TRASER: An innovative device for the treatment of nasal telangiectasias.

BACKGROUND: Destruction of blood vessels by selective photothermolysis has been successfully achieved using a number of different laser and light systems, none of which provide significant independent variation in parameters such as wavelength. OBJECTIVE: To evaluate the safety and efficacy of a novel configurable device in the treatment of nasal telangiectasias. METHODS: Fifteen subjects aged 42-73 with Fitzpatrick skin types I and II were treated for nasal telangiectasias of various sizes. Efficacy was measured by blinded analysis of pre and post images and self-assessment by the subjects. The primary endpoint was a 2-point improvement of telangiectasia based on a 5-point Telangiectasia Scale comparing the pre-treatment photograph to the post-treatment photograph at 30 days post final treatment by an independent reviewer. Treatment completion was defined as >75% vessel clearance. The TRASER (Total Reflection Amplification of Spontaneous Emission Radiation) was configured to produce a narrow spectral output, peaking at 541 ± 5 nm, with 20-40 millisecond pulses over an energy density range of 15-40 J/cm2 utilizing a 12 mm spot size were delivered with contact sapphire cooling tip at approximately 10°C. RESULTS: All 13 subjects (100%) in the efficacy population achieved procedure success at the end of the final treatment, that is a 2-point improvement of telangiectasis on the telangiectasia scale (pre- vs. post-treatment). A single treatment was effective in >75% of patients with at least a 75% reduction in blood vessels. Larger vessels responded well to longer pulse durations (40 milliseconds) while smaller vessels responded best to shorter pulse durations (25 milliseconds). No serious adverse events (SAEs) were recorded. LIMITATION: Short-term (1 month) follow up. CONCLUSION: The TRASER device is a safe and effective option for treatment of nasal telangiectasias with all subjects meeting primary endpoint success at the end of treatment and the majority of subjects demonstrating clearance after only one treatment. These treatments were well tolerated and provided high patient satisfaction. Lasers Surg. Med. 49:625-631, 2017. © 2017 Wiley Periodicals, Inc.

Retrospective analysis of the treatment of melasma lesions exhibiting increased vascularity with the 595-nm pulsed dye laser combined with the 1927-nm fractional low-powered diode laser.

BACKGROUND: Melasma presents a significant challenge to laser surgeons. Aggressive treatments often result in rebound melasma or post-inflammatory pigmentary alteration. Recent reports suggest melasma pathogenesis may have a vascular component. Spectrocolorimetry can detect subtle or sub-clinical telangiectatic erythema within melasma lesions. For certain patients identified by spectrocolorimetry, effective melasma treatment may include vascular-targeted therapy together with pigment-specific treatment modalities. Such combined therapies may reduce the likelihood of melasma recurrence. OBJECTIVE: To evaluate the efficacy of treating melasma lesions exhibiting subtle or sub-clinical telangiectatic erythema with the 595-nm pulsed dye laser (PDL) combined with the 1927-nm fractional low-powered diode laser (FDL). METHODS: A retrospective review was performed over a 2-year period as follows. Evaluated patients (n = 11) include 10 women and 1 man, average age of 38.7 years, and Fitzpatrick skin types II-IV. Each patient exhibited melasma lesions with subtle or sub-clinical telangiectatic erythema identified by spectrocolorimetry. Each underwent a series of treatments (average of four) at approximate 4-6 week intervals of the PDL followed by the FDL. Treatments were performed same-day, sequentially, with 10-15 minute interim time allowance for skin cooling. The following PDL parameters were utilized: 10 mm spot, 10-20 ms pulse duration, 7.5-8.5 J/cm2 fluence, 30/30 DCD. Eight passes with the FDL (Clear + Brilliant® Permea™, Solta Medical, Hayward, CA) were then performed utilizing a "low" treatment level. Clinical endpoint was mild erythema and edema. Patients were encouraged to practice strict photoprotection and apply topical skin lightening agents, but compliance was not measured. An independent physician evaluated photographs taken at baseline and at follow-up after last treatment session (average follow-up of 96 days). A quartile improvement score was used to grade the improvement of melasma and underlying telangiectatic erythema. At time of data analysis, patient satisfaction was self-graded on a three-point scale (0 = not satisfied, 1 = satisfied, 2 = very satisfied). RESULTS: Six out of eleven patients (54%) demonstrated greater than 50% improvement in melasma presentation. Improvement in melasma generally paralleled improvement in erythema. No rebound melasma, post-inflammatory changes, or adverse events were noted. Patient satisfaction responses averaged 1.6, with all (10) patients reporting 1 "satisfied" or 2 "very satisfied." CONCLUSIONS: Melasma lesions exhibiting subtle or sub-clinical telangiectatic erythema may be improved by combined vascular-targeted laser therapy together with fractional low-powered diode laser therapy. A parallel improvement in telangiectatic erythema suggests a relationship between the underlying vasculature and hyperpigmentation. There is a low risk of adverse effects and overall patient satisfaction is high. Follow-up to optimize treatment parameters and determine long-term durability is needed. Lasers Surg. Med. 49:20-26, 2017. © 2016 Wiley Periodicals, Inc.

Improvement of erythema dyschromicum perstans using a combination of the 1,550-nm erbium-doped fractionated laser and topical tacrolimus ointment.

BACKGROUND AND OBJECTIVE: Erythema dyschromicum perstans (EDP) is a cosmetically distressing, acquired pigmentary disorder of unknown etiology for which few successful therapies exist. Herein, we present the successful use of non-ablative fractional photothermolysis in combination with topical tacrolimus ointment. STUDY DESIGN/PATIENTS AND METHODS: A 35-year-old female with biopsy-confirmed EDP underwent a series of fractionated non-ablative treatment sessions utilizing the 1,550 nm erbium-doped fiber laser in combination with topical tacrolimus ointment over a period of 5 months. RESULTS: The patient's EDP improved by greater than 75% and results were maintained at the 8-month follow-up visit. CONCLUSION: The combination of non-ablative fractional photothermolysis and topical tacrolimus ointment is a potential safe and effective therapeutic option for erythema dyschromicum perstans. Additional prospective, comparative studies are warranted. Lasers Surg. Med. 49:60-62, 2017. © 2016 Wiley Periodicals, Inc.

Vitamin D deficiency in mycosis fungoides and Sézary syndrome patients is similar to other cancer patients.

BACKGROUND: The purpose of this study was to determine the prevalence of vitamin D deficiency in CTCL patients and whether supplementation corrects vitamin D deficiency or treatment outcome. PATIENTS AND METHODS: Three hundred eleven CTCL patients including 27/311 (8.7%) with Sézary syndrome (SS), 169 cancer controls, and 69 normal controls from the M.D. Anderson clinics had 25(OH)D3 levels determined and categorized as deficient (< 20 ng/mL),insufficient (20-29 ng/mL), or sufficient (≥ 30 ng/mL). Clinical response was determined according to a change in percent body surface area involvement. RESULTS: Low 25(OH)D3 (< 30 ng/mL) levels were present in 76.9% of mycosis fungoides/SS patients, 75.2% of cancer controls, and 66.7% of healthy controls (P » .05, .07) and in 30% to 39% of historical normal controls. Correction of deficiency was successful in 35% or 55 of 156 patients who were given dealer's choice of either vitamin D2 at 50,000 IU orally (p.o.) biweekly or D3 1000 IU p.o. daily. Correction of vitamin D levels was noted in 27 of 100 (27%) patients given D3 and 28 of 56 (50%) given D2. Responses to standard CTCL therapy was similar among patients with corrected and persistently low levels (P » .51). CONCLUSION: To our knowledge,this is the first study of vitamin D status in CTCL patients. Vitamin D deficiency was present in CTCL and other cancer patients compared with normal and historical controls. Correction of vitamin D deficiency and type of vitamin D supplementation used did not affect the overall clinical disease response.