We receive many questions regarding the use of fractional lasers for treatment of non-facial areas such as the hand. Few clinical studies have been reported in the literature documenting the efficacy of non-ablative modalities in the treatment of hands with visible photoaging conditions (search in Research).

Laser treatment for photoaging of the hands should ideally address pigmentary alteration as well as associated skin roughness and wrinkling. Fractional non-ablative resurfacing has been previously shown to effectively treat facial rhytids and dyschromia and are currently widely used by medical practitioners and aesthetic clinics.

About fractional non-ablative resurfacing

Non-ablative fractional photothermolysis (nFP) produces specific thermal injury areas called microthermal treatment zones (MTZ) at specific depths in the skin. The surrounding tissue of the MTZ and the stratum corneum of the epidermis remain intact during treatment, leading to rapid healing of the injured tissue. Macroscopic wounding is not apparent. Mild to moderate erythema and edema are usually apparent for several days post-treatment, therefore there is only minimal downtime for the patient. Several treatment courses are required, which is typical of any other non-ablative laser procedures. The most commonly used is the 1,550-nm diode-pumped erbium fiber laser by Solta Medical, formerly Reliant Technologies.

About clinical trials

Trials are conducted by medical doctors, proficient in the laser photothermolysis field, and sponsored by grants by laser manufacturers, Solta Medical in the reviewed cases. Patients (Fitzpatrick skin phototypes I to IV) with with bilateral moderate hand photodamage were randomized to receive 5-6 treatments with the 1,550-nm diode erbium fiber laser on either the right or left hand. Treatments were performed at settings of 8 to 9 mJ/microscopic treatment zone (MTZ) and density of 2,500 microscopic treatment zones/cm2. Subjective assessments by the patients and investigator were performed for skin roughness, wrinkling, pigmentation, skin texture and overall photodamage using an improvement scale. Skin biopsies were taken at baseline and at 1 and 3 months. In addition, some histological analyses (H&E) were carried out on several individuals.

Reported results

The subjective assessment and physician clinical assessment at 1 and 3 months revealed a mean 51% to 75% improvement in skin pigmentation and 25% to 50% improvement in skin roughness and wrinkling. Biopsies of the skin showed increased density of dermal collagen. Patients experienced transient erythema and edema and none had scarring or other adverse effects. Histologic evaluation showed a reduction in atypical keratinocytes, improvement in rete ridge formations, increased collagen density and a reduction in solar elastosis at 6 months post-treatment.

Fractional non-ablative resurfacing appears to be an effective and safe treatment modality for correcting both the pigmentary and the textural aspects of photoaging of non-facial anatomic areas such as the dorsum of the hands.