title: Efficacy of different modes of fractional CO2 laser in the treatment of primary cutaneous amyloidosis: A randomized clinical trial.
abstract: BACKGROUND
  Primary cutaneous amyloidosis (PCA) comprises three main forms: macular, lichen, and nodular amyloidosis. The current available treatments are quite disappointing.
  
  
  OBJECTIVE
  Assess and compare the clinical and histological changes induced by different modes of Fractional CO2 laser in treatment of PCA.
  
  
  METHODS
  Twenty five patients with PCA (16 macular and 9 lichen amyloidosis) were treated by fractional CO2 using; superficial ablation (area A) and deep rejuvenation (area B). Each patient received 4 sessions with 4 weeks intervals. Skin biopsies were obtained from all patients at baseline and one month after the last session. Patients were assessed clinically and histologically (Congo red staining, polarized light). Patients were followed-up for 3 months after treatment.
  
  
  RESULTS
  Both modes yielded significant reduction of pigmentation, thickness, itching, and amyloid deposits (P-value < 0.001). However, the percentage of reduction of pigmentation was significantly higher in area A (P-value = 0.003). Pain was significantly higher in area B. Significant reduction in dermal amyloid deposits denotes their trans-epidermal elimination induced by fractional photothermolysis.
  
  
  CONCLUSIONS
  Both superficial and deep modes of fractional CO2 laser showed comparable efficacy in treatment of PCA. Superficial mode being better tolerated by patients, is recommended as a valid therapeutic option.
authors.affiliation: Department of Dermatology, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt.
authors.forename: Samia M
authors.initials: SM
authors.lastname: Esmat
authors.affiliation: Department of Dermatology, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt.
authors.forename: Marwa M
authors.initials: MM
authors.lastname: Fawzi
authors.forename: Heba I
authors.initials: HI
authors.lastname: Gawdat
authors.affiliation: Department of Dermatology, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt.
authors.forename: Heba S
authors.initials: HS
authors.lastname: Ali
authors.affiliation: Department of Histology, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt.
authors.forename: Safinaz S
authors.initials: SS
authors.lastname: Sayed
mesh_terms: D000328:Adult; D028226:Amyloidosis, Familial / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D054020:Lasers, Gas / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D016037:Single-Blind Method; D012873:Skin Diseases, Genetic / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Deep rejuvenation; Fractional CO2; Primary cutaneous amyloidosis; Superficial ablation