Treatment of keratosis pilaris with 810-nm diode laser: a randomized clinical trial.
OBJECTIVE
Keratosis pilaris (KP) is a common skin disorder of follicular prominence and erythema that typically affects the proximal extremities, can be disfiguring, and is often resistant to treatment. Shorter-wavelength vascular lasers have been used to reduce the associated erythema but not the textural irregularity.


OBJECTIVE
To determine whether the longer-wavelength 810-nm diode laser may be effective for treatment of KP, particularly the associated skin roughness/bumpiness and textural irregularity.


METHODS
We performed a split-body, rater-blinded, parallel-group, balanced (1:1), placebo-controlled randomized clinical trial at a dermatology outpatient practice of an urban academic medical center from March 1 to October 1, 2011. We included all patients diagnosed as having KP on both arms and Fitzpatrick skin types I through III. Of the 26 patients who underwent screening, 23 met our enrollment criteria. Of these, 18 patients completed the study, 3 were lost to or unavailable for follow-up, and 2 withdrew owing to inflammatory hyperpigmentation after the laser treatment.


METHODS
Patients were randomized to receive laser treatment on the right or left arm. Each patient received treatment with the 810-nm pulsed diode laser to the arm randomized to be the treatment site. Treatments were repeated twice, for a total of 3 treatment visits spaced 4 to 5 weeks apart.


METHODS
The primary outcome measure was the difference in disease severity score, including redness and roughness/bumpiness, with each graded on a scale of 0 (least severe) to 3 (most severe), between the treated and control sites. Two blinded dermatologists rated the sites at 12 weeks after the initial visit.


RESULTS
At follow-up, the median redness score reported by the 2 blinded raters for the treatment and control sides was 2.0 (interquartile range [IQR], 1-2; P = .11). The median roughness/bumpiness score was 1.0 (IQR, 1-2) for the treatment sides and 2.0 (IQR, 1-2) for the control sides, a difference of 1 (P = .004). The median overall score combining erythema and roughness/bumpiness was 3.0 (IQR, 2-4) for the treatment sides and 4.0 (IQR, 3-5) for the control sides, a difference of 1 (P = .005).


CONCLUSIONS
Three treatments with the 810-nm diode laser may induce significant improvements in skin texture and roughness/bumpiness in KP patients with Fitzpatrick skin types I through III, but baseline erythema is not improved. Complete treatment of erythema and texture in KP may require diode laser treatment combined with other laser or medical modalities that address redness.


BACKGROUND
clinicaltrials.gov Identifier: NCT01281644.
Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio.
Omer
O
Ibrahim
Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Misbah
M
Khan
Section of Dermatology, University of Chicago, Chicago, Illinois.
Diana
D
Bolotin
Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Meghan
M
Dubina
Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Michael
M
Nodzenski
Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Wareeporn
W
Disphanurat
Department of Dermatology, Washington Hospital Center, Georgetown University, Washington, DC.
Rohit
R
Kakar
Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Simon
S
Yoo
Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Dennis
D
Whiting
Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Dennis P
DP
West
Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Emily
E
Poon
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia6Department of Medicine, Baptist Health South Florida, Miami.
Emir
E
Veledar
Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois7Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois8Department of Surgery, Feinberg School of Medicine, No.
Murad
M
Alam
D000015:Abnormalities, Multiple / Q000532:radiotherapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D007644:Darier Disease / Q000532:radiotherapy*; D004867:Equipment Design; D005138:Eyebrows / Q000002:abnormalities*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D028022:Low-Level Light Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome; D055815:Young Adult