Persistent eschar-like wound healing after Q-switched 1064 nm hybrid nanosecond-picosecond laser monochromatic tattoo removal: management and evolution.

Q-switched (QS) Nd: YAG lasers are frequently utilised light sources for tattoo removal due to their precise micro-confined photo-acoustic interaction with exogenous and endogenous pigments. In order to achieve optimal results, several treatment sessions are usually required. However, the number of sessions depend on tattoo size, design complexity, pigment quantity within dermal layers, and anatomical location. Higher energy settings have often been used to reduce treatment sessions to a minimum however, this approach may lead to possible post-laser skin complications such as pathological wound healing. This case report highlights the importance of recognizing early stages of pathological wound healing encountered after high fluence 1064 nm QS laser tattoo removal. Early implementation of a proportional wound care strategy with anti-neoangiogenic and anti-inflammatory properties through the unconventional use of potent topical steroids applied in a pulsed fashion resulted in positive control of the tissue repair processes. This approach led to effective wound healing re-modulation achieving near normal skin remodelling and optimal tissue healing which in turn, permitted the completion of necessary QS tattoo removal sessions to accomplish successful and safe tattoo fading whilst maintaining overall patient satisfaction.

Structure, Activation, and Regulation of NOX2: At the Crossroad between the Innate Immunity and Oxidative Stress-Mediated Pathologies.

Nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX) is a multisubunit enzyme complex that participates in the generation of superoxide or hydrogen peroxide (H2O2) and plays a key role in several biological functions. Among seven known NOX isoforms, NOX2 was the first identified in phagocytes but is also expressed in several other cell types including endothelial cells, platelets, microglia, neurons, and muscle cells. NOX2 has been assigned multiple roles in regulating many aspects of innate and adaptive immunity, and human and mouse models of NOX2 genetic deletion highlighted this key role. On the other side, NOX2 hyperactivation is involved in the pathogenesis of several diseases with different etiologies but all are characterized by an increase in oxidative stress and inflammatory process. From this point of view, the modulation of NOX2 represents an important therapeutic strategy aimed at reducing the damage associated with its hyperactivation. Although pharmacological strategies to selectively modulate NOX2 are implemented thanks to new biotechnologies, this field of research remains to be explored. Therefore, in this review, we analyzed the role of NOX2 at the crossroads between immunity and pathologies mediated by its hyperactivation. We described (1) the mechanisms of activation and regulation, (2) human, mouse, and cellular models studied to understand the role of NOX2 as an enzyme of innate immunity, (3) some of the pathologies associated with its hyperactivation, and (4) the inhibitory strategies, with reference to the most recent discoveries.

Higienização das mãos em unidades de terapia intensiva neonatal, pediátrica e adulto / Hand hygiene in neonatal, pediatric and adult intensive care units

Objetivo: Avaliar a efetividade de um programa educativo multimodal de higienização das mãos para profissionais da saúde de UTIs Neonatal, Pediátrica e Adulto. Método: Trata-se de uma pesquisa quasi-experimental, do tipo série temporal interrompida com um grupo e, portanto, esse foi avaliado antes e após a intervenção. A coleta de dados foi realizada em três períodos: (1) período pré-intervenção, realizada em 2017, observada a adesão à higienização das mãos pelos profissionais de saúde e identificado o consumo de álcool gel; (2) período de intervenção, realizada durante o ano de 2018, no qual foi executado o programa educativo multimodal; (3) período pós-intervenção, no qual foi realizada nova investigação utilizando a mesma metodologia empregada no primeiro período desta pesquisa. Resultados: Foram observadas 640 oportunidades e 327 ações, resultando assim em uma adesão global de 51,09%. O consumo de álcool em gel em 2018 obteve uma média de 27,01 mL/paciente-dia dentro das unidades e no ano de 2017 foi de 43,13 mL/paciente-dia no mesmo período. Conclusão: Apesar do período de intervenção ter ajudado os profissionais a esclarecerem dúvidas, esse ainda se mostrou não ser suficiente para manter os índices encontrados no período pré-intervenção. Pode-se sugerir que medidas educativas que promovam o aumento da adesão à higienização das mãos sejam rotineiramente realizadas. [au]

Objective: To assess the health of a multimodal hand hygiene educational program for Neonatal, Pediatric and Adult health professionals. Method: This is a quasi-experimental research, of the time series type with a group, therefore, the same group was evaluated before and after an intervention. The collection of this study was carried out in three periods: (1) pre-intervention period, carried out in 2017, observing the ingestion of hand hygiene by health professionals and identifying the gel; (2) intervention, carried out during 2018, where the multimodal educational program was implemented; (3) post-intervention period, where a new investigation was carried out using the same methodology used in the first period of this research. Results: 640 opportunities were observed and 327 actions were observed, thus resulting in an overall adherence of 1.09%. The consumption of gel alcohol in 2018 had an average of 27.01 mL/patient-day within the units and in 2017 it was 43.13 mL/patient-day in the same period. Conclusion: Although the intervention helped professionals with doubts, it still proved not to be sufficient for the rates found in the pre-vention period, it can be suggested that educational measures will maintain the increase in the extension of hand hygiene to be routinely performed. [au]

Q-S laser micro-drilling and multipass full-beam Q-S laser for tattoo removal - a case series.

The purpose of this study was to evaluate the safety and efficacy of a new combined method of Q-S laser-assisted tattoo removal. Ten patients with 13 professional, mostly mono-chromatic black tattoos were recruited. All tattoos received the same Q-S laser treatment sequence. An objective evaluation of tattoo clearing was assessed by careful analysis of a standardized collection of digital images taken from each tattoo, 2 months after each laser session, with the help of a custom-made pigment-fading percentage photographic ruler. The percentages of pigment clearance and side effects were evaluated by 4 independent dermatologists. Patient satisfaction and perceived discomfort during and post-procedure were evaluated according to specific scales. Clinical evaluators confirmed an average photographic pigment clearance of 97% after a median 4.85 treatment sessions. The Frac-Tat® method required 40% fewer sessions compared to those calculated by Kirby-Desai estimates. Photographic assessment of laser-exposed skin quality performed 2 months after tattoo clearing was considered almost comparable with untreated peripheral skin, confirming a very low side effect score. The Frac-Tat QS laser-assisted tattoo removal sequence used in our study showed a high degree of safety and efficiency, clearing exogenous pigments in a relatively few number of sessions. Preliminary ablative photo-acoustic fractional 1064-nm Q-S laser micro-drilling was considered an essential step in optimizing tattoo removal, increasing wavelength-independent micro-columnar clearing of deeper dermal exogenous pigments. Our preliminary observations also confirmed a significant improvement of tattoo procedure-induced micro-textural changes thanks to a tissue remodeling effect induced by the 1064-nm Q-S fractional laser photo-acoustic ablation.

Generic outcome set for the international registry on Laser trEAtments in Dermatology (LEAD): a protocol for a Delphi study to achieve consensus on what to measure.

INTRODUCTION: While laser technology has expanded the armamentarium of treatment for various skin diseases during the past years, heterogeneity in study outcomes hampers comparability and appropriate evidence synthesis. Part of these issues can be addressed by developing a generic outcome set. Using the Delphi method, this study aims to seek consensus between key stakeholders on relevant generic outcomes (what to measure) for implementation in the international registry on Laser trEAtments in Dermatology (LEAD). The registry is focused on collecting research data on various laser treatments for skin disorders. METHODS AND ANALYSIS: By reviewing the literature and involvement of key stakeholder groups and adult patients in need or after laser surgery and health professionals, a preliminary list of outcomes will be generated and categorised into domains. Using these outcomes, an international three-round Delphi study will be performed to rate the importance of outcomes in the selection of a generic outcome set. Participants are allowed to provide new outcomes to the preliminary list for revisions during the first Delphi round. Finally, results will be discussed during a consensus meeting to agree on generic outcomes to be used in the LEAD registry. ETHICS AND DISSEMINATION: An ethics approval was not applicable (W19_290 # 18.336). The study is registered with the Cochrane Skin Core OUtcome Set INitiative) and the Core Outcome Measures in Effectiveness Trials initiative. Procedures will be conducted according to the Declaration of Helsinki. The findings will be disseminated through peer-reviewed publications and conference presentations.

Importance of Scar Prevention and Treatment-An Approach From Wound Care Principles.

BACKGROUND: The increased number of cosmetic surgical and nonsurgical procedures has led to a greater demand to achieve aesthetically acceptable scars. Silicone gel (SG) dressings were evaluated in these cases following the principles of wound care and also minimizing abnormal scar formation. PATIENTS AND METHODS: A newly developed solution in wound care in the form of a SG has proven to be a highly effective treatment for a series of 4 clinically challenging cases presented in this article: postprocedure healing after a laser treatment, nonhealing scalp wounds, chronic relapsing xerotic eczematous cheilitis, and the treatment of scars caused by third degree burns. A standard SG was applied to improve the scar outcome of severe burns of a young child. RESULTS: Silicone gels offer excellent clinical results in these 4 cases. In terms of wound care and scar management, they provide a user friendly, convenient application form and increase patient comfort and compliance. CONCLUSION: To pursue these results, further studies need to be conducted but as of now, there is strong suggestive evidence that SGs indicate beneficial properties for wound care management and scar prevention.

SPF-RR sequential photothermal fractional resurfacing and remodeling with the variable pulse Er:YAG laser and scanner-assisted Nd:YAG laser.

BACKGROUND AND OBJECTIVE: Many different lasers, polychromatic high-intensity light sources (PCLs), and RF devices have claimed clinical efficacy in rejuvenating the skin. In this study, the sequential combination of two different laser wavelengths was evaluated to produce reliably significant clinical improvements optimizing treatment parameters. METHODS: The left volar aspects of the forearms of four volunteers were treated with nine different parameter settings using a variable pulsewidth fractional Er:YAG 2940-nm laser with and without air cooling. The pain perception level was recorded on a 0-10 point scale (0=No pain; 10=Most severe pain). Three evaluations were made: during treatment, immediately after treatment, and 5 minutes after treatment. The same investigation was made on the right volar aspects of the same four volunteers using a short-pulse, random pattern, 3-mm spot, scanner-assisted Nd-YAG 1064-nm laser at 0.3 ms pulsewidth at seven different parameter settings. Clinical evaluations were made concerning erythema and edema 3 days after treatment, as well as pre-operative and 60 days postoperative skin texture plus color uniformity. Considering that the majority of cosmetic patients are willing to accept a relatively short and uneventful downtime (2-4 days according to a study we are presently conducting) and do prefer to limit their intra- and postoperative pain to a minimum, the best combination of clinical improvement matching these two important parameters were selected for our study. A treatment strategy combining two sequential passes of long-pulse Nd:YAG laser (Nd:YAG-LP) at 0.3 and 35 ms followed by two passes of long-pulse fractional Er:YAG laser (Er:YAG-FT) at 600 micros was designed to treat the facial regions of 10 volunteers affected by a combination of intrinsic (chrono-) and extrinsic (mostly photo-) aging. The pain perception level was recorded on a 0-10 scale (0=No pain; 10=Most severe pain). Three evaluations were made: during, immediately after, and 5 minutes after treatment. Erythema and edema were evaluated on a 0-3 point scale (0=No clinical signs; 3=Severe Clinical signs) at 7, 15 and 30 days. Improvements were determined by blind evaluation of photographs before, at 4 weeks, and at 8 weeks following treatments. Patient satisfaction was also evaluated on a 0-4 point scale (0=No satisfaction; 4=Excellent perceived improvement, 76-100%). RESULTS: At the 30-day follow-up, participants had clinically detectable improvements of facial telangiectasias (1-25%), lentigines (25-50%), diffuse dyspigmentation (25-75%), fine lines (25-75%), and skin texture (25-75%). Clinical improvements were maintained at the 60-day follow-up, demonstrating the prolonged photothermally induced biological effect on skin function and texture. All volunteers confirmed their willingness to undergo the same procedure again to maintain and possibly improve their clinical results. Further clinical evaluations at 4 and 6 months will therefore be needed to identify a suitably convenient interval between two consecutive procedures. CONCLUSION: The present study demonstrates objective and subjective improvements in fine lines, skin texture and dyspigmentation of facial skin after one sequential non-ablative and ablative laser treatment combining two different laser sources (Nd:YAG laser + Er:YAG laser).