Epidermal and dermal hydration in relation to skin color parameters.

BACKGROUND: Our goal was to investigate linkages between skin color parameters and skin hydration. Since most prior studies focused on stratum corneum hydration, we focused on epidermal and dermal hydration in relation to skin color parameters in both sexes. MATERIALS AND METHODS: Thirty adults (16 female) with an age ± SD of 24.3 ± 0.6 years participated. Three sites on both volar forearms were evaluated for melanin index (MI), erythema index (EI), Individual Typology Angle (ITA), tissue dielectric constant (TDC) values to depths of 0.5 mm (TDC0.5) and 2.5 mm (TDC2.5), and Fitzpatrick skin type (FST). RESULTS: MI and EI were highly correlated (r = 0.800, p < 0.001) with maximum differences in MI and ITA along the arm of 3% and 6.3% with no difference between arms. Male MI was greater than females (p < 0.01). Male TDC2.5 was 36.1 ± 5.4 and correlated with EI (r = 0.231, p = 0.035). Contrastingly, female TDC25 was 28.5 ± 3.6 with no correlation with EI but was correlated with MI (r = -0.301, p = 0.003). These differential patterns held true for TDC0.5. For both sexes, FST and ITA were highly correlated (r = -0.756, p < 0.001). CONCLUSIONS: The findings revealed several correlations between skin color parameters and hydration that differed between males in females in some cases. The observed correlations may indicate that melanin may differentially impact water-holding capacity between sexes and provides a future research target. Further, these initial findings also may hold significance for dermatological assessments and the customization of skincare treatments tailored to individual skin types and demographics.

Differences of bioelectrical impedance in the development and healing phase of pressure ulcers and erythema in mouse model.

Pressure ulcers (PUs) are economically burdensome medical conditions. Early changes in pressure ulcers are associated with erythema. In this study, bioelectrical impedance was used to measure the differences between PUs and blanchable erythema. We divided 21 ICR mice into three groups: control, 1000 mmHg-1h, and 1000 mmHg-6h. Healthy skin, blanchable erythema, and PUs were induced on the dorsal skin. The results indicated an immediate increase in impedance, resistance, and reactance values in the pressure group after release, followed by a subsequent decrease until two days after release. Compared with the control group, impedance and reactance significantly increased by 30.9% (p < 0.05) and 30.1% (p < 0.01), respectively, in the 6 h-loading group immediately after release. One and two days after release, the 1 h-loading and 6 h-loading groups exhibited significantly different degrees of decline. One day after release, impedance and resistance decreased by 30.2% (p < 0.05) and 19.8% (p < 0.05), respectively, in the 1 h-loading group; while impedance, resistance, and reactance decreased by 39.2% (p < 0.01), 26.8% (p < 0.01), and 45.7% (p < 0.05), respectively, in the 6 h-loading group. Two days after release, in the 1 h-loading group, impedance and resistance decreased by 28.3% (p < 0.05) and 21.7% (p < 0.05), respectively; while in the 6 h-loading group, impedance, resistance, and reactance decreased by 49.8% (p < 0.001), 34.2% (p < 0.001), and 59.8% (p < 0.01), respectively. One and two days after release the pressure group reductions were significantly greater than those in the control group. Additionally, we monitored changes during wound healing. Distinguishing early PUs from blanchable erythema by noninvasive bioelectrical impedance technology may have applications value in early assessment of PUs.

Circadian rhythmicity on red ear syndrome in a patient with migraine: A case report.

BACKGROUND: Red ear syndrome (RES) was first described by Lance in 1994. It is characterized by recurrent attacks of redness of the ear, accompanied by burning pain, increased temperature, dysesthesia, and nosological relationship with headache. CASE: We report the case of a 43-year-old woman with migraine who developed RES. Redness episodes occurred at the same time of the day. She had a good therapeutic response to gabapentin. CONCLUSIONS: To the best of our knowledge, this is the first case of RES in which redness episodes occurred at the same time of the day.

Cervical lymphadenopathy in children: a diagnostic tree analysis model based on ultrasonographic and clinical findings.

OBJECTIVES: To establish a diagnostic tree analysis (DTA) model based on ultrasonography (US) findings and clinical characteristics for differential diagnosis of common causes of cervical lymphadenopathy in children. METHODS: A total of 242 patients (131 boys, 111 girls; mean age, 11.2 ± 0.3 years; range, 1 month-18 years) with pathologically confirmed Kikuchi disease (n = 127), reactive hyperplasia (n = 64), lymphoma (n = 24), or suppurative lymphadenitis (n = 27) who underwent neck US were included. US images were retrospectively reviewed to assess lymph node (LN) characteristics, and clinical information was collected from patient records. DTA models were created using a classification and regression tree algorithm on the basis of US imaging and clinical findings. The patients were randomly divided into training (70%, 170/242) and validation (30%, 72/242) datasets to assess the diagnostic performance of the DTA models. RESULTS: In the DTA model based on all predictors, perinodal fat hyperechogenicity, LN echogenicity, and short diameter of the largest LN were significant predictors for differential diagnosis of cervical lymphadenopathy (overall accuracy, 85.3% and 83.3% in the training and validation datasets). In the model based on categorical parameters alone, perinodal fat hyperechogenicity, LN echogenicity, and loss of fatty hilum were significant predictors (overall accuracy, 84.7% and 86.1% in the training and validation datasets). CONCLUSIONS: Perinodal fat hyperechogenicity, heterogeneous echotexture, short diameter of the largest LN, and loss of fatty hilum were significant US findings in the DTA for differential diagnosis of cervical lymphadenopathy in children. KEY POINTS: • Diagnostic tree analysis model based on ultrasonography and clinical findings would be helpful in differential diagnosis of pediatric cervical lymphadenopathy. • Significant predictors were perinodal fat hyperechogenicity, heterogeneous echotexture, short diameter of the largest LN, and loss of fatty hilum.

Use of beta-blockers for rosacea-associated facial erythema and flushing: A systematic review and update on proposed mode of action.

BACKGROUND: Flushing and erythema are frequent skin symptoms in rosacea. Because their adequate treatment remains a clinical challenge, new treatment options are explored, such as oral ß-blockers. OBJECTIVES: To evaluate the efficacy of oral ß-blockers for rosacea-associated facial flushing and erythema. METHODS: PubMed, Embase, Web of Science, and Cochrane Library were systematically searched, including studies providing original data on the efficacy of oral ß-blockers in rosacea patients with facial flushing and/or persistent erythema. Risk of bias was assessed using the Cochrane Risk of Bias tool, Newcastle-Ottawa scale, and Quality in Prognosis Studies tool. RESULTS: Nine studies evaluating the use of carvedilol, propranolol, nadolol, and ß-blockers in general were included. Articles studying carvedilol and propranolol showed a large reduction of erythema and flushing during treatment with a rapid onset of symptom control. Bradycardia and hypotension were the most commonly described adverse events. LIMITATIONS: Most studies had a retrospective design with a small sample size, and outcome measurement was often subjective. CONCLUSIONS: Oral ß-blockers could be an effective treatment option for patients with rosacea with facial erythema and flushing that does not respond to conventional therapy. Larger prospective trials with objective outcome assessment are needed to validate the promising results of these studies.

Breast tuberculosis in East London: A 13-year retrospective observational study.

SETTING: Breast tuberculosis (TB) is rare in Western Europe, and its diagnosis may be delayed through lack of awareness of presenting features. Our institution serves a large East London population with a high incidence of TB. OBJECTIVE: To characterize presenting features and avoidable diagnostic delay in breast TB patients. DESIGN: We conducted a 13-year retrospective study of breast TB patients treated at our institution including demographic, clinical, microbiology, and pathology data. RESULTS: Forty-seven cases were included; 44 (94%) were female, with a median age of 33 years (IQR 28.5-39.5). The main presenting feature was a breast lump in 41 cases (87%); which were predominantly solitary unilateral lesions (25, 61%) and frequently located in the upper outer quadrant (28, 68%). Where performed, Mycobacterium tuberculosis was cultured in 15/36 (42%) cases. Granulomata were present on biopsy or aspirate in 21 (47%) and 17 (36%) cases, respectively. The median duration between symptom onset and treatment was 20 weeks (IQR 15-30). Forty-six (98%) completed treatment successfully and one relapsed. CONCLUSION: A high index of suspicion for TB is required for individuals presenting with breast symptoms from countries where TB is endemic. Development of standardized pathways may improve detection and management of breast TB may reduce diagnostic delay.

The Impact of COVID-19 on the Faces of Frontline Healthcare Workers.

As the coronavirus epidemic continues, a host of new cutaneous complications is seen on the faces of frontline healthcare workers wearing personal protective equipment on a daily basis. To minimize the risk of COVID-19 infection, healthcare workers wear tight-fitting masks that lead to an excessive amount of pressure on the facial skin. Mechanical pressure, mask materials, and perspiration can all lead to various types of cutaneous lesions such as indentations of the face, skin tears, post-inflammatory hyperpigmentation, ulceration, crusting, erythema, and infection. The objective of this article is to provide effective and straightforward recommendations to those health care providers using facial masks in order to prevent skin-related complications. J Drugs Dermatol. 2020;19(9):858-864. doi:10.36849/JDD.2020.5259.

Paraneoplastic Dermatoses: A Brief General Review and an Extensive Analysis of Paraneoplastic Pemphigus and Paraneoplastic Dermatomyositis.

Skin manifestations of systemic disease and malignancy are extremely polymorphous. Clinicians should be familiarized with paraneoplastic dermatoses in order to perform an early diagnosis of the underlying neoplasm. Lack of familiarity with cutaneous clues of internal malignancy may delay diagnosis and treatment of cancer. In this review, we described several paraneoplastic dermatoses and discussed extensively two paradigmatic ones, namely paraneoplastic pemphigus and paraneoplastic dermatomyositis.

A quantitative study of hydration level of the skin surface and erythema on conventional and microclimate management capable mattresses and hospital beds.

BACKGROUND: In addition to pressure itself, microclimate factors are gaining more attention in the understanding of the development of pressure ulcers. While there are already various products to reduce pressure on sore-prone areas to prevent pressure ulcers, there are only a few mattresses/hospital beds that actively influence skin microclimate. In this study, we investigated if microclimate management capable mattresses/hospital beds can influence skin hydration and skin redness/erythema. METHODS: We included 25 healthy subjects in our study. Measurements were made using Courage & Khazaka Multi Probe Adapter MPA with Corneometer CM825 and Mexameter MX18 to determine skin hydration of the stratum corneum and skin redness/erythema before and after the subjects were lying in conventional (Viskolastic® Plus, Wulff Med Tec GmbH, Fedderingen, Germany and Duo™ 2 mattress, Hill-Rom GmbH Essen, Germany) or microclimate management capable mattresses/hospital beds (ClinActiv + MCM™ and PEARLS AFT, Hill-Rom GmbH Essen, Germany). RESULTS: While there was no difference in skin redness/erythema on the different mattresses/hospital beds, skin hydration of the stratum corneum decreased significantly in an air fluidized bed compared to baseline values and values measured on standard mattress/Viskolastic® Plus. CONCLUSION: Air-fluidized therapy reduces skin hydration and therefore could contribute to prevent moisture associated ulcers. Changes in skin hydration as one important factor of skin microclimate can be detected after a short time of incubation and even before an erythema appears.

Erythema of the skin after breast radiotherapy: It is not always recurrence.

Recurrence of breast cancer is a predominant fear for patients who were treated for breast cancer. Acute and late dermatologic effects of radiotherapy are not uncommon and could have similar characteristics to breast cancer recurrence. Thus, it is important to highlight key differences between the clinical and histologic presentations of radiation effects and recurrence. Herein, we present two patients who presented with late dermatologic effects of radiotherapy months to years after treatment, neither of whom had workup consistent with cancer recurrence. We provide clinical and microscopic descriptions of each case and provide a review to differentiate various dermatologic conditions. This report aims to outline potential late dermatologic effects of radiation treatment and emphasise that changes in the breast do not always signal breast cancer recurrence.

The microvascular response in the skin to topical application of methyl nicotinate: Effect of concentration and variation between skin sites.

BACKGROUND: Methyl nicotinate (MN) induces a local cutaneous erythema in the skin and may be used as a local provocation in the assessment of microcirculation and skin viability. The aims were to measure the effects of increasing doses of MN, to find the concentration that yields the most reproducible effect from day to day and between sites, and to study the variation between skin sites. METHODS: Microvascular responses to topically applied MN at different concentrations were measured in 12 subjects on separate days and on contralateral sides, using laser speckle contrast imaging (LSCI). MN effects were measured in four different body sites. RESULTS: At 20 mmol/L, the response to MN was most reproducible day-to-day and site-to-site, and resulted in a plateau response between 5 and 20 min after application. The skin region of the lower back had a lower perfusion value compared to the epigastric region (p = 0.007). When responses were compared to nearby, unprovoked areas, a significantly larger increase in perfusion was seen in the forearm, compared to all other anatomical sites (p < 0.03). CONCLUSION: A concentration of 20 mmol/L MN generated the most reproducible microvascular response in the skin. The response varies between different body sites.

A systematic review of necrotising fasciitis in children from its first description in 1930 to 2018.

BACKGROUND: Necrotising fasciitis is a rapidly progressing soft-tissue infection with a low incidence that carries a relevant risk of morbidity and mortality. Although necrotising fasciitis is often fatal in adults, its case fatality rate seems to be lower in children. A highly variable clinical presentation makes the diagnosis challenging, which often results in misdiagnosis and time-delay to therapy. METHODS: We conducted a protocol-based systematic review to identify specific features of necrotising fasciitis in children aged one month to 17 years. We searched 'PubMed', 'Web of Science' and 'SCOPUS' for relevant literature. Primary outcomes were incidence and case fatality rates in population-based studies, and skin symptoms on presentation. We also assessed signs of systemic illness, causative organisms, predisposing factors, and reconstructive procedures as secondary outcomes. RESULTS: We included five studies reporting incidence and case fatality rates, two case-control studies, and 298 cases from 195 reports. Incidence rates varied between 0.022 and 0.843 per 100,000 children per year with a case-fatality rate ranging from 0% to 14.3%. The most frequent skin symptoms were erythema (58.7%; 175/298) and swelling (48%; 143/298), whereas all other symptoms occurred in less than 50% of cases. The majority of cases had fever (76.7%; 188/245), but other signs of systemic illness were present in less than half of the cohort. Group-A streptococci accounted for 44.8% (132/298) followed by Gram-negative rods in 29.8% (88/295), while polymicrobial infections occurred in 17.3% (51/295). Extremities were affected in 45.6% (136/298), of which 73.5% (100/136) occurred in the lower extremities. Skin grafts were necessary in 51.6% (84/162) of the pooled cases, while flaps were seldom used (10.5%; 17/162). The vast majority of included reports originate from developed countries. CONCLUSIONS: Clinical suspicion remains the key to diagnose necrotising fasciitis. A combination of swelling, pain, erythema, and a systemic inflammatory response syndrome might indicate necrotising fasciitis. Incidence and case-fatality rates in children are much smaller than in adults, although there seems to be a relevant risk of morbidity indicated by the high percentage of skin grafts. Systematic multi-institutional research efforts are necessary to improve early diagnosis on necrotising fasciits.

Minimal erythema dose, minimal persistent pigment dose which model for whitening products evaluation is better?

BACKGROUND/AIMS: How to select a suitable method in whitening products evaluation is still under discussion. Here, we compared two different artificial pigmentation models and explored an ideal UV dosage for skin whitening products evaluation model establishment. METHODS: Thirty five healthy volunteers with type IV human skin were recruited and the skin minimal erythema dose (MEDs) and minimal persistent pigment dose (MPPDs) were measured. All volunteers were simultaneously exposed to six increasing doses of radiations from different ultraviolet sources on lower back bilateral flattening area: 95% UVA/5% UVB with the radiating doses of 0.75, 0.94, 1.17, 1.46, 1.83, 2.29 MEDs was used on the left side; meanwhile 99% UVA/1% UVB with radiating doses of 6.0, 7.5, 9.4, 11.7, 14.6, 18.3 MPPDs were used on the right side. Observations and pigmentation measurements were carried out before and after UV radiation for 24 weeks. RESULT: 1.83 MED and 2.29 MED induced medium depth pigmentation by 95% UVA/5% UVB irradiation. 1.83 MED dose causing minimal photo-damage on skin was selected as the most suitable dose. With 99% UVA/1% UVB irradiation, 9.4 MPPD and 11.7 MPPD induced medium depth pigmentation. 9.4 MPPD dose causing minimal photo-damage on skin was selected. CONCLUSION: These findings potentiate advanced understanding of UV model establishment and selection for skin whitening products evaluation as related to dermatopharmacology and dermatotoxicology.

The tissue viability imaging system-Suitable method for discovering minimal skin changes in occupational screenings? Results of a cross-sectional field study.

BACKGROUND: For early detection of initial skin changes in occupational screenings, only few objective assessment systems are available. OBJECTIVES: With the aim of assessing an objective measurement method for hand eczema, we trialed the application of the tissue viability imaging (TiVi) system, quantifying erythema non-invasively by polarized light spectroscopy. MATERIALS AND METHODS: In a field study with 625 employees of a semiconductor production company, 411 were exposed to prolonged wearing of occlusive gloves in the clean room. TiVi system and Hand Eczema Score for Occupational Screenings (HEROS), a quantitative skin score for the hands, were used, supplemented by a standardized personal interview. RESULTS: TiVi values of 65 up to 246 for each hand (palm or back), for each participant summed to overall 289 up to 848 (median 389), were measured. Higher TiVi values were noted for men, smokers, and with increasing age. Correlation between TiVi and HEROS was only weak. Several factors like skin pigmentation, thickness of the skin, or tattoos seem to influence TiVi results. CONCLUSIONS: The practical relevance of one-time measurements with the TiVi system in occupational screenings seems to be limited. Specifically, the TiVi system cannot replace dermatological examinations at the workplace. Notwithstanding, the application for other scientific purposes might be useful.

Assessment of Skin Physiology Change and Safety After Intradermal Injections With Botulinum Toxin: A Randomized, Double-Blind, Placebo-Controlled, Split-Face Pilot Study in Rosacea Patients With Facial Erythema.

BACKGROUND: Botulinum toxin (BTX) has been used cosmetically with good clinical efficacy and tolerable safety. OBJECTIVE: This randomized, double-blind, split-face clinical study aimed to investigate the efficacy and safety of intradermal BTX in patients with rosacea. MATERIALS AND METHODS: Twenty-four participants were enrolled and randomly given intradermal injections of BTX and normal saline in both cheeks. Clinician Erythema Assessment (CEA) score, Global Aesthetic Improvement Scale (GAIS) score, skin hydration, transepidermal water loss (TEWL), melanin content, erythema index, elasticity, and sebum secretions were evaluated at baseline and 2, 4, 8, and 12 weeks. RESULTS: On the BTX-treated side, the CEA score significantly decreased and the GAIS score significantly increased. The erythema index decreased at Weeks 4 and 8. Skin elasticity was improved at Weeks 2 and 4 and skin hydration, at Weeks 2, 4, and 8. However, TEWL and sebum secretion did not show significant differences. CONCLUSION: Intradermal BTX injections reduced erythema and rejuvenated the skin effectively and safely in patients with rosacea.

The effect of pre-phototest sun exposure on minimal erythema dose and minimal melanogenic dose among skin phototypes III, IV and V.

BACKGROUND: Ethnicity, skin phototype and colour influenced minimal erythema dose (MED). Sun exposure has been postulated to increase MED. We determined immediate pigment darkening dose to UVA (IPDDA), MED and minimal melanogenic dose (MMD) for UVB and UVA, and investigated factors affecting these doses. METHODS: Skin phototype was determined using Fitzpatrick phototype quiz, DSMII ColorMeter measured skin colours, sun exposure quantified using an index (SEI) and phototest performed with MEDlight-Multitester. RESULTS: A total of 167 healthy volunteers participated. There were 110 (66%) females and 56 (34%) males; 124 (74.7%) were Malay, 27 (16.3%) Chinese and 14 (8.4%) Indians. One hundred and nine (65.7%) skin phototype IV, 30 (18.1%) phototype III and 27 (16.3%) phototype V. IPDDA ranges from 6 ± 1.5-5.7 ± 1.4 J/cm2 . MED-UVB were 96.9 ± 17.6, 124 ± 29.3 and 118.6 ± 27.4 mJ/cm2 for phototype III, IV and V, respectively. All MED-UVA were outside the tested dose range of 3.6-11 J/cm2 . MMD-UVB were 106 ± 18.2, 134 ± 25.6 and 136 ± 31.1 mJ/cm2 while MMD-UVA were 4.1 ± 4.1, 4.9 ± 3.8 and 5.7 ± 3.7 J/cm2 respectively for phototypes III, IV and V. MED-UVB, MMD-UVB and MMD-UVA did not depend on skin phototype. Facultative skin whiteness (L*), erythema (E) and melanin content (M) correlated significantly with MED-UVB while constitutive skin colours were significant for L*, yellowness (b*), E and M. Sun exposure did not significantly correlate with MED-UVB and MMDs, however, an inverse relationship with MED-UVB was demonstrated. CONCLUSION: Minimal erythema doses in our cohort were slightly different from other regional countries. Constitutive and facultative skin whiteness, erythema and melanin content correlated with MED. There was no association between skin phototype and sun exposure with MED or MMD.

Annular Lesions: Diagnosis and Treatment.

Annular lesions can present in a variety of diseases. Knowledge of the physical appearance and history of presentation of these skin findings can help in the diagnosis. A pruritic, annular, erythematous patch that grows centrifugally should prompt evaluation for tinea corporis. Tinea corporis may be diagnosed through potassium hydroxide examination of scrapings. Recognizing erythema migrans is important in making the diagnosis of Lyme disease so that antibiotics can be initiated promptly. Plaque psoriasis generally presents with sharply demarcated, erythematous silver plaques. Erythema multiforme, which is due to a hypersensitivity reaction, presents with annular, raised lesions with central clearing. Lichen planus characteristically appears as planar, purple, polygonal, pruritic papules and plaques. Nummular eczema presents as a rash composed of coin-shaped papulovesicular erythematous lesions. Treatment is aimed at reducing skin dryness. Pityriasis rosea presents with multiple erythematous lesions with raised, scaly borders, and is generally self-limited. Urticaria results from the release of histamines and appears as well-circumscribed, erythematous lesions with raised borders and blanched centers. Annular lesions occur less commonly in persons with fixed drug eruptions, leprosy, immunoglobulin A vasculitis, secondary syphilis, sarcoidosis, subacute cutaneous lupus erythematosus, and granuloma annulare.

Defining and validating a Body Skin Discomfort Index (BSDI).

OBJECTIVE: To understand the drivers of body skin discomfort and to validate a new index to assess its severity. This index should be sensitive enough to capture changes in response to treatment. METHODS: Previous consumer studies suggested seven potential main dimensions behind skin discomfort. Four of them refer to self-declarations (stinging, itching, warming and tightening), whereas three can be assessed by a dermatologist (skin dryness, redness and desquamation). Intensity and frequency or extent of these items were measured using 0-9 ordinal scales. To generate the data for validation of a new index based on the 7 items, a group of 49 subjects complaining of skin discomfort was followed up for 5 weeks: 1-week without product application to check reproducibility, followed by 4 weeks of treatment to evaluate sensitivity to change. Items not significantly reported at baseline or with changes because of treatment not sufficiently correlated with the overall change measured by the index were discarded. A control group of 49 subjects presenting no discomfort at all was also included to check the capacity of our index to discriminate both groups. The final index (Body Skin Discomfort Index, BSDI) was normalized to facilitate the clinical interpretation of the results. RESULTS: After discarding warming and skin redness, the BSDI is finally a five-dimension score calculated as follows: (TI + TF + SI + SF + ItI + ItF + DI + DE + DqI + DqE) 9 9/90 where T, S, It, D and Dq refer to tightness, stinging, itching, dryness, desquamation respectively, and I, F or E refers to intensity, frequency or extent. The final BSDI score displayed a good capacity to discriminate people with skin discomfort from people with 'normal skin', a good reproducibility (intraclass coefficient correlation ICC = 0.85) and a good sensitivity to detect change because of treatment (Difference vs. Baseline of 2.63 on a 0-9 scale). CONCLUSION: The developed index, BSDI, is a reliable way to address the measurement issue of the multidimensional skin discomfort syndrome. It thus should simplify the evaluation of cosmetic products effect and helps to compare products dedicated to body cleansing.

Clinical and immunological profile in patients with mixed connective tissue disease.

Mixed connective tissue disease (MCTD) is a rare disease and presents with varied overlapping symptoms of different connective tissue disorders. Many patients evolve into other connective tissue disorders with the passage of time. The case series included 20 patients with the diagnosis of MCTD, registered at the Rheumatology Clinic of Jinnah Postgraduate Medical Centre (JPMC), Karachi, from June 2010 to May 2015. Of these, 16 (80.0%) were female and 4 (20.0%) patients were male. The mean age was 30.5±8.9 years and the mean duration of illness was 4.5±2 years. Commonest presenting symptom was arthralgia in 17 (85%) patients. All the patients had positive ANA and anti-RNP antibodies. Over the disease course of 6 years, 2 (10%) patients evolved into Systemic lupus erythematosus (SLE); One each (5%) into Sjogren's syndrome, Scleroderma and Rheumatoid arthritis.

Clinical Outcomes and Complications Associated with Fractional Lasers: A Review of 730 Patients.

BACKGROUND: Fractional lasers were introduced to provide increased safety, while maintaining high efficacy and patient satisfaction. Patients with virtually all Fitzpatrick skin types could be safely treated using a wide spectrum of wavelengths and a broad array of skin conditions, and aging could be addressed. Although safety studies have been reported for ablative CO2 and erbium lasers, surprisingly few data are available on adverse events and complications associated with fractional lasers. OBJECTIVE: We report the frequency of adverse events, skin improvement and complications in a broad range of skin types using a standardized protocol that can be safely tailored to the patient's presenting complaints by varying the laser wavelength and number of treatments. MATERIALS AND METHODS: The medical records of 730 patients (>90% females, age ranged from 50.5. to 59.9 years.) who had been treated at FACES+ Aesthetic Facility were reviewed. Patients were followed from 1 to 10 months and were reviewed to determine the frequency of complications, as well as their frequency, type, cause, treatment and resolution thereof. Patients were categorized by Fitzpatrick skin type (I-IV) to determine whether skin type was related to the frequency of complications. Improvement in skin condition (wrinkles, nasolabial folds and pigment) was rated by a technician before and after treatment using a Likert scale, 0-5, with 0 being no change and 5 being the most improvement. RESULTS: Seven hundred thirty patients underwent procedures using fractional lasers in our center. Procedures were carried out with 3 different laser wavelengths, depending on the condition(s) treated (wrinkling vs. pigmentation issues, etc.) and the patients' desired length of downtime. The fractional Fraxel 1927-nm laser was used in 224 patients [Fitzpatrick skin type I (2.2%), II (38.4%), III (46.0%), IV (12.5%)]; the fractional Fraxel 1550-nm laser was used in 334 [type I (4.5%), II (31.9%), III (50.0%), IV (13.3%)], and the fractional Fraxel CO2 laser was used in 172 [type 1 (4.7%), II (49.7%), III (41.5%), IV (4.1%)]. The Fraxel CO2 laser showed greater improvement in wrinkles and naso-labial fold (p < 0.001). The greatest improvement in pigmentation was seen with the Fraxel 1927-nm laser (p < 0.001). Adverse events and complications occurred in 31 of 730 patients (4.2%). There was no significant difference in the rate of complications among the three treatments (p = 0.26). Complications were generally minor, and all resolved completely with treatment. Complications occurred in 4.0% of patients having the fractional Fraxel 1927-nm laser, 3.3% of patients having the fractional Fraxel 1550 nm and 6.4% of patients having the fractional Fraxel CO2 laser. Complications included 5 herpes simplex virus breakouts, 13 acne eruptions, 1 abrasion, 1 bacterial infection, 9 dermatitis, 1 drug eruption, 4 prolonged erythema, 1 hyperpigmentation, 1 increased swelling and 1 telangiectasia. There was no significant relationship between Fitzpatrick skin type and incidence of complications (p = 0.37). CONCLUSIONS: Fractional lasers in general have reduced complication rates, while maintaining high degrees of patient satisfaction. Since their inception in early 2004, our clinic has utilized fractional lasers to treat patients from a variety of ethnic backgrounds and diverse skin types with an overall complication rate of 4.2%, all of which resolved. Comprehensive care of patients with facial aging is not limited to surgery alone and should include these types of strategies to appropriately and safely address photo-damage and photo-aging. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .