DALLAS – Fractional led to considerable clinical improvement, including thickening of the dermis, results from a case report showed.
“We have so much more to learn about how the laser treatments are modifying these intricate pathways,” lead study author Samantha Schneider, MD, said in an interview following the annual conference of the American Society for Laser Medicine and Surgery. “But, our project suggests that patients with genetic blistering diseases may benefit from fractional laser therapy in combination with topical PLLA. This may be a good option, particularly for patients who are looking for more therapeutic options for slowly healing wounds and have exhausted other more conventional treatment modalities.”
Dr. Samantha Schneider
Drawing from this previous work, Dr. Schneider and her associates hypothesized that fractional ablative laser treatment and topical PLLA might help a 27-year-old RDEB patient with revertant mosaicism who presented for management of large, nonhealing erosions on her upper back and posterior neck, complicated by frequent Staphylococcus infections. Over a 2-year period the researchers administered 15 fractional CO2 laser treatments with a single-pulse, nonoverlapping technique with settings of 15 mJ of energy and 15% density. They immediately applied concentrated topical PLLA to the treated area and obtained punch biopsy specimens from treated and untreated affected skin and clinically normal-appearing skin after the seventh treatment for histopathologic and immunohistologic examination.
Since the time of treatment, the patient reported marked improvement with a decreased number of erosions, as well as decreased pain. In addition, the hematoxylin and eosin slides showed increased collagen I (mature collagen) in the treated sample, “which suggests that we may be inducing a type of neocollagenesis, which is exciting particularly if it seems to work for patients with genetic alterations in collagen,” Dr. Schneider said. “Additionally, the indirect immunofluorescence [IIF] showed increased collagen VII, which is absent in the patient’s untreated skin. This was truly surprising and warrants more investigation as to how we may be affecting patients’ biology with this combination treatment.”
She acknowledged that more studies are required to confirm the findings. “Furthermore, we did not examine the fractional laser therapy and the topical PLLA independently so we cannot say whether the effect is synergistic or due primarily to one modality versus the other,” she noted. “Lastly, the IIF interpretation was challenging particularly in the untreated skin due to the epidermal detachment and edge staining. However, when viewed in comparison to the treated skin, we noted increased collagen VII in the treated sample.”
Dr. Schneider reported having no relevant disclosures.