Efficacy of different modes of fractional CO₂ laser in the treatment of primary cutaneous amyloidosis: A randomized clinical trial

Abstract

Background Primary cutaneous amyloidosis (PCA) comprises three main forms: macular, lichen, and nodular amyloidosis. The current available treatments are quite disappointing. Objectives Assess and compare the clinical and histological changes induced by different modes of Fractional CO2 laser in treatment of PCA. Patients and Methods Twenty five patients with PCA (16 macular and 9 lichen amyloidosis) were treated by fractional CO2 using; superficial ablation (area A) and deep rejuvenation (area B). Each patient received 4 sessions with 4 weeks intervals. Skin biopsies were obtained from all patients at baseline and one month after the last session. Patients were assessed clinically and histologically (Congo red staining, polarized light). Patients were followed‐up for 3 months after treatment. Results Both modes yielded significant reduction of pigmentation, thickness, itching, and amyloid deposits (P‐value < 0.001). However, the percentage of reduction of pigmentation was significantly higher in area A (P‐value = 0.003). Pain was significantly higher in area B. Significant reduction in dermal amyloid deposits denotes their trans‐epidermal elimination induced by fractional photothermolysis. Conclusion Both superficial and deep modes of fractional CO2 laser showed comparable efficacy in treatment of PCA. Superficial mode being better tolerated by patients, is recommended as a valid therapeutic option. Lasers Surg. Med. 47:388–395, 2015. © 2015 Wiley Periodicals, Inc.

A study on efficacy of high fluence Q-switched neodymium doped yttrium aluminium garnet laser in macular amyloidosis

“…15 Esmat et al, when compared efficacy of different modes of fractional carbon dioxide laser in treatment of primary cutaneous amyloidosis, demonstrated that both superficial and deep mode showed comparable efficacy whereas superficial mode is better tolerated by patients. 16…”

Laser treatment of medical skin disease in women

“…A case report of PDL treatment in a 57-year-old man with recalcitrant macular amyloidosis who was treated with three sessions of PDL at 2-week intervals showed improvement after each treatment ( Barsky and Buka, 2014 ). This resulted from a decrease in collagen and dermatan sulfate synthesis that is similar to the mechanism behind the reduction of the size of hypertrophic scars ( Esmat et al, 2015 ). The QS-Nd:YAG laser has also been studied in 20 patients with clinically diagnosed and pathologically confirmed macular amyloidosis who were treated with both 532 nm and 1064 nm doses in different parts or plaques.…”

“…Few studies have looked at the treatment of macular amyloidosis by laser therapy. One study of 25 patients with primary cutaneous amyloidosis used both superficial ablation and deep rejuvenation with a fractional CO 2 laser and found a significant reduction in pigmentation, thickness, itching, and amyloid deposition ( Esmat et al, 2015 ). In this study, superficial ablation was preferred by patients due to decreased pain with comparable efficacy ( Stellon, 2002 ).…”

Ultraviolet-A1 phototherapy in the treatment of primary diffuse cutaneous amyloidosis: an additional phototherapy regimen for cutaneous amyloidosis with review of treatment options

“…Topical dimethyl sulfoxide 50% solution in water was found to be beneficial in some cases with rapid and marked improvement of papules and itch (9), whereas partial and transient reduction of pruritus but no amyloid-dissolving properties have been reported by others (24). Fractional CO2 laser has been used to treat 25 patients affected by PCA with some benefit, using both superficial and deep modes of fractional laser (25). Two patients affected by lichen amyloidosis have been treated with CO2 surgical laser with good response especially for the pruritus, after a failed treatment with topical corticosteroids in both cases (26).…”