetic Surgery [J Cutan Aesthet Surg] 2018 Oct-Dec; Vol. 11 (4), pp. 217-221.
Introduction: Intradermal steroid injections are used as treatment option in resistant alopecia areata. However, it is difficult and quite painful to treat large areas of alopecia with this modality. Objective: To assess the efficacy and safety profile of a combination of fractional carbon dioxide (CO2) treatment followed by topical corticosteroid application in resistant alopecia areata. Materials and Methods: Ten cases of resistant alopecia areata who had not responded to multiple treatment modalities were treated with fractional CO2 laser followed by topical application of triamcinolone spray (10mg/mL) on the resistant lesions. Patients received 4-8 sessions that were repeated at an interval of 3-4 weeks. Response to treatment was assessed on a quartile physician assessment scale and labeled as excellent (>75% regrowth), good (50%-75% regrowth), fair (26%-50% response), and poor (<25% regrowth). Results: Eight of these ten cases completed the treatment process. Seven of these eight patients had complete recovery of the area treated. One patient however did not show good response even after four sessions. No significant adverse effects were noted in any of the patients. Conclusion: Fractional CO2 laser in combination with topical triamcinolone can prove to be an effective treatment option in resistant alopecia areata.
Journal Of Cutaneous And Aesthetic Surgery [J Cutan Aesthet Surg] 2014 Apr; Vol. 7 (2), pp. 87-92.
Background: While laser resurfacing remains the most effective treatment option for atrophic acne scars, the high incidence of post-treatment adverse effects limits its use. Fractional laser photothermolysis attempts to overcome these limitations of laser resurfacing by creating microscopic zones of injury to the dermis with skip areas in between. Aim: The aim of the present study is to assess the efficacy and safety of fractional CO2 laser resurfacing in atrophic facial acne scars. Materials and Methods: Sixty patients with moderate to severe atrophic facial acne scars were treated with 3-4 sessions of fractional CO2 laser resurfacing at 6-week intervals. The therapeutic response to treatment was assessed at each follow up visit and then finally 6 months after the last laser session using a quartile grading scale. Response to treatment was labelled as 'excellent' if there was >50% improvement in scar appearance and texture of skin on the grading scale while 25-50% response and <25% improvement were labelled as 'good' and 'poor' response, respectively. The overall satisfaction of the patients and any adverse reactions to the treatment were also noted. Results: Most of the patients showed a combination of different morphological types of acne scars. At the time of final assessment 6 months after the last laser session, an excellent response was observed in 26 patients (43.3%) while 15 (25%) and 19 patients (31.7%) demonstrated a good and poor response respectively. Rolling and superficial boxcar scars responded the best while pitted scars responded the least to fractional laser monotherapy. The commonest reported adverse effect was transient erythema and crusting lasting for an average of 3-4 and 4-6 days, respectively while three patients developed post-inflammatory pigmentation lasting for 8-12 weeks. Conclusions: Fractional laser resurfacing as monotherapy is effective in treating acne scars especially rolling and superficial boxcar scars with minimal adverse effects.
Mysore V, Mahadevappa OH, Barua S, Majid I, Viswanath V, Bhat RM, Talwar S, Thurakkal S, Aurangabadkar SJ, Chatterjee M, and Ganjoo A
Journal Of Cutaneous And Aesthetic Surgery [J Cutan Aesthet Surg] 2017 Oct-Dec; Vol. 10 (4), pp. 186-194.
Background: Currently, the standard protocol regarding the performance of procedures on patients receiving or having recently received isotretinoin (13-cis-retinoic acid) states that the procedures should not be performed. The recommendations in standard books and drug insert require discontinuation of isotretinoin for 6 months before performing cosmetic procedures, including waxing, dermabrasion, chemical peels, laser procedures, or incisional and excisional cold-steel surgery. These recommendations have been followed for over two decades despite little evidence for the stated increased risk of scarring. Objective: The Association of Cutaneous Surgeons (I) constituted a task force to review the evidence and to recommend consensus guidelines regarding the safety of skin procedures, including resurfacing, energy-device treatments, and dermatosurgical procedures in patients with concurrent or recent isotretinoin administration. Materials and Methods: Data were extracted from the literature through a PubMed search using the keywords "isotretinoin," "safety," "scarring," "keloids," "hypertrophic scarring," and "pigmentation." The evidence was then labeled and circulated to all members of task force for review. Results: The task force is of the opinion that there is insufficient evidence to support the current protocol of avoiding and delaying treatments in the patient group under consideration and recommends that the current practice should be discontinued. The task force concludes that performing procedures such as laser hair removal, fractional lasers for aging and acne scarring, lasers for pigmented skin lesions, fractional radio-frequency microneedling, superficial and medium-depth peels, microdermabrasion, dermaroller, biopsies, radio-frequency ablation, and superficial excisions is safe in patients with concurrent or recent isotretinoin administration.
Mahadevappa OH, Mysore V, Viswanath V, Thurakkal S, Majid I, Talwar S, Aurangabadkar SJ, Chatterjee M, Bhat MR, Barua S, and Ganjoo A
Journal Of Cutaneous And Aesthetic Surgery [J Cutan Aesthet Surg] 2016 Apr-Jun; Vol. 9 (2), pp. 106-14.
Background: The current standard recommendation is to avoid surgical interventions in patients taking oral isotretinoin. However, this recommendation has been questioned in several recent publications. Aim: To document the safety of cosmetic and surgical interventions, among patients receiving or recently received oral isotretinoin. Materials and Methods: Association of Cutaneous Surgeons, India, in May 2012, initiated this study, at 11 centers in different parts of India. The data of 183 cases were collected monthly, from June 2012 to May 2013. Of these 61 patients had stopped oral isotretinoin before surgery and 122 were concomitantly taking oral isotretinoin during the study period. In these 183 patients, a total of 504 interventions were performed. These included 246 sessions of chemical peels such as glycolic acid, salicylic acid, trichloroacetic acid, and combination peels; 158 sessions of lasers such as ablative fractional laser resurfacing with erbium-doped yttrium aluminum garnet and CO2, conventional full face CO2 laser resurfacing, laser-assisted hair reduction with long-pulsed neodymium-doped yttrium aluminum garnet, diode laser, and LASIK surgery; 27 sessions of cold steel surgeries such as microneedling, skin biopsy, subcision, punch elevation of scars, excision of skin lesion, and wisdom tooth extraction; 1 session of electrosurgery. Results: No significant side effects were noted in most patients. 2 cases of keloid were documented which amounted to 0.4% of side effects in 504 interventions, with a significant P value of 0.000. Reversible transient side effects were erythema in 10 interventions and hyperpigmentation in 15. Conclusion: The study showed that performing dermatosurgical and laser procedures in patients receiving or recently received isotretinoin is safe, and the current guidelines of avoiding dermatosurgical and laser interventions in such patients taking isotretinoin need to be revised.
Journal Of Cutaneous And Aesthetic Surgery [J Cutan Aesthet Surg] 2011 Jan; Vol. 4 (1), pp. 38-40.
Background: Vitiligo is an acquired disorder of depigmentation. Various surgical modalities are recommended for quicker resolution of lesions in stable cases. Aim: To report the efficacy of split thickness skin grafting in a series of 50 patients with stable vitiligo. Materials and Methods: Fifty patients with stable vitiligo, not responding to adequate trial of medical line of treatment were taken in this prospective study. After doing complete investigations, including coagulogram, they were subjected to split thickness skin grafting. Result: Satisfactory cosmetic results were obtained in all cases. Colour match was good with minimal complications reported. Conclusion: Split thickness skin grafting remains a promising option for patients with stable recalcitrant vitiligo. Limitations: Comparison of efficacy and side effects of various vitiligo surgical modalities was not done.