Optimizing wound healing in the face after laser abrasion.

Author: Goldman MP, Roberts TL 3rd, Skover G, Lettieri JT, Fitzpatrick RE

Author affiliation: Dermatology Associates of San Diego County, Inc., 9850 Genesee Ave. Suite 480, La Jolla, CA 92037, USA. mgderm@aol.com

Publication date & source: 2002.03, J Am Acad Dermatol., 46(3):399-407.

Publication type: Clinical Trial; Randomized Controlled Trial

BACKGROUND: Laser resurfacing is a popular procedure to improve the physical signs of photoaging. In addition to improvements in treatment modalities, optimizing posttreatment regimens will enhance patient care. OBJECTIVE: Our purpose was to evaluate the efficacy of two forms of wound care for the face after laser abrasion. METHODS: Forty-two patients received full-face laser resurfacing at two clinics by using either the UltraPulse carbon dioxide (CO(2)) laser (Coherent Laser Corp, Palo Alto, Calif) alone or followed by an erbium:YAG laser (Derma-20, ESC Sharplan, Inc, Needham, Mass) and/or a blended CO(2)/Er:YAG laser (Derma-K, ESC Sharplan) or a variable pulse erbium:YAG laser (Contour, Sciton Laser Corp, Palo Alto). Twenty-one patients were randomly assigned to a postoperative regimen including Silon-TSR (Bio Med Sciences, Inc, Allentown, Pa) for the first 2 to 3 days after laser resurfacing, followed by Aquaphor ointment (Beiersdorf, Charlotte, NC) to complete the first 2 weeks. The other 21 patients received the resurfacing recovery system (RRS, Neutrogena, Los Angeles, Calif) following a specific regimen. The system includes Fibracol wound dressing (Johnson & Johnson, Skillman, NJ) for 2 days, followed by a hydrogel dressing for 1 to 2 days, followed by an ointment to complete the first 2 weeks. Patients were evaluated for wound healing on days 2, 3, 6-10, 14-16, and 28-30. The skin was swabbed for colonization at every visit to determine the quantity of bacteria throughout the healing process. RESULTS: Ninety percent of patients in both groups experienced either "no pain" or "minimal pain" during the first 3 days. Total bacterial counts peaked on days 3 and 6 in the patients managed with the RRS and the Silon-TSR/Aquaphor regimen, respectively. The average day at which patients did not require a dressing was 3.0 days in the group managed with the RRS and 3.7 days in the group managed with the Silon-TSR/Aquaphor dressing regimen (P < or =.05). The average day of complete epithelial regeneration was significantly shorter at 6.3 days using the RRS compared with 7.4 days for patients using the Silon-TSR/Aquaphor regimen (P < or =.02). There was no difference in infection, adverse sequelae, exudate management, or pain in either group. CONCLUSION: Healing was optimized in patients using the RRS after laser resurfacing.

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