Abstract
Fractionated carbon dioxide (CO2) laser resurfacing is an effective treatment of skin aging. Several studies investigated the morphologic changes due to this laser treatment by using skin biopsies or animal model. Recently, reflectance confocal microscopy (RCM) has emerged as a new tool that can “optically” scan the skin in vivo with a nearly histologic resolution and in a totally noninvasive modality. Our study aims to analyze the skin changes following the ablative fractional CO2 laser sessions by using RCM. Ten patients were subjected to ablative fractional CO2 laser sessions for skin aging. Confocal microscopic images were acquired at baseline (w0), 3 weeks (w3), 6 weeks (w6), and 12 weeks (w12) after laser session. Previously identified confocal parameters were used to assess the skin aging at baseline and after treatment. At w3, the epidermis showed a complete disappearance of the mottled pigmentation upon RCM along with the presence of few Langherans’ cells. The collagen type as seen upon RCM observed at baseline was replaced by a newly formed collagen type of long, bright and straight fibers (collagen remodeling). These fibers were parallel arranged and observed throughout the entire RCM mosaic. At w6 and w12 the confocal aspects of the skin was unchanged compared to w3. RCM confirmed the presence of an intense collagen remodeling following laser resurfacing. In line with previous studies, this collagen showed a peculiar arrangement and distribution. The collagen remodeling was still present after 3 months and confirms the long-term effect of the treatment. This is the first time that the skin can be analyzed in vivo at patient’s bedside. In the near future, RCM can be an essential adjunct for Clinicians to measure the effects of laser treatment and possibly to gain new insights into the development of side effects.
Similar content being viewed by others
Abbreviations
- RCM:
-
reflectance confocal microscopy
- KC:
-
keratinocyte
References
Yaar M, Eller MS, Gilchrest BA (2002) Fifty years of skin aging. J Investig Dermatol Symp Proc 7(1):51–58
Shamsaldeen O, Peterson JD, Goldman MP (2011) The adverse events of deep fractional CO(2): a retrospective study of 490 treatments in 374 patients. Lasers Surg Med 43(6):453–456
Berlin AL, Hussain M, Phelps R, Goldberg DJ (2009) A prospective study of fractional scanned nonsequential carbon dioxide laser resurfacing: a clinical and histopathologic evaluation. Dermatol Surg 35(2):222–228
Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR (2004) Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med 34(5):426–438
Ciocon DH, Engelman DE, Hussain M, Goldberg DJ (2011) A split-face comparison of two ablative fractional carbon dioxide lasers for the treatment of photodamaged facial skin. Dermatol Surg 37:784–790
Campbell TM, Goldman MP (2010) Adverse events of fractionated carbon dioxide laser: review of 373 treatments. Dermatol Surg 36(11):1645–1650
Dainichi T, Ueda S, Fumimori T, Kiryu H, Hashimoto T (2010) Skin tightening effect using fractional laser treatment II: a pilot animal study on skin remodeling. Dermatol Surg 36(1):71–75
Hantash BM, Bedi VP, Kapadia B et al (2007) In vivo histological evaluation of a novel ablative fractional resurfacing device. Lasers Surg Med 39(2):96–107
Rajadhyaksha M, Grossman M, Esterowitz D, Webb RH, Anderson RR (1995) In vivo confocal scanning laser microscopy of human skin: melanin provides strong contrast. J Invest Dermatol 104(6):946–952
González S, Swindells K, Rajadhyaksha M, Torres A (2003) Changing paradigms in dermatology: confocal microscopy in clinical and surgical dermatology. Clin Dermatol 21(5):359–369
Calzavara-Pinton P, Longo C, Venturini M, Sala R, Pellacani G (2008) Reflectance confocal microscopy for in vivo skin imaging. Photochem Photobiol 84(6):1421–1430
Huzaira M, Rius F, Rajadhyaksha M, Anderson RR, González S (2001) Topographic variations in normal skin, as viewed by in vivo reflectance confocal microscopy. J Invest Dermatol 116(6):846–852
Stumpp OF, Bedi VP, Wyatt D, Lac D, Rahman Z, Chan KF (2009) In vivo confocal imaging of epidermal cell migration and dermal changes post nonablative fractional resurfacing: study of the wound healing process with corroborated histopathologic evidence. J Biomed Opt 14(2):024018
Longo C, Casari A, Beretti F, Cesinaro AM, Pellacani G (2012) Skin aging: in vivo microscopic assessment of epidermal and dermal changes by means of confocal microscopy. J Am Acad Dermatol (in press)
Pellacani G, Scope A, Ferrari B et al (2009) New insights into nevogenesis: in vivo characterization and follow-up of melanocytic nevi by reflectance confocal microscopy. J Am Acad Dermatol 61(6):1001–1013
Rajadhyaksha M (2009) Confocal microscopy of skin cancers: translational advances toward clinical utility. Conf Proc IEEE Eng Med Biol Soc 2009:3231–3233
Pellacani G, Guitera P, Longo C, Avramidis M, Seidenari S, Menzies S (2007) The impact of in vivo reflectance confocal microscopy for the diagnostic accuracy of melanoma and equivocal melanocytic lesions. J Invest Dermatol 127(12):2759–2765
Longo C, Fantini F, Cesinaro AM, Bassoli S, Seidenari S, Pellacani G (2007) Pigmented mammary Paget disease: dermoscopic, in vivo reflectance-mode confocal microscopic, and immunohistochemical study of a case. Arch Dermatol 143(6):752–754
Longo C, Rito C, Beretti F et al (2011) De novo melanoma and melanoma arising from pre-existing nevus: in vivo morphologic differences as evaluated by confocal microscopy. J Am Acad Dermatol 65(3):604–614
Rishpon A, Kim N, Scope A et al (2009) Reflectance confocal microscopy criteria for squamous cell carcinomas and actinic keratoses. Arch Dermatol 145(7):766–772
González S, Rajadhyaksha M, González-Serva A, White WM, Anderson RR (1999) Confocal reflectance imaging of folliculitis in vivo: correlation with routine histology. J Cutan Pathol 26(4):201–205
Ardigò M, Longo C, Cristaudo A, Berardesca E, Pellacani G (2012) Evaluation of allergic vesicular reaction to patch test using in vivo confocal microscopy. Skin Res Technol 18:61–63
Agozzino M, Tosti A, Barbieri L et al (2011) Confocal microscopic features of scarring alopecia: preliminary report. Br J Dermatol 165:534–540
Richtig E, Hofmann-Wellenhof R, Kopera D, El-Shabrawi-Caelen L, Ahlgrimm-Siess V (2011) In vivo analysis of solar lentigines by reflectance confocal microscopy before and after Q-switched ruby laser treatment. Acta Derm Venereol 91(2):164–168
Conflict of interest
No conflict of interest to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Longo, C., Galimberti, M., De Pace, B. et al. Laser skin rejuvenation: epidermal changes and collagen remodeling evaluated by in vivo confocal microscopy. Lasers Med Sci 28, 769–776 (2013). https://doi.org/10.1007/s10103-012-1145-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10103-012-1145-9