Single Ablative Fractional Resurfacing Laser Treatment For Forearm Actinic Keratoses: 6-Month Follow-Up Data From An Intrapatient Comparison Between Treated and Untreated Sites

Abstract

Background and objectives: Actinic keratoses (AK) are common pre-cancerous lesions, which are associated with ultraviolet light exposure and aging. Wounding therapies such as fractionated laser resurfacing (FLR) have been previously demonstrated to effectively treat facial AK. However, the effectiveness of FLR on other sites commonly afflicted with AK has not been studied in detail. Previously, our group has reported that treatment of aged skin with wounding therapies including dermabrasion and ablative fractionated resurfacing results in the removal of senescent fibroblasts and normalizing the pro-carcinogenic acute ultraviolet B radiation responses associated with aged skin. The current studies were designed to test the effectiveness of FLR of the forearm skin of subjects aged 60 and older to remove AKs.

Study design/materials and methods: Between February 2018 and March 2019, 30 subjects were enrolled in a study, in which they underwent a single FLR treatment of one extremity including the dorsal forearm, wrist, and dorsal hand. The number of AKs was recorded on both extremities at baseline, 3 and 6 months in a blinded fashion. Side effects of the FLR were documented.

Results: A single FLR treatment resulted in a 62% reduction in the absolute number of AK in the treated arm at 6 months post-treatment. The laser treatment was well-tolerated without major complications.

Conclusions: These studies demonstrate that FLR using settings, which have demonstrated to remove senescent fibroblasts and normalize the pro-carcinogenic UVB-response of aged skin is a potentially effective and safe field therapy treatment that should be studied for long-term efficacy for use in treating upper extremity AKs. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Trial registration: ClinicalTrials.gov NCT03906253.

Keywords: actinic keratosis; insulin-like growth factor; laser.

Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and have no disclosures.

© 2019 Wiley Periodicals, Inc.

Figures

Figure 1.. Fractionated laser resurfacing of forearm skin.

(A) Cartoon of treatment site (grey area), with left vs right side treatment based upon odd/even Social Security Number. Subjects had AKs (red dots) counted and sites mapped on dorsal forearms/wrists, then following use of topical xylocaine (4%) anesthesia, underwent a single pass of the Pearl Fractional 2,790nm yittrium scandium gallium garnet ablative fractional resurfacing device. (B) Examples of post-FLR treated skin.

Figure 2.. Fractionated laser resurfacing results in decreased numbers of AKs.

(A) Changes in numbers of AKs in treated (blue) vs untreated (red) sites at 0 (pre-treatment), 3 and 6 months post-treatment. (B) Ratio of AKs in FLR-treated versus –untreated sites. Asterisk (*) denotes statistically significant (P < 0.001) differences from pre-treatment values.