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Laser Treatments for Acne and photo-damaged skinThere are a number of options available for skin rejuvenation and various treatments of acne, but the benefits of laser skin resurfacing in trained hands cannot be surpassed by any one of these. Although there are various new technologies touted to be comparable to laser, no treatment modality to date can replace laser treatment with respect to overall improvement of chronically photodamaged skin. Some lasers have also shown promise as treatments for acne.
Damage to the skin caused by photo aging presented in various forms like rhytides and actinic keratoses, scarring from severe acne, surgery, or trauma, are cosmetic disfigurements which pose psychologic problems to the patients and it is important to note here that most of these can very well be corrected using lasers as skin resufacing modality.
Laser resurfacing as a skin rejuvenation treatment uses a light beam from a carbon dioxide (CO2) laser for vaporizing the upper layers of damaged skin at specific and controlled levels of penetration.
HistoryThe carbon dioxide laser has been used for more than 25 years for treating the skin. Initially, the carbon dioxide (CO2) laser (10,600 nm) was introduced as a destructive modality in the 1970s by Goldman for the treatment of verruca vulgaris and actinic cheilitis. But the biggest disadvantage of this continuous wave laser treatment was that it resulted in uncontrolled thermal damage to the skin with a high risk of scarring.
But with the development of selective photothermolysis, significant advances in the use of laser technology for skin resurfacing have been made. The improved technology was helpful in decreasing the residual thermal damage. With the use of shorter pulse durations of laser light, the minimizing of thermal damage greatly reduced the risk for scarring on the skin.
Shortly thereafter the computerized pattern generator (CPG) scanning device was developed which not only helped in standardizing the treatment through the uniform delivery of the laser pulses, but also increased the precision of the laser resurfacing procedures and reduced the treatment time.
The latest procedures use an intense beam of light to destroy the skin tissue instantly. Recently developed carbon dioxide and Er:YAG lasers are able to perform highly specific vaporization of tissue using powerfully focused light to precisely remove the layers of skin, vaporizing the ridges of scars and wrinkles and smoothing out the surface of the skin.
The CO2 laser tightens the skin more, whereas the Er:YAG laser is used more for sculpting. Depending upon the degree of damage and the needs of individual, the two types of lasers can be used in combination to maximize the therapeutic benefit offered by the therapy.
The latest modalities for skin resurfacing consist of new-generation resurfacing lasers which are either the high-energy pulsed or scanned carbon dioxide (CO2) lasers emitting at a wavelength of 10,600 nm, the single- or variable pulse or dual ablative/coagulative mode erbium:yttrium aluminum garnet (Er:YAG) lasers emitting at a wavelength of 2940 nm, or the systems combining both wavelengths. These new laser therapies have been proven in many patients, superior to older modalities in the treatment of actinic damaged skin and scarring.
The reason for better results with these combinations can be attributed to the fact that it provides precise skin vaporization with minimal postoperative morbidity, by better control of the depth of ablation, and control of energy fluence to the target tissue. The major advantages of the newer resurfacing lasers is that different systems can be chosen and treatment parameters can be accurately adjusted to the type of lesion being treated. This makes laser treatment a safe, reproducible, and predictable procedure.
The CO2 and Er:YAG lasers today are used in the treatment of the following skin conditions:
- Acne scars
- Actinic keratoses
- Actinic cheilitis
- Seborrheic keratoses
- Adnexal tumors
- Scar revision
On the whole, laser resurfacing is the method of choice for scar revision and the treatment of photo-aged skin and also as treatments of acne.
1.E. Papadavid,and A. Katsambas, “Lasers for facial rejuvenation: a review”, 2003, The International Society of Dermatology, 42, 480–487
2.D. Railan, and S. Kimlmer, “Ablative treatment of photoaging”, Dermatologic Therapy, Vol. 18, 2005, 227–241