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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63 JCAD journal of clinical and aesthetic dermatology June 2017 • volume 10 • Number 6 r E v I E w RECOMMENDATION levels of evidence and strength of recommendation is summarized in table 10. Careful patient selection and setting realistic expectations prior to starting treatment are the most important preliminary steps to ensure a favorable outcome. the importance of post- procedure skin care cannot be overemphasized. Patients should be counseled and strongly encouraged to use broad spectrum sunscreen during the course of treatment. the use of pre-and post-procedure hydroquinone to prevent PiH has been advocated my several authors, but studies confirming the efficacy of hydroquinone in preventing resurfacing laser- induced PiH are currently lacking. 28 Patients should be made aware that clinical improvement and side effects largely depend on what laser settings are used which are further determined based on the skin type and indication for treatment. both energy and density are key parameters that determine the safety and efficacy of fractional resurfacing in skin of color patients although treatment density plays a more important role in determining the risk of PiH; the higher the treatment density (MtZ/cm 2 ), the higher the risk of PiH. other parameters which can be modified to decrease the incidence of side effects are number of passes per treatment session, increasing treatment intervals and providing additional cooling between passes to reduce bulk heating. it is advisable to increase the duration between two treatment sessions if PiH occurs between two laser treatment sessions. 40 CONCLUSION in conclusion, the available evidence strongly suggests that fractional lasers are a favorable treatment option for a variety of dermatological diseases in skin of color. as the patient population seeking laser procedures becomes more diverse, it is increasingly important to understand racial, ethnic and phototype variations in safety and overall treatment outcomes. Key strategies should include careful patient selection, appropriate device selection, use of conservative treatment settings and sunscreens. Fractional resurfacing has opened the door to laser treatment of numerous table 10: summary of evidence-based recommendations disEasE Entit y HigHEst lEvEl oF EvidEncE rEcommEndation acne 1b strong NAF is safe and effective for treating a cne acne scars 2b moderate NAF is safe and effective for treating acne scars melasma 2b moderate n aF vs. tcc : NAF is comparable in efficacy and recurrence rate to TCC naF + tcc: Good approach for resistant melasma Well maintained results compared to monotherapy skin rejuvenation 1b strong Safe and effective for superficial photodamage naF + prp: Good results, increased subject satisfaction naF + Fillers and lipolysis: Good results with combination therapy scars 2a moderate NAF leads to improvement in scars. Early intervention leads to better results naF+ prp/fat grafts/ topical steroids: better outcome than laser alone striae 1b strong NAF safe and effective for reducing striae

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