Fraktionale Laser: Wunsch und Wirklichkeit

Zusammenfassung

Die neuen Erkenntnisse zu den Möglichkeiten der fraktional therapierten Haut haben konsequenterweise zur Etablierung von neuen Standardverfahren insbesondere im Bereich der gealterten Haut und bei Narben geführt. Daneben wird das Potenzial aber auch auf fibrosierende Dermatosen, Fremdkörperentfernung, inflammatorische Hauterkrankungen und vieles mehr erweitert.

Das größte Potenzial jedoch hat die kontaktfreie temporäre Eröffnung der Hautbarriere (TOR, temporary opening of the epidermal barrier). Das TOR zur Haut hat im wahrsten Sinne des Wortes die Potenz, Zugang zu neuen und intensivierten Therapieformen zu ermöglichen. Vieles liegt hier allerdings noch im experimentellen Bereich, die ersten Ergebnisse sind jedoch mehr als vielversprechend. So zeigt eine erste klinische Studie Überlegenheit der durch fraktionale Laser intensivierten PDT bei der Therapie der aktinischen Keratose. Risiken können sich allerdings infolge der schon erhältlichen Heimgeräte im Zusammenhang mit der Anwendung jedweder Topika im Sinne toxischer Reaktionen oder Sensibilisierungen ergeben.

Die Prinzipien der aktuell wirksamen fraktionalen Laserverfahren (Wirklichkeit) und potenzielle Konzepte (Wünsche) werden dargestellt.

Abstract

Recent insights to the potential of fractional skin treatments have established standard laser procedures to treat aged and sun-damaged skin and scars. On top of this the concept has been extended to fibrosing conditions, to remove foreign bodies and to treat inflammatory skin diseases.

The biggest potential however is foreseen with the option of a contact-free temporary opening of the epidermal barrier (TOR, German: gate) to promote new and intensified treatment regimens. To date those concepts are predominantly experimental although first clinical studies show a better response rate if actinic keratoses are treated by fractional laser intensified PDT in comparison to the conventional PDT. Possible risks may arise from the fact that fractional laser home-devices are available. Used in conjunction with topicals of all origin, toxic and allergic reactions may occur.

Principles of current fractional laser interventions are presented as facts while visions are given as fictive future indications.

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