title: Nonablative fractional photothermolysis for facial actinic keratoses: 6-month follow-up with histologic evaluation.
abstract: BACKGROUND
  A number of epidermal and papillary dermal skin conditions can be treated safely and effectively with fractional photothermolysis (FP).
  
  
  OBJECTIVE
  We sought to evaluate the effectiveness of FP with a 1550-nm fractionated erbium-doped fiber laser for the treatment of facial actinic keratoses (AKs).
  
  
  METHODS
  Fourteen men, ages 59 to 79 years, underwent 5 laser treatments (2- to 4-week intervals) at an energy fluence of 20 to 70 mJ and treatment level of 11 (8-10 passes), corresponding to 32% to 40% surface area coverage. AK counts and photographs were taken at baseline, before each treatment, and at 1-, 3-, and 6-month follow-ups after the last treatment. Biopsies were performed at baseline and at the 3-month follow-up. The clinical improvement of the actinic lesions was evaluated by a dermatologist using digital photography and lesion counts at all 3 follow-up visits.
  
  
  RESULTS
  The AK count for each patient was reduced on average by 73.1% (67.5%-77.7%) at the 1-month, 66.2% (60.0%-71.5%) at the 3-month, and 55.6% (43.9%-64.8%) at the 6-month follow-up visit. Excluding two cases, all biopsy specimens (baseline and at the 3-month follow-up) were positive for histologic features of AK and/or squamous cell carcinoma.
  
  
  CONCLUSIONS
  This study is limited by a small number of patients; therefore further clinical studies are warranted.
  
  
  CONCLUSIONS
  FP decreases the number of clinical AKs; however, posttreatment biopsy specimens indicate the histologic persistence of AKs (epidermal tumors). FP is not an adequate single-treatment modality for AKs.
authors.affiliation: DermSurgery Associates, Houston, Texas.
authors.forename: Tracy M
authors.initials: TM
authors.lastname: Katz
authors.affiliation: DermSurgery Associates, Houston, Texas; Methodist Hospital, Houston, Texas.
authors.forename: Leonard H
authors.initials: LH
authors.lastname: Goldberg
authors.affiliation: DermSurgery Associates, Houston, Texas.
authors.forename: Denise
authors.initials: D
authors.lastname: Marquez
authors.affiliation: DermSurgery Associates, Houston, Texas.
authors.forename: Arash
authors.initials: A
authors.lastname: Kimyai-Asadi
authors.affiliation: Department of Dermatology, University of Texas, Houston, Texas.
authors.forename: Kristel D
authors.initials: KD
authors.lastname: Polder
authors.affiliation: DermSurgery Associates, Houston, Texas.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Landau
authors.affiliation: Dermatology & Laser Surgery Center, Houston, Texas; Department of Dermatology, University of Texas, Houston, Texas; Methodist Hospital, Houston, Texas. Electronic address: drpaul@dermlasersurgery.com.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Friedman
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D016001:Confidence Intervals; D005148:Facial Dermatoses / Q000473:pathology* / Q000532:radiotherapy*; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D055623:Keratosis, Actinic / Q000473:pathology* / Q000532:radiotherapy*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D028022:Low-Level Light Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome