Efficacy and safety of fractional microneedle radiofrequency for atrophic acne scars: A real-world clinical study of 126 patients.

OBJECTIVE: To analyze the clinical efficacy and safety of fractional microneedle radiofrequency (FMR) for facial atrophic acne scars in a real-world setting. METHODS: The clinical data of patients with atrophic acne scars who had received FMR therapy from February 2018 to August 2022 were retrospectively analyzed. The improvement of atrophic acne scars was assessed using the ECCA Grading Scale (échelle d'évaluation clinique des cicatrices d'acné), Global Aesthetic Improvement Scale (GAIS), and modified Manchester Scar Scale (mMSS). Adverse reactions during FMR treatment were also recorded. Univariate and multivariate logistic regression analyses were performed to evaluate the efficacy and safety of FMR for atrophic acne scars. RESULTS: A total of 126 patients with facial atrophic acne scars were included. A total of 590 FMR treatment sessions were accomplished, with each of 82 patients receiving 4 or more treatment sessions, and 1 receiving a maximum of 14 sessions. All patients showed improvement in symptoms after FMR treatment, with moderate to significant improvement (ECCA score reduction of 26%-100%) in 92 (73.0%) patients. As the number of treatment sessions increased, the ECCA score gradually decreased from an average of 85.6 before to 35.0 after FMR. The average scores for distortion, color, and visual analogue scale (VAS) of mMSS all showed certain reductions. The change in GAIS score indicated improvement after treatment, with minimal improvement in 16 patients (12.7%), good improvement in 57 patients (45.2%), significant improvement in 45 patients (35.7%), and optimal improvement in 8 patients (6.4%). The univariate and multivariate logistic regression analyses revealed that the long pulse width and the number of FMR treatment sessions were positively associated with clinical efficacy. Compared to the short pulse-width group (200 ms), the longer pulse-width group (300 ms) (odds ratio [OR] = 8.3, p = 0.003) and the even longer pulse-width group (400-500 ms) (OR = 52.6, p < 0.001) demonstrated stronger efficacies. Patients who received more than three treatment sessions had better outcomes compared to those who received three or fewer treatment sessions (OR = 4.0, p = 0.036). All patients experienced posttreatment transient erythema, but no crusting, infection, or blister. Six cases developed grid-like erythema around 1 month posttreatment and one case experienced hyperpigmentation, both of which resolved within 1-3 months after appropriate management. CONCLUSION: FMR is a safe and effective treatment modality for improving facial atrophic acne scars, and the number of FMR treatment sessions and pulse width are associated with clinical efficacy.

Expert consensus on perioperative integrated skincare for noninvasive energy-based device aesthetic procedures in clinical practice in China.

BACKGROUND: Noninvasive energy-based device (NI-EBD) aesthetic procedures has recently gained widespread usage for treating various skin conditions, enhancing skin texture and performing rejuvenation-related procedures. However, practically all NI-EBD procedures result in variable degrees of damage to the skin barrier, inducing pathological and physiological processes such as oxidative stress and inflammation, and only a small percentage of individuals possess the innate ability to restore it. OBJECTIVE: To introduce the concept of integrated skincare and establish standardized operational procedures for perioperative integrated skincare, and furnish a theoretical basis for clinical diagnosis and treatment performed by professional medical aestheticians. METHODS: The author leveraged domestic and international guidelines, clinical practice expertise and evidence-based research, adapting them to suit the specific circumstances in China. RESULTS: The consensus were provided four parts, including concept and essence of integrated skincare, integrated skincare significance during the perioperative phase of NI-EBD procedures, active ingredients and functions of effective skincare products, standardized perioperative skincare procedure for NI-EBD procedures and precautions. For the standardized perioperative skincare procedure, four recommendations were listed according to different stages during NI-EBD procedures. CONCLUSION: These recommendations create the 'Expert Consensus on Perioperative Integrated Skincare for Noninvasive Energy-Based Device Aesthetic Procedures in Clinical Practice in China'.

A dose-finding study for hemoporfin in photodynamic therapy for port-wine stain: A multicenter randomized double-blind phase IIb trial.

BACKGROUND/PURPOSE: Previous studies have shown that hemoporfin-mediated photodynamic therapy (PDT) was a treatment for port-wine stain (PWS). Our current study aimed to identify optimal hemoporfin dose. METHODS: A prospective, multicenter, double-blind, randomized clinical trial was conducted. Patients were assigned into low- or high-dose hemoporfin (2.5 mg/kg and 5 mg/kg intravenously, respectively), or control (placebo) group, at a rate of 2:2:1. Treatment efficacy was evaluated at week 8. Then, patients in control group were randomly assigned into either high- or low-dose hemoporfin group. Treatment reactions and adverse events were analyzed at week 16. RESULTS: A total of 100 patients (40, 40, 20 in low-, high-dose hemoporfin, and control group, respectively) were enrolled. Compared to low dose (40%) and control group (15%), a higher proportion of patients in high-dose group (75%) had achieved skin lesion improvements. Treatment satisfactions were graded highest in high-dose group. Compared to low-dose group (14.3%), high-dose group (46.0%) had more frequent skin hyperpigmentation, which disappeared 3-6 months after treatment. Other treatment reactions and adverse events were comparable between two groups. CONCLUSIONS: Photodynamic therapy with 5 mg/kg hemoporfin could be an effective and safe treatment for PWS.

Efficacy and safety of hemoporfin in photodynamic therapy for port-wine stain: a multicenter and open-labeled phase IIa study.

BACKGROUND/PURPOSE: This phase IIa study aimed to study the efficacy and safety of hemoporfin in photodynamic therapy (PDT) with a 532 nm continuous laser for port-wine stain (PWS). METHODS: In this 8-week open-labeled study in three centers, three different laser exposure times (532 nm continuous laser for 20, 30 and 40 min) were used in stage I, group A, stage II, group B and stage III, group C, respectively. Primary efficacy assessment was performed by an independent group of experts, who reviewed the standardized photos. Secondary efficacy assessment consisted of the subjective grading of the PWS fading by the investigators and the patients. Treatment reactions and adverse events (AE) were recorded separately. RESULTS: Forty patients were initially enrolled in the study, but stage III had to be cancelled eventually for the safety of the patients. Patients in groups A and B showed similar satisfactory results in efficacy assessments, the total 'response' rate being 80.0% and 94.7% in groups A and B, respectively. The AE rates were also similar in the two groups. Self-limiting photosensitive dermatitis and hyperpigmentation were the most frequently observed AE. CONCLUSION: Hemoporfin-PDT is effective and safe for patients with PWS aged 16-50.

The effects of 595- and 1,064-nm lasers on rooster comb blood vessels using dual-wavelength and multipulse techniques.

BACKGROUND AND OBJECTIVE: After laser irradiation, hemoglobin can transform into methemoglobin and coagulum, which have high absorptivity of near-infrared light. Sequential irradiation with 595 nm and 1,064 nm may be more effective than single wavelength to decrease residual vessel number in rooster combs. METHODS: Six protocols (single pulse with 595 nm, double pulse with 595 nm, single pulse with 1,064 nm, double pulse with 1,064 nm, sequential irradiation with 595 nm and 1,064 nm (multiplex), and a blank control group) were used to compare the effects of sequential and single-wavelength irradiation on reducing residual vessel number, as well as the epidermal side effects, in the rooster comb. Different treatment techniques were applied to the same comb, at the same time. The treated areas of the epidermis and the residual vessels were observed using an optical microscope. RESULTS: All five techniques were effective in decreasing the number of residual vessels in the comb, and the side effects on the epidermis were similar for all. CONCLUSION: Considering the selectivity of the 595-nm laser and the rich melanin in the human epidermis, the dual-wavelength laser has a distinct advantage in treating vascular lesions. The authors have indicated no significant interest with commercial supporters.

Hair removal utilizing the LightSheer Duet HS hand piece and the LightSheer ET: a comparative study of two diode laser systems in Chinese women.

OBJECTIVE: To compare the clinical efficacy, safety and pain associated with the use of the LightSheer Duet HS as compared to the original LightSheer ET diode Laser for axillae hair removal in Chinese women. METHODS: Thirty-six Chinese women received three axillae laser hair removal treatments using the LightSheer Duet HS on one side and the LightSheer ET on the other side. Subjects were evaluated for hair removal efficiency. The immediate pain associated with the treatments was noted. RESULTS: At 1 month following the final laser treatment, hair reduction on the LightSheer Duet HS side and on the LightSheer ET side was 81 ± 13% and 85 ± 9% respectively. There was no statistical difference. Immediate pain scores at the first session on the LightSheer Duet HS sites and LightSheer ET sites was 5.71 ± 1.74 and 6.86 ± 1.80 respectively, which was statistically significant (p < 0.05). Following the second and third sessions, immediate pain scores of the LightSheer Duet HS sites were both less than those of the LightSheer ET sites, but the differences were not statistically significant. CONCLUSIONS: The LightSheer Duet HS laser is a safe and effective method of hair removal in Chinese women. Treatment with the LightSheer Duet HS causes less pain.

An efficacy comparison of hair removal utilizing a diode laser and an Nd:YAG laser system in Chinese women.

BACKGROUND: The 800 nm diode laser and the 1064 nm Nd:YAG laser have been used successfully for hair removal for many years. OBJECTIVE: To compare the efficacy of a diode laser with a Nd:YAG laser regarding axillary fossa hair removal in Chinese women. METHODS: Twenty-nine Chinese women underwent three treatment sessions at 4-week intervals with a diode laser (34-38 J/cm(2)) on one side and a Nd:YAG laser (34-40 J/cm(2)) on the other side. Assessments included the reduction of hair diameter following treatment, the regrowth rate in hair length, total hair reduction and the immediate pain associated with the treatments. RESULTS: At follow-up visit number 1 (4 weeks after the first session), the average reduction in hair diameter on the diode laser side and the Nd:YAG laser side was 2.44 µm and -0.6 µm, respectively. The regrowth rates of the hair were 61.93 µm/day and 59.84 µm/day, respectively, which were not statistically significant (p > 0.05). At follow-up visit number 1, hair reduction was 60.09% and 41.44%, respectively. At follow-up visit number 2 (4 weeks after the second session), hair reduction was noted to be 78.56% and 64.50%, respectively, which were both statistically significant (p < 0.05). Immediate pain scores at the first session were 6.97 and 6.17, respectively; at the second session were 5.48 and 6.69, respectively; and at the third session were 5.76 and 7.45, respectively; all statistically significant (p < 0.05). CONCLUSIONS: The diode laser showed more efficacy and was found to be more comfortable than the Nd:YAG laser for axillary fossa hair removal in Chinese women.

Eczematous dermatitis after vascular laser therapy: a report of two cases.

Eczematous dermatitis was found in two port wine stain (PWS) lesions in two different individuals following variable pulsed 532-nm laser therapy. Both of the individuals described in this report had received low-dose superficial X-ray several years prior to the development of the eczematous dermatitis. The eczematous dermatitis in the PWS lesions was characterized by oozing, crusting, and pruritus, which showed a tendency to expand to other sites when exacerbated. Treatment with topical corticosteroid ointments produced some temporary improvement, but the dermatitis in both cases recurred when the topical medications were stopped. The mechanism of action for the development of an eczematous dermatitis in a PWS remains unclear, but may be related to multiple factors including abnormal hemodynamic forces resulting from the malformed vessels, an abnormal production of cytokines, local pathophysiological and immunological changes resulting from either the X-ray therapy or the laser therapy, and atopic constitution inherent in these individuals. These hypotheses and ideas need further study for additional insight into this rare, but reported adverse event.

Clinical analysis of port wine stains treated by intense pulsed light.

BACKGROUND: Port wine stains (PWS) are formed by dilation and malformation of dermal capillaries without endothelium proliferation. Despite the improvements in lasers and light therapy for PWS therapy in the past 10 years, the 'cure' rate is only about 10%. Intense pulsed light (IPL) is a non-coherent light based on the theory of selective photothermolysis. OBJECTIVE: To evaluate the efficacy of a new IPL on PWS. METHODS: Seventy-two patients with PWS treated with an IPL with synchronous cooling were retrospectively analyzed. According to AQ1: sentence re-punctuated in places. Please check through and confirm correct the Fitzpatrick skin type, color, location of the lesion, and treatment reaction, light filters of 560 nm 590 nmor 640 nm were used with a single pulse with a pulse width of 6-14 ms and a fluence of 16-29 J/cm2; a double pulse with a pulse width of 3.5-4.0 ms, a pulse delay of 20-30 ms, and a fluence of 17-23 J/cm2; or a triple pulse with a pulse width of 3.0-4.0 ms, a pulse delay of 20-40 ms, and a fluence of 18-22 J/cm2. The adverse effects and the relationships among the lesion type, treatments, ages and location were analyzed. RESULTS: Most of the PWS lesions faded significantly and the response rate in this series was 76.4%. Patients resistant to other forms of therapy also showed good clinical results. Adult lesions were easier to remove than those in younger individuals. Further improvement did not occur after three treatments. We failed to find any relationship between efficacy and location of the PWS. CONCLUSION: The IPL treatment modality is safe and efficient for the treatment of PWS and for those which may be resistant to other therapies. The IPL is an alternative method for most PWS lesions.

Comparison of a single treatment with Q-switched ruby laser and Q-switched Nd:YAG laser in removing black-blue Chinese tattoos.

BACKGROUND: Black and blue are two popular colors in Chinese tattooing. Two Q-switched lasers, ruby and Nd:YAG, are effective for tattoo removal. No reference with regard to a comparison of the effects and adverse reactions in Chinese individuals has been made in the literature. OBJECTIVE: To compare a single treatment of black-blue tattoos with the Q-switched ruby laser and Q-switched Nd:YAG (1064 nm) laser. METHODS: A total of 35 Chinese patients with black-blue tattoos at the laser center of the Institute of Dermatology, Chinese Academy of Medical Sciences were enrolled into a self-control study. Tattoos were split into two parts or two nearby tattoos on the same body part were used; one side was treated with the Q-switched ruby laser and the other with the Q-switched Nd:YAG laser. Immediate response, treatment outcome and adverse effects were compared. The statistical significance level was set at p< 0.05. RESULTS: Edema and exudation were more common immediately after ruby laser treatment (p< 0.05). The Q-switched Nd:YAG laser had a significant difference in tattoo lightening versus the Q-switched ruby laser after a single treatment (p<0.05). There was no significant difference in adverse effects between the two lasers. CONCLUSION: The Q-switched Nd:YAG laser is more effective at tattoo lightening for Chinese individuals. Its immediate response after treatment is slighter than the Q-switched ruby laser.

Hair removal using a new intense pulsed light source in Chinese patients.

BACKGROUND: Unwanted hair is a widespread cosmetic problem. Several lasers and intense pulsed light (IPL) have been utilized for this purpose. A new IPL device (Lumenis One) with OPT is one of the newer modalities to be studied in Chinese patients. OBJECTIVE: This study evaluates the short-term efficacy and side effects of the new IPL device for epilation in Chinese patients. METHODS: Eighteen Chinese women with Fitzpatrick skin types III-V and black hair, were treated four times at 4 to 6-week intervals using IPL (Lumenis One) on the axillae (n=13) and the upper lip (n=5). The energy density for treatment ranged from 14 to 22 J/cm(2). Parameters utilized were 695-/755-nm filters, triple pulse for patients on the axillae, and 640-/695-nm filters, double pulse for patients on the upper lip (3.5- to 7-ms pulse, 30- to 90-ms pulse delay, 15x35 mm spot size). Hair reduction was assessed at baseline, immediately before each treatment session, and at 4 weeks after the fourth treatment. Patient's satisfaction on a 5-point scale was also evaluated. RESULTS: The average hair reduction for all sites was 49.9% after one session, 58.6% after two sessions, 79.3% after three sessions, and 83.8% after four sessions (p=0.001). The hair reduction of 44.1%, 52.1%, 81.1%, and 86.0% were achieved after each treatment for axillae, with 65.1%, 75.7%, 74.6%, and 78.0% for upper lip. Patients got more satisfaction after four sessions (score 3.1) than that after two sessions (2.0) (p=0.001). In both the assessments, upper lip appeared to show a better response than axillae after two IPL treatments, which reversed after four treatments. No significant complications or adverse events were reported. CONCLUSION: The new IPL device provides a safe and effective means of hair removal for Chinese patients. Treatment efficacy varies with the anatomic location and number of treatments. However, further study is necessary to determine the long-term clinical efficacy in Chinese patients.

[Photoaging: laser and light-based therapy].

Photoaging is clinical character by dyspigmentations, telangiectacia, and wrinkles. Therefore, the assessment of therapeutic effects of photoaging depends on the management results of these three lesions. This article introduces the effect of laser and light-based therapies on photoaging.

Dynamic changes in nerve growth factor and substance P in the murine hair cycle induced by depilation.

Increasing evidence suggests that various neurotrophins and neuropeptides play an important role in the progression of hair follicle cycling. Among them, nerve growth factor (NGF) and substance P (SP) have attracted special interest recently. However, the interaction between these factors during hair cycling has not yet been systematically studied. We therefore investigated the mutual relationships between NGF and SP and the mechanism by which the anagen stage of the hair cycle is initiated. Fluctuations in numbers of SP-positive nerve fibers and variations in amounts of SP, NGF, and another neurotrophic factor, glial cell-derived neurotrophic factor, in skin in the C57BL/6 mouse depilation-induced hair cycle model, together with the spatiotemporal expression patterns of each of these factors, were followed simultaneously by enzyme-linked immunosorbent assay and immunohistochemistry. The main finding was that a surge in NGF expression and a rapid increase in NGF content in skin is an initial event within 1 day after depilation, followed by elevation of SP content and numbers of SP-containing fibers 2 days after the increase in NGF. Our findings suggest that a rapid and abundant increase in NGF plays a key role in the induction and progression of anagen hair cycling through keratinocyte growth promotion. NGF may also induce plastic changes such as sprouting and hyperplasia in dermal nerve fibers and enhance their SP production. Elevated levels of SP in skin may additionally contribute to the progression of consecutive anagen hair cycles.

Hemoporfin Photodynamic Therapy for Port-Wine Stain: A Randomized Controlled Trial.

BACKGROUND AND OBJECTIVES: Photodynamic therapy (PDT) has shown potentially beneficial results in treating port-wine stain, but its benefit-risk profile remains undefined. This study aimed to evaluate the efficacy and safety of PDT conducted with hemoporfin and a 532 nm continuous wave laser to treat port-wine stain clinically. PATIENTS AND METHODS: This randomized clinical trial was conducted in eight hospitals in China. Participants were adolescent and adult patients (age range: 14-65 years old) with port-wine stain. During stage 1 (day 1 to week 8) all patients were randomized at a 3:1 ratio to treatment (532 nm laser irradiation (96-120 J/cm2) with hemoporfin (5mg/kg; PDT-hemoporfin, n = 330)) or placebo groups (irradiation with placebo (PDT-placebo, n = 110)); during stage 2 (week 8 to 16) patients in both groups were offered treatment. Clinician-evaluators, who were blind to the study, classified each case on the following four-level scale according to assessment of before and after standardized pictures of the lesion area: no improvement: <20%; some improvement: 20-59%; great improvement: 60-89%; or nearly completely resolved: ≥90%. The primary efficacy endpoint was proportion of patients achieving at least some improvement at week 8. The secondary efficacy endpoints were proportion of patients achieving nearly completely resolved or at least great improvement at week 8, proportion of patients achieving early completely resolved, at least great improvement, or at least some improvement at week 16, and the corresponding satisfaction of the investigators and the patients (designated as 'excellent', 'good', 'moderate', or 'ineffective') at weeks 8 and 16. RESULTS: Compared to the PDT-placebo group, the PDT-hemoporfin group showed a significantly higher proportion of patients that achieved at least some improvement (89.7% [n = 295; 95% CI, 85.9%-92.5%] vs. 24.5% [n = 27; 95% CI, 17.4%-33.3%]) at week 8 (P < 0.0001) and higher improvements for all secondary efficacy endpoints. Treatment reactions occurred in 99.5% (n = 731; 95% CI, 98.7%-99.8%) of the PDT-hemoporfin treatments (n = 735). Hyperpigmentation occurred in 22.9 per 100 patient-treatments (n = 168; 95% CI, 20.0-26.0) in the PDT-hemoporfin treated patients. CONCLUSIONS: Hemoporfin-mediated PDT is an effective and safe treatment option for adolescent and adult patients with port-wine stain. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-TRC-08000213.

Two new susceptibility loci 1q24.2 and 11p11.2 confer risk to severe acne.

Severe acne is a chronic inflammatory skin disorder characterized by widespread inflammatory lesions including nodules, cysts and potential scarring. Here we perform the first genome-wide association study of severe acne in a Chinese Han population comprising 1,056 cases and 1,056 controls using the Illumina HumanOmniZhongHua-8 BeadChip. In an independent cohort of 1,860 cases and 3,660 controls of Chinese Han, we replicate 101 SNPs of which 3 showed consistent association. We identify two new susceptibility loci at 11p11.2 (DDB2, rs747650, P(combined)=4.41 × 10⁻9 and rs1060573, P(combined)=1.28 × 10⁻8) and 1q24.2 (SELL, rs7531806, P(combined)=1.20 × 10⁻8) that are involved in androgen metabolism, inflammation processes and scar formation in severe acne. These results point to new genetic susceptibility factors and suggest several new biological pathways related to severe acne.