Wound Healing Process After Thermomechanical Skin Ablation

Kokolakis, Georgios; Grawert, Leonie von; Ulrich, Martina; Lademann, Juergen; Zuberbier, Torsten; Hofmann, Maja

doi:10.1002/lsm.23213

Cited by 17 publications

(24 citation statements)

References 19 publications

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“…Compared with lasers, mainly CO 2 lasers, the effect of TMA is more superficial [17,18]. However, pre-treatment with low-energy TMA was shown to increase the percutaneous permeation of compounded 20% ALA gel linearly over the first 5 hours from application, resulting in higher average PpIX fluorescence intensity measurements compared with only topical ALA application [17].…”

Section: Discussionmentioning

confidence: 99%

Thermomechanical Ablation‐Assisted Photodynamic Therapy for the Treatment of Acne Vulgaris. A Retrospective Chart Review of 30 Patients

Hilerowicz

Friedman

Zur³

et al. 2020

Lasers Surg Med

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Background and Objectives Acne vulgaris, a chronic inflammatory disease, affects more than 90% of teenagers. The first‐line treatments for acne vulgaris are topical and oral medications, mainly antibiotics and retinoids. However, antibiotic resistance of Propionibacterium acnes, contraindications, partial response, significant adverse effects, or recurrence creates demand for novel treatment options in acne. Aminolevulinic acid (ALA) photodynamic therapy (PDT) is a well‐established modality in the treatment of acne. Nevertheless, PDT has limitations: it may not be effective for every patient; several treatments are usually required to achieve sufficient outcome; incubation time is 1–3 hours; treatment pain and post‐treatment downtime may be difficult for some patients to endure; and adverse effects may occur. This retrospective chart review was conducted to evaluate the efficacy and safety of PDT, assisted by a thermomechanical ablation (TMA) fractional injury device in the treatment of patients with moderate to severe acne. Study Design/Materials and Methods We conducted a retrospective chart review of 30 acne patients treated with TMA immediately before 5% ALA application with an incubation time of 1 hour and exposure to 60 J/cm2 red light (630 nm). Patients received up to three monthly treatments and were followed for 16 weeks. Two independent investigators evaluated the subject outcomes according to high definition photographs taken at baseline, before each treatment and at follow‐up visits. Three acne grading methods were used: Acne Grading Scoring System (AGSS), the Leeds revised acne grading system, and the general response to the treatment score. Patients also provided self‐assessments of improvement using the patient global impression of change (PGIC). Results Compared with baseline, the AGSS has showed a statistically significant reduction of 26.7% and 23.7%, respectively, at weeks 8 and 16 after final treatment. The Leeds score showed 65.2% and 60.6% improvement at the respective visits. The overall response rate was graded 3.3 ± 0.5 out of 4. PGIC score given by the patients was 5.5 out of 7, reflecting high satisfaction. Conclusion TMA used immediately prior to ALA application may enhance the effectiveness of PDT in the treatment of acne with minimal side effects, reduced downtime, and fewer sessions. The exact mechanism of TMA‐assisted PDT is still to be understood. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Thermomechanical Ablation‐Assisted Photodynamic Therapy for the Treatment of Acne Vulgaris. A Retrospective Chart Review of 30 Patients

Hilerowicz

Friedman

Zur³

et al. 2020

Lasers Surg Med

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“…With the current settings, TMFI produced nonablative coagulation zones with low trauma to the skin barrier, resulting in enhanced PpIX accumulation in superficial skin layers, which is consistent with PDT's current Food and Drug Administration (FDA) indication for superficial AK. However, offering high tolerability and minimal downtime posttreatment [22], TMFI holds potential as a novel tool to enhance ALA-induced PpIX accumulation.…”

Section: Discussionmentioning

confidence: 99%

Thermo‐Mechanical Fractional Injury Enhances Skin Surface‐ and Epidermis‐ Protoporphyrin IX Fluorescence: Comparison of 5‐Aminolevulinic Acid in Cream and Gel Vehicles

et al. 2020

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Background and Objectives: Thermo-mechanical fractional injury (TMFI) impacts the skin barrier and may increase cutaneous drug uptake. This study investigated the potential of TMFI in combination with 5-aminolevulinic acid (ALA) cream and gel formulations to enhance Protoporphyrin IX (PpIX) fluorescence at the skin surface and in the skin. Study Design/Materials and Methods: In healthy volunteers (n = 12) a total of 144 test areas were demarcated on the upper back. Test areas were randomized to (i) TMFI (6 milliseconds, 400 µm at a single pass) or no pretreatment and (ii) 20% ALA in cream or gel formulations. Skin surface PpIX fluorescence was quantified by PpIX fluorescence photography and photometry in 30-minute intervals until 3 hours. PpIX fluorescence microscopy quantified separate PpIX fluorescence in the epidermis, and in superficial-, mid-, and deep-dermis from punch biopsies sampled after 3 hours of ALA incubation. Local skin reactions (LSR) and pain intensities (numerical rating scale 0-10) were evaluated immediately, at 3 hours and 14 days after the intervention. Results: TMFI exposure before photosensitizer application significantly increased skin surface PpIX fluorescence, both for ALA cream (TMFI-ALA-cream 7848 arbitrary units [AU] vs. ALA-cream 5441 AU, 3 hours, P < 0.001) and ALA gel (TMFI + ALA-gel 4591 AU vs. ALA-gel 3723 AU, 3 hours, P < 0.001). The TMFImediated increase in PpIX fluorescence was similar for ALA-cream and -gel formulations (P = 0.470) at the skin surface. In the epidermis, PpIX fluorescence intensities increased from combination treatment with TMFI and ALA-cream (TMFI + ALA-cream 421 AU vs. ALA-cream 293 AU, P = 0.034) but not from combination with TMFI and ALA-gel (TMI + ALA-gel 264 AU vs. ALA-gel 261 AU, P = 0.791). Dermal fluorescence intensities (superficial-, mid-, or deep dermis) were unaffected by TMFI pretreatment in both ALA-cream and ALA-gel exposed skin (P = 0.339). ALA-cream generally induced higher PpIX fluorescence intensities than ALA-gel (skin surface P < 0.001 and epidermis P < 0.03). TMFI induced low pain intensities (median 3) and mild LSR that were resolved at 14 days follow-up. Conclusion: Given the present study design, TMFI, in combination with the standardized application of 20% ALA cream and gel formulations, significantly enhanced skin surface PpIX fluorescence compared to no pretreatment. Additionally, TMFI increased epidermal PpIX fluorescence combined with 20% ALA cream vehicle. Thus, TMFI pretreatment and formulation characteristics exert influence on PpIX fluorescence intensities in normal skin. Lasers Surg. Med.

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“…= (0); (15) = * (0); (13) = 6 ∫ ℜ ()ℜ ()∞ 0 ; (14) = ℌ ˎ (0); (15) = ℌ * ˎ (0); (9) = 7 ∫ ℜ ()ℑ (); (10) = (0…”

Section: Methodsunclassified

“…(3) − 3 ( 11 (4) 11 (6) + 11 ( 7) 11 (9) ); ℳ 11 (6) = 11 ( 7) 11 (8) + 3 11 ( 12) 11 (14) ; ℳ 11 (7) = 11 ( 9) 11 (10) + 2 11 ( 12) 11 (14) ; ℳ 11 (8) = 1 11 ( 9) 11 (11) + 11 ( 12) 11 (13) ; 11 (6) = 11 ( 7) 11 (8) + 3 11 ( 12) 11 (14) ; 11 (7) = 11 ( 9) 11 (10) + 2 11 ( 12) 11 (14) ; 11 (8) = 11 (12) 11 (13) + 1 11 ( 9) 11 (11) ; Ӄ (7) = 11…”

Section: Methodsunclassified

“…In the present work, no significant damage to the skin tissue or dermal coagulation was reported. The underlying wound-healing processes after skin ablation with thermomechanical ablation were investigated by Kokolakis et al [13]. It was concluded that the wound-healing process after TMA is much faster, and the recovery time minimizes significantly compared to other ablative techniques.…”

Section: Introductionmentioning

confidence: 99%

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Two-Dimensional Vibrating And Thermal Response of Skin Tissue To Different Types of Heat Sources Considering The Hyperbolic Heat Transfer Equation

Ghanbari

Rezazadeh

2021

Preprint

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Laser-induced thermal therapy, due to its applications in various clinical treatments, has become an efficient alternative, especially for skin ablation. In this work, the two-dimensional thermomechanical response of skin tissue subjected to different types of thermal loading is investigated. Considering the thermoelastic coupling term, the two-dimensional differential equation of heat conduction in the skin tissue based on the Cattaneo–Vernotte heat conduction law is presented. The two-dimensional differential equation of the tissue displacement coupled with the two-dimensional hyperbolic heat conduction equation of tissue is solved simultaneously to analyze the thermal and mechanical response of the skin tissue. The existence of mixed complicated boundary conditions makes the problem so complex and intricate. The Galerkin-based reduced-order model has been utilized to solve the two-sided coupled differential equations of skin displacement and heat transfer with accompanying complicated boundary conditions. The effect of various types of heating sources such as thermal shock, single and repetitive pulses, repeating sequence stairs, ramp-type, and harmonic-type heating, on the thermomechanical response of the tissue is investigated. The temperature distribution in the tissue along the depth and radial direction is also presented. The transient temperature and displacement response of tissue considering different relaxation times are studied, and the results are discussed in detail.

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Wound Healing Process After Thermomechanical Skin Ablation

Cited by 17 publications

References 19 publications

Thermomechanical Ablation‐Assisted Photodynamic Therapy for the Treatment of Acne Vulgaris. A Retrospective Chart Review of 30 Patients

Thermomechanical Ablation‐Assisted Photodynamic Therapy for the Treatment of Acne Vulgaris. A Retrospective Chart Review of 30 Patients

Thermo‐Mechanical Fractional Injury Enhances Skin Surface‐ and Epidermis‐ Protoporphyrin IX Fluorescence: Comparison of 5‐Aminolevulinic Acid in Cream and Gel Vehicles

Two-Dimensional Vibrating And Thermal Response of Skin Tissue To Different Types of Heat Sources Considering The Hyperbolic Heat Transfer Equation

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