Glahn Joshua Zev, Wang-Evers Michael, Carlson Abigail R, Marks Haley, Karasik Daniel, Hilge Felix, Goverman Jeremy, Manstein Dieter
Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Cutaneous Biology Research Center, Boston, Massachusetts, USA.
Department of Surgery, Massachusetts General Hospital, Sumner Redstone Burn Center, Boston, Massachusetts, USA.
Lasers Surg Med. 2025 Jan;57(1):112-120. doi: 10.1002/lsm.23865. Epub 2024 Dec 16.
Ablative fractional CO laser (10,600 nm) treatment creates an array of microscopic treatment zones composed of an ablation zone (AZ) surrounded by a denatured coagulation zone (CZ). The CZ is believed to play a functional role in skin tightening, posttreatment inflammation, and laser-assisted drug delivery. This study investigates the viability of enzymatic post-processing to remove the CZ without affecting the surrounding tissue.
Ex vivo skin samples were treated with either control, papain, urea, or papain-urea solutions before being covered with occlusive dressing and incubated at 37°C for 1 h. Tissue viability as well as AZ and CZ geometries were assessed histologically.
Treatment with all three experimental solutions resulted in a decrease in CZ. The largest average reduction in CZ area was observed in the papain-urea group (44%, p < 0.001), followed by the papain (14%, p < 0.001) and urea (11%, p < 0.001) only groups. Only the papain-urea group showed a significant increase in AZ (14%) and changes in lesion geometry.
This exploratory study of enzymatic post-processing with papain-urea highlighted the potential of selectively removing the CZ after treatment with ablative fractional laser therapy. If results can be translated to in vivo studies, these findings could expand the use of high-fluence CO laser therapy with functional implications for lowering posttreatment recovery time, providing clinicians more control over skin tightening, and enabling a broader range of laser-assisted drug delivery.
剥脱性分数CO2激光（10,600nm）治疗会形成一系列微观治疗区，由一个消融区（AZ）及其周围的变性凝固区（CZ）组成。据信，凝固区在皮肤紧致、治疗后炎症反应以及激光辅助药物递送中发挥着功能性作用。本研究旨在探究酶促后处理在不影响周围组织的情况下去除凝固区的可行性。
对离体皮肤样本分别用对照溶液、木瓜蛋白酶、尿素或木瓜蛋白酶-尿素溶液进行处理，然后覆盖封闭敷料，并在37°C下孵育1小时。通过组织学评估组织活力以及消融区和凝固区的几何形态。
所有三种实验溶液处理后凝固区均减少。木瓜蛋白酶-尿素组凝固区面积平均减少幅度最大（44%，p<0.001），其次是仅用木瓜蛋白酶组（14%，p<0.001）和仅用尿素组（11%，p<0.001）。只有木瓜蛋白酶-尿素组的消融区有显著增加（14%）且损伤几何形态发生改变。
这项关于木瓜蛋白酶-尿素酶促后处理的探索性研究突出了剥脱性分数激光治疗后选择性去除凝固区的潜力。如果研究结果能够转化为体内研究，这些发现可能会扩大高能量CO2激光治疗的应用范围，在缩短治疗后恢复时间、让临床医生对皮肤紧致有更多控制以及实现更广泛的激光辅助药物递送等方面具有功能意义。
