Cosmetic Fractional Laser Use

Implications for Infection Control

Gursevak Kasbia MSc. CIPHI(C)Special Thanks to Linda Cleroux (EOHU) and Collette Oulette (QCH)

Outline

Introduction

Fractional Lasers

Implications for Fractional Lasers

Complications of Fractional Laser Use

Infection Control

Summary

Questions/Answers

Introduction

LASER: Light Amplification by Stimulated Emission of Radiation

Different classifications for different functional purposes of lasers (Class 1 and 2 are quite safe, class 3b and 4 are more dangerous)

Fractional Lasers are considered Class II lasers

FRACTIONAL LASERS:

A type of laser device that can be both ablative and non-ablative and can emit anywhere from 1550 to 10600nm and used to treat a variety of skin related disorders.

Figures 1 & 2: spectrum of wavelength for different laser based procedures

What is a Fractional Laser?

Fractional Lasers are typically Non Ablative Fractional Lasers that generate microthermal treatment zones (small holes 7*7 or 12*12) (MTZs)

Small columns of thermally denatured skin of controlled width and depth. (i.e. 1550nm)

These small holes signal stem

cells from the dermal layer of

skin to reproduce and rise to

surface replacing the older

disintegrated ones.Figure 3: Fractional Unit: contains arm, computerized control system, scanner which delivers the micro-spots in a variety of patterns and sequences (Solta Medical Inc, 2010)

Fractional Laser Skin Therapy Fractional Laser technology is newer

(1998) than CO2 based lasers that were released in the 1980's

Ablative vs. Non-Ablative

Some Ablative lasers use a higher

wavelength and require anesthesia.

Typically ablative devices are used for

different medical conditions such as for

removal of Begnin malignancies of skin.

Non-Ablative lasers require no anesthesia and can be medically delegated.

Figure 1: Laser Wavelength Spectrum (BCCDC)

Figure 4: Anasthetic Cream used in procedures (courtesy drugline.org)

Laser Devices used for SkinIntense Pulse Light Sources (550-

1200nm):

1) Targets both blood vessels and melanin

2) Aids in neo-collagenesis

Mid-Infrared Laser(1320-10600nm):

1) Targets water in epidermal and dermal layer of skin.

2) "Rejuvinates skin"

2) Aids in neo-collagenesis

Visible Laser(400-700nm): uses a concentrated beam of light that targets blood vessels in the skin.

i.e. Pulsed Dye laser and KTP

1) Used to treat pigment related disorders such as port stains, freckles, rosacea etc.

Figure 5: layers of skin and fractional laser impact, fractional lasers will typicall ablate the skin in 7*7 or 9*9 formations

Medical Uses of Fractional Laser Fractional Laser treatment can be

prescribed for:

1) Cosmetic use such as removal of scars, wrinkles, dis-pigmentation etc.

2) Medically prescribed for actinic keratosis, scarring, wrinkles and pigment discolouration (vitiligo)

3) Certain stages of tatoo and scar removal (combination of ablative and non-ablative fractional laser use)

Figure 6: Different medical conditions of skin including acne, vitiligo.

Potential Complications

Cases of transmission of herpes and MRSA infection

have been noted (Alster et al. 2010)

Goldman et al (2011) found that 4% of procedures

produced herpes zoster outbreaks (1.07%), contact

dermatitis (4.6%) and acne eruption (3.48%) and

erythema (1.07%).

Graber et al (2008) found in a clinical study of over 960

procedures that the 1550 nm fractional laser

produced significantly less cases of infection as

opposed to CO2 lasers

Graber’s study concluded that fractional procedures using the 1550nm wavelength seemed to produce less skin infection.

Skin Dammage and Repair

Figure 7. Fife et al (2009) found that erosion and crusting occurred in this patient 1 week post-operative, however the majority of patients do recover well in the long term and most sever cases occur with CO2 based lasers.

Infection Control

Infection Control:1. Does the clinic have a detailed

questionnaire before the procedure (skin type etc)?

2. Is there informed consent?

3. Is there postoperative care procedures?

4. Is there appropriate ventilation in rooms (Laser Plume Safety)?

5. Are appropriate masks being worn (n95)

6. Are proper consulation forms used (not all skin types are the same!)

7. What are steps for disinfection of the scanner? Is it disposable?

Laser Safety1. Has the operator had training

(Delegation)?

2. Is the operator knowledgeable of Laser Safety?

3. Are UV/wavelength specific eyewear available to protect both the operator and patient?

4. Does the room have signage for when laser is in use (remember this is radiation)

5. Are the scanner components cleaned? Is the scanner head replaced (single use) or disinfected.

Summary

• Lasers are used for many different types of medical procedures in in-patient and outpatient formats

• Infection control should include a checklist of items required including anasthetics/creams, pre/post-operative procedures, equipment cleaning.

• Safety of the patient and the healthcare worker is imperative (ie. Exposure to radiation, eye damage)

• While generally safe fractional lasers do pose harm if used improperly or without proper consultation

References• BCCDC: Laser Hair Removal Devices. Accessed May 23rd 2013.

http://www.health.gov.bc.ca/library/publications/year/2011/Laser-hair-removal-guidelines.pdf

• Behroozan, D. S., Goldberg, L. H., Dai, T., Geronemus, R. G., & Friedman, P. M. (2006). Fractional photothermolysis for the treatment of surgical scars: A case report. Journal of Cosmetic and Laser Therapy,8(1), 35-38. Retrieved from www.scopus.com

• Biesman, B. S. (2009). Fractional ablative skin resurfacing: Complications. Lasers in Surgery and Medicine, 41(3), 177-178. Retrieved from www.scopus.com

• Canadian Centre for Occupational Health and Safety: Laser Safety: Accessed May 23 rd 2013. http://www.ccohs.ca/oshanswers/phys_agents/lasers.html

• Fife, D. J., Fitzpatrick, R. E., & Zachary, C. B. (2009). Complications of fractional CO 2 laser resurfacing: Four cases. Lasers in Surgery and Medicine, 41(3), 179-184. Retrieved from www.scopus.com

• Graber, E. M., Tanzi, E. L., & Alster, T. S. (2008). Side effects and complications of fractional laser photothermolysis: Experience with 961 treatments. Dermatologic Surgery, 34(3), 301-305. Retrieved fromwww.scopus.com

• Choudhary, S., McLeod, M., Meshkov, L., & Nouri, K. (2011). Lasers in the treatment of acne scars.  Expert Review of Dermatology, 6(1), 45-60. Retrieved from www.scopus.com

• Gold, M. H. (2007). Fractional technology: A review and clinical approaches. Journal of Drugs in Dermatology : JDD, 6(8), 849-852. Retrieved from www.scopus.com

• Rinaldi, F. (2008). Laser: A review. Clinics in Dermatology, 26(6), 590-601. Retrieved from www.scopus.com

• Saedi, N., Petelin, A., & Zachary, C. (2011). Fractionation: A new era in laser resurfacing.  Clinics in Plastic Surgery, 38(3), 449-461. Retrieved from www.scopus.com

• Tierney, E. P., Eisen, R. F., & Hanke, C. W. (2011). Fractionated CO 2 laser skin rejuvenation.  Dermatologic Therapy, 24(1), 41-53. Retrieved from www.scopus.com

• Images from ADAM medical images