Single Ablative Fractional Resurfacing Laser Treatment For Forearm Actinic Keratoses: 6‐Month Follow‐Up Data From An Intrapatient Comparison Between Treated and Untreated Sites

Abstract

Background and Objectives: Actinic keratoses (AK) are common pre-cancerous lesions, which are associated with ultraviolet light exposure and aging. Wounding therapies such as fractionated laser resurfacing (FLR) have been previously demonstrated to effectively treat facial AK. However, the effectiveness of FLR on other sites commonly afflicted with AK has not been studied in detail. Previously, our group has reported that treatment of aged skin with wounding therapies including dermabrasion and ablative fractionated resurfacing results in the removal of senescent fibroblasts and normalizing the procarcinogenic acute ultraviolet B radiation responses associated with aged skin. The current studies were designed to test the effectiveness of FLR of the forearm skin of subjects aged 60 and older to remove AKs. subjects were enrolled in a study, in which they underwent a single FLR treatment of one extremity including the dorsal forearm, wrist, and dorsal hand. The number of AKs was recorded on both extremities at baseline, 3 and 6 months in a blinded fashion. Side effects of the FLR were documented. Results: A single FLR treatment resulted in a 62% reduction in the absolute number of AK in the treated arm at 6 months post-treatment. The laser treatment was well-tolerated without major complications. Conclusions: These studies demonstrate that FLR using settings, which have demonstrated to remove senescent fibroblasts and normalize the pro-carcinogenic UVB-response of aged skin is a potentially effective and safe field therapy treatment that should be studied for long-term efficacy for use in treating upper extremity AKs. Lasers Surg. Med.

Randomized controlled trial of fractionated laser resurfacing on aged skin as prophylaxis against actinic neoplasia

“…Throughout the current 36 month follow-up period, this ratio has been maintained; in fact, none of the ratios determined at 3, 6, 12, 18, 24, 30, or 36 months post-FLR are significantly different. As described in our first report on this cohort, these data indicate FLR is an effective treatment for existing AKs (15). However, our model predicts that FLR treatment will also prevent the occurrence of new AK lesions.…”

“…As this is an ongoing study, the number of return visits by subjects is also shown in Table 1. We have previously reported outcomes for of these subjects at 3 and 6 months following FLR treatment (15). Subsequent to that report, 18 additional subjects have been recruited to the study.…”

“…All of the AKs were small (<3 mm; Grades I or II). Specific requirements for inclusion and exclusion criteria were identical to above and have been previously published (15).…”

Insulin‐like Growth Factor‐1 Impacts p53 Target Gene Induction in UVB‐irradiated Keratinocytes and Human Skin

“…Mutations in pol g lead to a variant form of the skin cancer-prone disease xeroderma pigmentosum (XP-V) (33), and thus, the lower expression of pol g protein in sunlight-exposed geriatric skin may explain the elevated risk of skin cancer in these individuals. Interestingly, skin rejuvenation approaches such as fractionated laser resurfacing demonstrated the ability to restore IGF-1 expression in geriatric skin to levels found in young adult skin (8,19,20,55) and may prevent the development of actinic keratoses (56). Thus, it will be interesting to determine whether these clinical interventions similarly restore the capacity for proper p53 signaling in the skin of older individuals.…”

Wounding Therapies for Prevention of Photocarcinogenesis

“…In recent years, novel treatments aimed for geriatric patients both predisposed and exposed to NMSC have been developed. One such modality is wounding therapy, which attempts to reverse the geriatric fibroblast senescence phenotype by inducing a "wounding response" (19)(20)(21)(22)(23). This effectively serves to rejuvenate geriatric skin to a more youthful phenotypic and constitutive expression.…”