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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62 JCAD journal of clinical and aesthetic dermatology June 2017 • volume 10 • Number 6 r E v I E w treating traumatic scars. they suggest that combining fractional lasers with platelet rich plasma yields better results as compared to a solitary approach. in conclusion, there is moderate level evidence that nonablative fractional lasers are a safe and effective treatment option for scars with improvement in both texture and appearance of scars. STRIAE DISTENSAE striae distensae or stretch marks are a result of rapid stretching of the dermis usually due to sudden changes in weight, use of corticosteroids, pregnancy and adolescent growth spurts. striae develop through three stages: initial inflammatory stage when they are red in color known as striae rubra, progressing to next stage of purple coloration and last stage of white atrophic striae referred to as striae alba (table 8). 56–62 striae distensae are a challenging condition to treat. Fractional lasers lead to clinical as well as histopathological improvement in striae by promoting collagen regeneration. 58 Yang et al 56 conducted a randomized blinded split study comparing nonablative and ablative fractional laser for the treatment of striae distensae on abdomen. No significant difference was seen between the two groups. Kim et al 57 performed a prospective right left comparison study with erYaG laser treatment on one side and other side serving as control. they suggested erYaG nonablative fractional laser is an safe and effective treatment for striae distensae. another prospective open label trial by De angelis et al 58 also confirmed the efficacy of nonablative fractional lasers in reducing striae distensae. there is moderate evidence (2a) suggesting the efficacy of nonablative lasers for treating striae in skin of color. to the best of the authors' knowledge, none of the studies so far have included skin types vi and only one study treated skin type v patient. therefore, more high quality studies are needed to establish the efficacy of nonablative fractional lasers for treating striae in darker skin types. COMPLICATIONS Fractional lasers represent a better standard of safety than the traditional lasers but they are not without side effects. Post- treatment side effects, such as transient erythema, edema and hyperpigmentation, have been well documented in almost all the studies. Graber et al 9 reported the incidence of complications from1550nm erbium doped laser treatments. they performed 961 consecutive treatments in 422 patients of sPt i to v. the most common complications were acneiform eruptions (1.87%), outbreaks of herpes simplex virus (Hsv) (1.77%) and erosions (1.35%). other less frequent side effects were prolonged erythema (0.83%), PiH (0.73%), prolonged edema (0.62%) and dermatitis (0.21%). single cases of impetigo and purpura were also reported. Most of the side effects listed above were seen equally in all skin types except PiH, which was reported to be more common in skin of color patients. 2,9 recognition of the potential complications of fractional laser use is important owing to its growing popularity. table 9 summarizes the commonly encountered side effects according to their degree of severity. 9,10,63,64 table 9: complications of fractional laser use 9,10,63,64 mild modEratE sEvErE Prolonged erythema Infection Scarring Acneiform eruption Pigmentary alteration Disseminated infection Delayed purpura Eruptive keratoacanthomas Edema Anesthesia toxicity Superficial erosions

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