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The Cutting Edge: Challenges in Medical and Surgical Therapies |

Use of a Fractional Ablative 10.6- μm Carbon Dioxide Laser in the Treatment of a Morphea-Related Contracture

Donald Kineston, MD; Julia M. Kwan, MD; Nathan S. Uebelhoer, DO; Peter R. Shumaker, MD
Arch Dermatol. 2011;147(10):1148-1150. doi:10.1001/archdermatol.2011.247.
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The advent of ablative fractional laser technology has introduced potential new therapeutic options for patients with skin conditions involving fibrosis and scarring. We describe our experience using ablative fractional laser therapy in a patient with a morphea-related contracture refractory to conventional treatment.

Department of Dermatology, Naval Medical Center San Diego, San Diego, CaliforniaCorrespondence: Peter R. Shumaker, MD, Department of Dermatology, Naval Medical Center San Diego, 34520 Bob Wilson Dr, Ste 300, San Diego, CA 92134 (peter.shumaker@med.navy.mil).

Accepted for Publication: May 5, 2011.

Author Contributions: Drs Kineston, Kwan, Uebelhoer, and Shumaker had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Kineston, Uebelhoer, and Shumaker. Acquisition of data: Kineston, Uebelhoer, and Shumaker. Analysis and interpretation of data: Kineston, Kwan, Uebelhoer, and Shumaker. Drafting of the manuscript: Kineston, Kwan, and Shumaker. Critical revision of the manuscript for important intellectual content: Kineston, Kwan, Uebelhoer, and Shumaker.

Financial Disclosure: None reported.

Disclaimer: The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government.

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Figure 1. Bandlike sclerotic plaque extends across the left ankle to the mediodorsal foot, restricting patient ambulation. The treated area is marked with gentian violet.

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Figure 2. The goniometer demonstrates restricted plantar flexion of the left foot, with the indicator line at the 135 ° mark (45 ° of plantar flexion from neutral, or 90 °).

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Figure 3. One year after the initial fractional ablative carbon dioxide laser treatment with continued methotrexate and physical therapy, the goniometer shows normalized plantar flexion of the left foot, with the indicator line at the 155 ° mark (65 ° of plantar flexion from neutral, or 90 °).

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