Light-emitting diode 415 nm in the treatment of inflammatory acne: an open-label, multicentric, pilot investigation.

BACKGROUND: The management of acne remains a challenge, with current therapies linked to significant side effects and patient non-compliance. Phototherapy using blue light has been proven in the treatment of acne vulgaris and offers the clinician an effective alternative. OBJECTIVE: To determine the effect of narrowband light-emitting diode (LED) blue light in the reduction of inflammatory and non-inflammatory lesions in patients with mild to moderate acne and to evaluate patient tolerance of the therapy. METHODS: Forty-five patients were treated with high-intensity pure blue light, 415 nm and 48 J/cm2, receiving two treatments of 20 minutes per week for a period of 4-8 weeks. Clinical assessment was performed at baseline, and 2, 4 and 8 weeks after treatment. A patient's therapeutic response was measured using a global improvement scoring system. RESULTS: The mean improvement score was 3.14 at 4 weeks and 2.90 at 8 weeks. Nine patients experienced complete clearing at 8 weeks. The treatment was well tolerated, with 50% of patients highly satisfied with the treatment. CONCLUSION: This open-label study suggests the therapeutic efficacy of high-intensity LED pure blue light in the treatment of acne vulgaris with no reported side effects.

Comparison of skin anesthetic effect of liposomal lidocaine, nonliposomal lidocaine, and EMLA using 30-minute application time.

BACKGROUND: Liposomes are microscopic phospholipid vessels that have been utilized to extend the action of topical medications. Previous studies have demonstrated that liposomal vehicles can prolong the action of a variety of medications, including antifungals, anesthetics, interferon, and antineoplastic agents. OBJECTIVE: The purpose of this study was to examine the degree and duration of anesthesia produced by lidocaine in a liposomal vehicle compared with lidocaine in a nonliposomal vehicle and compared with EMLA. The topical preparations in this study were allowed to contact the skin for a 30-minute period prior to evaluation of anesthetic effectiveness. Unoccluded and Tegaderm-occluded topical preparations were evaluated in two separate arms of the study. MATERIALS AND METHODS: Thirteen healthy volunteers (three male, 10 female) were recruited for the nonocclusion arm of the study. Six healthy volunteers (two male, four female) were recruited for the occlusion arm of the study. Subjects with a history of allergy to lidocaine, a history of seizures, cardiac or respiratory difficulty, pregnant patients, and patients less than 18 years old were excluded. Written informed consent was obtained from all patients prior to testing. The volar forearms of the volunteers were swabbed with isopropyl alcohol and allowed to dry. A template was then utilized to mark 2 x 2-cm squares with a skin marker on both volar forearms. In total, nine squares corresponding to nine test areas were marked. The nine test preparations were applied to the test areas in a double-blinded fashion using a clean swab stick. The test preparations were then allowed to remain on the skin for 30 minutes in either occluded or nonoccluded from depending upon the arm of the study. Following the 30-minute application period, the test preparations were wiped off with clean gauze. Testing for anesthesia was performed by following a previously published method utilizing gentle pinpricks. A new pinprick apparatus was used for each patient. Pinprick testing was performed at 0, 15, 30, 60, and 90 minutes following the end of the 30-minute application period. Patients' responses to the pinprick were recorded in a binary fashion, as being either: 1) totally painless or 0) painfully sharp to any degree. Ten applications of the pinprick were applied randomly across each 2 x 2-cm test area. The number of painless applications of the pinprick out of a total of 10 applications of the pinprick was then recorded for each test area at every particular test time. In total, nine test preparations were evaluated. Analysis of the data was performed by a PhD statistical faculty consultant from the UCLA Mathematics Department. RESULTS: Liposomal lidocaine preparations evidenced longer durations of anesthesia than lidocaine preparations in nonliposomal vehicles. Five percent liposomal lidocaine preparations were statistically equivalent to EMLA in anesthetic effectiveness. CONCLUSION: Five percent liposomal lidocaine is an effective alternative topical agent for use in the attainment of temporary local anesthesia of the skin.

Topical anesthetic agents in dermatologic surgery. A review.

BACKGROUND: The ideal topical anesthetic agent is one that provides 100% anesthesia in a short period of time, work on intact skin without systemic side effects, and invokes neither pain nor discomfort. The quest to find such an agent continues today. Because a topical anesthetic agent will induce anesthesia painlessly, the need for an effective agent is clear. This will serve to eliminate painful injections with lidocaine prior to many dermatologic procedures. OBJECTIVE: To provide a review of topical agents used in the past, to present products that are being used today, and to look to the future of topical anesthesia. CONCLUSIVE: During the last three decades a variety of methods have been employed to administer topical anesthesia. Presently, EMLA (eutectic mixture of local anesthetics) is the most often used method among practicing dermatologists. However, iontophoresis and the anesthetic patch are equally effective with a few notable advantages over EMLA. Liposomal agents show promise as we enter into a new millennium.

External ultrasonic tumescent liposuction. A preliminary study.

BACKGROUND: External ultrasonic tumescent liposuction represents a new application of ultrasound energy to the standard tumescent liposuction procedure. Hoping to retain the in vivo properties of ultrasonic delivery while avoiding the growing number of invasive complications, external ultrasonic tumescent liposuction is a new technique with the potential of improving traditional tumescent liposuction therapy. OBJECTIVE: The purpose of this preliminary study was to evaluate the role of external ultrasonic tumescent liposuction as an adjunct to traditional tumescent liposuction. METHODS: Ten patients underwent standard tumescent liposuction with the addition of 10 minutes of preoperative ultrasound therapy applied to one-half of their targeted treatment regions. Both objective and subjective parameters were assessed during the subsequent side-by-side evaluations. RESULTS: Six of the 10 cases had a measurable increase in the amount of supernatant fat extracted per unit of aspirate volume from those regions pretreated with ultrasound energy. In five of the 10 cases, the operating physician noted slightly easier cannula maneuverability through adipose tissue on the ultrasound side. Roughly half of the patients had an improved postoperative course, with less swelling/edema, less bruising or ecchymoses, more skin retraction, and less postoperative pain/discomfort. CONCLUSION: The favorable results of this preliminary study warrant further investigation and research into external ultrasonic tumescent liposuction as an adjunct to the traditional tumescent liposuction procedure.

Tumescent anesthesia with a lidocaine dose of 55 mg/kg is safe for liposuction.

BACKGROUND: The safe upper limit of lidocaine dosage in tumescent anesthesia for liposuction has been reported to be 35 mg/kg. OBJECTIVE: This study was undertaken to: 1) evaluate the safety of tumescent anesthesia in liposuction when lidocaine doses greater than 35 mg/kg are required, 2) determine the time interval when the peak plasma lidocaine level occurs following administration of tumescent anesthesia, and 3) assess if the safety of large volume tumescent anesthesia is due to significant lidocaine removed by liposuction. METHODS: Sixty patients who underwent liposuction with a mean lidocaine dose of 57 mg/kg were prospectively evaluated for development of any signs or symptoms of lidocaine toxicity by multiple interviews over a 24-hour period. In addition, another 10 patients who received a mean lidocaine dose of 55 mg/kg had serial plasma lidocaine level measurements over a 24-hour period following liposuction. The lidocaine level of the aspirate was also measured to assess any significant lidocaine removed by liposuction. RESULTS: No evidence of lidocaine toxicity was found based on subjective evaluation of 60 patients as well as determined by plasma sampling of 10 patients. The peak plasma lidocaine concentration occurred at approximately 4 or 8 hours after infusion of tumescent anesthesia. The 24-hour plasma lidocaine level suggests that residual lidocaine is present in the subcutaneous tissue allowing for postoperative analgesia beyond this time. A negligible amount of lidocaine was removed by liposuction as determined by the lidocaine level of the aspirate. CONCLUSION: This study suggests that tumescent anesthesia with a total lidocaine dose of up to 55 mg/kg is safe for use in liposuction.

Comparison of room temperature and warmed local anesthetic solution for tumescent liposuction. A randomized double-blind study.

BACKGROUND: The tumescent technique of local anesthesia has been accepted as the standard of care for liposuction surgery. Large volumes of a dilute solution of lidocaine, epinephrine, sodium bicarbonate, and triamcinolone are infused into the subcutaneous fat. The technique eliminates the need for general anesthesia and provides greater safety and improved esthetic results. OBJECTIVE: A study was designed to evaluate the benefit of warming of the local anesthetic to 40 degrees C prior to infiltration and thus to determine whether warming provides improved patient comfort. METHODS: A double-blind randomized cross-over study was performed in 16 patients undergoing outpatient tumescent liposuction. Pain scores were determined using a visual analog pain scale. RESULTS: The mean pain score was significantly lower for areas treated with the 40 degrees C warmed solution. CONCLUSION: Warming of local anesthetic solution for tumescent liposuction significantly reduces pain as perceived by the patient and is recommended in all tumescent liposuction surgery.

Low skin temperatures produced by new skin refrigerants.

Temperatures produced by Cryosthesia -30 degrees C, Cryosthesia -60 degrees C, and Frigiderm were measured in minipigs. Cryosthesia -60 degrees C and Cryosthesia -30 degrees C were both found to rapidly lower skin temperatures to levels that have been shown to cause cell injury, necrosis, and loss of melanocytes. Use of these agents requires extreme caution in dermabrasion.