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A clinical and histologic comparison of electrosurgical and carbon dioxide laser peels
K M Acland1, E Calonje, P T Seed
1Dermatological Surgery and Laser Unit, St. John's Institute of Dermatology, St. Thomas' Hospital, London, United Kingdom.
Background:
A radiofrequency-controlled electrosurgical device (ESD) has been adapted for skin peeling. A high-voltage, low-amperage current converts an irrigant into an ionized vapor, causing molecular dissociation and superficial damage in adjacent tissue.
Objective:
We compared the clinical and histologic effects of a scanning carbon dioxide (CO(2)) laser (ESC/Sharplan 40C) and the ESD (Visage Cosmetic Surgery System, Arthrocare).
Methods:
This study was a matched clinical trial involving 9 subjects. Two strips (2 x 1 cm) of skin on the temple were alternately assigned to receive 2 passes with either the CO(2) laser (Silktouch mode, 260 handpiece, fluence 15 J/cm(2), 10 mm(2)) or the ESD (125 V = setting 4, 5 mm handpiece). Strips were wiped with moist gauze after the first pass, and 4-mm punch biopsy specimens were taken immediately and after 3 months. Clinical assessment of re-epithelialization, erythema, and hyperpigmentation was made at 1, 2, 4, and 12 weeks.
Results:
Median erythema scores were significantly greater in skin treated with the CO(2) laser. Histologic examination showed greater epidermal loss and a significantly thicker zone of underlying thermal damage (average difference, 63 microm; 95% confidence interval, 40-87; P =.0002) in skin treated with the CO(2) laser compared with skin treated with the ESD. After 3 months, a band of superficial dermal fibrosis was thicker in skin treated with the CO(2) laser (average difference, 170 microm; 95% confidence interval, 69-271; P =.0075).
Conclusion:
Two passes with the ESD elicited a more superficial skin peel than the CO(2) laser. Despite minimal thermal damage, superficial dermal fibrosis was seen at 3 months in skin treated with the ESD.
