Latest news with #ASLMS
Medscape
7 days ago
- Health
- Medscape
Full Ablation Making a Comeback in Energy-Based Medicine
ORLANDO, Fla. — For years, fully ablative laser skin resurfacing — in which the epidermis is removed using carbon dioxide or erbium lasers — fell out of favor among energy-based medicine specialists and their patients because of long recovery times and the need for general anesthesia. Fractional ablative laser resurfacing, a less invasive procedure that makes tiny holes in the epidermis and leaves surrounding skin intact, became more popular, along with nonablative collagen-stimulating treatments. But at The American Society for Laser Medicine and Surgery (ASLMS) 2025 Annual Meeting, held from April 24 to 26, several presenters spoke about a 'resurgence' of the full ablation approach. They cited two reasons: First, results from fractional treatments have not been as dramatic or durable as hoped for, especially in older patients, and second, newer laser technologies are allowing for ablation to be performed without general anesthesia and with healing times closer to those seen with less-invasive treatments. Echoing many of his colleagues at the conference, Oculofacial Surgeon Brian Biesman, MD, of Vanderbilt University, who is in private practice in Nashville, Tennessee, said that in recent years he has returned to performing fully ablative procedures after having given them a rest. 'The moment for me was when I saw a patient who I knew I had seen several years before,' Biesman said in an interview. 'I didn't remember what [procedure] I had done, and I thought she needed laser resurfacing. I opened her chart and realized that I had done fractional ablative resurfacing on her 3 years before. That was when I decided that for what we put people through, they need to have a better result than this 3 years later. I decided to get back to more aggressive approaches.' Dermatologic Surgeon Thomas Rohrer, MD, who is in private practice in Chestnut Hill, Massachusetts, said in an interview that to treat deeper lines, especially in certain parts of the face, 'we're coming to a consensus that we need that more aggressive treatment. That's why you're seeing a lot of talks this year about fully ablative devices. But with that comes the risks associated with it and the downtime.' Ablative Therapy With Less Pain and Shorter Recovery While ablative procedures using time-tested technologies — CO2 and erbium lasers — are also making a comeback, Rohrer and other specialists pointed to a newer device that they described as a game changer: The UltraClear 2910 nm cold ablative fractional laser, cleared by the US Food and Drug Administration in 2022 to treat photoaging, wrinkles, and acne scars, which has since seen its indications expanded to include some types of pigmented lesions. The device can be used on fractional ablative or fully ablative settings. It does not heat tissue the way traditional ablative lasers do. This results in reduced pain and shorter recovery time, and offers additional protection against hypo- and hyper-pigmentation, a key concern with darker skin types. The 2910 nm laser 'has really revitalized our resurfacing practice in patients aged 50 to 80,' said Paul Friedman, MD, who is in private practice in Houston, 'because of the patient comfort and the quicker recovery process,' which can be as little as a week compared with a month or more for other technologies. Ablative procedures with the 2910 nm laser usually require only 'topical anesthesia and occasional nitrous oxide,' Friedman said at the meeting. 'Prior to this technology, with our traditional resurfacing modalities, we found it more efficient to bring in an anesthesiologist. But obviously there is hesitance from patients about this.' Suzanne Kilmer, MD, a dermatologist at the University of California, Davis, California, who is also in private practice in Sacramento, California, and a widely recognized expert on full ablation, said that she was still getting to know the device. She has yet to use the 2910 nm laser for a fully ablative procedure, she said, sticking to its fractional settings. 'I use it in conjunction with the traditional erbium and CO2 lasers,' Kilmer said in an interview, adding that she is fine with going slow for now. 'There always is a learning curve with devices,' she cautioned. 'And you're learning on risky procedures.' Preventing and Mitigating Complications Full ablation 'is a great procedure — there's nothing else like it,' Kilmer continued. But unlike with fractional treatments, it also means that 'you've taken off the whole top of the skin. There's a huge open wound. You've completely disrupted the dermal-epidermal junction.' During different seminars at the conference, experts offered strategies for avoiding treatment-related complications, including hypo- and hyper-pigmentation, scarring, and infections. They spoke about selecting the patients who are likely to comply with demanding aftercare protocols, highlighting how they rescued cases in which patients did not. And they shared horror stories of patients who went kayaking 3 days after ablative treatment, accidentally vomited on their wounds, who developed severe erythema or scarring, or developed serious infections despite the use of antiviral and antibiotic prophylaxis. With some of these complications, practitioners acknowledged that there is little consensus on how they should be managed. Jacqueline Watchmaker, MD, a dermatologist in private practice in Scottsdale, Arizona, reviewed the case of a patient who developed a severe bacterial infection following ablation because of noncompliance with aftercare recommendations. It is important to know how soon infections are likely to appear, Watchmaker said, and to be aware of signs — especially pain that increases over days. It's also important to select patients carefully for their likelihood of complying, she added. Other presenters discussed ways to improve compliance, such as by making video tutorials. Dermatologist Arisa Ortiz, MD, director of Laser and Cosmetic Dermatology, at UC San Diego Health, San Diego, and the past president of ASLMS, warned that even with antibiotic and antiviral prophylaxis, patients can develop breakthrough infections requiring emergency treatment. The right type of antibiotic prophylaxis remains controversial in fully ablative resurfacing, she noted. Any apparent infections should be cultured before treating them and systemic infections, requiring hospital treatment, can occur. Biesman, in his comments, agreed that antibiotic prophylaxis remains a controversial topic with ablative resurfacing. 'The argument from infectious disease is that you don't need antibiotic prophylaxis,' he told the conference, but in practice it is standard. And while many clinicians use cefalexin, which does not prevent infections from methicillin-resistant Staphylococcus aureus , or MRSA, 'you really need to think about MRSA coverage' when prescribing an antibiotic, he said.
Medscape
21-05-2025
- Health
- Medscape
Lasers Designed for Acne and Aging Effective for Rosacea
ORLANDO, Fla. — For decades, pulsed dye laser (PDL) has been an established treatment for rosacea, with intense pulsed light (IPL) emerging as a more recent alternative. But new energy-based approaches also appear promising, especially for hard-to-treat disease subtypes. At The American Society for Laser Medicine and Surgery (ASLMS) 2025 Annual Meeting, specialists shared experimental strategies for treating rosacea and other vascular skin conditions, including rare presentations and severe subtypes. Several of the treatment strategies involved energy-based devices designed for other indications. Acne-Targeting Laser for Papulopustular and Phymatous Rosacea Dermatologist Hyemin Pomerantz, MD, who practices in Wellesley, Massachusetts, presented results from an observational study using a 1726 nm laser, which is designed to treat acne by selectively targeting sebaceous glands, in patients with mild to severe papulopustular rosacea. In this disease subtype, papules and pustules occur alongside redness and inflammation. The idea for the study, Pomerantz said at the meeting, came from her observations of treating patients with acne using the device. 'It works well for inflammatory papules in acne vulgaris,' she noted. And in a small, unpublished split-face study using the device in patients with acne, Pomerantz and her colleagues saw that inflammatory symptoms also improved on the untreated side. 'We were wondering if there might be a systemic influence of the device in lowering inflammation,' she said. 'We then wondered if it would help the inflammatory aspect of papulopustular rosacea.' The five patients in Pomerantz's study ranged in age from 31 to 50 years; three were women. Four had failed oral antibiotics or topical therapies, and one responded to these therapies but wanted to avoid medication because she was pregnant. Patients underwent 1-3 laser treatments spaced 1 month apart. While the oldest patient saw less improvement than the rest, all experienced visible improvement, Pomerantz reported. This argument, she said, called for further investigation of the 1726 nm laser as a treatment for rosacea. While some sebaceous gland involvement is thought to occur in all rosacea, phymatous rosacea is characterized by the overgrowth of these glands, often on the nose (rhinophyma). This growth can also affect other areas of the face. Usual treatment involves surgery, which may result in more severe scarring and other adverse effects in patients with disease in areas besides the nose. At the meeting, David Hashemi, MD, who practices dermatology in Neptune, New Jersey and New York City, presented two cases using the 1726 nm laser in two men, aged 62 and 60 years, with severe, disfiguring phymatous rosacea. The first patient underwent electrosurgery on the nose, followed by 1726 nm laser treatment on the cheeks and chin. Similar to what Pomerantz observed in her inflammatory acne pilot study, the patient saw improvement in an untreated area — the forehead. The second patient, treated with the laser only, experienced halted progression and clinical improvement. In an interview, Hashemi said he had also used the device on a patient with the more common erythematotelangiectatic subtype of rosacea, which is characterized by redness and flushing, and the benefit was less pronounced. Still, he noted, papulopustular rosacea 'is almost as common as the redness type. And then when it starts to get into the phymatous category, that's where we see the most significant results' from the 1726 nm laser. Phymatous presentations are rare, Hashemi said, but can be difficult to treat. 'The eye, the chin, the cheeks, the forehead — you don't necessarily want to be doing electrosurgery in those areas.' Commenting on the findings by Hashemi and Pomerantz, dermatologist Paul M. Friedman, MD, who practices in Houston and is a past president of the ASLMS, praised them as an example of 'utilizing existing technology outside of the box to target and go after challenging conditions.' Tightening Laser Shows Surprise Benefit Against Redness A 1550 nm laser with 'focal point' technology, designed to promote skin tightening in all skin types, also works on facial erythema, according to results presented by Dieter Manstein, MD, PhD, of the Cutaneous Biology Research Center at Massachusetts General Hospital in Boston. 'Typically, you wouldn't pick a 1550 nm laser for treatment of vascular lesions,' Manstein said at the meeting. But in a prospective study enrolling 31 patients with facial erythema (ages 22-66 years; 71% women; Fitzpatrick skin types I-IV), Manstein found that erythema was reduced by a mean 30% after an average of four treatments with the device ( P < .05), administered at 4- to 6-week intervals. Blinded evaluations of pre- and posttreatment photos were used to determine treatment effect, and the improvement was sustained at 3-month follow-up. The device used in the study creates a conical shape that allows for less involvement of the epidermis while delivering high energy deeper into the dermal layers. Although the 1550 nm wavelength has no selectivity for blood vessels, as with the PDL, the focal point laser can seal small blood vessels by generating a pattern of coagulation zones within the dermis. In an interview following his presentation, Manstein said his results 'serve as a reminder that for the treatment of abnormal blood vessels, we might want to also consider concepts other than the classic 'selective photothermolysis,' he said, referring to the established laser treatment model using wavelengths that selectively target hemoglobin. 'To use a nonselective laser for treatment of blood vessels is a game changer.' In a separate presentation, Roy Geronemus, MD, of NYU Langone Health, New York City, who also has a private practice in New York City, showed the case of an older adult woman patient with a severe port wine stain he successfully treated using the 1550 nm focal point laser. Port wine stains are a type of vascular lesion that can begin as a birthmark and thicken and redden over time. These, too, are usually treated with PDLs. In an interview, Geronemus said that he has been using the device experimentally for treatment-resistant port wine stains and seeing success. 'We are working right now on a case series, a retrospective analysis of our efforts to improve port wine stains that haven't responded as well as we'd like to laser treatment, and also some of the hypertrophic or thicker stains that are more difficult to treat,' he said. The laser 'is helping a variety of vascular [skin] conditions. This is a sort of an accidental finding,' Geronemus added, noting that his own investigations were inspired by findings from Manstein's group. 'There's a lot to explore there.' PDL: An Option for Refractory Ocular Rosacea Rosacea blepharitis, also known as ocular rosacea, occurs when inflamed facial blood vesselsrelease proinflammatory cytokines that propagate to the eyelids, disrupting the function of the eye's meibomian glands and causing dry eye symptoms. Though cases have been treated successfully with IPL, a team of dermatologists at the Naval Medical Center, San Diego, presented results from a split-face placebo-controlled trial using a 595 nm PDL. They chose this approach, they said, because it had the advantages of a smaller handpiece to maneuver, no need for pretreatment anesthesia, easier cleanup, and possible therapeutic benefits over standard treatment. Monica Borza, DO, presented findings from five patients referred to the hospital's dermatology service from ophthalmology. Four were treated with PDL on one side of the face, including the periocular area, cheek, and forehead, and received sham treatment on the opposite hemiface, while one patient was treated on both sides. Treatment was performed every month for 4 months, and intraocular metal eye shields were used in all patients. Borza reported that the PDL treatment was safe and well tolerated and that all patients had significant improvement on the treated side, according to assessments by ophthalmologists using a validated disease scoring tool. She noted that this was the first time PDL had been investigated in patients with rosacea blepharitis and may offer a more practical option for dermatologists over IPL. Commenting in an interview on the study by Borza and her colleagues, Manstein said he found the results intriguing for a different reason. 'For years, we have treated rosacea with the idea that skin improves only where you directly aim the laser,' he said. 'Here we saw that treating the skin adjacent to the eye reduced an inflammation of the eye. I would like to know whether this represents the kind of anti-inflammatory 'field effect' we are seeing in the other studies.' What the findings from the conference collectively show, Manstein continued, 'is that we still don't know everything about rosacea and that a paradigm change may be underway.' Geronemus disclosed financial relationships (consulting, contract research, and/or speaker fees) with Accure, Allergan, AbbVie, Avava, BellaMia Technologies, Inc., Candela Medical, Cynosure Lutronic, Cytrellis Biosystems, Inc., Galderma, Novoxel, Sofwave Medical, Solta Medical, and the New York Stem Cell Foundation. Friedman disclosed financial relationships with Acclaro, Allergan, Candela Medical, Cytrellis Biosystems, Inc., Merz Aesthetics, R2, and Solta Medical. Manstein is a co-founder of Blossom Innovations, the company that manufactures the AVAVA (1550 nm) device used in his study, and reported relationships with German Medical Engineering, R2, Shiseido, and IPG Photonics. Pomerantz is a consultant for Accure.
