Ablative versus non-ablative treatment of perioral rhytides. A randomized controlled trial with long-term blinded clinical evaluations and non-invasive measurements.

BACKGROUND AND OBJECTIVE: To compare efficacy and side effects of CO(2) laser resurfacing and intense pulsed light (IPL) rejuvenation for treatment of perioral rhytides. METHODS: Twenty-seven female subjects with perioral rhytides (class I-III) were randomly treated with either CO(2) laser or IPL (three monthly treatments). Efficacy was evaluated by patient self-assessments and blinded photographs up to 12 months postoperatively. Side effects were assessed clinically. Non-invasive measurements included: trans epidermal water loss (TEWL), skin reflectance, skin elasticity, and ultrasound. RESULTS: CO(2) laser resurfacing resulted in higher degrees of patient satisfaction and clinical rhytide reduction compared to IPL rejuvenation up to 12 months postoperatively (patient evaluations, P < 0.05) (observer evaluations, P < 0.008). Laser-induced side effects included erythema, dyspigmentation, and milia whereas no side effects were observed after IPL rejuvenation. Non-invasive measurements showed a significant higher reduction of the subepidermal low-echogenic band in CO(2) laser treated areas versus IPL treated areas (12 months postoperatively, P < 0.001). Skin elasticity (expressed as Young's modulus) increased in both groups (P = ns). One month postoperatively a significant increase in TEWL values (P < 0.009) and skin redness% (P < 0.02) was found in CO(2) laser treated patients versus IPL treated patients. No significant differences were seen in skin pigmentation% during the observation period. CONCLUSION: CO(2) laser resurfacing induces a significantly higher degree of clinical rhytide reduction followed by considerably more side effects compared to IPL rejuvenation in a homogeneous group of patients.

Skin reactions to histamine of healthy subjects after hypnotically induced emotions of sadness, anger, and happiness.

BACKGROUND: The severity of symptoms in asthma and other hypersensitivity-related disorders has been associated with changes in mood but little is known about the mechanisms possibly mediating such a relationship. The purpose of this study was to examine the influence of mood on skin reactivity to histamine by comparing the effects of hypnotically induced emotions on flare and wheal reactions to cutaneous histamine prick tests. METHODS: Fifteen highly hypnotically susceptible volunteers had their cutaneous reactivity to histamine measured before hypnosis at 1, 2, 3, 4, 5, 10, and 15 min after the histamine prick. These measurements were repeated under three hypnotically induced emotions of sadness, anger, and happiness presented in a counterbalanced order. Skin reactions were measured as change in histamine flare and wheal area in mm2 per minute. RESULTS: The increase in flare reaction in the time interval from 1 to 3 min during happiness and anger was significantly smaller than flare reactions during sadness (P<0.05). No effect of emotion was found for wheal reactions. Hypnotic susceptibility scores were associated with increased flare reactions at baseline (r=0.56; P<0.05) and during the condition of happiness (r=0.56; P<0.05). CONCLUSION: Our results agree with previous studies showing mood to be a predictor of cutaneous immediate-type hypersensitivity and histamine skin reactions. The results are also in concordance with earlier findings of an association between hypnotic susceptibility and increased reactivity to an allergen.

Oesophageal manometry and video-radiology in patients with systemic sclerosis: a retrospective study of its clinical value.

The aim of this retrospective study was to evaluate the initial video-radiology and manometry in 40 consecutive patients with systemic sclerosis (n=21) or suspected systemic sclerosis (n = 19) in relation to oesophageal symptoms; and, furthermore, to evaluate the consequence of radiographic or manometric findings in the oesophagus on diagnosis and treatment. Evaluating oesophageal abnormalities in relation to diagnosis and treatment has, to our knowledge, not been reported before. Video-radiology together with manometry demonstrated oesophageal dysfunction in 80% of patients. Thirteen patients (33%) were asymptomatic in spite of identified motility abnormalities. Following the radiographic and manometric investigation, 9 patients (23%) had a change of diagnosis and, in 20 patients (50%), systemic treatment was instituted or intensified. The study confirms that both manometry and video-radiology are important for the identification of oesophageal motility abnormalities in patients with systemic sclerosis. Oesophageal symptom profiles alone do not predict abnormal findings.

Effect of sensory stimulation (acupuncture) on sympathetic and parasympathetic activities in healthy subjects.

It has been postulated that sensory stimulation (acupuncture) affects the cardiovascular system via the autonomic nervous system. Previously, skin temperature, thermography, plethysmography and blood pressure changes have been used in evaluation of sympathetic nerve activity following acupuncture. By using power spectral analysis, the low frequency and high frequency components of heart rate variability can be calculated reflecting the sympathetic and parasympathetic activity. The purpose of this study was to investigate to what extent acupuncture applied into the thenar muscle and into the cavum concha of the ear induced changes in the sympathetic and/or parasympathetic nervous system in healthy subjects. MATERIALS AND METHODS: Twelve healthy volunteers, six men and six women, mean age 34.4 (range 23-48) participated in three balanced, randomly distributed sessions. At an individual initial visit the 12 volunteers were introduced to the needle sensation by having a needle inserted into the point LI 11. The needle sensation was evoked and the subject was trained to identify the characteristic needle sensation. The introduction was followed by three test sessions. SESSION A: A short acupuncture needle, (Seirin no 3, ∅0.20x15 mm) was inserted perpendicular into the earpoint, Lu 1, in the left inferior hemi-conchae. SESSION B: An acupuncture needle (Hwato, ∅0.30x30 mm) was inserted perpendicular into the Hegu point (LI 4) in the middle of the right dorsal thenar muscle. SESSION C: An acupuncture needle (Hwato, ∅0.30x30 mm) was inserted perpendicular superficially into the skin overlying the Hegu point on the left hand. Results. Stimulation of the ear induced a significant increase in the parasympathetic activity during the stimulation period of 25 min (P<0.05) and during the post-stimulation period of 60 min (P<0.05). No significant changes were observed in either the sympathetic activity, blood pressure or heart rate. Stimulation of the thenar muscle resulted in a significant increase in the sympathetic and the parasympathetic activity during the stimulation period (P<0.01) and during the post-stimulation period (P<0.01 and P<0.001, respectively). A significant decrease in the heart rate frequency (P<0.05) at the end of the post-stimulation period was also demonstrated. The superficial needle insertion into the skin overlaying the right thenar muscle caused a pronounced balanced increase in both the sympathetic and parasympathetic activity during the post stimulation period of 60 min (P<0.01) while no changes were observed during the stimulation period. CONCLUSION: It is indicated that sensory stimulation (acupunctura) in healthy persons is associated with changed activity in the sympathetic and parasympathetic nervous system depending on site of stimulation and period of observation.

Effect of EMLA cream on skin thickness and subcutaneous venous diameter. A randomized, placebo-controlled study in children.

EMLA cream, which is used to provide analgesia prior to venepuncture, induces a skin-blanching reaction. This reaction may be caused by both skin hydration and vasoconstriction. Twenty healthy children with veins suitable for venepuncture on the dorsa of the hands or at the antecubital fossae had applied either EMLA cream or placebo cream under occlusion for 60-70 min in a randomized, double-blind, cross-over study. An ultrasound examination of the skin was conducted. The mean percentage change in vein diameter after removal of EMLA cream was not significant whereas, 15 min after EMLA cream removal, the decrease in the initial vein diameter (13.5%) was significant (p<0.01). The mean percent increase in skin thickness after the removal of EMLA cream was also significant (19.3%; p=0.01). The changes in vein diameter and skin thickness due to the application of EMLA cream do not seem to be of clinical importance to vein cannulation.

Hair reduction using a new intense pulsed light irradiator and a normal mode ruby laser.

OBJECTIVE: The main purpose of this clinical study was to compare the effectiveness of an intense pulsed light irradiator system (IPL) and a normal mode ruby laser for hair removal. MATERIALS AND METHODS: Thirty-one patients were treated 3 times with a new IPL system on one side of the chin and neck and with a normal mode ruby laser on the other side. After 6 months, nine of the patients received 3 additional IPL treatments and 11 patients received 3 additional ruby laser treatments. All treatment intervals were 2 months. Hair reduction was measured by hair counts on close-up photographs. RESULTS: Hair reduction was obtained by 93.5% of the patients after 3 IPL treatments and by 54.8% after 3 ruby laser treatments. The average hair count was reduced by 49.3% after IPL treatments and by 21.3% after ruby laser treatments. Three additional IPL treatments following 3 IPL treatments resulted in only 6.6% further hair reduction--in total 55.9%, whereas 3 IPL treatments following 3 ruby laser treatments resulted in an additional 35.5% hair reduction--in total 56.8%. CONCLUSIONS: The IPL was found to be 3.94 times more effective than the ruby laser for hair removal. In the chin and neck region, more than 3 treatments with the IPL did not improve the therapeutic result significantly.

Skin pigmentation and texture changes after hair removal with the normal-mode ruby laser.

Promising clinical results have been obtained with the normal mode ruby laser for removal of unwanted hair. Melanin within the hair follicles is thought to act as target for the ruby laser pulses, whereas epidermal melanin is thought to be a competitive chromophore, responsible for potential side effects. This study aimed (i) to objectify postoperative changes in skin pigmentation and texture and (ii) to evaluate the importance of variations in preoperative skin pigmentation for the development of side effects 12 weeks after 1 treatment with the normal-mode ruby laser. A total of 17 volunteers (skin types I-IV) were laser-treated in the hairy pubic region (n = 51 test areas). A shaved test area served as control. Skin reflectance spectroscopical measurements, 3-dimensional surface contour analysis and ultrasonography objectified postoperative changes in skin pigmentation and texture. Blinded clinical assessments revealed postoperative hyperpigmentation (2% of test areas) and hypopigmentation (10%), whereas no textural changes were seen. Reflectance spectroscopically-determined pigmentary changes depended on the degree of preoperative skin pigmentation, fairly pigmented skin types experiencing subclinical hyperpigmentation and darkly pigmented skin types experiencing subclinical hypopigmentation. Three-dimensional surface profilometry documented similar pre- and postoperative surface contour parameters, indicating that the skin surface texture is preserved after laser exposure. Ultrasonography revealed similar skin thicknesses in laser-exposed and untreated control areas. It is concluded that normal-mode ruby laser treatment is safe for hair removal in skin types I-IV.

Bowel problems in patients with systemic sclerosis.

BACKGROUND: The impact of systemic sclerosis on bowel function is still unknown. The aim of this study was therefore to assess the frequency and severity of colorectal problems among patients with systemic sclerosis and to determine whether these problems are associated with age, gender, type of systemic sclerosis, or time since diagnosis. METHODS: A detailed questionnaire describing diarrhoea, constipation, obstructed defecation, faecal incontinence, bowel habits, social activities, and quality of life was sent to 96 consecutive patients with systemic sclerosis. RESULTS: Among 83 respondents (86%) 16% did not have a normal desire to defecate, 18% regularly needed digital stimulation or evacuation of the rectum, and 38% had faecal incontinence. Most patients (79%) had episodes of diarrhoea, and 38% had this once or more each month. Overall, 20% reported that colorectal dysfunction caused some or a major restriction of social activities or the quality of life. CONCLUSIONS: Colorectal dysfunction is very common among patients with systemic sclerosis, often restricting social activities and the quality of life. Therefore, further studies of colorectal pathophysiology in patients with systemic sclerosis are needed.

Effect of intradermal injection of methionine-enkephalin on human skin.

Methionine-enkephalin (met-enk) detected in monocytes in psoriatic skin can modulate inflammatory processes and keratinocyte differentiation/proliferation in vitro. The purpose of the present study was to determine the effect of intradermal injection of met-enk on normal human skin and on the development of a delayed type skin hypersensitivity reaction. In 6 healthy volunteers, 50 microl of met-enk (16, 30, and 45 nmol) was injected once in the forearm and the reaction was evaluated clinically and by video-optical recording for 120 min. Compared to vehicle (0.9% saline), met-enk induced a time- and dose-dependent flare reaction, but no significant stimulation of a weal reaction. The flare reaction was maximal after 1 min and disappeared within 45 min. Pre-treatment with the antihistamine cetirizine reduced the flare reaction. Furthermore, the effect of met-enk on lymphocyte/monocyte infiltration and epidermal proliferation in normal skin and on a delayed type skin hypersensitivity reaction was assessed. Met-enk (45 nmol/ 50 microl) was injected at 0, 24 and 48 h. In normal skin, met-enk increased the number of dermal lymphocytes/monocytes (CD3/CD68 positive cells) and the degree of epidermal proliferation (MIBI-Ki67). In a delayed type hypersensitivity reaction induced by tuberculin (PPD), the degree of epidermal proliferation and the number of infiltrating lymphocytes/monocytes were reduced compared to PPD alone. Our study suggests that intradermal injection of met-enk in normal human skin induces an inflammatory reaction that may involve the release of histamine. In contrast, met-enk seems to down-regulate the development of a delayed type skin hypersensitivity reaction. These results may indicate that the direction of the effect of the opioid peptide met-enk on human skin depends on the rate of epidermal proliferation and the activity of immunocompetent cells.

Pain and mechanical injury of human skin following needle insertions.

Needle insertion is a very common invasive procedure, but little has been done to study how pain is related to the mechanical properties of the needle insertion, and how pain from the procedure may be minimized. The aim of the present study was to investigate the pain evoked by standardized needle insertion into the human skin. Needle insertions were performed with continuous registration of the mechanical force on the needle. Forty consecutive needle insertions to the depth of 8 mm with 27G and 30G needles, 2 and 19 mm/s velocities, and at 45 and 90 degree angles to the skin surface were performed in a randomized and blinded design in 30 healthy volunteers. The occurrence, intensity and quality of pain, as well as the maximum mechanical needle penetration force and the total mechanical workload were registered. The mechanical parameters of needle insertions were significantly related to needle size and velocity of insertion. Occurrence of pain and bleeding were significantly related to the needle size. High needle insertion velocity was significantly related to a higher rate of sharp and pricking pain, and low insertion velocity to a significantly higher rate of dull and burning pain. The present study provides quantitative data on pain and mechanical parameters of standardized needle insertions through normal human skin. Copyright 1999 European Federation of Chapters of the International Association for the Study of Pain.

Comparison of the efficacy and safety of three different depilatory methods.

BACKGROUND/AIMS: Three methods of electrical energy-based depilation were compared for safety and efficacy. METHODS: Ten volunteers had one treatment with each device followed by weekly observations up to 9 weeks. The protocol used was basically that of the International Guild of Professional Electrologists, which is used to define "permanent" hair removal. RESULTS: Radio frequency tweezers, direct current tweezers and needle based electrolysis all demonstrated statistically significant reductions in hair counts after 9 weeks of 60.3%, 65.8% and 55.9%, respectively. The differences between the treatments were not statistically significant. However, large differences in side effects and pain scores existed. Both tweezer type epilators induced pain rated at 13/100 on a visual analogue scale while the needle based depilator induced significant pain at 59/100. Furthermore, acute inflammation and late scarring was seen only following treatment with the electrolysis needle. CONCLUSION: The tweezer-type epilators are as effective as needle-based electrolysis but without the pain and side effects of the latter.

Comparison of the analgesic effect of EMLA cream and EMLA patch on normal skin evaluated with laser-induced pain stimuli.

In the present study the onset, duration and efficacy of the analgesic effect of EMLA patch compared to EMLA cream were investigated on the skin of the forearms of 12 healthy adults. EMLA patch and cream were applied for 30, 60 and 120 min. The pain threshold was determined 5 min after removal of the test substance, using high-energy argon laser stimuli, and thereafter every 30 min for 4 h. After 120 min of application, both EMLA cream and EMLA patch ensured total analgesia. The clinical analgesic efficacy of EMLA patch was found equal to that of EMLA cream.

Regional variations in skin perfusion and skin thickness may contribute to varying efficacy of topical, local anaesthetics in neonates.

The national Swedish screening programme for inborn errors of metabolism includes blood sampling from all neonates. Heel lancing has hitherto been the method of choice for these screening tests. Studies have recently been done to find out whether the use of EMLA can alleviate pain caused by heel lancing. EMLA had little, if any effect when applied to the heel of full term babies. Similar results were reported concerning preterm infants. Other authors have found that differences in skin thickness or in skin blood perfusion may influence the effect of EMLA. The aim of this study was to establish whether differences in skin thickness or in skin blood perfusion were present in three regions: the forehead, the dorsum of the hand and the heel. Ten healthy full term neonates were included in the study on skin perfusion. Measurements were made with a laser Doppler flux meter. Twenty-seven healthy full term neonates were included for measurements of skin thickness using a high frequency B-mode ultrasonic meter. The heel skin perfusion was two to three times higher than the skin perfusion at the dorsum of the hand and at the forehead but there was no significant difference when comparing skin thickness of the heel with the dorsum of the hand and the forehead. A rapid clearance of a topically applied local anaesthetic, due to high cutaneous blood flow, may explain why EMLA seems to be of little value when it is applied to the neonatal heel.