Therapeutic outcome of melasma treatment by dual-wavelength (511 and 578 nm) laser in patients with skin phototypes III-V.

BACKGROUND: Recent evidence suggests that vascular abnormalities are involved in the pathogenesis of melasma. Copper bromide (CuBr) laser, which emits dual wavelengths (511 and 578 nm), enabling simultaneous and selective destruction of melanin-containing cells and blood vessels, may be of benefit in the treatment of melasma. AIM: To investigate the efficacy and adverse effects (AEs) of CuBr laser for melasma treatment in patients with skin phototypes III-V. METHODS: We enrolled 24 Thai women with melasma to receive six CuBr laser treatments, 2 weeks apart. Objective (colour measurement) and subjective (clinical evaluation of photographs by three dermatologists blinded to the order of the photographs) assessments were obtained at baseline, after three and six treatments, and at the 3-month follow-up visit. A visual analogue scale (VAS) was used for patient assessment of change at baseline, after six treatments and at the 3-month follow-up. AEs were recorded at every follow-up visit. RESULTS: Of the 24 patients, 20 completed the study. Mean melanin index (MI) showed no statistically significant improvement compared with baseline measurements at any of the follow-up visits. There were significant improvements in clinical evaluation after three treatments (P = 0.00); however, this difference was no longer visible after six treatments. At follow-up 1 week after the end of the full course of six treatments, there was an improvement in VAS (P = 0.02). However, there was no improvement as measured by clinical evaluation or MI. Mild, transient AEs including erythema, burning sensation, scaling, hyperpigmentation and crusting were noted. CONCLUSIONS: CuBr laser did not show effectiveness in improving melasma in patients with skin phototypes III-V.

The use of sunscreen starting on the first day after ablative fractional skin resurfacing.

BACKGROUND: The most common side-effect of ablative fractional skin resurfacing in Asians is post inflammatory hyperpigmentation (PIH). Various attempts have been made to reduce the occurrence of PIH after laser treatment including sun avoidance, the use of preoperative and postoperative treatment regimens, and treatment using conservative energy settings and epidermal protection. OBJECTIVES: To determine whether the use of broad-spectrum sunscreen with anti-inflammatory agents starting on the first day after fractional CO2 laser skin resurfacing reduces the incidence of post laser PIH. MATERIALS AND METHODS: Thirty patients were treated with ablative fractional CO2 resurfacing on both sides of their faces at 10 mJ and 10% density. Each subject was randomly treated on one side of the face with petrolatum ointment four times a day for the first week after laser treatment and on the other side of the face with petrolatum ointment four times a day plus broad-spectrum sunscreen with anti-inflammatory agents in the morning starting on the first day after laser treatment. Transepidermal water loss was recorded at baseline and every day for 1 week. Melanin and erythema indexes were measured at baseline, 1-, 2-week, 1-, 2- and at 3-month post treatment. RESULTS: Of the 30 patients involved in the study, 26 received the treatment and attended 1-, 2-week, 1-, 2- and 3-month post-treatment visits. Four patients were withdrawn from the study because they could not attend every follow-up visit. There was no statistically significant difference in transepidermal water loss at baseline, immediately after laser treatment, or at the D1 to D7 follow-up visits. Erythema index had no significantly statistical difference at baseline, 1-, 2- and at 3-month after laser treatment. Furthermore, there was a statistically significant difference in melanin index at 1-week post laser treatment between both sides (P = 0.001). Melanin index at the 1-week follow-up visit on the side treated with broad-spectrum sunscreen with anti-inflammatory agents starting on the first day after laser treatment was significantly less than the control side. CONCLUSION: The use of broad-spectrum sunscreen with anti-inflammatory agents starting on the first day after ablative fractional skin resurfacing can decrease the incidence of PIH after laser treatment at 1-week postoperatively.

The efficacy in melasma treatment using a 1410 nm fractional photothermolysis laser.

BACKGROUND: Melasma treatment modalities including topical and procedural therapy have been employed with variable results and high recurrence rate. OBJECTIVE: To quantitatively assess improvement in melasma and side effects after 1410 nm fractional photothermolysis laser treatments and to determine efficacy at 1-, 2- and 3-month follow-up after treatment. METHODS: Thirty volunteers with melasma were treated with 1410 nm fractional photothermolysis for four passes on full face and additional four passes on melasma area. They were randomly treated on one side of their face with 20 mJ at 5% coverage and the other side of their face with 20 mJ at 20% coverage. All subjects were treated monthly for five times. Melanin index, Visual analogue scale and Melasma Area and Severity Index score were measured at baseline and 1-, 2- and 3-month follow-up after complete treatment protocol. RESULTS: There was statistically significant improvement of Melanin index at 2- and 3-month follow-up visits, but not at 1-month follow-up visit. Visual analogue scale and Melasma Area and Severity Index score improved significantly on both sides at 1-, 2- and 3-month follow-ups. The overall patients' satisfaction was significantly higher on the side treated with 20 mJ, 5% coverage. Adverse reactions included erythema, dryness and post-inflammatory hyperpigmentation on melasma area. Those side effects were significantly more intense on the side treated with 20 mJ, 20% coverage. CONCLUSIONS: 1410 nm fractional photothermolysis laser treatment is a safe and temporary effective procedure for melasma; however, long-term follow-up is still needed. Only 5% coverage should be used to minimize risks of adverse effects.

The efficacy in treatment of facial atrophic acne scars in Asians with a fractional radiofrequency microneedle system.

BACKGROUND: Treatment of acne scars remains a challenge to dermatologists. Multiple modalities have been employed with variable results and adverse effects. OBJECTIVE: To determine the efficacy and adverse effects of a fractional radiofrequency microneedle system (FRMS) on acne scars in Asians at 1-, 3- and 6-month follow-up visits after treatment. METHODS: Thirty subjects with atrophic acne scars for more than 6 months were enrolled in the study. All volunteers were treated with a FRMS on affected areas. The subjects were treated for a total number of three treatment sessions at 1-month intervals. Subjective assessments were obtained at baseline, 1, 3 and 6 months after the last treatment session by self-evaluation and two blinded dermatologists. Objective evaluation using an ultraviolet A-light video camera was also performed. In addition, pain scores, immediate reactions, healing times and other adverse effects were evaluated. RESULTS: Twenty-six subjects with skin phototypes III-V completed treatment protocol. The average mean scar age was 7 years (range: 0.5-15 years). At 6-month follow-up visit, the majority of the subjects (42.3%) reported a 26-50% improvement on their acne scars. Percent reduction in scar volume corresponded to clinical evaluation. Adverse reactions of the treatment included pain, immediate oedema/erythema, minimal scabbing and transient pigmentary alteration on treated areas. The average pain score was 5.6 of 10. Worsening of skin texture or new scar formation was not observed in any subjects. CONCLUSION: Fractional radiofrequency microneedle system is a safe and effective device for treating acne scars in Asians with minimal risk of downtime and adverse effects.

A split axilla comparison study of axillary hair removal with low fluence high repetition rate 810 nm diode laser vs. high fluence low repetition rate 1064 nm Nd:YAG laser.

BACKGROUND: A low fluence, high repetition rate 810 nm diode laser using constant motion technique has been recently introduced with advantages of less treatment discomfort and fewer side effects compared with traditional laser hair removal. OBJECTIVE: To compare hair reduction and side effects of low fluence high repetition rate 810 nm diode with high fluence low repetition rate 1064 nm Nd:YAG lasers. METHODS: Forty-nine subjects were randomly received five monthly treatments with diode laser on one side of their axilla and long-pulsed Nd:YAG laser on the other side. Hair count was recorded at baseline, 1- and 6-month follow-up visits. RESULTS: Percentage of axillary hair reduction at 1-month follow-up visit after receiving diode and Nd:YAG laser treatment were 71.0% and 82.3%, respectively, and at 6-month follow-up were 35.7% and 54.2%, respectively. There were significant differences in hair reduction between both laser systems at 1- and 6-month follow-ups (P < 0.001 and P < 0.001, respectively). Patients reported lower pain on the diode laser side (P < 0.001). Side effects of both laser systems were mild and transient erythema and swelling. CONCLUSIONS: High fluence low repetition rate Nd:YAG laser was superior in hair reduction and provided higher patient satisfaction. However, low fluence high repetition rate diode laser was less painful.

Unit cost of Mohs and Dermasurgery Unit.

BACKGROUND: Appropriate pricing for medical services of not-for-profit hospital is necessary. The prices should be fair to the public and should be high enough to cover the operative costs of the organization. OBJECTIVE: The purpose of this study was to determine the cost and unit cost of medical services performed at the Mohs and Dermasurgery Unit (MDU), Department of Dermatology, The University of Texas-MD Anderson Cancer Center, Houston, TX from the healthcare provider's perspective. METHODS: MDU costs were retrieved from the Financial Department for fiscal year 2006. The patients' statistics were acquired from medical records for the same period. Unit cost calculation was based on the official method of hospital accounting. RESULTS: The overall unit cost for each patient visit was $673.99 United States dollar (USD). The detailed unit cost of nurse visit, new patient visit, follow-up visit, consultation, Mohs and non-Mohs procedure were, respectively, $368.27, $580.09, $477.82, $585.52, $1,086.12 and $858.23 USD. With respect to a Mohs visit, the unit cost per lesion and unit cost per stage were $867.89 and $242.30 USD respectively. CONCLUSIONS: Results from this retrospective study provide information that may be used for pricing strategy and resource allocation by the administrative board of MDU.