بسم الله الرحمن الرحيم Sudan University Of Science & Technology College Of Post Graduate Studies Utilization Of Carbon Dioxide Laser ( 10600nm) In The Treatment Of Seborrheic Keratosis In Some Sudanese Patients BY: Dr. Nuha Mohammed Ali Nassar M. D. Dermatology Supervisor: Dr. Faiz M. B. Elshafia P.h.D of Laser Dr. Elfatih Ali Hassan M.D. Dermatology June 2014 بسم الله الرحمن الرحيم Sudan University Of Science & Technology College Of Post Graduate Studies Utilization Of Carbon Dioxide Laser ( 10600nm) In The Treatment Of Seborrheic Keratosis In Some Sudanese Patients BY: Dr. Nuha Mohammed Ali Nassar M. D. Dermatology Supervisor: Dr. Faiz M. B. Elshafia P.h.D of Laser Dr. Elfatih Ali Hassan M.D. Dermatology June

This study aimed to use the CO 2 laser to treat the seborrheic keratosis as a sign of chronological aging that associated with the passage of time that give signature in the skin clinically as skin laxity, wrinkling, dispigmentation, telangiectasis pigmented seborrheic keratosis, on sun-exposed sites due to the repeated exposure to ultra violet radiation (UVR). Background 2

Seborrheic keratosis (also known as "seborrheic verruca," and "senile wart") is a noncancerous benign skin growth that originates in keratinocytes. Like liver spots, seborrheic keratoses are seen more often as people age. The lesions appear in various colors, from light brown to black. They are rounded or oval, feel flat or slightly elevated, and range in size from very small to more than 2 centimeters. 3

The carbon dioxide laser became available in 1964 and soon became the most widely used laser in dermatologic practice. It emits an invisible infrared beam at a 10,600-nm wavelength, targeting both intracellular and extracellular water. When light energy is absorbed by water-containing tissue, skin vaporization occurs with production of coagulative necrosis in the remaining dermis. 4

The main objectives for this study were:  To evaluate the efficacy of CO 2 laser 10600nm in the treatment of Seborrheic Keratosis in some Sudanese patients.  To determine complications of the CO 2 laser on the treated patients. The main objectives for this study were:  To evaluate the efficacy of CO 2 laser 10600nm in the treatment of Seborrheic Keratosis in some Sudanese patients.  To determine complications of the CO 2 laser on the treated patients. OBJECTIVES 5

This study was conducted in laser institute, Sudan University of Science and technology, during the period from May to Sep Ten patients clinically diagnosed as cases of seborrheic keratosis, were randomly selected for this study from different dermatological clinics in Khartoum State, considered as study population. All the patients signed a written informed consent ethical clearance. Materials And Methods 6

The laser system used in this study was CO 2 laser its 1B-601B. CO 2 laser surgical system is an intelligent laser treatment instrument. It can be applied for different treatments such as cutting, vaporization, and cauterizing. The CO 2 laser with a specific wavelength of nm can be absorbed by human body tissue (no matter what color the skin is) almost by 100%, with the laser slightly passing through the skin. The laser system used in this study was CO 2 laser its 1B-601B. CO 2 laser surgical system is an intelligent laser treatment instrument. It can be applied for different treatments such as cutting, vaporization, and cauterizing. The CO 2 laser with a specific wavelength of nm can be absorbed by human body tissue (no matter what color the skin is) almost by 100%, with the laser slightly passing through the skin. 7

Figure : 30 W CO2 laser surgical system (10600nm). 8

Laser Parameters: The laser power was adjusted to 5 watt, the exposure time was 0.1 s, single pulse mode in one session. The lasing switch was turned on, the foot switch pressed and different exposure intervals applied point by point on the lesions, till popcorn like sound heard or bleaching of the lesion color seen. Laser Parameters: The laser power was adjusted to 5 watt, the exposure time was 0.1 s, single pulse mode in one session. The lasing switch was turned on, the foot switch pressed and different exposure intervals applied point by point on the lesions, till popcorn like sound heard or bleaching of the lesion color seen. 9

Evaluation of Clinical Response: According to the degree of lesions clearance, using the clinical evaluation as follow:  % = Excellent.  50 – 74 % = Very Good.  25 – 49 % = Good.  Less than 25% = Bad. The evaluation was done clinically. Evaluation of Clinical Response: According to the degree of lesions clearance, using the clinical evaluation as follow:  % = Excellent.  50 – 74 % = Very Good.  25 – 49 % = Good.  Less than 25% = Bad. The evaluation was done clinically. 10

The response to the treatment by CO 2 laser had been evaluated clinically after 6 weeks. The clinical response was evaluated according to the degree of lesions clearance after one session of treatment. The response was as follows: Excellent in seven patients ( 70%), and Very Good in three patients ( 30%), The response to the treatment by CO 2 laser had been evaluated clinically after 6 weeks. The clinical response was evaluated according to the degree of lesions clearance after one session of treatment. The response was as follows: Excellent in seven patients ( 70%), and Very Good in three patients ( 30%), Results 11

Table :Response to the treatment. 12

Figure : Seborrheic keratosis before and after treatment with CO 2 laser in a 65 years old female on the forehead face. A: Before treatment. B: After six weeks with CO 2 laser, power 5 W (one session). Excellent response of treatment. Figure : Seborrheic keratosis before and after treatment with CO 2 laser in a 65 years old female on the forehead face. A: Before treatment. B: After six weeks with CO 2 laser, power 5 W (one session). Excellent response of treatment. 13

Figure : Seborrheic keratosis before and after treatment with CO 2 laser in a 25 years old female on the (cheek) face. A: Before treatment. B: After six weeks with CO 2 laser, power 5 W (one session). Excellent response of treatment. Figure : Seborrheic keratosis before and after treatment with CO 2 laser in a 25 years old female on the (cheek) face. A: Before treatment. B: After six weeks with CO 2 laser, power 5 W (one session). Excellent response of treatment. 14

Figure : Seborrheic keratosis before and after treatment with CO 2 laser in a 47 years old male on the left side of the neck. A: Before treatment. B: After six weeks with CO 2 laser, power 5 W (one session). Excellent response of treatment. Figure : Seborrheic keratosis before and after treatment with CO 2 laser in a 47 years old male on the left side of the neck. A: Before treatment. B: After six weeks with CO 2 laser, power 5 W (one session). Excellent response of treatment. 15

Figure : Seborrheic keratosis before and after treatment with CO 2 laser in a 35 years old male on the back. A: Before treatment. B: After six weeks with CO 2 laser, power 5 W (one session). Excellent response of treatment. Figure : Seborrheic keratosis before and after treatment with CO 2 laser in a 35 years old male on the back. A: Before treatment. B: After six weeks with CO 2 laser, power 5 W (one session). Excellent response of treatment. 16

g Figure : Seborrheic keratosis before and after treatment with CO 2 laser in a 35 years old male on the anterior chest. A: Before treatment. B: After six weeks with CO 2 laser, power 5 W (one session). Excellent response of treatment. Figure : Seborrheic keratosis before and after treatment with CO 2 laser in a 35 years old male on the anterior chest. A: Before treatment. B: After six weeks with CO 2 laser, power 5 W (one session). Excellent response of treatment. 17

Figure : Seborrheic keratosis before and after treatment with CO 2 laser in a 65 years old female on the left (cheek) face. A: Before treatment. B: After six weeks with CO 2 laser, power 5 W (one session). V.good response of treatment. Figure : Seborrheic keratosis before and after treatment with CO 2 laser in a 65 years old female on the left (cheek) face. A: Before treatment. B: After six weeks with CO 2 laser, power 5 W (one session). V.good response of treatment. 18

All patients (100%) acquired pain and oedema immediately after the laser session, because it’s common side effects of any laser application. (60%) of the patients received hyper- pigmentation 2 weeks after the session, due to post inflammatory hyper-pigmentation which resolved 6 weeks later. Discussion 19

From the obtained results one can conclude that: 1.CO 2 laser 10600nm a can be used as first choice treatment of seborrheic keratosis. 2.This CO­ nm laser is easy to perform, with excellent to very good response and without complications in treating these patients. From the obtained results one can conclude that: 1.CO 2 laser 10600nm a can be used as first choice treatment of seborrheic keratosis. 2.This CO­ nm laser is easy to perform, with excellent to very good response and without complications in treating these patients. Conclusion 20

THANKS 21