Persistent improvement at three year follow-up in a patient with localized deep morphea treated with both injected and laser-assisted topical poly-l-lactic acid
Yeager D, and Ozog DM. Persistent improvement at three year follow-up in a patient with localized deep morphea treated with both injected and laser-assisted topical poly-l-lactic acid. Lasers Surg Med 2019; 51:S11-S12.
Lasers Surg Med
Background: Morphea is a rare fibrosing disorder that can cause significant cosmetic disfigurement and many correction techniques may lead to suboptimal results. Here in, we report a novel case of localized deep morphea that was successfully treated with fractionated CO2 laser in combination with topical and injected PLLA. Study Design/Materials and Method: A 44-year-old female with biopsy proven localized deep morphea presented with a depressed sclerotic plaque with shiny hypopigmentation on her left lateral shoulder. She received four treatments separated by approximately three months time of both superficial and deep fractional CO2 laser treatment (pulse energy 80 mJ, density 5% and pulse energy 50 mJ, density 10%) followed by immediate application of 0.3-1 cc of topical PLLA as well as 0.2-1 cc of injected PLLA. Results: She tolerated her treatments well without any adverse effects. One month after her treatments, significant cosmetic improvement was noted. She was seen for follow-up three years following her final treatment and the site retained its cosmetic improvement without the need for repeated treatments. Conclusion: Fractional CO2 in combination with PLLA is a promising treatment modality in cases of cosmetically disfiguring morphea. Immediate formation of microscopic treatment zones (MTZs) removes fibrotic tissue and releases skin tightness. Delayed wound healing then occurs via collagen production. Furthermore, vertical channels of ablation created by the CO2 laser can then be used for laser-assisted drug delivery. PLLA, unlike other typical volume-based fillers, stimulates collagen production and results have been reported to last 18-36 months or longer. In our case presented here, correction was performed with excellent patient satisfaction and continued improvement at three year follow-up with no reduction in perceived efficacy. In summary, we highlight that PLLA filler may be used in combination with fractionated CO2 laser for sustained cosmetic improvement in morphea by synergistically increasing new collagen synthesis.