Erbium:YAG laser resurfacing of the hands, arms, and neck.

BACKGROUND: Resurfacing procedures to improve photodamage, rhytides, and scars have been developed and refined over the last century. Laser resurfacing is a relatively new procedure in the resurfacing spectrum. It has been appreciated that resurfacing of nonfacial skin by dermabrasion, chemical peels, or carbon dioxide (CO2) laser carries an unacceptably high risk of scarring. More recently, the erbium:YAG (Er:YAG) laser has been developed and marketed for facial and nonfacial resurfacing. Specifically, manufacturers have promoted Er:YAG lasers as safe for resurfacing photodamaged skin on the hands, forearms, and neck. Surprisingly, there is little evidence to support these claims.

OBJECTIVE: To evaluate the safety and efficacy of resurfacing photodamaged skin on the dorsum of the hands, forearms, and neck with an Er:YAG laser.

METHODS: Twelve patients with photodamage of the neck or of the hands and forearms participated in this study. Seven patients received laser resurfacing of the hands and forearms utilizing the Er:YAG laser with a 5 mm spot size at an energy of 1 J (5 J/cm2). These patients received 2 to 3 passes. Five patients received resurfacing of photodamaged neck skin with a 5 mm spot size at 1 J (5 J/cm2). These patients received one to 2 passes. Patients were evaluated for time to healing, cosmetic improvement, and satisfaction with the procedure.

RESULTS: Several observations of note are reported in patients receiving nonfacial resurfacing. Despite previous reports of patients receiving Er:YAG laser treatment with topical anesthesia alone, all patients required some intralesional anesthesia during the procedure for some areas. All patients required significantly longer to heal as compared to the face. Both the hands and forearms and the neck require 2-3 weeks to heal. Two of 7 hand and forearm patients developed bacterial infections during healing. One of 5 neck resurfacing patients developed transitory hyperpigmentation. Cosmetic improvement was mild, with 6 of 7 hand and forearm patients showing poor (0-25%) cosmetic improvement and one of 7 showing fair (25-50%) improvement. In the neck resurfacing group, 3 of 5 had poor (0-25%) improvement, one of 5 had fair (25-50%) improvement, and one of 5 had good (50-75%) results.

CONCLUSION: Er:YAG laser resurfacing of the hands, forearms, and neck may be safely performed. Topical anesthesia alone is inadequate, healing takes up to 3 weeks, and cosmetic improvement is minimal with the parameters used in this study.