Real World Dermatology: Evaluating the Safety of Combination Laser Procedures in a Single Clinic Session

November 2022 | Volume 21 | Issue 11 | 1181 | Copyright © November 2022


Published online October 24, 2022

doi:10.36849/JDD.6766

Gabriella Alvarez MSa, Neel Nath MDb, Amanda Suggs MDb

aDuke University School of Medicine, Durham, NC
bDepartment of Dermatology, Duke University, Durham, NC

Abstract
Background: Studies show it is safe to have multiple sessions of single laser treatment over an appropriate time period, which allows for the skin to heal between treatments. Waiting to have several sessions may not be realistic for every patient. Physicians may combine laser treatments into a single session to accommodate for patient convenience and to achieve cosmetic improvement faster. Although individual laser therapies are reported to have minimal side effects, few studies explore the safety of multiple laser treatments in a single session.
Methods:
This study is a retrospective chart review from a single-physician patient pool. Patients who received 1 laser treatment in a single session were compared to those who received 2 or more laser treatments in a single session. Patients were evaluated for treatment type and safety, measured by the Common Terminology Criteria for Adverse Events (CTCAE). The CTCAE is a validated severity scale (1-5) where 1 represents minimal adverse events and 5 represents death. Adverse event scores were acquired from follow-up visits, messages through the electronic health record, or follow-up phone calls.
Results: Over a 12-month period, 89 patients qualified for the study with 152 sessions recorded: 116 had 1 laser treatment and 36 had 2 or more laser treatments in a single session. All but 1 patient scored a 1 on the CTCAE, the other, a 2.
Conclusion: This study suggests there is no difference in adverse events from a single laser treatment vs 2 or more laser treatments in a single session.

J Drugs Dermatol. 2022;21(11):1181-1184. doi:10.36849/JDD.6766

INTRODUCTION

Noninvasive laser procedures have gained increasing popularity in the dermatology field in the United States. Lasers of different wavelengths exist to treat cutaneous disorders and improve aesthetic outcomes for cosmetic purposes. Over the years, advancements in lasers have allowed for more effective results in a shorter amount of time. Traditionally, 1 laser treatment was performed per visit with ample time allowed between visits to minimize adverse events. Expected adverse events can include erythema, swelling, blistering, and post-inflammatory pigmentation (PIH), especially in darker skin types, etc.1 Typically, the skin needs 1 to 3 months to heal from each treatment depending on laser type.

As devices have evolved and improved, laser procedures are now often overlapped or combined in practice to achieve faster and, often, better outcomes. This is particularly the case when the devices have a synergistic effect on the skin. Synergistic effects of combined treatment have led to greater improvement in pigment distribution, fine wrinkles, sallowness, and skin tone.2 Waiting to have several sessions may not be realistic for every patient. Patients seeking laser procedures may have jobs, families, and other social factors that make multiple session treatments challenging. Therefore, it is becoming more common for physicians to combine laser treatments into a single session to accommodate for patient convenience.

Most evidence that supports combined use of laser treatments evaluate for aesthetic outcomes. There are few studies that examine for safety. One prospective study evaluated the safety of combining CO2 and erbium:YAG lasers in a single session for perioral skin resurfacing. It showed that combining lasers reduced the duration of crusting, swelling, and itching post-treatment compared to CO2 laser alone.3 Another case report described a combination of CO2 laser, pulsed dye laser (PDL), and triamcinolone acetonide injection in a single session for keloid treatment. This combination decreased the size of the keloids dramatically, with minimal side effects.4 Of the studies that looked at aesthetic outcomes alone, a combination of PDL and non-ablative fractional erbium:glass/thulium laser showed significant improvement in outcomes for the treatment of burn scars.5 In addition, fractional CO2 treatments alternating with sessions of PDL have shown significant improvement