American Society for Laser Medicine and Surgery Abstracts 1 AMERICAN SOCIETY FOR LASER MEDICINE AND SURGERY ABSTRACTS Conclusion: These initial data suggest that AFxL pre-treatment CUTANEOUS LASER is likely to enhance the uptake of IngMeb in the skin. This might enable treatment of hyperkeratotic lesions as well as increase SURGERY overall efficacy when treating AK’s with IngMeb. #2 #1 SPLIT FACE COMPARISON OF THE EFFECTS OF FRACTIONAL LASER-MEDIATED DELIVERY OF VITAMIN CE FERULIC FORMULA SERUM TO INGENOL MEBUTATE - PRELIMINARY RESULTS DECREASE POST-OPERATIVE RECOVERY AND FROM AN IN VITRO FRANZ CELL STUDY INCREASE NEOCOLLAGENOSIS IN FRACTIONAL Andre´s M. Erlendsson, Elisabeth H. Taudorf, ABLATIVE LASER RESURFACING FOR Andre´ H. Eriksson, John R. Zibert, Uwe Paasch, PHOTODAMAGE R. Rox Anderson, Merete Haedersdal Jill Waibel, Adam Wulkan Bispebjerg Hospital, University of Copenhagen, Copenhagen, Miami Dermatology & Laser Institution, Miami, FL; Denmark; LEO Pharma A/S, Ballerup, Denmark; University of Miami University, Miami, FL Leipzig, Leipzig, Germany; Wellman Center for Photomedicine, Background: New fractional ablative laser skin resurfacing is Massachusetts General Hospital, Harvard Medical School, associated with shorter periods of recovery time in comparison Boston, MA with older ablative technology. However one deterrent is the Background: Ingenol Mebutate gel (IngMeb) is a new FDA seven days of downtime associated with the procedure. Previous approved field directed treatment against Actinic Keratosis (AK). studies have shown that application of vitamin C, E and ferulic A recent study on clinically typical AK’s showed complete acid improves wound healing and promotes the induction of clearance rates of 34% for trunk and extremities, and 42% for face collagen. The objective of this study was to prospectively evaluate and scalp (Lebwohl et al., N Engl J Med., 2012 Mar the efficacy of vitamin C, E, ferulic acid decreasing post-operative 15;366(11):1010-9). The epidermal permeability barrier, primarily downtime. Secondary objectives were to evaluate synergistic constituted by the stratum corneum (SC), limits the uptake of response of laser and topical application on the up regulation and topically applied drugs. Pre-treatment with fractional ablative formation of collagen through histological evaluation of mRNA laser (AFxL) generates micropores that increase the skin and collagen I and III. permeability. AFxL pre-treatment may improve the uptake of Study: A double blinded (patient and assessor) randomized IngMeb and enable future treatment of hyperkeratotic lesions and (one side active vs vehicle) prospective IRB approved study add to the overall efficacy. The objective of this study is to with 15 subjects with moderate photodamage were chosen investigate whether AFxL pre-treatment enhances the uptake of according to Glogau classification scale. Subjects were treated IngMeb in the skin. with immediate post-operative application of vitamin C, E, and Study: Penetration was investigated in an in vitro Franz cell ferulic acid to one side of face and vehicle to the other side of model, using porcine skin. Prior to IngMeb application the skin face after fractional laser therapy and daily for six months. was pre-treated with a fractional 2940 Er:YAG laser. Two Three blinded investigators evaluated photographs to evaluate settings were used, delivering 11.2 mJ/laser channel (1.7 W, the ‘‘day patient could return to work.’’ Randomly 5 patients 125 ms, 2 stacks) and 128 mJ/laser channel (1.3 W, 225 ms, were chosen for preauricular biopsies at baseline, five days, 10 stacks) at different densities. The shape and depth of the 3 months and six months for H&E, RT-PCR for mRNA micropores were evaluated in a dissecting microscope. collagen I and III and collagen I & III levels. Patients were also After 21 h in the Franz cells, SC was tape stripped and evaluated daily for days 1–7 for photographs and patient liquid chromatography–mass spectrometry (LC-MS) was questionnaires. used to analyze IngMeb concentrations in SC, skin and receptor Results: Post-operative vitamin C, E, and ferulic delivery fluid. resulted in decreasing edema vs. vehicle on post-operative Results: Superficial and mid-dermal, cone shaped pores were day 3 and decreased erythema vs. vehicle post-operative created at penetration depths of approximately 50 and 500 mm. day 3, 4 and 5. Preliminary results from LC-MC analysis (n ¼ 5) show that AFxL Conclusion: Overall vitamin C, E and ferulic acid is well pre-treatment at 5% density with mid-dermal pores (500 mm) tolerated immediately post fractional ablative laser. Data review increases the epidermal/dermal uptake with up to 100%, show trends of decreasing downtime 24–48 hours with ability of compared to normal skin. patients to return to work and social life more quickly. Published online in Wiley Online Library ß 2013 Wiley Periodicals, Inc. (wileyonlinelibrary.com). DOI 10.1002/lsm.22127 2 American Society for Laser Medicine and Surgery Abstracts #3 Study: Seven healthy female subjects (Mean 53.8 Æ SD 10.0) with visible signs of facial and neck skin aging were treated with EFFECT OF TOPICAL CORTICOSTEROIDS ON fractional, non-ablative Q-Switched 1064 nm neodymium:YAG THE INCIDENCE OF POST-INFLAMMATORY laser device (Pixel QS Nd:YAG, Alma LasersTM). Treated areas HYPERPIGMENTATION AFTER TREATMENT OF were the face, including the periorbital and perioral regions ATROPHIC ACNE SCARS IN ASIANS WITH (particularly the upper lip), neck and chest. Treatments consisted ABLATIVE FRACTIONAL CO2 LASER of 3 sessions at 2–4 week intervals. Follow-up was performed RESURFACING monthly following the final treatment. The Alexiades-Armenakas Woraphong Manuskiatti, Nutjira Cheyasak, Comprehensive Grading Scale of Skin Aging was employed to Rungsima Wanitphakdeedecha assess efficacy. Pain ratings were recorded by 10-point visual assessment scoring. Siriraj Hospital, Mahidol University, Bangkoknoi, Thailand Results: Employing the validated, quantitative grading scale for Background: Post-inflammatory hyperpigmentation is the most common adverse effect of laser treatments in dark-skinned rhytids of the face and neck, a 0.29 grade improvement or 11.3% individuals. Treatment of PIH is difficult because there are few, if improvement over baseline grade was observed in the 7-subject any, therapeutic options that are consistently successful. Little is cohort that completed follow-up following a mean of approximately 2 treatments at approximately 1 month follow-up. known about whether PIH can be prevented or minimized. The objective of the present study was to investigate the effect of No pain and rapidly resolving minimal erythema were noted in all short-term application of topical corticosteroids on the incidence of subjects during treatment. PIH after ablative fractional resurfacing in Asian patients. Conclusion: The results of this pilot case series suggest that the treatment with the fractional, non-ablative Q-Switched 1064 nm Study: Forty subjects with skin phototype IV and atrophic acne Nd:YAG laser device significantly improves superficial rhytides. scars were treated with a fractional fractional CO2 laser. Post- operatively, one randomly selected face side of each patient was With its outstanding safety it seems to be particularly suitable for the treatment of sensitive areas, such as periorbital, lip, neck and applied clobetasol propionate 0.05% ointment for the first two days, followed by petrolatum jelly for the rest of the week, and the chest. The Q-switched Nd:YAG laser is a facile, safe and fast other side was applied petrolatum jelly for seven days. Objective treatment for aesthetic skin rejuvenation. and subjective assessments on clinical outcome, wound healing process and the occurrence of PIH were obtained once weekly for the first month and at 2 and 3 months post-treatment. #5 Results: The sides treated with petrolatum jelly alone had significantly (p <.001) higher incidence of PIH (PIH incidence of NOVEL LOW ENERGY LOW DENSITY 75%) after laser irradiation than the sides treated with topical NON-ABLATIVE FRACTIONAL TREATMENT OF corticosteroids and petrolatum jelly (PIH incidence of 40%). The MELASMA AND POST INFLAMMATORY clinical evaluation corresponded to the color reading. The PIH HYPERPIGMENTATION occurring on the petrolatum jelly-treated sides had significantly Jeremy Brauer, Roy G. Geronemus, Lilia Correa, higher intensity (p <.001) and spread over a significantly larger Leonard Bernstein, Elizabeth K. Hale, area (p <.001), compared with the corticosteroids and petrolatum Lori A. Brightman, Julie K. Karen, Elliot T. Weiss, jelly-treated sides. In addition, the petrolatum jelly-treated sides Robert Anolik, Jeremy A Brauer were associated with longer duration of post-operative discomfort Laser & Skin Surgery Center of New York New York, NY (p ¼.004). There were no significant differences in treatment Background: Hyperpigmentation, including melasma and post outcome, duration of crusting, erythema and edema, and adverse inflammatory hyperpigmentation (PIH), is a common complaint effects between two post-operative regimens. among dermatologic patients. Laser therapies utilized to date Conclusion: Short-term application of topical corticosteroids have failed to yield consistent and longstanding reduction in post-operatively is associated with a decreased risk of PIH after pigmentation, especially in individuals of darker skin types. We ablative fractional resurfacing. present the first report of a new low energy, low density nonablative fractional