Clinical, laboratory, and MRI analysis of cellulite treatment with a unipolar radiofrequency device.

BACKGROUND: Cellulite is seen in more than 85% of postpubertal women. Recent studies show that bipolar radiofrequency and low-level laser devices can produce mild skin tightening of cellulite. OBJECTIVE: The primary objective was to determine if a novel unipolar, more deeply penetrating, radiofrequency device can promote better skin tightening with fewer treatments than is seen with previously described devices. The secondary objective was to determine if such a deeply penetrating device produced undesired effects on lipid metabolism. METHODS: Thirty subjects, with Nurnberger-Muller Scale III-IV upper thigh cellulite, were entered into the study. All were treated, every other week, with a unipolar radiofrequency device for a total of six treatments. Subjects were evaluated before and 6 months after treatment with clinical photographs, clinical measurements, biopsies, MRIs, and blood lipid evaluations. RESULTS: Twenty-seven subjects showed evidence of clinical improvement. The mean decrease in leg circumference was 2.45 cm. Histologic changes showed dermal fibrosis of the upper dermis. No MRI or lipid abnormalities were noted. CONCLUSION: Upper thigh skin cellulite can be improved with a new unipolar radiofrequency device. Histologic changes suggest skin tightening as the method of improvement. No undesired complications of the skin or lipid metabolism were noted.

Treatment of skin laxity of the lower face and neck in older individuals with a broad-spectrum infrared light device.

BACKGROUND: Non-ablative approaches with infrared and radiofrequency energy sources have been shown to reduce skin laxity, but studies have focused on individuals with early-stage, mild-to-moderate degenerative dermal changes. OBJECTIVE: The purpose of this prospective study was to evaluate the safety and efficacy of an infrared light device for the treatment of skin laxity in patients with soft tissue ptosis of the lower face and neck characteristic of the sixth decade of life and beyond. MATERIALS AND METHODS: Thirteen females, aged 58-83 years old (average: 64 years), were treated with a filtered 1100-1800 nm infrared light-based device. All individuals presented with ptotic soft tissue, but varied in the extent of skin laxity from no visible laxity to having pendulous excess skin. Two treatment sessions were provided at monthly intervals. The individuals returned for follow-up visits at 1, 3 and 6 months after the second treatment. Twelve of the individuals completed the study. RESULTS: Changes were dramatic for those individuals in whom the skin envelope appeared to drape separately from deeper soft tissue. No treatment complications were noted. CONCLUSION: Infrared light source-induced skin tightening may be induced even in older individuals.

Vancomycin-induced linear IgA disease manifesting as bullous erythema multiforme.

BACKGROUND: Vancomycin-induced linear immunoglobulin A (IgA) disease, an autoimmune, blistering disease in response to vancomycin administration, is characterized by a subepidermal, vesiculobullous eruption and linear IgA deposition along the basement membrane zone on direct immunofluorescence. CASE REPORT: We report the case of an 81-year-old man treated with vancomycin who developed diffuse erythema multiforme and tense bullae involving the palmoplantar surfaces. Discontinuation of vancomycin therapy resulted in complete resolution of this patient's cutaneous eruption. RESULTS: Biopsy of a representative skin lesion demonstrated lichenoid interface dermatitis with focal subepidermal clefting, dyskeratosis, and prominent eosinophils. Direct immunofluorescence showed linear basement membrane staining with immunoreactants to IgA; indirect immunofluorescence demonstrated the presence of circulating IgG antibodies binding in an intercellular pattern. Immunoprecipitation studies using the patient's serum revealed 210, 130, and 83 kDa target antigens. CONCLUSIONS: Presenting with an initial clinical picture suggestive of bullous erythema multiforme, this patient's subsequent clinical course and direct immunofluorescence confirm the diagnosis of linear IgA bullous disease (LABD). His indirect immunofluorescence findings and immunoprecipitation results suggest that circulating non-IgA antibodies may represent a newly recognized immunopathologic feature of vancomycin-induced linear IgA disease, underscoring the variable and unpredictable manifestations of this drug-induced cutaneous disease.