Rox Anderson Sheds Light on Future

Rox Anderson’s vision of the future of laser surgery was presented here in Naples, Florida, at the 2010 annual meeting of the Florida Society of Dermatology and Dermatologic Surgery. He would like to cure acne …. for good! The best hope in this regard would be the use of photodynamic therapy. ALA or methyl-ALA is absorbed preferentially by the sebaceous glands in the skin. ALA 20% with three hours under occlusion allows better uptake than the more usual 60 minutes application. Red light at 635 nm is probably the optimal wavelength over a prolonged period. Short contact (<60 minutes) is not going to do it. Blue light is probably not optimal for this technique, (but can by itself reduce P Acnes numbers in the skin.) These patients are going to have quite an aggressive response, but it should be worth it in the end. Remember that cooling and bright light reduce the PDT process, so incubate your patients in a warm dark location “just like mushrooms”.

“Low level light (LLL) is going to be used by most of us in ten years when we can work out how best to manipulate it”. It’s all related to mitochondrial absorption of light. The cytochrome (cell color) absorption of specific wavelengths (630, 670, 810, 900 nm) can control oxygenation of tissue by affecting the nitric oxide (NO) switch. Stress caused by surgery or other injury induces copious amounts of NO, which competes with oxygen tissue binding sites. LLL pulls NO off these key binding sites which allows greater tissue oxygenation (read more by Harvey Whelan and Uri Oron. This is likely to help all ischemic tissue states, and has even been found to have a significant beneficial effect on acute stroke patients. The exception that both Dr Anderson and Dr Matt Avram stated was that they had a hard time believing the claims made by Zerona that inches could be lost with the use of this device.

Fractionation of Laser Energy

Rox Anderson MD discussed the microscopic effects of fractionated laser surgery at the FSDDS meeting in Naples, FL, Sunday 31^st May. Each area of injury is like a tiny murder, which is pretty innocuous on the grand scale of things, and induces new healing, new collagen. The maximum depth for the non ablative devices is about 1.2 mm “we’re not going to get much deeper than that’, said Anderson. They also do a pretty good job with fine superficial telangiectases and for atrophic skin conditions. ‘Don’t be in a hurry, because some of these great results take 5 or 6 treatments’.

He reminded us of Dr Jil Waibel’s work who has induced remodeling of scars on a microscopic scale, which has made very significant changes to hypertrophic scars after burns and surgery. Also, Chad Hivnor MD USAF, who has been treating shrapnel scars on the men and women coming back from the Afghan and Iraq wars. Fractionated ablative surgery has been found to be very useful in reducing both hypertrophic and atrophic scars.

Combination use of fractionated ablative lasers with Methyl-ALA (porphyrin precursor) indicates 10-100 times more agent gets into the deeper skin than would otherwise. There is a very fast uptake of any molecule, which will also include bugs ….. “there’s a ying and yang for everything”. Massaging the topical agent makes no difference in its uptake.

Scarring can occur if the technique and parameters are incorrect, as evidenced by the work by Matt Avram and Christopher Zachary published in separate articles last year.