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BACKGROUND: An intense pulsed light (IPL) narrowband "KTP/PDL-like" filter (525–585 nm) may combine the tolerability of the IPL with the precision of KTP and PDL lasers. This study evaluated the impact of IPL with a KTP/PDL-like filter on telangiectasias. METHODS: This was a single-center, prospective study of 17 subjects with facial telangiectasias and skin types I–III. Three monthly treatments were performed using this specific filter, with follow-up visits at 1, 3, and 6 months. Telangiectasia improvement was assessed by the investigator and subjects using a 5-point scale. Facial photographs and safety assessments were obtained at each visit. Subject discomfort was evaluated using a visual analog scale (VAS) immediately posttreatment, and subject downtime was recorded at each subsequent visit. RESULTS: All facial telangiectasias significantly improved. At 1-month follow-up, >50% lesion clearance was noted in 97.1% of facial (n=36) and 85.7% of non-facial (n=7) lesions, with 73% of subjects satisfied or very satisfied. An increase in mean social downtime (0, 2.3, and 3 days) and VAS scores (3.5, 4.5, and 4.8) with treatments 1, 2, and 3, respectively, mirrored a stepwise increase in fluence with subsequent sessions. CONCLUSIONS: The use of a novel IPL narrowband KTP/PDL-like filter can significantly improve facial and non-facial telangiectasias with minimal downtime. J Drugs Dermatol. 2020;19(9):844-850. doi:10.36849/JDD.2020.4834.
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Dermatoses Faciais/terapia , Dor/diagnóstico , Fototerapia/instrumentação , Dermatopatias Vasculares/terapia , Telangiectasia/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dermatoses Faciais/diagnóstico , Feminino , Seguimentos , Humanos , Luz/efeitos adversos , Pessoa de Meia-Idade , Dor/etiologia , Medição da Dor , Satisfação do Paciente/estatística & dados numéricos , Fotografação , Fototerapia/efeitos adversos , Fototerapia/métodos , Estudos Prospectivos , Pele/irrigação sanguínea , Pele/diagnóstico por imagem , Pele/efeitos da radiação , Dermatopatias Vasculares/diagnóstico , Telangiectasia/diagnóstico , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Optical energy-based devices, including intense pulsed light (IPL) and potassium titanyl phosphate (KTP) lasers achieve reduction of pigmented and vascular lesions in a relatively similar number of treatments. This study aimed to evaluate the efficacy and safety of an IPL with a "KTP-like" filter emitting a wavelength of 525-585 nm for the treatment of solar lentigines on the hands and face. METHODS: This was a single center, prospective, open-label clinical trial including 16 healthy Caucasian subjects (15 females, mean age, 55 years; skin types II and III) with hand and facial solar lentigines. Subjects were treated with three IPL treatment sessions with a KTP-like filter conducted at monthly intervals. Follow-up evaluations were performed 1, 3, and 6 months after the last treatment session. Overall pigmentation improvement, pigmentation clearance per lesion, adverse events, and subject tolerability to treatment were evaluated. RESULTS: Significant improvements in facial and hand pigmentation were noted at all follow-up visits (P < 0.0001). One month after the last treatment session, good to excellent outcomes were noted in 74.6% of treated facial areas and 90% of treated hand regions. Although the effect of treatment gradually declined in both treatment regions over the 6-month follow-up period, over 60% of subjects demonstrated good to excellent results at the study end. Clinical effectiveness was further confirmed by the reduction in Melanin Index (MI) following each treatment as compared to baseline. Downtime and complications were minimal. CONCLUSIONS: IPL treatment with a KTP-like filter is a well-tolerated and effective method for reducing facial and hand pigmentation. Lasers Surg. Med. 51:500-508, 2019. © 2019 Wiley Periodicals, Inc.
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Terapia de Luz Pulsada Intensa/instrumentação , Lasers de Estado Sólido/uso terapêutico , Lentigo/terapia , Envelhecimento da Pele , Adulto , Idoso , Feminino , Seguimentos , Humanos , Lentigo/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Photodamaged skin of the chest is characterized by skin laxity, lines/wrinkles, hyperpigmentation, erythema, tactile roughness, atrophy, and telangiectasias. METHODS: A MEDLINE search was performed on combination treatments in chest rejuvenation, and the results are summarized. Practical applications for these combinations of procedures are discussed. RESULTS: Reports of injectable poly-L-lactic acid (PLLA), hyaluronic acid (HA), and chemical peels, along with lasers and light therapies such as intense pulsed light (IPL), vascular lasers, photodynamic therapy (PDT), nonablative fractionated lasers (NAFLs), ablative fractionated lasers (AFLs), and microfocused ultrasound (MFU) have been reported for chest rejuvenation. Few articles were discovered pertaining to combination therapy. The authors review their approaches to combination therapy. CONCLUSION: Multiple options exist alone or in combination for minimally invasive rejuvenation of the skin of the chest including PLLA, HA, chemical peels, IPL, vascular lasers, PDT, NAFL, AFL, and MFU. Little was found in the literature pertaining to the safety and efficacy of combining such procedures and devices. The authors' experience in clinical practice is that combination, same day chest rejuvenation techniques can be performed safely. A combination approach often produces the most optimal outcome for the patient seeking chest rejuvenation.
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Hiperpigmentação/terapia , Rejuvenescimento , Envelhecimento da Pele , Terapia Combinada , Preenchedores Dérmicos/uso terapêutico , Eritema/terapia , Humanos , Terapia de Luz Pulsada Intensa , Ceratose Actínica/terapia , Terapia a Laser , Pescoço , Fotoquimioterapia , Ombro , Telangiectasia/terapia , TóraxAssuntos
Fármacos Dermatológicos/efeitos adversos , Durapatita/efeitos adversos , Ácido Hialurônico/efeitos adversos , Oxigenoterapia Hiperbárica , Pele/patologia , Adulto , Bochecha , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sulco Nasogeniano , Necrose/induzido quimicamente , Necrose/terapiaRESUMO
BACKGROUND: Sixty-three subjects' legs were randomized to receive treatment with polidocanol (POL) or hypertonic saline (HS) for telangiectasias and reticular leg veins. OBJECTIVE: To compare the safety and efficacy of two sclerosing agents in three dermatologic surgery practices. METHODS: After exclusion of saphenofemoral junction incompetence, each subject's veins were categorized (telangiectasias <1 mm and reticular veins 1-3 mm) and randomized. Telangiectasias were treated with POL 0.5% or 11.7% HS and reticular veins with POL 1% or 23.4% HS. An independent, blinded physician determined efficacy and adverse events. Subject satisfaction questionnaires were administered and global clinical improvement assessments performed. RESULTS: All patients completed four visits at 0, 1, 4, and 12 weeks. Patients reported significantly greater pain during treatment with HS (2.42) than POL (1.03) (p < .001). There were no significant differences in physician-assessed improvement of reticular leg veins or telangiectasias; subject- or physician-assessed overall improvement; or physician-assessed phlebitis, pigmentation, edema, or matting in either of the three practices or the entire cohort. Two subjects developed ulcerations with HS. No ulcerations or allergic reactions developed after POL injections. CONCLUSION: Both agents provided effective treatment, but HS caused 2.35 times as much pain during injections and resulted in two episodes of tissue necrosis.
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Perna (Membro)/irrigação sanguínea , Polietilenoglicóis/uso terapêutico , Solução Salina Hipertônica/uso terapêutico , Soluções Esclerosantes/uso terapêutico , Escleroterapia , Telangiectasia/terapia , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polidocanol , Telangiectasia/patologia , Veias/patologiaRESUMO
BACKGROUND: Coagulation parameters have not been investigated when foam sclerotherapy is used to treat reticular leg veins. OBJECTIVE: To evaluate the effect of foam bubbles on coagulation and fibrinolysis by measuring platelet count and concentrations of clotting factors and fibrinogen after foam sclerotherapy with sodium tetradecyl sulfate (STS) mixed with room air. MATERIALS AND METHODS: Patients with reticular veins received treatment with up to 30 mL of foam sclerotherapy prepared with STS and room air in a 1:4 ratio (1 mL STS, 4 mL room air) using the double-syringe technique. Venous blood was drawn immediately beforesclerotherapy and 15 minutes after the procedure. Pre- and post-treatment laboratory values were compared. RESULTS: Subjects treated with up to 30 mL of foam (30 mL foam = 6 mL sclerosing solution and 24 mL air) showed no statistically significant difference in coagulation or fibrinolysis, as measured according to platelet count and concentrations of clotting factors and fibrinogen, after foam sclerotherapy with STS mixed with room air. CONCLUSION: STS foam made with room air, up to 30 mL, when injected into reticular veins does not affect coagulation parameters.
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Fibrinólise , Perna (Membro)/irrigação sanguínea , Soluções Esclerosantes/uso terapêutico , Escleroterapia/métodos , Tetradecilsulfato de Sódio/uso terapêutico , Varizes/terapia , Adulto , Idoso , Fatores de Coagulação Sanguínea/análise , Feminino , Fibrinogênio/análise , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Resultado do TratamentoRESUMO
BACKGROUND: Options for acne scar reduction include peels, subcision, fillers, lasers, dermabrasion, and surgical excision, although not all are applicable in darker skin types. A novel device with a handpiece combining optical and radiofrequency (RF) energies along with a fractionated RF handpiece is available for nonablative resurfacing. OBJECTIVES: Our primary objective was to evaluate the improvement in acne scars and skin texture. Secondary objectives were determination of patient satisfaction and comfort and evaluation of scar pigmentation improvement. Patients received five treatments at 30-day intervals. Post-treatment follow-up visits were performed 30 and 90 days after the last treatment. RESULTS: A 72.3% decrease (p<.001) was observed on the acne scar scale from day 1 to 210. From day 30 to 210, investigator-rated changes in scarring, texture, and pigmentation improved 68.2% (p<.001), 66.7% (p<.001), and 13.3% (p=.05), respectively. Patient satisfaction scores showed no significant change over time, although patient-evaluated overall improved scores increased 60% over baseline (p=.02). CONCLUSION: This technology may be a useful, nonablative resurfacing treatment for acne scarring. Scarring, texture, and pigmentation improved significantly according to investigator-rated assessment parameters. Although patient satisfaction scores did not improve, overall improvement scores did.
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Acne Vulgar/complicações , Cicatriz/etiologia , Cicatriz/cirurgia , Terapia a Laser/métodos , Ondas de Rádio , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Transtornos da Pigmentação/etiologia , Transtornos da Pigmentação/cirurgia , Estudos Prospectivos , Resultado do TratamentoRESUMO
Cellulite affects all races, and it is estimated that 85% of women older than 20 years have some degree of cellulite. Many currently accepted cellulite therapies target deficiencies in lymphatic drainage and microvascular circulation. Devices using radiofrequency, laser, and light-based energies, alone or in combination and coupled frequently with tissue manipulation, are available for improving cellulite. Laser assisted liposuction may improve cellulite appearance. Although improvement using these devices is temporary, it may last several months. Patients who want smoother skin with less visible cellulite can undergo a series of treatments and then return for additional treatments as necessary.
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Tecido Adiposo/efeitos da radiação , Terapia a Laser , Lipodistrofia/terapia , Adipócitos , Tecido Adiposo/fisiopatologia , Desenho de Equipamento , Humanos , Terapia a Laser/instrumentação , Lipectomia/instrumentação , Lipectomia/métodos , Obesidade/fisiopatologia , Tela Subcutânea/diagnóstico por imagem , UltrassonografiaRESUMO
BACKGROUND: Fractionated carbon dioxide CO(2) laser resurfacing unites the idea of fractional photothermolysis with an ablative 10,600-nm wavelength. This technology permits effective treatment of deeper rhytides, photodamaged skin, and scars, with shorter recovery and a decreased side effect profile as compared to traditional CO(2) laser resurfacing. OBJECTIVES: To study the rate of the adverse events associated with the use of deep fractional CO(2) laser. METHODS: A retrospective study of 490 fractionated CO(2) laser treatments in 374 patients by ten physicians within one practice was performed between March 3, 2008 and July 28, 2010. Treatment areas included the face, neck, chest, hands, back, and abdomen. RESULTS: Of the 490 treatments, 365 were of both superficial and deep fractional treatments while 125 treatments were deep. Patients treated were of Fitzpatrick skin types I-IV. Four hundred ninety treatments resulted in 67 adverse events (13.6%) in 63 patients (16.8%), the most frequent adverse events were acneiform eruption (5.3%), herpes simplex outbreak (2.2%), bacterial infections (1.8%), yeast infections (1.2%), hyperpigmentation (1.2%), prolonged erythema beyond 1 month (0.8%), and (0.8%) contact dermatitis. There were no reports of scarring or hypopigmentation. CONCLUSIONS: Fractional deep CO(2) laser is a safe method for treating rhytides, photodamaged skin, and scars with a low incidence of adverse events.
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Técnicas Cosméticas/efeitos adversos , Terapia a Laser/efeitos adversos , Terapia a Laser/métodos , Lasers de Gás/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
BACKGROUND: Numerous studies on cosmetic uses of the two major forms of botulinum type A toxin-onabotulinumtoxinA and abobotulinumtoxinA--have been reported, but there is a lack of published, non-industry-funded data regarding efficacy and patient satisfaction with abobotulinumtoxinA. OBJECTIVES To evaluate the efficacy of and patient satisfaction with abobotulinumtoxinA injections. METHODS: Retrospective, two-phase study of 185 patients treated with abobotulinumtoxinA for dynamic facial rhytid reduction over an 8-month period. Data were gathered using chart review and patient follow-up. RESULTS: The average total amount of abobotulinumtoxinA injected per visit was similar in each phase (93.7 U in phase I, which used a ratio of 2.5 abobotulinumtoxinA units to 1 onabotulinumtoxinA unit, and 99.6 U in phase II, which used a ratio of 3:1). Of patients with a history of onabotulinumtoxinA injections (89.1% in phase I and 91% in phase II), the majority preferred onabotulinumtoxinA. A similar percentage in each group reported overall satisfaction with abobotulinumtoxinA (70.9% in phase I and 68% in phase II). CONCLUSION: Although generally satisfied with abobotulinumtoxinA, when given a choice between abobotulinumtoxinA and onabotulinumtoxinA, the majority of patients favored the latter. This preference remained even after the dilution of abobotulinumtoxinA was decreased.
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Toxinas Botulínicas Tipo A/administração & dosagem , Fármacos Neuromusculares/administração & dosagem , Satisfação do Paciente , Envelhecimento da Pele , Face , Humanos , Injeções , Resultado do TratamentoRESUMO
BACKGROUND: Photo-damaged skin of the chest is characterized by skin laxity, lines and wrinkles, hyperpigmentation, erythema, tactile roughness, atrophy, and telangiectasias. STUDY DESIGN: A Medline search was performed on rejuvenation of the chest from 1960 to 2010. Practical applications to these procedures are also provided. RESULTS: Chest-based reports of injectable poly-L-lactic acid (PLLA), botulinum toxin, sclerotherapy, and chemical peels, along with lasers and light therapies such as intense pulsed light (IPL), photodynamic therapy (PDT), nonablative fractionated lasers, and ablative fractionated lasers were identified. CONCLUSION: Review of the literature revealed that options for minimally invasive treatment options for rejuvenation of the skin of the chest include injectable PLLA, botulinum toxin, sclerotherapy, and chemical peels, along with lasers and light therapies such as IPL, PDT, and nonablative fractionated lasers. For more dramatic results, ablative fractional lasers can be safely used, although longer healing times and potential adverse effects are to be expected. Adverse events are often due to the thinness of the dermis and epidermis and the lower concentration of pilosebaceous units. If treatments are tailored to the skin of the chest, the incidence of adverse events is lower, and patients can be safely treated.
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Técnicas Cosméticas , Rejuvenescimento , Envelhecimento da Pele , Tórax , Atrofia , Humanos , Hiperpigmentação/terapia , Telangiectasia/terapia , Raios Ultravioleta/efeitos adversosRESUMO
BACKGROUND: Foam sclerotherapy is an increasingly popular modality in varicose vein treatment. Our previous work showed that the half-life of room air foam varied according to the percentage and type of sclerosant solution. MATERIALS AND METHODS: A plastic connector was used to create foam made from a combination of 0.25%, 0.50%, and 1% sodium tetradecyl sulfate (STS) and room air, carbon dioxide (CO(2)), oxygen (O(2)), or a mixture of CO(2) and O(2). To measure foam stability, the foam half-life was defined as the time it took for half the original volume of sclerosing solution to settle. RESULTS: Half-life varied according to sclerosant concentration when room air, O(2), or a mixture of CO(2) and O(2) was used for foam creation but not when CO(2) was used. Room air foam is more than 3 times as stable as CO(2) foam and 1.5 times as stable as a mixture of CO(2) and O(2). CONCLUSIONS: CO(2) foam half-life did not vary according to sclerosant solution concentration, though room air, O(2) , and CO(2)/O(2) did. The half-life of room air foam is more than 3 times as long as that of CO(2) and 1.5 times as long as that of a mixture of CO(2) and O(2). Foam half-life for room air and O(2) are similar at low concentrations of STS but differ at higher concentrations.
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Dióxido de Carbono/química , Oxigênio/química , Soluções Esclerosantes/química , Escleroterapia/instrumentação , Varizes/terapia , Dióxido de Carbono/administração & dosagem , Formas de Dosagem , Estabilidade de Medicamentos , Meia-Vida , Humanos , Oxigênio/administração & dosagem , Soluções Esclerosantes/administração & dosagem , SeringasAssuntos
Neoplasias Palpebrais/cirurgia , Hemangioma/cirurgia , Terapia a Laser , Criança , Humanos , Fatores de TempoRESUMO
In order to examine the efficacy and side effects of the monoclonal antibody anti-CD20 (rituximab) on autoimmune blistering skin diseases, we performed a comprehensive survey of 71 consecutive patients from initial use up to 2007, using the PubMed database. A heterogeneous group of patients, including 51 patients with pemphigus vulgaris, one with pemphigus vegetans, nine with pemphigus foliaceus, five with paraneoplastic pemphigus, four with epidermolysis bullosa acquisita, and one with both bullous pemphigoid and graft vs host disease was included in this survey. Overall the monoclonal antibody seems to be effective in that 69% of patients showed complete response, 25% of patients showed partial response, whereas 6% of patients showed progressive disease. Six deaths occurred in association with the treatment, with four of these deaths in patients with paraneoplastic pemphigus, a disease characteristically resistant to conventional medication and with a high mortality rate. Of note, 11 patients who received combined rituximab and intravenous immune globulin treatments had the best outcome: complete response without any serious side effects. Therefore further investigation on rituximab with controlled clinical trial is a worthy pursuit.
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The role angiogenesis plays in atopic dermatitis is not well understood. The authors previously demonstrated ultrastructurally dermal microvascular angiogenesis in the IL-4-transgenic mouse model of atopic dermatitis. Here, they determine the angiogenic factors involved in dermal microvascular angiogenesis, regulatory function of inflammatory cytokines on the VEGF-A production, and microvascular permeability in this model. Computer-assisted photometric analyses for immunofluorescence-labeled CD31 demonstrated a progressive increase in blood vessel number, diameter, and percent dermal areas occupied by CD31(+) vessels as the disease evolves in transgenic mice from before disease onset through early and late skin lesions. Similar findings were documented for VEGR2(+) vessels. Quantification of skin angiogenic factor mRNAs showed progressive increase of transcripts of VEGF-A, but not VEGF-B, VEGF-C, or VEGF-D. ELISA showed a similar increase of VEGF-A in the serum and skin of transgenic mice. IL-6 and IFN-gamma stimulated VEGF-A mRNA production in the skin and in primary keratinocytes of transgenic mice. Other skin angiogenic factors that increased included Ang-1, Ang-2, GBP-1, and VE-cadherin. Microvascular leakage began in the transgenic mouse skin before disease onset and peaked in the late stage. In conclusion, IL-6 and IFN-gamma may play important roles in upregulation of VEGF-A, along with other pro-angiogenic factors, to induce dermal microvascular angiogenesis.
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Dermatite Atópica/fisiopatologia , Derme/irrigação sanguínea , Interleucina-4/genética , Queratina-14/genética , Neovascularização Patológica/fisiopatologia , Angiotensina I/metabolismo , Angiotensina II/metabolismo , Animais , Antígenos CD/metabolismo , Caderinas/metabolismo , Células Cultivadas , Dermatite Atópica/imunologia , Dermatite Atópica/metabolismo , Derme/citologia , Derme/fisiologia , Modelos Animais de Doenças , Proteínas de Ligação ao GTP/metabolismo , Interferon gama/metabolismo , Interleucina-4/metabolismo , Interleucina-6/metabolismo , Queratina-14/metabolismo , Queratinócitos/citologia , Camundongos , Camundongos Transgênicos , Microcirculação/fisiologia , Neovascularização Patológica/imunologia , Neovascularização Patológica/metabolismo , Regulação para Cima/imunologia , Fator A de Crescimento do Endotélio Vascular/metabolismoRESUMO
BACKGROUND: Pemphigus foliaceus is an autoimmune blistering disorder that affects the skin owing to autoantibodies against desmoglein 1. METHODS: We employed clinical, histologic, immunopathologic, and serum laboratory studies to investigate a case of an erythrodermic variant of pemphigus foliaceus in an elderly man following treatment with bisoprolol-hydrochlorothiazide. RESULTS: Early histopathology revealed psoriasiform dermatitis, but later biopsies showed subcorneal and granular layer separation with neutrophilic infiltrate. Direct immunofluorescence showed intercellular deposits of immunoglobulin G throughout the epidermis, granular staining of C3 along the basement membrane zone, and fibrin and C3 deposition around the blood vessels. Indirect immunofluorescence on monkey esophagus showed a titer of greater than 1:1,280. Indirect immunofluorescence on rat bladder, antinuclear antibody, lupus panel, and kidney function panel were all negative. CONCLUSION: There are no reports in the literature of pemphigus foliaceus being induced by bisoprolol, but reports exist of propanolol resulting in drug-induced pemphigus foliaceus.