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Hypertrophic scar could be associated with several complications that interfere with patient daily activities, physical and psychological health and impact patient quality of life. Several therapeutics and maneuvers are used for treatment of hypertrophic scar with variable success and side effects. We aim to evaluate safety and efficacy of fractional carbon dioxide laser on treatment of hypertrophic scar both clinically and histopathologically. Hypertrophic scars in each patient of total thirty patients were subjected to random division with sealed envelope into two parts, part A treated with fractional carbon dioxide laser every month for 5 sessions, and part B lift without treatment for control. Hypertrophic scars in each patient were single or multiple, Single scar was more than 15 cm length. Clinical evaluation was done by two blinded dermatologists, using Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) for each part before, 3 months and 6 months after treatment. Histopathological evaluation was done for each part before and 3 months after treatment by measuring epidermal thickness, collagen area percent, and elastin area percent. The upper significant clinical and histopathological improvement was shown in carbon dioxide laser treated parts than control parts without significant side effects for fractional carbon dioxide laser treatment. Treatment of hypertrophic scar with fractional carbon dioxide laser is beneficial and generally considered safe, with minimal risk of harm when performed with appropriate laser parameters for male and female patients with skin type III and IV, at different ages and different body regions.

Background Fractional ablative CO2 lasers are widely used for skin rejuvenation but are associated with post‐procedural erythema, crusting, tenderness, and downtime. Carboxytherapy masks, a modality utilizing carbon dioxide, have been suggested to enhance healing and aesthetic outcomes post CO2 laser treatment; however, controlled clinical data remain limited. Objective To evaluate the efficacy and safety of a topical carboxytherapy mask in enhancing recovery, reducing adverse effects, and improving patient satisfaction following fractional ablative CO2 laser treatment. Methods Ten subjects (aged 45–70 years, Fitzpatrick skin types I–III) undergoing full‐face fractional CO2 laser resurfacing were enrolled in this randomized pilot study. Participants were assigned to either the active arm (n = 8, carboxytherapy mask was applied pre‐ and post‐procedure and at designated intervals for 14 days) or placebo arm (n = 2, bland moisturizer). Outcomes included blinded investigator assessments of erythema, edema, crusting, healing rate, pigmentation, and wrinkle severity at Days 28 and 84; patient‐reported diaries of discomfort and healing parameters; and self‐assessments of satisfaction and global aesthetic improvement. Results The active group demonstrated reduced erythema during the first week (mean scores: Day 1, 3.1 vs. 3.5; Day 7, 0.6 vs. 1.0 for placebo). By Day 7, healing surface area averaged 97% in the active group with no crusting. At Day 28, the active group exhibited fewer fine and coarse lines (mean coarse line score 2 vs. 4 in placebo). At Day 84, coarse line reduction and abnormal pigmentation improvement favored the active group (0.75 vs. 1.5, respectively). Patient‐reported tenderness, burning, and crusting were consistently lower in the active group, with higher satisfaction and confidence scores at both Day 28 and 84. No adverse effects were reported. Conclusion In this pilot study, the carboxytherapy mask enhanced post‐laser healing, reduced erythema and discomfort, and improved long‐term wrinkle and pigmentation outcomes compared to placebo. These findings support the adjunctive use of the carboxytherapy mask to improve recovery and patient satisfaction after ablative CO2 laser resurfacing. Larger, controlled trials are warranted to confirm these results.

In this study, we aimed to investigate the efficacy and safety of combined fractional carbon dioxide laser and topical timolol maleate 0.5% solution versus topical timolol maleate 0.5% solution alone in inflammatory acne. Thirty adult patients with inflammatory facial acne were randomized in this study. The patients received 3 biweekly sessions of fractional CO2 laser on one side of the face followed by topical timolol maleate ophthalmic solution 0.5% once daily for 7 days on both sides. Outcome was evaluated 2 weeks after the first session, 2 weeks after the last session, and 1 month after the last session by lesion count, erythema, hyperpigmentation, qualitative global scarring grading, and patients’ satisfaction. Side effects were also evaluated. Trial registration (IRB No. 417, 30/10/2023). At 2 weeks after the first session, there were insignificant differences between both sides regarding lesion count, erythema, hyperpigmentation, and qualitative global scarring grading ( p value = 0.8, 0.05, 0.7, 0.1 respectively). At 2 weeks after the last session, the erythema on the combined side was reduced by a mean of 0.2 ± 0.4 SD compared to timolol only side with significant difference between both sides ( p value = 0.03), while there were insignificant differences between both sides regarding lesion count, hyperpigmentation, qualitative global scarring grading, and patients’ satisfaction ( p value = 0.1, 0.5, 0.8, 0.3 respectively). Recurrence was detected at one month after the last session. No side effects were reported. Combined fractional CO2 laser and topical timolol maleate 0.5% solution were significantly more effective than topical timolol maleate 0.5% solution alone in reduction of erythema of inflammatory facial acne in adolescent men with Fitzpatrick’s skin type III-IV at 2 weeks after 3 biweekly sessions with insignificant differences between both sides regarding lesion count, hyperpigmentation, qualitative global scarring grading, and patients’ satisfaction. Further and larger studies are still needed.

Burn scars are significant consequence of thermal burn injuries, causing cosmetic concerns and potentially leading to symptomatic discomfort or functional limitations; therefore, continuous adoption of novel methods is warranted to improve outcomes. This study aims to assess and compare the effectiveness, safety, and satisfaction of fractional CO2 laser treatment alone versus its combination with oral pentoxifylline at a dosage of 400 mg twice daily for four months in patients with hypertrophic/keloid burn scars. In a assessor and analyst blinded randomized controlled trial, patients with hypertrophic/keloidal thermal burn scars were allocated into two intervention groups. Both groups underwent treatment with a fractional CO2 laser, while one group additionally received oral pentoxifylline at a dosage of 400 mg twice daily for four months. The assessment of scar improvement was performed using the modified Vancouver Scar Scale (mVSS) at baseline and during subsequent follow-up sessions. Significant improvements were noted within both groups, with mVSS scores decreasing from 7.73 to 4.73 in the CO2 laser group and from 7.36 to 3.91 in the combination therapy group ( p  < 0.001 for both). However, the between-group difference in mVSS score reduction was not statistically significant ( p  = 0.39). Confidence intervals for the mean change in mVSS scores from baseline to endpoint were [2.45, 3.10] for the CO2 laser group and [3.15, 3.85] for the combination therapy group. The combination therapy group also showed a more pronounced improvement in pigmentation subscore of mVSS and higher patient satisfaction rates. No adverse effects were reported in either group. Fractional CO2 laser with or without Pentoxifylline appears to be an effective and safe option for the improvement of hypertrophic/keloidal burn scars. Patient satisfaction seems to increase when the laser is combined with oral Pentoxifylline. Nevertheless, further studies involving larger patient cohorts are warranted to draw more robust conclusions. Capsule summary What is known in this topic Burn scars from thermal burn injuries can have significant cosmetic and functional complications. Multiple treatment approaches, such as fractional CO2 laser therapy, have been extensively studied to enhance scar outcomes. However, the investigation of Pentoxifylline, an oral medication, in scar management remains somewhat limited. What this article adds We discovered total mVSS score reduction was indifferent between Pentoxifylline combined with CO2 laser versus laser monotherapy. However the combination treatment elicited more improvements in pigmentation and higher satisfaction rates versus CO2 laser alone. Both treatment regimens were effective, safe, and tolerable.

Background: Autologous platelet-rich plasma has recently attracted significant attention throughout the medical field for its wound-healing ability. Aims: This study was conducted to investigate the potential of platelet-rich plasma combined with fractional laser therapy in the treatment of acne scarring. Methods: Sixteen patients (12 women and 4 men) who underwent split-face therapy were analyzed in this study. They received ablative fractional carbon dioxide laser combined with intradermal platelet-rich plasma treatment on one half of their face and ablative fractional carbon dioxide laser with intradermal normal saline on the other half. The injections were administered immediately after laser therapy. The treatment sessions were repeated after an interval of one month. The clinical response was assessed based on patient satisfaction and the objective evaluation of serial photographs by two blinded dermatologists at baseline, 1 month after the first treatment session and 4 months after the second. The adverse effects including erythema and edema were scored by participants on days 0, 2, 4, 6, 8, 15 and 30 after each session. Results: Overall clinical improvement of acne scars was higher on the platelet-rich plasma-fractional carbon dioxide laser treated side but the difference was not statistically significant either 1 month after the first treatment session (P = 0.15) or 4 months after the second (P = 0.23). In addition, adverse effects (erythema and edema) on the platelet-rich plasma-fractional carbon dioxide laser-treated side were more severe and of longer duration. Limitations: Small sample size, absence of all skin phototypes within the study group and lack of objective methods for the evaluation of response to treatment and adverse effects were the limitations. Conclusion: This study demonstrated that adding platelet-rich plasma to fractional carbon dioxide laser treatment did not produce any statistically significant synergistic effects and also resulted in more severe side effects and longer downtime.

Alopecia Areata (AA) is a chronic, immune-mediated inflammatory condition primarily targeting hair follicles, leading to non-scarring hair loss. Traditional therapeutic approaches, including topical and systemic immunosuppressive treatments, often yield inconsistent results and carry significant side effects. Recently, laser therapy has emerged as a promising modality for AA treatment, particularly when combined with adjunctive agents that enhance hair follicle stimulation. This study evaluates the efficacy and safety of a novel therapeutic combination: CO2 fractional laser therapy with Bimatoprost 0.03% solution application. Conducted at Al-Azhar University Hospital between January 2019 and May 2023, the study involved 60 patients with clinically and dermoscopically confirmed AA. Participants were randomly assigned into two groups: Group A ( n  = 30) received three CO2 fractional laser sessions with subsequent daily application of Bimatoprost 0.03%, while Group B ( n  = 30) underwent laser therapy alone. Clinical outcomes were assessed using standardized photographic documentation, dermoscopic evaluation, and patient-reported improvement scores. Results demonstrated a significantly higher response rate in Group A compared to Group B (80% vs. 40%, p  = 0.025). The combination therapy led to faster and more pronounced hair regrowth, with notable improvements in hair density, pigmentation, and thickness. Minimal adverse effects were reported, limited to transient erythema and mild procedural discomfort. Statistical analysis confirmed a superior treatment response in Group A across all assessment parameters ( p  < 0.05). These findings suggest that the combination of CO2 fractional laser therapy with Bimatoprost 0.03% offers a safe and effective treatment modality for AA, outperforming laser therapy alone. This study provides a foundation for further research and highlights the potential integration of prostaglandin analogs with laser-based interventions in AA management. Future studies with larger sample sizes and extended follow-up periods are necessary to validate these promising results and assess long-term treatment sustainability.

Background Genitourinary syndrome of menopause (GSM) includes clinical manifestations attributed to estrogen deficiency affecting the genitourinary tract of postmenopausal women. Treatment may require a multifaceted approach, including patient education, lifestyle modifications, physical, as well as hormonal and non‐hormonal therapies. Aims To evaluate the efficacy and tolerability of vaginal CO2 laser therapy (MonaLisa Touch) combined with an oral food supplement containing bioactive collagen peptides (BCP) and other functional components for GSM treatment. We hypothesized that this combination would enhance GSM symptom relief. Patients/Methods Twenty postmenopausal women with GSM were divided into two groups. Group 1 (n = 10) underwent three sessions of vaginal CO2 laser treatment alone, while Group 2 (n = 10) received the same laser treatment in addition to oral food supplementation. Improvements in vaginal health (Vaginal Health Index—VHI), vaginal pain (Visual Analogue Scale—VAS), and sexual function (Female Sexual Function Index—FSFI), along with patient satisfaction and tolerability, were evaluated. Results Both groups showed improvements in VHI, pain scores, and FSFI, with Group 2 displaying more significant gains. Compared to Group 1, Group 2 had greater median differences in VHI (Δ = 11.00 vs. Δ = 8.50, p = 0.005) and VAS (Δ = −7.00 vs. Δ = −5.50, p = 0.017). Similarly, FSFI scores increased meaningfully in both groups, more so in Group 2 (from 53.50 to 67.50, p = 0.005 vs. from 51.50 to 60.50, p = 0.014 in Group 1). Treatment satisfaction was also higher in Group 2 (p = 0.047). Conclusions The addition of oral supplementation with BCP and other functional components to vaginal CO2 laser treatment for GSM offered significant benefits over laser treatment alone, improving vaginal health, reducing pain, and ameliorating sexual function. This combination therapy presents a promising non‐hormonal option for GSM management, warranting further investigation in larger, long‐term studies to confirm these preliminary findings.

Introduction and hypothesisTo evaluate the efficacy and safety of a single carbon dioxide (CO2) laser maintenance treatment in women previously treated successfully with laser for stress urinary incontinence (SUI), who have demonstrated a decline in treatment effect.MethodsWomen aged 40–70 years who experienced temporary significant improvement in symptoms following CO2 laser treatments for SUI were randomized to either the treatment group or the sham treatment control group. Cough test results, 1-h pad weights and scores on the Urogenital Distress Inventory (UDI6), the International Consultation of Incontinence Questionnaire (ICIQ-UI) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) were obtained at baseline and 3 and 6 months.ResultsOf 183 women screened, 131 were included in the final analysis. Demographic characteristics and baseline measures in the outcome tests were similar between the groups. Statistically significant improvements were demonstrated in the study compared to the control group at 3 months post-treatment in positive cough test (44.4% vs. 79.4%, P = 0.002), mean pad weight test (2.3 g ± 1.3 vs. 5.6 ± 1.1, P < 0.001), mean UDI-6(24.7 ± 12.1 vs. 45.1 ± 13.6 SD, P = 0.004), mean ICIQ-UI (16.5 ± 4.3 vs. 10.3 + 3.8, P = 0.003) and mean PISQ-12 (21.3 ± 6.8 vs. 36.6 ± 7.5, P = 0.003). However, values at 6 months post-treatment were similar to those at baseline.ConclusionsOur results suggest that a single maintenance laser treatment for reducing symptoms of SUI is transiently effective, well tolerated and safe. This treatment modality provides alternative non-surgical therapy for women with SUI.

Background Postpartum abdominal laxity is a growing concern for women. Noninvasive options like microwave technology and fractional carbon dioxide (CO2) laser show promise, but their combined efficacy and safety require further investigation. Aim To compare the efficacy and safety of microwaves versus combined microwaves and fractional CO2 laser in the treatment of postpartum abdominal laxity among Filipino patients. Patients/Methods Thirty‐two patients with Fitzpatrick skin types III–V and postpartum abdominal laxity received three microwave sessions, with one side randomly assigned an additional fractional carbon dioxide laser session (designated as Side B, while the other as Side A). Global aesthetic improvement scale (GAIS) scores and patient satisfaction (PS) scores were determined at every follow‐up. Baseline and completion anthropometric measurements were taken, and adverse effects were recorded. Results Significant improvements in GAIS and PS scores were noted for both sides across all sessions (p < 0.001), with side B showing superior scores post‐CO2 laser (p < 0.001). A moderate correlation between metabolic equivalent (METs) scores and GAIS scores (p = 0.413, p = 0.019) indicated that higher levels of physical activity were associated with higher GAIS scores. These improvements were attributed to epidermal thickening and dermal collagen and elastin remodeling, the latter seen histologically in a representative patient. Adverse effects were mild and noted only with CO2 laser. Conclusions The combined use of the microwave system and fractional CO2 laser is safe and well tolerated and is superior to microwaves alone in the treatment of postpartum abdominal laxity.