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Heat-Induced “Recall” of Treatment Zone Erythema Following Fractional Resurfacing With a Combination Laser (1320 nm/1440 nm)

Heat-Induced “Recall” of Treatment Zone Erythema Following Fractional Resurfacing With a... The latest technological advance in the field of fractional lasers is demonstrated in a novel fractional device: Affirm with Multiplex technology (Cynosure, Westford, Massachusetts), a combination Nd:YAG laser emitting 1320- and 1440-nm wavelengths in sequential 3-millisecond pulses composed of 1000 microbeams per 10-mm spot. The 1440-nm wavelength exerts a resurfacing effect and acts more superficially, targeting rhytids and pigmentation. The 1320-nm wavelength targets deeper tissues, stimulating neocollagenesis and thereby improving skin laxity. In all patients, treatment with this device results in circular erythematous patches that uniformly dissipate within 24 to 48 hours without accompanying edema or desquamation. However, we have observed that the treatment zone erythema can be reproduced by a hot shower after its previous complete disappearance. The existence of this “recall” phenomenon was confirmed by the manufacturer (Marina Kamenakis, e-mail communication, October 2007), who added that it can also be precipitated following prolonged exposure to direct sunlight. Report of a Case Evidence for the recall phenomenon is described herein as a time course experiment and is graphically represented in the Figure. This experiment was performed on healthy adult male forearm skin (Figure, A) using a 10-mm spot size and a range of fluence combinations: 8.0 to 9.0 J/cm2 for the 1320-nm wavelength and 1.5 to 2.0 J/cm2 for 1440-nm wavelength. The typical wheal response was observed 5 minutes after treatment (Figure, B). Thirty minutes after treatment, the wheal response abated, and a well-demarcated erythematous patch was present (Figure, C). Forty-eight hours after treatment, the erythematous patches corresponding to treatment zones completely disappeared (Figure, D). Reappearance of the erythematous patches was precipitated at 48 hours after a hot shower (Figure, E). While the results shown here were obtained from experiments performed in the absence of direct and forced air cooling, identical results have been obtained in the presence or absence of cooling, indicating that the recall phenomenon is not cooling dependent (data not shown). Figure. View LargeDownload Reappearance of fractional laser–induced treatment zone erythema following a hot shower. A, Appearance of normal forearm skin prior to treatment. Appearance of treatment areas after 5 minutes (B), 30 minutes (C), 48 hours (D), and 48 hours after a hot shower (E). Arrows indicate nevi. Fluences of the corresponding wavelengths of the combination fractional laser device are provided. Although these results were obtained from a time course experiment in which forced air and direct cooling were not used, the recall phenomenon occurs in the presence or absence of cooling (data not shown). Comment This phenomenon has not been reported with other fractional lasers. The wavelengths or deep heating component of this combination device might be responsible for the phenomenon through the activation of pathways1 or increased levels of molecules that produce erythema in the skin: histamine, 5-hydroxytryptamine, phospholipase A2, cyclooxygenase, interleukin-1α, and tumor necrosis factor. However, in contrast to this line of thinking, a previous study assessing the wheal and flare reaction following treatment of human forearm skin with an argon laser demonstrated that the reaction could not be blocked by pretreatment with acetylsalicylic acid or antihistamines, suggesting a neurogenic rather than a histamine- or mast cell–dependent mechanism.2 The technology behind fractional lasers continues to evolve. Each new device or drug has associated adverse effects that become apparent after its extensive use. These range in severity and potential for permanent adverse consequences, and examples are numerous in the literature (eg, mild injection site reactions resulting from etanercept use3 and prolonged postoperative erythema following ablative carbon dioxide laser resurfacing4). In our practice, we have not had complaints about this phenomenon, and while it is transient and without lasting consequence, it is beneficial for practitioners and patients to be aware of this effect. Correspondence: Dr Moy, Moy-Fincher Medical Group, 100 UCLA Medical Plaza, Ste 590, Los Angeles, CA 90024 (rmoy@ucla.edu). Financial Disclosure: Drs Moy and Foster have received funding support from Cynosure for other trials. References 1. Halliday GM Inflammation, gene mutation and photoimmunosuppression in response to UVR-induced oxidative damage contributes to photocarcinogenesis. Mutat Res 2005;571 (1-2) 107- 120PubMedGoogle ScholarCrossref 2. Algermissen BHermes BHenz BMMuller UBerlien HP Laser-induced weal and flare reactions: clinical aspects and pharmacological modulation. Br J Dermatol 2002;146 (5) 863- 868PubMedGoogle ScholarCrossref 3. Zeltser RValle LTanck CHolyst MMRitchlin CGaspari AA Clinical, histological, and immunophenotypic characteristics of injection site reactions associated with etanercept: a recombinant tumor necrosis factor alpha receptor: Fc fusion protein. Arch Dermatol 2001;137 (7) 893- 899PubMedGoogle Scholar 4. Geronemus RG Fractional photothermolysis: current and future applications. Lasers Surg Med 2006;38 (3) 169- 176PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Heat-Induced “Recall” of Treatment Zone Erythema Following Fractional Resurfacing With a Combination Laser (1320 nm/1440 nm)

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Publisher
American Medical Association
Copyright
Copyright © 2008 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.144.10.1398
Publisher site
See Article on Publisher Site

Abstract

The latest technological advance in the field of fractional lasers is demonstrated in a novel fractional device: Affirm with Multiplex technology (Cynosure, Westford, Massachusetts), a combination Nd:YAG laser emitting 1320- and 1440-nm wavelengths in sequential 3-millisecond pulses composed of 1000 microbeams per 10-mm spot. The 1440-nm wavelength exerts a resurfacing effect and acts more superficially, targeting rhytids and pigmentation. The 1320-nm wavelength targets deeper tissues, stimulating neocollagenesis and thereby improving skin laxity. In all patients, treatment with this device results in circular erythematous patches that uniformly dissipate within 24 to 48 hours without accompanying edema or desquamation. However, we have observed that the treatment zone erythema can be reproduced by a hot shower after its previous complete disappearance. The existence of this “recall” phenomenon was confirmed by the manufacturer (Marina Kamenakis, e-mail communication, October 2007), who added that it can also be precipitated following prolonged exposure to direct sunlight. Report of a Case Evidence for the recall phenomenon is described herein as a time course experiment and is graphically represented in the Figure. This experiment was performed on healthy adult male forearm skin (Figure, A) using a 10-mm spot size and a range of fluence combinations: 8.0 to 9.0 J/cm2 for the 1320-nm wavelength and 1.5 to 2.0 J/cm2 for 1440-nm wavelength. The typical wheal response was observed 5 minutes after treatment (Figure, B). Thirty minutes after treatment, the wheal response abated, and a well-demarcated erythematous patch was present (Figure, C). Forty-eight hours after treatment, the erythematous patches corresponding to treatment zones completely disappeared (Figure, D). Reappearance of the erythematous patches was precipitated at 48 hours after a hot shower (Figure, E). While the results shown here were obtained from experiments performed in the absence of direct and forced air cooling, identical results have been obtained in the presence or absence of cooling, indicating that the recall phenomenon is not cooling dependent (data not shown). Figure. View LargeDownload Reappearance of fractional laser–induced treatment zone erythema following a hot shower. A, Appearance of normal forearm skin prior to treatment. Appearance of treatment areas after 5 minutes (B), 30 minutes (C), 48 hours (D), and 48 hours after a hot shower (E). Arrows indicate nevi. Fluences of the corresponding wavelengths of the combination fractional laser device are provided. Although these results were obtained from a time course experiment in which forced air and direct cooling were not used, the recall phenomenon occurs in the presence or absence of cooling (data not shown). Comment This phenomenon has not been reported with other fractional lasers. The wavelengths or deep heating component of this combination device might be responsible for the phenomenon through the activation of pathways1 or increased levels of molecules that produce erythema in the skin: histamine, 5-hydroxytryptamine, phospholipase A2, cyclooxygenase, interleukin-1α, and tumor necrosis factor. However, in contrast to this line of thinking, a previous study assessing the wheal and flare reaction following treatment of human forearm skin with an argon laser demonstrated that the reaction could not be blocked by pretreatment with acetylsalicylic acid or antihistamines, suggesting a neurogenic rather than a histamine- or mast cell–dependent mechanism.2 The technology behind fractional lasers continues to evolve. Each new device or drug has associated adverse effects that become apparent after its extensive use. These range in severity and potential for permanent adverse consequences, and examples are numerous in the literature (eg, mild injection site reactions resulting from etanercept use3 and prolonged postoperative erythema following ablative carbon dioxide laser resurfacing4). In our practice, we have not had complaints about this phenomenon, and while it is transient and without lasting consequence, it is beneficial for practitioners and patients to be aware of this effect. Correspondence: Dr Moy, Moy-Fincher Medical Group, 100 UCLA Medical Plaza, Ste 590, Los Angeles, CA 90024 (rmoy@ucla.edu). Financial Disclosure: Drs Moy and Foster have received funding support from Cynosure for other trials. References 1. Halliday GM Inflammation, gene mutation and photoimmunosuppression in response to UVR-induced oxidative damage contributes to photocarcinogenesis. Mutat Res 2005;571 (1-2) 107- 120PubMedGoogle ScholarCrossref 2. Algermissen BHermes BHenz BMMuller UBerlien HP Laser-induced weal and flare reactions: clinical aspects and pharmacological modulation. Br J Dermatol 2002;146 (5) 863- 868PubMedGoogle ScholarCrossref 3. Zeltser RValle LTanck CHolyst MMRitchlin CGaspari AA Clinical, histological, and immunophenotypic characteristics of injection site reactions associated with etanercept: a recombinant tumor necrosis factor alpha receptor: Fc fusion protein. Arch Dermatol 2001;137 (7) 893- 899PubMedGoogle Scholar 4. Geronemus RG Fractional photothermolysis: current and future applications. Lasers Surg Med 2006;38 (3) 169- 176PubMedGoogle ScholarCrossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Oct 20, 2008

Keywords: erythema,heat (physical force),lasers,mental recall

References