Fractionated CO2 laser for treatment of linear morphea: A case series.
J Am Acad Dermatol
This case series explores the outcomes of 2 patients with a diagnosis of morphea after treatment with deep fractionated CO 2 laser.
Case 1: A 50-year-old man with biopsy-proven linear morphea of right parietofrontal scalp/forehead presented with concerns about facial asymmetry with expressions and hyperpigmentation related to his condition. He underwent 1 round of deep fractional CO 2 laser treatment (pulse energy 15 mJ/cm 2 and density 15%) followed immediately by 0.3 cc topical poly-L-lactic acid and 2 months later by 6 units of onabotulinumtoxinA to the bilateral corregators. Patient noted improvement in both hyperpigmentation and asymmetry after just 1 round of treatment.
Case 2: A 22-year-old woman with linear morphea of left posterior thigh received 5 rounds of deep fractional CO 2 laser (pulse energy 100 mJ/cm 2 and density 3%) with significant improvement in hyperpigmentation, induration and range of motion. The patient is now able to reach her toes on the left side unlike before treatment. Morphea is a rare inflammatory disease primarily involving the dermis and subcutaneous fat, which can result in significant functional impairment as a result of pain, skin tightness and reduced range of motion. Associated discoloration and asymmetry can also be of significant cosmetic concern. Fractional ablative CO 2 laser utilizes the principles of controlled thermal injury to initiate favorable healing and remodeling response. It produces a pattern of ablation and coagulation varying in density and depths separated by undamaged skin. The proposed mechanism of action involves an immediate mechanical effect, which removes fibrotic tissue, releasing the skin tightness as well as a delayed effect of dynamic wound healing with induction of collagen remodeling. Collagenase levels (which allows for breakdown of abnormal collagen) have been shown to be increased in morphea tissue treated with CO 2 laser, whereas TGF-β1 (a fibrotic marker) has been shown to be decreased. Recent studies have shown improved patient satisfaction with the results of CO 2 laser treatment compared with more traditional therapies such as UVA1.