Devices Currently Available

See Table 11.1 for a list of devices and their corresponding characteristics.

11.2 Treatment Complications and Management

The most common side effects, such as erythema, edema, pruritis, flakiness, petechiae/ purpura, and acneiform eruptions are transient and self-limiting. Oral or topical steroids may be given for persistent erythema, edema, and pruritis. However, these symptoms can generally be managed with adequate moisturization, and antihistamines if necessary.

More serious complications can arise, however. There have been reports of a 10-12% inci­dence of PIH following fractional photothermolysis [18]. As discussed earlier, this is most common in patients with a history of PIH or melasma, and in patients of darker skin types (IV-VI). Treating with lower densities seems to minimize the disruption of the dermal – epidermal junction, which in turn decreases the risk of developing postinflammatory

CO

CD

Cn

hyperpigmentation [24]. Utilizing lower-energy levels and densities, as well as topical hyd – roquinone pre – and posttreatment, may help limit the incidence of PIH to less than 5% [43].

There have also been case reports of systemic lidocaine toxicity following topical applica­tion of lidocaine cream or gel, [37]. CNS toxicity can be seen at plasma lidocaine levels as low as 1-5 pg/ml with clinical symptoms of tinnitus, dysgeusia, light-headedness, nausea, and diplopia. At higher levels, nystagmus, slurred speech, hallucinations, muscle tremors, seizures, and eventually coma and respiratory arrest can ensue [44].

Lidocaine is primarily metabolized through the hepatic system. Therefore, its use should be limited in patients who have compromised liver function, or in those who are taking medications that may inhibit liver enzymes responsible for its metabolism. Other factors to consider in determining toxicity are duration of application, whether it is under occlusion, the total amount of surface area covered, BMI of the patient, and if there is any disruption in the stratum corneum. Management of toxicity includes maintenance of airway and res­piration and administration of benzodiazepines [37].

11.10 Conclusions

Skin rejuvenation using the concept of fractional photothermolysis is a safe and effective treatment modality. Creating microscopic lesions in the epidermis and dermis can lead to expulsion of necrotic debris and dermal collagen remodeling that correlates with improvement

in dyschromia, wrinkles, texture, and scarring, with minimal downtime and side effects.

Many fractional lasers may also be used for nonfacial resurfacing of the neck, chest, and

hands, unlike traditional ablative devices. As technologies advance and biological mecha­nisms unfold, this promises to be useful for an array of dermatologic conditions.