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Effects of non-ablative Er:YAG laser on the skin and the vaginal wall: systematic review of the clinical and experimental literature

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Abstract

Introduction and hypothesis

Er:YAG laser is frequently used in dermatology and gynecology. Clinical studies document high satisfaction rates; however, hard data on the effects at the structural and molecular levels are limited. The aim of this systematic review was to summarize current knowledge about the objective effects of non-ablative Er:YAG laser on the skin and vaginal wall.

Methods

We searched MEDLINE, Embase, Cochrane, and the Web of Science. Studies investigating objectively measured effects of non-ablative Er:YAG laser on the skin or vaginal wall were included. Studies of any design were included. Owing to the lack of methodological uniformity, no meta-analysis could be performed and therefore results are presented as a narrative review.

Results

We identified in vitro or ex vivo studies on human cells or tissues, studies in rats, and clinical studies. Most studies were on the skin (n = 11); the rest were on the vagina (n = 4). The quality of studies is limited and the settings of the laser were very diverse. Although the methods used were not comparable, there were demonstrable effects in all studies. Immediately after application the increase in superficial temperature, partial preservation of epithelium and subepithelial extracellular matrix coagulation were documented. Later, an increase in epithelial thickness, inflammatory response, fibroblast proliferation, an increase in the amount of collagen, and vascularization were described.

Conclusions

Er:YAG laser energy may induce changes in the deeper skin or vaginal wall, without causing unwanted epithelial ablation. Laser energy initiates a process of cell activation, production of extracellular matrix, and tissue remodeling.

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Acknowledgements

The authors wish to thank the biomedical reference librarians of the KU Leuven Libraries – 2Bergen – learning Centre Désiré Collen (Leuven, Belgium) for their help in conducting the systematic literature search.

The authors would also like to extend their thanks to Petra Stevens (Department of Development and Regeneration, G-PURE laboratory, KU Leuven) for technical support.

Funding

J. Deprest has a service agreement with FOTONA, receiving funding for independent assessment of laser application in an experimental setting. The contract is managed by Leuven Research and Development. The author has designed the protocol and is owner of the results, and reports these independently of FOTONA. L. Hympanova and L. Krofts were supported by a grant Progress Q34, Charles University, Prague, Czechia.

Author information

Authors and Affiliations

  1. Centre for Surgical Technologies, Group Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium

    Lucie Hympanova, Katerina Mackova & Jan Deprest

  2. Department of Development and Regeneration, Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium

    Lucie Hympanova, Katerina Mackova, Jan Bosteels & Jan Deprest

  3. Institute for the Care of Mother and Child, Third Faculty of Medicine, Charles University, Prague, Czech Republic

    Lucie Hympanova, Katerina Mackova & Ladislav Krofta

  4. Department of Dermatology and Venereology, Minia University, Al-Minya, Egypt

    Moetaz El-Domyati

  5. Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands

    Eva Vodegel & Jan-Paul Roovers

  6. CEBAM, The Centre for Evidence-based Medicine, Cochrane Belgium, KU Leuven-University of Leuven, Leuven, Belgium

    Jan Bosteels

  7. Pelvic Floor Unit, University Hospitals KU Leuven, Leuven, Belgium

    Jan Deprest

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  1. Lucie Hympanova
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  2. Katerina Mackova
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  3. Moetaz El-Domyati
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  4. Eva Vodegel
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  5. Jan-Paul Roovers
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  6. Jan Bosteels
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  7. Ladislav Krofta
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  8. Jan Deprest
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Contributions

J. Deprest and J.P. Roovers: project development and supervision, manuscript editing. L. Hympanova and K. Mackova: protocol creation, review registration, literature search, data collection, synthesis and analysis, manuscript writing; M. El-Domyati consultations from the dermatological field, manuscript editing; J. Bosteels: consultations on search, statistics, and bias, manuscript editing; L. Krofta and E. Vodegel: data synthesis and analysis, manuscript editing.

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Correspondence to Jan Deprest.

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Hympanova, L., Mackova, K., El-Domyati, M. et al. Effects of non-ablative Er:YAG laser on the skin and the vaginal wall: systematic review of the clinical and experimental literature. Int Urogynecol J 31, 2473–2484 (2020). https://doi.org/10.1007/s00192-020-04452-9

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