Er : YAG laser for the treatment of actinic keratoses

BACKGROUND. There is no single optimal treatment for multiple facial actini c keratoses. The existing therapies such as topical 5-fluorouracil, chemica l peels, cryotherapy, dermabrasion, and CO2 laser resurfacing can produce p rolonged recovery time or are often operator dependent. OBJECTIVE. The purpose of this study was to investigate another therapeutic modality which provides a shorter recovery time with uniform results. We p erformed a prospective pilot study investigating the use of the Fr:YAG lase r for the treatment of multiple facial actinic keratoses. METHODS. Five patients with multiple facial actinic keratoses were treated with two to three passes of Er:YAG laser. Anesthesia was achieved in all ca ses by topical application and local infiltration when indicated. All patie nts were treated with 2.0 J, 5 mm spot size, and a fluence of 10 J/cm(2). C linical and histologic evaluations were performed both pre- and postoperati vely. RESULTS. All patients showed a decrease in the total number of clinical act inic keratoses on the face ranging from 86 to 96%. In addition to the rever sal of actinic damage in the epidermis, histologic evidence revealed increa sed fibroplasia and decreased superficial solar elastosis 3 months after th e laser resurfacing. Reepithelialization occurred in 5-8 days, and erythema lasted for about 3-6 weeks after the procedure. There was no evidence of s carring or pigmentary changes in any of the patients during the follow-up p eriod. CONCLUSION. Fr:YAG laser skin resurfacing is a safe and effective treatment for multiple facial actinic keratoses. Histologic data suggest a new zone of collagen deposition occurs in the superficial papillary dermis. Under ou r current parameters, Fr:YAG laser skin resurfacing has a relatively short recovery period and a low risk of scarring. Unlike the CO2 laser, Er:YAG la ser skin resurfacing can be performed with topical anesthesia alone.