Photobiomodulation CME Part I: Overview and Mechanism of Action.

Photobiomodulation (PBM), previously known as low-level laser light therapy, represents a non-invasive form of phototherapy that utilizes wavelengths in the red light (RL, 620-700 nm) portion of the visible light (VL, 400-700 nm) spectrum and the near-infrared (NIR, 700-1440 nm) spectrum. PBM is a promising and increasingly used therapy for the treatment of various dermatologic and non-dermatologic conditions. Photons from RL and NIR are absorbed by endogenous photoreceptors including mitochondrial cytochrome C oxidase (COX). Activation of COX leads to the following changes: modulation of mitochondrial adenosine triphosphate (ATP), generation of reactive oxygen species (ROS), and alterations in intracellular calcium levels. The associated modulation of ATP, ROS and calcium levels promotes the activation of various signaling pathways (e.g., insulin-like growth factors, phosphoinositide 3-kinase pathways), which contribute to downstream effects on cellular proliferation, migration and differentiation. Effective PBM therapy is dependent on treatment parameters (e.g., fluence, treatment duration and output power). PBM is generally well-tolerated and safe with erythema being the most common and self-limiting adverse cutaneous effect.

Photobiomodulation CME part II: Clinical applications in dermatology.

Photobiomodulation (PBM) is an emerging treatment modality in dermatology with increasing office and home-based use. PBM is the use of various light sources in the red light (620-700 nm) and near-infrared (700-1440 nm) spectrum as a form of light therapy. PBM is often administered through low-level lasers or light-emitting diodes. Studies show that PBM can be used effectively to treat conditions secondary to cancer therapies, alopecia, ulcers, herpes simplex virus, acne, skin rejuvenation, wounds, and scars. PBM offers patients many benefits compared to other treatments. It is noninvasive, cost-effective, convenient for patients, and offers a favorable safety profile. PBM can be used as an alternative or adjuvant to other treatment modalities including pharmacotherapy. It is important for dermatologists to gain a better clinical understanding of PBM for in-office administration and to counsel patients on proper application for home-use devices to best manage safety and expectations as this technology develops. PBM wavelengths can induce varied biological effects in diverse skin types, races, and ethnicities; therefore, it is also important for dermatologists to properly counsel their skin of color patients who undergo PBM treatments. Future clinical trials are necessary to produce standardized recommendations across conditions and skin types.

Energy-based devices for the treatment of Acne Scars: 2022 International consensus recommendations.

BACKGROUND AND OBJECTIVES: Acne scars are one of the most distressing and long-term consequences of acne vulgaris, with damaging effect on a person's physical, mental, and social well-being. Numerous treatment options are available including surgical and nonsurgical techniques, depending on the clinical presentation. Although considerable advances in the development of new treatment technologies and applications have been made in the last decade, international treatment guidelines and reimbursement schemes have not yet caught up with current knowledge and practice in many centers. The authors intend to highlight the potential utility of energy-based devices (EBDs) for acne scarring, offer recommendations for safe and efficacious treatment, and provide consensus-based EBD treatment options based on varying presentations demonstrated in a series of real-life clinical photographs. STUDY DESIGN/MATERIALS AND METHODS: An international panel of 24 dermatologists and plastic surgeons from 12 different countries and a variety of practice backgrounds was self-assembled to develop updated consensus recommendations for the treatment of acne scars. A two-step modified Delphi method took place between March 2020 and February 2021 consisting of two rounds of emailed questionnaires. The panel members approved the final manuscript via email correspondence. RESULTS: The manuscript includes a comprehensive discussion and panel recommendations regarding the following topics: 1. the role of EBD in mitigating and treating acne scars in a patient with active acne, 2. the use of various EBDs for the treatment of different acne scar types with special focus on commonly used laser platform such as vascular lasers, ablative fractional lasers (AFLs) and non-AFLs (NAFLs), 3. treatment combinations, and 4. acne scar treatments in skin of color. The last part comprised of 10 photos of real-life clinical cases with the panel recommendation treatment plan to achieve best aesthetic outcome. CONCLUSION: Panel members were unanimous in their view that EBDs have a role in the management of acne scars, with AFLs, NAFLs, vascular lasers, and RF devices preferentially selected by most of the panel experts. EBDs are considered a first-line treatment for a variety of acne scar types and patients without access to these treatments may not be receiving the best available care for optimal cosmetic results. Future high-quality research and updated international treatment guidelines and reimbursement schemes should reflect this status.

Coronavirus Disease 2019 and Dermatology Practice Changes.

The impact of the COVID-19 pandemic on dermatology practice cannot be overstated. At its peak, the pandemic resulted in the temporary closure of ambulatory sites as resources were reallocated towards pandemic response efforts. Many outpatient clinics have since reopened and are beginning to experience a semblance of pre-pandemic routine, albeit with restrictions in place. We provide an overview of how COVID-19 has affected dermatology practice globally beginning with the rise of teledermatology. A summary of expert recommendations that shape the "new normal" in various domains of dermatology practice, namely, dermatology consultation, procedural dermatology, and phototherapy, is also provided.

Pulsed dye laser and pulsed dye laser-mediated photodynamic therapy in the treatment of dermatologic disorders.

BACKGROUND: The pulsed dye laser (PDL) is used for treating cutaneous vascular disorders. Recent reports have also shown its effectiveness in conditions of other etiologies, although the precise mechanisms of action are unknown. PDL has also been used in photodynamic therapy (PDT) for many dermatologic conditions. We review the broad array of disorders that can be effectively managed using the PDL. OBJECTIVES AND METHODS: A review of the literature on the application of the PDL and PDL-mediated PDT in dermatologic disorders. A literature-based search was performed using PubMed from 1997 to 2010. Search terms included: "pulsed dye laser," "pulsed dye laser photodynamic therapy," and "pulsed dye laser indications." RESULTS: The PDL was initially designed for cutaneous vascular disorders. Recent investigations have demonstrated successful results when treating malignant, inflammatory, viral, and collagenous conditions. Side effects, including pain, purpura, edema, and postinflammatory hyperpigmentation, were mild, well tolerated, and transient. CONCLUSIONS: PDL is accepted as first-line therapy for vascular disorders including port-wine stains, telangiectasias, and hemangiomas. PDL causes selective photothermolysis of dermal vasculature. This mechanism also allows it to be applicable for disorders of other etiologies. Recent studies suggest that the PDL may induce cytokine expression and collagen formation, further increasing its applicability in dermatology.

Current methods employed in the prevention and minimization of surgical scars.

BACKGROUND: Postsurgical scars are of significant concern to patients and surgeons. Many studies have focused on different treatment options for established surgical scars. The prevention and minimization of such aberrant healing responses is more likely to yield better outcomes and require less time and expense. OBJECTIVE AND METHOD: A review of the literature on various forms of prophylactic treatments intended to prevent or minimize the development of prominent postsurgical scars was performed using the Pubmed database over a period from 1987 to 2010. Search terms included "scar prevention," "scar minimization," "post-surgical scar management," and "surgical scars." RESULTS: Various over-the-counter topical products commonly used by patients have failed to demonstrate any significant benefits in improving final scar outcomes. Numerous interventions performed around the time of surgery, including botulinum toxin, lasers, and intradermal injectable products, have shown effectiveness in minimizing eventual scar appearance. CONCLUSIONS: Patient education on proper wound care is a simple method of improving the cosmetic appearance of surgical scars. At the other end of the spectrum, our knowledge of the complex mechanisms of wound healing has allowed for the development of new, effective treatment modalities, including lasers, botulinum toxin, cytokines, and stem cells.

Safety and efficacy of erbium-doped yttrium aluminum garnet fractionated laser for treatment of acne scars in type IV to VI skin.

BACKGROUND: Ablative resurfacing lasers are effective for treatment of acne scars, but they have a high risk of complications. Fractional lasers have less severe side effects but more moderate efficacy than ablative devices. Studies were performed in individuals with Fitzpatrick skin type I to VI. OBJECTIVE: To determine the efficacy and safety of an erbium 1,550-nm fractional laser in the treatment of facial acne scars in Fitzpatrick skin types IV to VI. METHODS: We conducted a prospective, single-blind, randomized trial in patients with acne scars (n=15), skin type IV to VI, with a 1,550-nm erbium fractionated laser. Patients were divided into two groups; one was treated with 10 mJ and the other with 40 mJ. Five monthly laser sessions were performed. A patient questionnaire was distributed. RESULTS: There was a significant improvement in the acne scarring and overall appearance (p<.001). No significant difference was found between 10 and 40 mJ. Patients were highly satisfied with their results. Significant postinflammatory hyperpigmentation was seen; pain was significantly higher in darker skin. CONCLUSIONS: Fractional photothermolysis is effective for the treatment of acne scars, but practition-ers should be aware of the higher incidence of pain and postinflammatory hyperpigmentation in individuals with skin types IV to VI.

Acrodermatitis paraneoplastica responding to topical PUVA treatment.

Acrodermatitis paraneoplastica is a rare paraneoplastic entity that has been associated with multiple neoplasms, most commonly squamous cell carcinoma of the aerodigestive tract. Therapies have focused on treatment of the underlying carcinoma. We report a case of acrodermatitis paraneoplastica successfully treated with PUVA therapy.