Laser Proves Itself in Treating Difficult Skin Disorders
AAD Conference Showcases Presentations Highlight Success of XTRACTM Excimer Laser in Treating Psoriasis, Vitiligo and Scar TissueLeukoderma
New York – At the recent American Academy of Dermatology Conference held in Washington, D.C., three physicians shared exciting developments in treating some of the most challenging and disfiguring distressing skin disorders -- psoriasis, vitiligo, scar tissue, repigmentation, and leukoderma. Each focused on the same new technology: thenarrow- narrow-band UVB XTRACÔ excimer laser system from PhotoMedex, Inc.
Roy Geronemus, M.D., of the Laser & Skin Surgery Center of New York, who presented his investigative work with Dr. Paul M. Friedman utilizing the excimer laser for the repigmentation of post-surgical and laser-induced leukoderma, has this to say about the treatment: "The XTRAC excimer laser is the first and only treatment shown to restore pigmentation to scar tissue. It's a therapeutic option for treating the often permanent hypopigmentation that can result from skin or laser surgery."
Steven Feldman, M.D., Ph.D., of Wake Forest University Medical School in Winston-Salem, N.C., described the XTRAC excimer laser treatment for psoriasis as a "quantum leap forward for patients with localized psoriasis."
And Mark Lebwohl, M.D., head of the Scientific Department of Dermatology at Mt. Sinai Medical Center in New York, believes that the laser's most exciting use could be forrestoring pigmentation to white splotches of skin caused by vitiligo, "simply because the dermatology community does not currently have any treatment that works this quickly."
Among the presentation highlighting the XTRAC excimer laser at the AAD conference, Drs. Feldman and Geronemusalso reported on their clinical studies using excimer laser therapy.the XTRAC excimer laser.
Treating Leukoderma: Restoring Pigment to Scar Tissue*
Dr. Geronemus described preliminary results of a pilot study using the XTRAC excimer laser system to restore lost pigmentation to scar tissue, a condition called leukoderma. After six to 10 treatments, the 10 patients enrolled in the study achieved a 50 percent or greater improvement with steady darkening of the scars. The patients are now being followed to determine if the repigmentation is permanent.
"Scars are ubiquitous, and for the first time we have a treatment that can be used to improve the appearance of scars that are the consequence of cosmetic surgery, surgery for medically necessary conditions, and scars from previous traumatic injury, including burns," said Dr. Geronemus. "Our preliminary results suggest that the 308-nm XTRAC excimer laser offers a rapid and effective treatment for stimulating residual melanocytes in patients with leukoderma from laser or skin surgery at a relatively low cumulative UVB dose. The attractiveness of this treatment is that it is safe, painless, and there is no injury to the skin after each treatment session."
Dr. Geronemus is beginning a larger, prospective clinical trial of excimer laser therapy for leukoderma and repigmentation of scars.
Advanced Psoriasis Solution
While psoriasis is clearly a physical condition, Gerald Krueger, M.D., Professor, Cumming Presidential Endowed Chair in Dermatology at the University of Utah and Chairman of the Medical Advisory Board for the National Psoriasis Foundation, said psoriasis usaully affects a patient's psychological state and frequently undermines his or her self-esteem. "People with psoriasis are often frustrated by the current level of treatment available for their condition," he said. "The physical and mental impact of this disease is as debilitating as that of other major medical diseases such as arthritis and diabetes."
Dr. Feldman, director of Wake Forest's Psoriasis Treatment Center, reported results of a multi-center clinical trial looking at the XTRAC excimer laser's efficacy in 124 patients with localized psoriasis. He said a statistical analysis of the results indicate that 90 percent of those with localized psoriasis who completed the study achieved at least a 75 percent clearance with 10 or fewer treatments. In the study, patients who improved to that degree did so with an average of 6.2 treatments.
Comparing the excimer laser with conventional UVB phototherapy, Dr. Feldman said it was highly effective, worked in 10 or fewer treatments, and did not involve healthy skin. Conventional phototherapy, on the other hand, typically requires 25 to 30 treatments and exposes healthy skin to high doses of UV light.
A Breakthrough for Vitiligo: Fast, Dramatic Improvement
While not formally presenting any trial data at the meeting, Dr. Lebwohl and his colleagues are studying the XTRAC laser's effectiveness in vitiligo, a disease characterized by white splotches of skin that often occur on the face.
"Our preliminary studies at Mt. Sinai show the majority of patients responding quickly and dramatically," Dr. Lebwohl said. As with psoriasis, conventional phototherapy for vitiligo typically entails many treatments conducted over several months.
FDA Approved/Cleared Laser Treatments Can Help Millions
Adding to the existing indication for psoriasis, the FDA recently granted its first approval market clearance for excimer laser treatment of vitiligo to PhotoMedex, Inc. for its XTRAC narrow-band UVB excimer laser. The XTRAC laser also received the FDA's first approval for laser treatment of psoriasis early last year. Vitiligo affects two to four million Americans; seven million Americans have psoriasis and 80 percent of those have localized psoriasis.
Why Does it Work?
The XTRAC excimer laser uses a carefully focused beam of laser light transported through a sophisticated fiber-optic device to deliver an intense dose of the most therapeutic light directly to the skin where psoriasis, vitiligo, or leukoderma scars occur.
Why early investigation with the XTRAC excimer laser shows that it seems to work for leukoderma where other phototherapies have fallen short or failed isn't known. Dr. Geronemus speculates that the laser may stimulate the cells responsible for producing skin color – melanocytes - to repopulate scar tissue. His larger prospective trial will include histopathology of the leukoderma scars to evaluate cellular changes. Theoretically, if the laser is able to stimulate residual pigment cells, that might also account for its effectiveness in vitiligo.
In the case of psoriasis, Dr. Feldman believes the quicker healing seen in his study is due to the higher doses of UVB that can be targeted and delivered immediately. He says that many of the initial treatments in a conventional series of phototherapy are not therapeutic but merely condition healthy skin to tolerate light exposure.
In light of the impressive preliminary results being reported on the uses the XTRAC excimer laser system, Dr. Feldman believes its usefulness will rapidly expand and improve. "Interest in the XTRAC laser has exploded over the past year," he said. I believe this is largely because physicians recognize intuitively how much sense this particular laser therapy makes."
Based in Radnor, PA, PhotoMedex is engaged in the development of proprietary excimer laser and fiber optic systems and techniques directed toward dermatological applications. To find out more information about the mXtrac exierXTRACexcimer laser, visit the PhotoMedex website at www.photomedex.com
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