Journal of Clinical and Aesthetic Dermatology

JUN 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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60 JCAD journal of clinical and aesthetic dermatology June 2017 • volume 10 • Number 6 r E v I E w respectively. in summary, available evidence supports that nonablative fractional lasers are comparable in efficacy to triple combination creams in the treatment of melasma. the ideal fractional laser settings for melasma treatment largely depends on the skin phototype and the type of melasma being treated. Higher treatment densities and sPt are associated with a greater risk of hyperpigmentation post procedure. 39 Patients with melasma should be counseled about the potential risk of worsening of their pigmentation post resurfacing. 40 SKIN RE JUVENATION aging presents with different features in different skin types and ethnicities. age along with cumulative ultraviolet (Uv) damage over the years leads to development of rhytids, skin laxity, textural changes, wrinkles and abnormal pigmentation. Due to the photoprotective effects of melanin, the appearance of wrinkles is usually delayed in ethnic skin and pigmentary changes tend to present earlier. 16 Nonablative fractional lasers are widely used for skin rejuvenation but only a few studies have been done to assess their impact in skin type iv to vi (table 6). 41–49 Kono et al 41 assessed the efficacy and complications of different energy and density settings of nonablative fractional laser. Pain, edema and erythema were more common in patients treated with higher energy and density settings. Patient satisfaction was reported to be significantly higher in groups treated with higher fluence but not with higher density. shin et al 44 performed a randomized blinded study where patients were either treated with fractional laser and platelet rich plasma (PrP) or fractional laser alone. the group treated with fractional laser and PrP reported higher patient satisfaction when compared to laser alone. saedi et al 45 performed a single center non-randomized study and determined that 1440nm fractional laser was safe and efficacious in improving visible facial pores and skin texture. Wattanakrai et al 46 compared non ablative fractional laser with table 7: nonablative fractional lasers for scar resurfacing in spt iv–vi autHors, yEar sKin t ypEs no. oF patiEnts spt Hiv, v, vii trEatmEnt modalit y p ostinFlammatory HypErpigmEntation HpiH %i Lin et al, 2011 50 I–VI 20 1,1,3 Randomized study with 1550nm Er:YAG Group A: 40mJ/26% coverage Group B: 40mJ/14% coverage No PIH reported Cervelli et al, 2011 5 1 I–IV 60 2,0,0 Group A: fat grafts + PRP Group B: 1540nm fractional laser G roup C: fat grafts + PRP + 1540nm fractional laser 6.66% Kim et al, 2012 5 2 III–IV 7 Not mentioned Split scar: One half treated with 1550nm Er:Glass laser and other half with fractional 2940nm Er:YAG laser No PIH observed Bach et al, 2012 53 IV 1 1,0,0 1550nm Er:YAG No PIH observed Verhaeghe et al, 2013 54 I–IV 22 3,0,0 1540nm Er:YAG 5% Ibrahim et al, 2016 55 II–V 13 6,1,0 CO 2 laser followed by 1540nm fractional laser No PIH observed SPT: Fitzpatrick skin photo type

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