Fractional Laser Side Effect Risk Low, Study Finds

CHICAGO — Fractional laser photothermolysis should be considered first-line therapy for cutaneous resurfacing because of the device's efficacy in treating a wide range of skin types with minimal adverse events.

"There is a very low complication rate, compared with other ablative laser methods such as the carbon dioxide and erbium lasers. The most common side effect in our study was acneiform eruption, which occurred less than 2% of the time," said Dr. Emmy Graber at the annual meeting of the American Society for Dermatologic Surgery.

Acne-prone patients were more likely to experience posttreatment acne in a study conducted by Dr. Graber and colleagues. Use of oral antibiotics (doxycycline 20 mg b.i.d.) during subsequent treatments prevented further outbreaks.

Treatment with fractional lasers has been shown to be effective for the treatment of photodamaged skin and fresh scars. However, there are limited studies evaluating the side effects and complications of the technique. "This is the first large-scale study to evaluate complications with the Fraxel laser," said Dr. Graber, a fellow at the Washington (D.C.) Institute of Dermatologic Laser Surgery.

The investigators conducted a retrospective chart study of 961 treatments using a 1,550-nm erbium-doped fiber laser (Fraxel, Reliant Technologies Inc.). Dr. Graber, now with SkinCare Physicians in Chestnut Hill, Mass., declared no financial conflicts and said the study received no funding or equipment from Reliant.

The study included 422 patients with skin types I-IV treated by two operators between October 2004 and September 2006.

"All treatments were done with either the Fraxel 1 or Fraxel 2 using the 15-mm handpiece with a fluence range from 10 to 40 J/cm2, and the average fluence used was 25 J," she said, adding that densities ranged from 125 to 250 microscopic treatment zones per square centimeter, and average total delivered energy per treatment was 4.2 kJ.

All study patients were telephoned by a nurse 1 day after treatment and all had follow-up visits at 1 month. Most patients were followed for at least 1 year after final treatment, Dr. Graber said.

Most of those treated were women (91%) and most treatments were performed on the face (74%). Nearly one-fourth of patients were treated on both the face and other parts of the body. The majority of treatments (743) were for photodamage. The remaining treatments were for scars (175) and other diagnoses (43).

Overall, the 961 treatments resulted in 73 complications, which included acneiform eruptions (18), herpes simplex virus outbreak (17), erosions (13), prolonged erythema (8), postinflammatory hyperpigmentation (7), prolonged edema (6), dermatitis (2), impetigo (1), and purpura (1).

The side effect rate did not differ with regard to gender, age, body location, or diagnosis, Dr. Graber said.

"Those with complications had significantly darker skin types, and this discrepancy was most evident when comparing the incidence of postinflammatory hyperpigmentation, which appeared an average of 11 days post treatment and lasted an average of 50 days, which was longer than any other complication," Dr. Graber said.

In addition, 27% (259) of the 961 treatments were on patients with histories of herpes simplex virus (HSV). One-third of these patients (86) received antiviral prophylaxis, and 6 developed an HSV outbreak despite prophylaxis. Of the remaining two-thirds who did not receive prophylaxis, eight developed an HSV outbreak, she said, adding that of the 702 treatments on patients without histories of HSV, 3 resulted in HSV outbreak.

Because the complication rate in darker-skinned patients was low, pretreatment of all Fraxel patients with hydroquinones or other lighteners is not recommended, said study coauthor Dr. Tina Alster, the institute's director. "If you see a problem postoperatively, you can try to fade it out then, but in our study of close to a thousand treatments, the number of complications was virtually nil," Dr. Alster said, adding that the treatment should be avoided in tanned skin.

Fraxel 1, now called the Fraxel 750, received Food and Drug Administration approval in November 2003, according to a company spokesperson. The second-generation Fraxel 2, which has an adjustable spot-size feature, was approved last year.

CHICAGO — Fractional laser photothermolysis should be considered first-line therapy for cutaneous resurfacing because of the device's efficacy in treating a wide range of skin types with minimal adverse events.

"There is a very low complication rate, compared with other ablative laser methods such as the carbon dioxide and erbium lasers. The most common side effect in our study was acneiform eruption, which occurred less than 2% of the time," said Dr. Emmy Graber at the annual meeting of the American Society for Dermatologic Surgery.

Acne-prone patients were more likely to experience posttreatment acne in a study conducted by Dr. Graber and colleagues. Use of oral antibiotics (doxycycline 20 mg b.i.d.) during subsequent treatments prevented further outbreaks.

Treatment with fractional lasers has been shown to be effective for the treatment of photodamaged skin and fresh scars. However, there are limited studies evaluating the side effects and complications of the technique. "This is the first large-scale study to evaluate complications with the Fraxel laser," said Dr. Graber, a fellow at the Washington (D.C.) Institute of Dermatologic Laser Surgery.

The investigators conducted a retrospective chart study of 961 treatments using a 1,550-nm erbium-doped fiber laser (Fraxel, Reliant Technologies Inc.). Dr. Graber, now with SkinCare Physicians in Chestnut Hill, Mass., declared no financial conflicts and said the study received no funding or equipment from Reliant.

The study included 422 patients with skin types I-IV treated by two operators between October 2004 and September 2006.

"All treatments were done with either the Fraxel 1 or Fraxel 2 using the 15-mm handpiece with a fluence range from 10 to 40 J/cm2, and the average fluence used was 25 J," she said, adding that densities ranged from 125 to 250 microscopic treatment zones per square centimeter, and average total delivered energy per treatment was 4.2 kJ.

All study patients were telephoned by a nurse 1 day after treatment and all had follow-up visits at 1 month. Most patients were followed for at least 1 year after final treatment, Dr. Graber said.

Most of those treated were women (91%) and most treatments were performed on the face (74%). Nearly one-fourth of patients were treated on both the face and other parts of the body. The majority of treatments (743) were for photodamage. The remaining treatments were for scars (175) and other diagnoses (43).

Overall, the 961 treatments resulted in 73 complications, which included acneiform eruptions (18), herpes simplex virus outbreak (17), erosions (13), prolonged erythema (8), postinflammatory hyperpigmentation (7), prolonged edema (6), dermatitis (2), impetigo (1), and purpura (1).

The side effect rate did not differ with regard to gender, age, body location, or diagnosis, Dr. Graber said.

"Those with complications had significantly darker skin types, and this discrepancy was most evident when comparing the incidence of postinflammatory hyperpigmentation, which appeared an average of 11 days post treatment and lasted an average of 50 days, which was longer than any other complication," Dr. Graber said.

In addition, 27% (259) of the 961 treatments were on patients with histories of herpes simplex virus (HSV). One-third of these patients (86) received antiviral prophylaxis, and 6 developed an HSV outbreak despite prophylaxis. Of the remaining two-thirds who did not receive prophylaxis, eight developed an HSV outbreak, she said, adding that of the 702 treatments on patients without histories of HSV, 3 resulted in HSV outbreak.

Because the complication rate in darker-skinned patients was low, pretreatment of all Fraxel patients with hydroquinones or other lighteners is not recommended, said study coauthor Dr. Tina Alster, the institute's director. "If you see a problem postoperatively, you can try to fade it out then, but in our study of close to a thousand treatments, the number of complications was virtually nil," Dr. Alster said, adding that the treatment should be avoided in tanned skin.

Fraxel 1, now called the Fraxel 750, received Food and Drug Administration approval in November 2003, according to a company spokesperson. The second-generation Fraxel 2, which has an adjustable spot-size feature, was approved last year.

CHICAGO — Fractional laser photothermolysis should be considered first-line therapy for cutaneous resurfacing because of the device's efficacy in treating a wide range of skin types with minimal adverse events.

"There is a very low complication rate, compared with other ablative laser methods such as the carbon dioxide and erbium lasers. The most common side effect in our study was acneiform eruption, which occurred less than 2% of the time," said Dr. Emmy Graber at the annual meeting of the American Society for Dermatologic Surgery.

Acne-prone patients were more likely to experience posttreatment acne in a study conducted by Dr. Graber and colleagues. Use of oral antibiotics (doxycycline 20 mg b.i.d.) during subsequent treatments prevented further outbreaks.

Treatment with fractional lasers has been shown to be effective for the treatment of photodamaged skin and fresh scars. However, there are limited studies evaluating the side effects and complications of the technique. "This is the first large-scale study to evaluate complications with the Fraxel laser," said Dr. Graber, a fellow at the Washington (D.C.) Institute of Dermatologic Laser Surgery.

The investigators conducted a retrospective chart study of 961 treatments using a 1,550-nm erbium-doped fiber laser (Fraxel, Reliant Technologies Inc.). Dr. Graber, now with SkinCare Physicians in Chestnut Hill, Mass., declared no financial conflicts and said the study received no funding or equipment from Reliant.

The study included 422 patients with skin types I-IV treated by two operators between October 2004 and September 2006.

"All treatments were done with either the Fraxel 1 or Fraxel 2 using the 15-mm handpiece with a fluence range from 10 to 40 J/cm2, and the average fluence used was 25 J," she said, adding that densities ranged from 125 to 250 microscopic treatment zones per square centimeter, and average total delivered energy per treatment was 4.2 kJ.

All study patients were telephoned by a nurse 1 day after treatment and all had follow-up visits at 1 month. Most patients were followed for at least 1 year after final treatment, Dr. Graber said.

Most of those treated were women (91%) and most treatments were performed on the face (74%). Nearly one-fourth of patients were treated on both the face and other parts of the body. The majority of treatments (743) were for photodamage. The remaining treatments were for scars (175) and other diagnoses (43).

Overall, the 961 treatments resulted in 73 complications, which included acneiform eruptions (18), herpes simplex virus outbreak (17), erosions (13), prolonged erythema (8), postinflammatory hyperpigmentation (7), prolonged edema (6), dermatitis (2), impetigo (1), and purpura (1).

The side effect rate did not differ with regard to gender, age, body location, or diagnosis, Dr. Graber said.

"Those with complications had significantly darker skin types, and this discrepancy was most evident when comparing the incidence of postinflammatory hyperpigmentation, which appeared an average of 11 days post treatment and lasted an average of 50 days, which was longer than any other complication," Dr. Graber said.

In addition, 27% (259) of the 961 treatments were on patients with histories of herpes simplex virus (HSV). One-third of these patients (86) received antiviral prophylaxis, and 6 developed an HSV outbreak despite prophylaxis. Of the remaining two-thirds who did not receive prophylaxis, eight developed an HSV outbreak, she said, adding that of the 702 treatments on patients without histories of HSV, 3 resulted in HSV outbreak.

Because the complication rate in darker-skinned patients was low, pretreatment of all Fraxel patients with hydroquinones or other lighteners is not recommended, said study coauthor Dr. Tina Alster, the institute's director. "If you see a problem postoperatively, you can try to fade it out then, but in our study of close to a thousand treatments, the number of complications was virtually nil," Dr. Alster said, adding that the treatment should be avoided in tanned skin.

Fraxel 1, now called the Fraxel 750, received Food and Drug Administration approval in November 2003, according to a company spokesperson. The second-generation Fraxel 2, which has an adjustable spot-size feature, was approved last year.