Erbium : YAG laser resurfacing of the hands, arms, and neck

BACKGROUND. Resurfacing procedures to improve photodamage, rhytides, and sc ars have been developed and refined over the last century. Laser resurfacin g is a relatively new procedure in the resurfacing spectrum. It has been ap preciated that resurfacing of nonfacial skin by dermabrasion, chemical peel s, or car bon dioxide (CO2) laser carries an unacceptably high risk of scar ring. More recently, the erbium:YAG (Er:YAG) laser has been developed and m arketed for facial and nonfacial resurfacing. Specifically, manufacturers h ave promoted Er:YAG lasers as safe for resurfacing photodamaged skin on the hands, forearms, and neck. Surprisingly, there is little evidence to suppo rt these claims. OBJECTIVE. To evaluate the safety and efficacy of resurfacing photodamaged skin on the dorsum of the hands, forearms, and neck with an Er:YAG laser. METHODS. Twelve patients with photodamage of the neck or of the hands and f orearms participated in this study. Seven patients received laser resurfaci ng of the hands and forearms utilizing the Er:YAG laser with a 5 mm spot si ze at an energy of 1 J (5 J/cm(2)). These patients received 2 to 3 passes. Five patients received resurfacing of photodamaged neck skin with a 5 mm sp ot size at 1 J (5 J/cm(2)). These patients received one to 2 passes. Patien ts were evaluated for time to healing, cosmetic improvement, and satisfacti on with the procedure. RESULTS. Several observations of note are reported in patients receiving no nfacial resurfacing. Despite previous reports of patients receiving Er:YAG laser treatment with topical anesthesia alone, all patients required some i ntralesional anesthesia during the procedure for some areas. All patients r equired significantly longer to heal as compared to the face. Both the hand s and forearms and the neck require 2-3 weeks to heal. Two of 7 hand and fo rearm patients developed bacterial infections during healing. One of 5 neck resurfacing patients developed transitory hyperpigmentation. Cosmetic impr ovement was mild, with 6 of 7 hand and forearm patients showing poor (0-25% ) cosmetic improvement and one of 7 showing fair (25-50%) improvement. in t he neck resurfacing group, 3 of 5 had poor (0-25%) improvement, one of 5 ha d fair (25-50%) improvement, and one of 5 had good (50-75%) results. CONCLUSION. Er:YAG laser resurfacing of the hands, forearms, and neck may b e safely performed. Topical anesthesia alone is inadequate, healing takes u p to 3 weeks, and cosmetic improvement is minimal with the parameters used in this study.