The 1440 nm and 1927 nm Nonablative Fractional Diode Laser: Current Trends and Future Directions.

Clinical characteristics of skin exposed to ultraviolet and infrared radiation include dryness, dyschromia, laxity, roughness, sallowness, scaling, telangiectasia, and wrinkles. Fractional photothermolysis promotes skin remodeling by formation of new dermal collagen. The nonablative fractional diode laser (NFDL) system employs fractional photothermolysis to rejuvenate the skin, using 2 distinct handpieces for wavelengths of 1440 nm and 1927 nm. Fractional photothermolysis from nonablative fractional diode lasers facilitates delivery of small molecular-weight compounds, such as L-ascorbic acid, through the skin without compromising barrier function of the stratum corneum. Both handpieces of the NFDL system are effective for rejuvenation of photodamaged facial skin, providing clinical improvement in skin tone, skin texture, fine lines, and dyschromia and reducing the number of detectable skin pores. Application of the 1927 nm wavelength handpiece has shown clinical improvement of hyperpigmentation, melasma, and postinflammatory hyperpigmentation, which have been challenging to treat effectively with other laser devices. With a target chromophore of water, the infrared energy of the 1440 nm and 1927 nm NFDL system is appropriate for skin rejuvenation and treatment of dyschromia in skin of color, with a reduced risk of the adverse events observed with other nonablative and ablative fractional lasers. Clinical data have demonstrated that both the 1440 nm and 1927 nm wavelengths are effective, with high levels of patient satisfaction, transient side effects, and minimal patient downtime.

Radiofrequency: Thermage.

Nonablative procedures for facial rejuvenation have become increasingly popular. One such method to improve laxity and diminish rhytids is monopolar capacitively coupled radiofrequency (MRF). The authors discuss clinical studies using MRF. The authors also discuss their clinical experiences as well as recommendations for optimal results. MRF using the Thermage CPT system (Solta Medical, Hayward, California) offers minimal downtime with a favorable side-effect profile. Although there are many radiofrequency devices on the market for aesthetic use, MRF has the most clinical trials to date to support its use as an effective, evidence-based modality to improve rhytids and tighten the skin.

Nonablative fractional photothermolysis for facial actinic keratoses: 6-month follow-up with histologic evaluation.

BACKGROUND: A number of epidermal and papillary dermal skin conditions can be treated safely and effectively with fractional photothermolysis (FP). OBJECTIVE: We sought to evaluate the effectiveness of FP with a 1550-nm fractionated erbium-doped fiber laser for the treatment of facial actinic keratoses (AKs). METHODS: Fourteen men, ages 59 to 79 years, underwent 5 laser treatments (2- to 4-week intervals) at an energy fluence of 20 to 70 mJ and treatment level of 11 (8-10 passes), corresponding to 32% to 40% surface area coverage. AK counts and photographs were taken at baseline, before each treatment, and at 1-, 3-, and 6-month follow-ups after the last treatment. Biopsies were performed at baseline and at the 3-month follow-up. The clinical improvement of the actinic lesions was evaluated by a dermatologist using digital photography and lesion counts at all 3 follow-up visits. RESULTS: The AK count for each patient was reduced on average by 73.1% (67.5%-77.7%) at the 1-month, 66.2% (60.0%-71.5%) at the 3-month, and 55.6% (43.9%-64.8%) at the 6-month follow-up visit. Excluding two cases, all biopsy specimens (baseline and at the 3-month follow-up) were positive for histologic features of AK and/or squamous cell carcinoma. LIMITATIONS: This study is limited by a small number of patients; therefore further clinical studies are warranted. CONCLUSIONS: FP decreases the number of clinical AKs; however, posttreatment biopsy specimens indicate the histologic persistence of AKs (epidermal tumors). FP is not an adequate single-treatment modality for AKs.

Thyrotoxicosis after denileukin diftitox therapy in patients with mycosis fungoides.

CONTEXT: Denileukin diftitox is a recombinant novel fusion protein of diphtheria toxin and the ligand-binding domain of human IL-2. Denileukin diftitox binds to the high-affinity IL-2 receptor on the cell surface, and it is internalized by endocytosis and enzymatically cleaved. The cytotoxic A-fragment of the toxin inhibits protein synthesis and causes cell death. OBJECTIVE: The objective of this study was to recognize thyrotoxicosis in association with denileukin diftitox therapy. DESIGN: This study was a retrospective case series. SETTING: The setting of this study was a comprehensive cancer center. PATIENTS: Eight mycosis fungoides patients who were receiving 9 or 18 microg/kg.d iv denileukin diftitox for 5 d every 3 wk were identified with thyrotoxicosis. INTERVENTION(S): Thyroid testing was performed. Hypothyroidism after thyrotoxicosis was treated. RESULTS: In eight mycosis fungoides patients who developed transient thyrotoxicosis during therapy, thyroid function tests were normal before onset of therapy. Clinical thyrotoxicosis developed within days of the first cycle of denileukin diftitox therapy in four patients and after the second cycle in the other four patients. Symptoms included tremors, nervousness, tachycardia, diarrhea, and weight loss. After cessation of denileukin diftitox, thyrotoxicosis resolved in all patients; two became euthyroid, and five became hypothyroid, requiring levothyroxine therapy. One patient was lost to follow-up. CONCLUSIONS: Monitoring thyroid function before and during treatment with denileukin diftitox is recommended. Symptomatic thyrotoxicosis may be missed due to other acute reactions to the drug, and subsequent hypothyroidism may develop.