LAUSR

interleukin-1, as well as several growth factors including platelet-derived growth factor, fibroblast growth factor, and epidermal growth factor, have been implicated in the pathogenesis of DD. Traditionally, DD has been treated surgically, although less invasive approaches have now been instituted. Notarnicola and colleagues recently evaluated a temperaturecontrolled high-energy adjustable multimode emission laser, and found that study patients experienced a decrease in self-reported functional limitation and pain, along with an increase in patient satisfaction. Although an improvement in joint extension was observed, this was not believed to be significant. Our report represents the first case to document the potential utility of a fractionated CO2 laser to treat DD. Once the skin site is prepared, the laser treatment itself is brief (less than 10 minutes) and the procedure is well tolerated with minimal patient discomfort and downtime. Fractionated CO2 lasers have been used successfully to improve various scar types, including hypertrophic and mature burn scars. In one study evaluating burn scars, significant improvements in both Vancouver Scar Scale scores and clinical appearance were observed after 3 fractional CO2 laser treatments. 2 Histology from that study showed a statistically significant increase and decrease in type III collagen and type I collagen, respectively. Improvement of hypertrophic and burn scars after ablative fractionated laser treatment is believed to occur through the induction of an inflammatory process, including the increased expression of heat shock proteins and matrix metalloproteinases, and downregulation of TGF-b and fibroblast growth factor expression. Treatment induces a change from mature burn scars (which are primarily Type I collagen) to a histology more closely resembling fetal skin (which has more Type III collagen). Clinically, this results in decreased scar thickness, enhanced pliability, and improved overall function. The fractionated CO2 laser may improve DD through a related mechanism of action, although this has not yet been investigated. More recently, laser-assisted drug delivery for burn and other scars has been explored in an attempt to enhance treatment responses, and this may be used to improve laser treatment of DD in the future.