Actinic Damage, Epidermis

Ultrapulse Encore™ laser

The Ultrapulse Encore™ CO2 laser from Lumenis is a ‘workhorse’ laser in terms of highest power output and speed but results are user dependent. It can deliver very precise ablative collimated focussed incisional modes.

With the CPG scanner on the one hand, full resurfacing can be carried out and on the other hand nonsequential fractional treatments (ActiveFX™). The DeepFX™ scanner allows deep penetration of microthermal zones in standard mode and several mm of penetration in ScaarFX™ mode for fenestration of burn scars which can reduce contractures and improve function.

In this practice the Ultrapulse Encore™ CO2 laser 10600nm is used to treat benign skin lesions which require precise ablation or cutting.

Secure haemostasis sets this type of laser apart from the Erbium YAG. Alternative surgical or electrosurgical treatments including the excellent Surgitron™ may also be used with good outcomes in experienced hands.

Resurfacing and fractional photothermolysis

Full resurfacing with the Ultra Pulse Encore™ CO2 laser is an effective option for severely sun damaged skin but generally ablative fractional photothermolysis (ActiveFX™ and DeepFX™) are now preferred because of quicker recovery and fewer side effects; especially permanent loss of skin colour.

The deeper fractional ablative techniques are also effective for improving acne scarring and can be carried out under nerve blocks and tumescent anaesthesia. Non-ablative fractional photothermolysis with the erbium glass laser at 1550nm (Fraxel Dual™) may also be effective and may be better tolerated although multiple treatments are likely to be required.

Resurfacing causes a zone of ablation and thermal necrosis over a sub-denaturation zone of thermal injury. This situation favours an ordered deposition of new collagen and elastin (collagen remodelling). In the case of ablative fractional resurfacing there is true tissue removal from the microscopic treatment zones, (rather than the coagulation of non-ablative resurfacing).

An up-regulation of heat shock cytokines leads to production of procollagen 1 and 3 and subsequent neo-collagenesis.

Full resurfacing and very occasionally ablative fractional resurfacing of facial skin can cause delayed loss of pigmentation and rarely scarring. There is also an initial extensive recovery period of 7-10 days with widespread crusting and impaired skin barrier function.

Subsequent erythema can last for many weeks but gradually fades. These techniques do however give excellent results for badly photodamaged skin, lines and scars for most affected patients are considered safer than dermabrasion or deep chemical peels.

Fractional photothermolysis was developed to treat a portion of the skin (depending on the densities used) to bypass the problems associated with full skin removal. For the far infrared (10600nm) CO2 laser the depth of penetration can be altered by the fluence and is not so dependent on wavelength factors as is the case with visible light. This also applies to the non-ablative mid infrared 1550nm erbium glass (Fraxel™) laser. For both of these lasers the chromophore is water.

Photorejuvenation

Where photodamage is confined to the epidermis and dermoepidermal junction photorejuvenation with the thulium laser 1927nm (Fraxel Dual™, Cureda™) is indicated, with good results often after a single treatment.

Where pigmentary lesions (actinic lentigines, dyspigmentation) are combined with vascular lesions such as fine telangiectasia broader based intense pulsed light M22™ may be indicated - multiple treatments are required for vascular component.

For more information about this condition, please contact the Solais team below...