Dr. Goldenberg is Assistant Professor, Department of Dermatology, Mount Sinai School of Medicine, New York, New York, and Medical Director of the Dermatology Faculty Practice, New York (http://www.goldenbergdermatology.com).
Dr. Goldenberg reports no conflicts of interest in relation to this post.
Weiss and colleagues (J Am Acad Dermatol. 2013;68:98-102) conducted a 6-month safety, tolerance, and efficacy trial of nonablative 1927-nm fractional resurfacing of facial actinic keratosis (AK) with the Fraxel Dual (Solta Medical) laser. Twenty-four patients (5 male; 19 female) underwent up to 4 facial treatments with the 1927-nm laser with a 6-month follow-up period. The average patient age was 60 years, and Fitzpatrick skin types I and II were most common. Skin biopsy was performed in 7 patients prior to the initial procedure and at the 6-month follow-up.
Overall, there was an 86.6% reduction in absolute number of AK lesions at the 6-month follow-up visit. Cosmetic improvement was assessed on a 4-point scale. At the end of the 6-month study, the patients graded their improvement as 3.04 and investigators graded the improvement as 3.54. All 7 patient biopsies confirmed AK prior to treatment. At 6-month follow-up, 6 specimens (85.7%) showed histologic evidence of AK clearance.
What’s the issue?
The fractionated 1927-nm nonablative thulium laser is approved by the US Food and Drug Administration for the treatment of AK. Fraxel works by creating thermal zones, and the thermal damage targets AK lesions in the superficial skin. Actinic keratosis, the second most common condition treated by dermatologists, has many therapeutic options, including cryosurgery, photodynamic therapy, and multiple topical agents.
According to this study, 1927-nm fractional resurfacing appears to be a promising option for facial AK treatment. The added cosmetic benefit is a huge plus for many patients. More studies with long-term follow-up are needed.