SEOUL, SOUTH KOREA – The nonablative fractionated thulium laser at 1,927-nm wavelength is a promising new noninvasive therapy for actinic keratoses.
The laser was actually developed for superficial skin resurfacing, an application for which it is particularly well suited because the 1,927-nm wavelength minimizes patient discomfort. But while investigating the device for improvement of pigmentation, Dr. Roy G. Geronemus noted incidentally that patients were also achieving "a rather dramatic resolution" of multiple facial actinic keratoses (AKs). So he decided to conduct a formal examination of the laser’s performance for this purpose, he said at the World Congress of Dermatology
To date, in 15 patients followed for 1-6 months after the last of several thulium laser treatment sessions for multiple facial AKs, the mean clearance of the lesions was 84%-91%.
"This compares very favorably to other modalities that are out there, including the topical chemotherapies, immunomodulatory agents, and photodynamic therapy. The advantage of this is not only do you improve the AKs, but you’re also getting the cosmetic benefit simultaneously," said Dr. Geronemus, medical director of the Laser and Skin Surgery Center of New York.
Patients received up to four treatments at 2- to 6-week intervals. The laser setting was 5-20 mJ, with 30%-70% coverage per session. Topical anesthetic was utilized for 1 hour, supplemented as needed by intramuscular ketorolac.
After a single treatment a mean of 63% of AKs were cleared. After two, 84%, and after three, 85%.
The laser therapy was well tolerated. The average pain score during treatment was 2.7 on a 0-9 scale. No scarring or infections have occurred. Mild redness and peeling typically lasted 4-5 days.
Dr. Geronemus said he and his colleagues have also found that the 1,927-nm fractionated thulium laser brings about "dramatic improvement" in actinic cheilitis, and is also highly effective for the thorny problem of enlarged facial pore size.
Dr. Geronemus is a shareholder in Solta Medical, which markets the 1,927-nm fractionated thulium laser. He also is on the advisory boards of numerous dermatologic laser manufacturers.