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BACKGROUND: Current treatment options for rosacea include topical agents, oral therapies, phototherapy using lasers, or intense pulsed light (IPL). Combination therapy for rosacea often yields better results than monotherapy. The safety of laser/light treatments in combination with systemic doxycycline has been questioned because of the theoretical risk of photosensitivity. OBJECTIVE: The purpose of this study was to assess the incidence of phototoxicity or photosensitivity in rosacea patients receiving concomitant laser or light treatments and systemic doxycycline. METHODS: Treatment records of 36 patients receiving laser/light treatments while also being treated with standard dose or anti-inflammatory dose of doxycycline were retrospectively reviewed. RESULTS: No adverse reactions related to doxycycline combined with laser/light therapy were reported. Specifically, no photosensitivity or sensitivity to wavelengths in the pulsed dye laser (PDL), or IPL range was observed in this cohort. All patients achieved some degree of clearance. CONCLUSION: The results of this retrospective study demonstrate that doxycycline used in conjunction with laser or nonlaser light therapy is a valid combination therapy for improving signs and symptoms of rosacea. No photosensitivity reactions were observed to commonly used IPL or PDL devices.
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Antibacterianos/efectos adversos , Doxiciclina/efectos adversos , Tratamiento de Luz Pulsada Intensa/efectos adversos , Terapia por Luz de Baja Intensidad/efectos adversos , Rosácea/terapia , Administración Cutánea , Adolescente , Adulto , Anciano , Antibacterianos/administración & dosificación , Terapia Combinada/efectos adversos , Terapia Combinada/métodos , Preparaciones de Acción Retardada/administración & dosificación , Preparaciones de Acción Retardada/efectos adversos , Doxiciclina/administración & dosificación , Femenino , Humanos , Tratamiento de Luz Pulsada Intensa/instrumentación , Tratamiento de Luz Pulsada Intensa/métodos , Láseres de Colorantes/efectos adversos , Terapia por Luz de Baja Intensidad/métodos , Masculino , Persona de Mediana Edad , Trastornos por Fotosensibilidad/diagnóstico , Trastornos por Fotosensibilidad/etiología , Estudios Retrospectivos , Piel/efectos de los fármacos , Piel/efectos de la radiación , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Picosecond lasers have been reported to be effective for removal of tattoo pigment. This prospective study evaluated the efficacy and safety of the treatment of peri-oral and -ocular wrinkles using a novel diffractive lens array coupled with a picosecond 755 nm alexandrite laser. METHODS: Forty female subjects presenting with wrinkles from photodamage were enrolled in an IRB approved study. Subjects received four picosecond diffractive lens array treatments to the full face at 1 month intervals. Six subjects were biopsied (two subjects at 1 month, two subjects at 3 months, and two subjects at 6 months). Digital photographic images were taken at 1, 3, and 6 months post-final treatment visits. Images were graded by blinded physicians for fine lines/wrinkles, erythema, dyschromia, and global improvement. Data on discomfort level, satisfaction, and side effects were recorded. RESULTS: Overall blinded physician rated global improvement ranged from improved to much improved at 1-, 3-, and 6-month time points. At baseline the average Fitzpatrick wrinkle score was 5.48. At the 6-month follow-up the average score was 3.47. The overall average change in score from pre-treatment to post-treatment was 1.97. Subject self-assessment at 6 months indicated that 90% of subjects were extremely or satisfied with their results. Unanticipated adverse events were absent with anticipated post-treatment erythema lasting for just several hours. CONCLUSIONS: A novel diffractive lens array used with a picosecond 755 nm alexandrite laser for treatment of wrinkles is highly effective and safe for wrinkles and other signs of photoaging. Lasers Surg. Med. 49:40-44, 2017. © 2016 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.
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Láseres de Estado Sólido/uso terapéutico , Terapia por Luz de Baja Intensidad/métodos , Satisfacción del Paciente , Envejecimiento de la Piel/efectos de la radiación , Adulto , Estética , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Rejuvenecimiento , Medición de Riesgo , Método Simple Ciego , Resultado del TratamientoRESUMEN
BACKGROUND: The American Council of Graduate Medical Education, which oversees much of postgraduate medical education in the United States, has championed the concept of "milestones," standard levels of achievement keyed to particular time points, to assess trainee performance during residency. OBJECTIVE: To develop a milestones document for the American Society for Dermatologic Surgery (ASDS) Cosmetic Dermatologic Surgery (CDS) fellowship program. METHODS: An ad hoc milestone drafting committee was convened that included members of the ASDS Accreditation Work Group and program directors of ASDS-approved Cosmetic Dermatologic Surgery (CDC) fellowship training programs. Draft milestones were circulated through email in multiple rounds until consensus was achieved. RESULTS: Thirteen milestones were developed in the 6 Accreditation Council for Graduate Medical Education (ACGME) competency areas, with 8 of these being patient-care milestones. Additional instructions for milestone administration more specific to the CDS fellowship than general ACGME instructions were also approved. Implementation of semiannual milestones was scheduled for the fellowship class entering in July 2018. CONCLUSION: Milestones are now available for CDS fellowship directors to implement in combination with other tools for fellow evaluation.
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Técnicas Cosméticas , Procedimientos Quirúrgicos Dermatologicos/educación , Educación de Postgrado en Medicina , Becas , Objetivos Organizacionales , Acreditación , Humanos , Sociedades Médicas , Estados UnidosRESUMEN
BACKGROUND AND OBJECTIVE: This study examined the outcomes of over a decade of endovenous thermal ablation (EVTA) treatments for great and small saphenous vein (GSV and SSV) insufficiency, utilizing three different endovenous thermal ablation systems. MATERIALS AND METHODS: This retrospective study reviewed EVTA treatments performed at an outpatient clinic (MDLSVI) from April 1999 to February 2013. Systems included 810 nm diode (hemoglobin targeting), 1,320 nm laser (water targeting) and a radiofrequency (direct thermal transfer) (RF) device. Clinical and ultrasonographic evaluation were performed before treatment and at each follow-up visit. Patients were examined yearly by Duplex ultrasonography. Success was defined as complete absence of reflux. RESULTS: Analysis of 934 treatments demonstrated that although recanalization could occur over time, endovenous ablation has a very high success rate. Ablation rates were 92.5%, 85.9%, and 71.9% at 6-months, 1-year, and 5-years after procedures. Recanalization occurred in 156 out of 934 treatments (16.7%) during the follow-up period. Among three difference systems, the total ablation success rate was significantly different (P < 0.001). The 1,320 nm Nd:YAG laser (n = 502) provided the highest ablation rate compared to the radiofrequency (n = 398) and 810 nm diode (n = 34) throughout their follow-up period, which were 8, 13, and 9 years, respectively. At 1-year follow-up, successful ablation rates of RF, 810 nm, and 1,320 nm were 78.2%, 80.8%, and 93.7%, respectively. At 5-year follow-up, successful ablation rates of RF, 810 nm, and 1,320 nm were 61.7%, 65.7%, and 84.7%, respectively. CONCLUSION: EVTA is very effective for ablation of the GSV and SSV. Complete ablation varied significantly among different systems with water targeting 1,320 nm providing the highest incidence saphenous vein ablation. This remained durable at 8-year follow-up by Duplex ultrasound.
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Ablación por Catéter/instrumentación , Terapia por Láser/instrumentación , Vena Safena , Insuficiencia Venosa/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Análisis de Supervivencia , Factores de Tiempo , Resultado del Tratamiento , Insuficiencia Venosa/diagnóstico , Adulto JovenRESUMEN
In this multi-site case series, the efficacy of high intensity focused radiofrequency (RF) delivered to the dermis was evaluated for treating acne scars. A novel delivery system that uses insulated microneedles to deliver a desired thermal effect to multiple depths of the dermis while sparing the epidermis from RF injury was used. Four (4) healthy subjects from four different practices were evaluated and used in this case report. The subjects were treated between 3 or 4 times depending on the severity of the acne scars presented. The depth of thermal delivery was adjusted before each pass and all subjects received at a minimum, three passes to the treated area. Before and after photographs along with adverse effects were recorded. The theory behind the use of insulated needles with the active RF delivery at the distal tip is to allow for significant thermal injury to several layers of the dermis while avoiding thermal injury to the epidermis. This case report demonstrates significant improvement on acne scars and that all skin types should be safely treatable with minimum downtime realized.
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Acné Vulgar/complicaciones , Cicatriz/terapia , Dermatosis Facial/terapia , Terapia por Radiofrecuencia , Adulto , Cicatriz/etiología , Dermatosis Facial/etiología , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: The American Society for Dermatologic Surgery (ASDS) periodically develops consensus documents for its members concerning various aspects of dermatologic surgery. Unwanted and painful leg veins are a very widespread problem. Many advances in sclerotherapy of varicose and telangiectatic leg veins have occurred since the previous consensus documents. OBJECTIVE: In 2013, the ASDS Board of Directors voted to have a committee of experts in the field to develop consensus documents on sclerotherapy. MATERIALS AND METHODS: An expert panel reviewed the literature on sclerotherapy and discussed the findings. A consensus was reached with evidence-based recommendations on diagnostic evaluation and treatment of varicose and telangiectatic leg veins. RESULTS: The consensus documents include discussion of indications for treatment, patient selection, contraindications, diagnostic testing, treatment approaches, use of compression, and expected outcome. Common sclerosants and their mechanisms of action, advantages and disadvantages of foam sclerotherapy, and minimizing and treating complications are presented. CONCLUSION: The ASDS consensus documents on sclerotherapy will be helpful in educating their members on safe and effective sclerotherapy of varicose and telangiectatic leg veins.
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Pierna/irrigación sanguínea , Soluciones Esclerosantes/uso terapéutico , Escleroterapia/normas , Telangiectasia/terapia , Várices/terapia , Vendajes de Compresión , Contraindicaciones , Medicina Basada en la Evidencia , Humanos , Selección de Paciente , Soluciones Esclerosantes/efectos adversos , Escleroterapia/efectos adversos , Sociedades Médicas , Telangiectasia/diagnóstico , Estados Unidos , Várices/diagnósticoRESUMEN
BACKGROUND/OBJECTIVE: This study investigates the efficacy, tolerance, and usability of a single product containing cycloastragenol, growth factors, peptides, and antioxidants to decrease the visible signs of aging, including fine lines, and wrinkles, texture, pore size, elasticity, skin color/clarity, redness, hydration, and overall skin quality. METHODS: Twenty subjects were enrolled in a 12-week, open-label, patient-assessment study. Subjects used a gentle cleanser, cycloastragenol, growth factors, peptides, and antioxidants (Regeneration Booster™, Jan Marini Skin Research (San Jose, CA) and a broad spectrum SPF for the duration of the 12-week study. Assessments were taken at baseline, 2, 4, 8, and 12 weeks. All assessments were compared against baseline for statistical significance. RESULTS: Eighteen of the twenty subjects completed the 12-week study. Improvement was significant after just 2 weeks of use for all measured categories except erythema and significant for all categories at 12 weeks. One hundred percent of study subjects noted improvement in at least 3 or more of the 8 assessed categories with an average improvement in 6.7 categories. Improvement response rate for individual categories ranged from 67% to 100% of study subjects. There were zero cases of sensitivity or irritation and product smell, feel and ease of application were rated "positive" by 100% of study subjects. Photographic improvement was most notable in texture and lines on the cheeks and eye area. CONCLUSION: Regeneration Booster, when used as a stand-alone anti-aging solution, delivers rapid and significant reduction in the visible signs of aging. Subject satisfaction was extremely high and there were zero reported cases of sensitivity or irritation. Based on these observations, Regeneration Booster is a safe and effective topical product for individuals seeking significant improvement in the appearance of aging skin.
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Antioxidantes/administración & dosificación , Péptidos y Proteínas de Señalización Intercelular/administración & dosificación , Péptidos/administración & dosificación , Sapogeninas/administración & dosificación , Envejecimiento de la Piel/efectos de los fármacos , Cuidados de la Piel/métodos , Administración Cutánea , Adulto , Anciano , Química Farmacéutica , Evaluación de Medicamentos/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Envejecimiento de la Piel/patologíaRESUMEN
BACKGROUND: Sixty-three subjects' legs were randomized to receive treatment with polidocanol (POL) or hypertonic saline (HS) for telangiectasias and reticular leg veins. OBJECTIVE: To compare the safety and efficacy of two sclerosing agents in three dermatologic surgery practices. METHODS: After exclusion of saphenofemoral junction incompetence, each subject's veins were categorized (telangiectasias <1 mm and reticular veins 1-3 mm) and randomized. Telangiectasias were treated with POL 0.5% or 11.7% HS and reticular veins with POL 1% or 23.4% HS. An independent, blinded physician determined efficacy and adverse events. Subject satisfaction questionnaires were administered and global clinical improvement assessments performed. RESULTS: All patients completed four visits at 0, 1, 4, and 12 weeks. Patients reported significantly greater pain during treatment with HS (2.42) than POL (1.03) (p < .001). There were no significant differences in physician-assessed improvement of reticular leg veins or telangiectasias; subject- or physician-assessed overall improvement; or physician-assessed phlebitis, pigmentation, edema, or matting in either of the three practices or the entire cohort. Two subjects developed ulcerations with HS. No ulcerations or allergic reactions developed after POL injections. CONCLUSION: Both agents provided effective treatment, but HS caused 2.35 times as much pain during injections and resulted in two episodes of tissue necrosis.
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Pierna/irrigación sanguínea , Polietilenglicoles/uso terapéutico , Solución Salina Hipertónica/uso terapéutico , Soluciones Esclerosantes/uso terapéutico , Escleroterapia , Telangiectasia/terapia , Adulto , Anciano , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polidocanol , Telangiectasia/patología , Venas/patologíaRESUMEN
Over the past decade, the popularity of nonsurgical cosmetic procedures has increased exponentially. Last year, according to the American Society of Aesthetic Plastic Surgery, more than 5 million procedures were performed using cosmetic injectables such as botulinum toxin and dermal filling agents. According to the society's recent statistics, more than 85% of all dermal filler procedures occurred with a hyaluronic acid derivative.These numbers are expected to rise in the future as there is currently no other class of filling agent that rivals the popularity of hyaluronic acid. The popularity of hyaluronic acid specifically stems from its effectiveness, ease of administration, and safety profile.
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Materiales Biocompatibles/administración & dosificación , Técnicas Cosméticas , Ácido Hialurónico/administración & dosificación , Materiales Biocompatibles/efectos adversos , Materiales Biocompatibles/química , Reactivos de Enlaces Cruzados , Cara , Humanos , Ácido Hialurónico/efectos adversos , Ácido Hialurónico/química , Inyecciones , Estructura Molecular , Rejuvenecimiento , Envejecimiento de la PielRESUMEN
BACKGROUND AND OBJECTIVES: Monopolar radiofrequency skin heating coupled with cryogen cooling of facial skin for skin tightening has been utilized on over 10,000 patients since 2002. In order to establish the actual rate and degree of side effects in our clinical experience, a retrospective chart review was performed. STUDY DESIGN: Charts and clinical images of over 600 consecutive patient treatments between May 2002 and June 2006 using a monopolar radiofrequency device (Thermacool, Thermage, Haywood, CA) for skin tightening at the Maryland Laser, Skin and Vein Institute were retrospectively reviewed. The primary presentation for treatment was skin laxity of the lower face. Treatment was delivered with a 1-cm2 standard tip at fluences of 81 to 124 J/cm2 (level of 12.5 to 15), a 1-cm2 "fast" tip at fluences of 62 to 109 J/cm2 (level of 72.0 to 76.0), a 1.5-cm2 "big fast" tip at fluences of 75 to 130 J/cm2 (level of 61.5 to 65), and a 3-cm2 "bigger" tip at equivalent fluences as each became available. As treatment algorithms evolved over 4 years, the algorithm of multiple passes at lower fluence associated with better clinical outcomes and greater patient acceptance has been adopted. RESULTS: The most common immediate and expected clinical effects were erythema and edema lasting less than 24 hours, although 6 patients reported edema lasting for up to 1 week. There were no permanent side effects. In total, 2.7% of treatments resulted in temporary side effects, the most significant of which was a slight depression on the cheek (n = 1), which completely resolved within 3.5 months. Other side effects included localized areas of acneiform subcutaneous erythematous papules (n = 4) and a linear superficial crust (n = 1) with the original tip, all of which resolved within 1 week. One patient reported small erythematous subcutaneous nodules resolving in 17 days. Tenderness of the neck lasting from 2 weeks (n = 2) to 3 weeks (n = 1) was also reported. CONCLUSIONS: Our data, obtained in an office setting without injectable anesthetic or i.v. sedation, indicate that monopolar RF for skin tightening is a very safe procedure. The treatment algorithm and tips have evolved over several years leading to increased safety and efficacy. Side effects are infrequent, self-limited, and minor, comparing favorably to other nonablative devices utilized for facial rejuvenation.
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Terapia por Radiofrecuencia , Ritidoplastia/métodos , Piel/efectos de la radiación , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Rejuvenecimiento , Estudios Retrospectivos , Piel/patología , Resultado del TratamientoRESUMEN
BACKGROUND: Restylane (Restylane; Q-Medical, Uppsala, Sweden) is a nonanimal stabilized hyaluronic acid (NASHA) that has become increasingly popular for soft tissue augmentation and volume correction because of its greater longevity and lower rate of hypersensitivity reactions when compared with collagen. Despite manufacturer warnings, the remaining material in the syringe is commonly stored for subsequent treatment in the same patient. OBJECTIVE: Our purpose was to determine the incidence of bacterial contamination of NASHA stored after initial patient injection. METHODS: After use of a specific sterile sequence, NASHA from previously used syringes stored at room temperature for 2 to 9 months was cultured under aerobic (n = 20) and anaerobic conditions (n = 10). RESULTS: No bacteria were cultured from any of the samples. LIMITATIONS: Limitations of this study include sample size and storage period for a maximum of 9 months. CONCLUSIONS: NASHA remaining in syringes after patient injection was not contaminated with bacteria. Our study raises the possibility that re-use of the remaining portion of material in the syringe may be safe and is more economical than discarding it.
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Bacterias/aislamiento & purificación , Contaminación de Medicamentos , Ácido Hialurónico/análogos & derivados , Esterilización , Jeringas , Geles , Proyectos PilotoAsunto(s)
Administración de la Práctica Médica/organización & administración , Escleroterapia , Telangiectasia/terapia , Current Procedural Terminology , Documentación , Humanos , Registros Médicos , Educación del Paciente como Asunto , Fotograbar , Soluciones Esclerosantes , Escleroterapia/instrumentación , Telangiectasia/diagnóstico por imagen , UltrasonografíaAsunto(s)
Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Epinefrina/administración & dosificación , Ácido Hialurónico/administración & dosificación , Lidocaína/administración & dosificación , Procedimientos de Cirugía Plástica/métodos , Técnicas Cosméticas , Humanos , Inyecciones Intradérmicas , Inyecciones Subcutáneas , Satisfacción del PacienteRESUMEN
BACKGROUND: The short-pulsed pulsed dye laser (PDL) has been previously reported to improve the appearance of hypertrophic scars. Prolonged purpura following treatment led to the development of the newer long-pulsed pulsed dye laser (LPDL). Intense pulsed light (IPL) has been extensively used to improve the various components of photo damage and to reduce the incidence of purpura, but its effect on scars has not been analyzed. The objective of this pilot study was to prospectively determine and compare the safety and efficacy of LPDL and IPL on surgically induced scars. METHODS: Breast reduction scars (N = 10 scars) and abdominoplasty scars (N=5 scars) were treated using both LPDL and IPL. For breast reduction scars, one side was treated with each technique. For abdominoplasty scars, one half of the scar was treated with each device. Two treatments were performed 2 months apart. Physician global assessment scores of improvement were determined by side-by-side comparison of preoperative and randomly presented postoperative photographs. Patient pain scores during treatment were also obtained and the presence of post, treatment purpura was assessed. RESULTS: Mean improvement on a 0 to 3 point scale was 2.2 (55%) after the first LPDL treatment and 3.2 (80%) after the second. Mean improvement was 1.8 (45%) after the first IPL treatment and 2.6 (65%) after the second. Differences in improvement between the LPDL and IPL sides were not statistically significant. Patients rated IPL as more painful than LPDL. The incidence of post-treatment purpura was lower with IPL. CONCLUSIONS: This pilot study suggests that LPDL and IPL are equally effective in improving the appearance of hypertrophic surgical scars. IPL offers a novel method of treating scars that minimizes the risk of purpura.
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Cicatriz Hipertrófica/radioterapia , Luz , Terapia por Luz de Baja Intensidad/métodos , Complicaciones Posoperatorias/radioterapia , Femenino , Humanos , Proyectos PilotoRESUMEN
Photomodulation is a process that manipulates or regulates cell activity using light sources without thermal effect. Previous studies of LED photomodulation have shown skin textural improvement accompanied by increased collagen deposition with reduced MMP-1 (collagenase) activity in the papillary dermis. The purpose of this study was to investigate a separate cohort of patients (N =93) with a wide range of Fitzpatrick skin types treated by LED photomodulation using the Gentlewaves full panel 590 nm high energy LED array with a specific sequence or code of pulsing in the millisecond domain. Results showed improvement of signs of photoaging in 90%. The majority of patients demonstrated improvement in peri-ocular wrinkles, reduction in Fitzpatrick photoaging classification, global skin texture and background erythema, and pigmentation. No side effects were noted. LED photomodulation is a safe and effective non-painful non-ablative modality for improvement of photoaging.
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Dermatosis Facial/terapia , Fototerapia/instrumentación , Envejecimiento de la Piel/efectos de la radiación , Estudios de Cohortes , Dermatosis Facial/patología , Femenino , Humanos , Masculino , Índice de Severidad de la Enfermedad , Envejecimiento de la Piel/patología , Pigmentación de la Piel , Resultado del TratamientoRESUMEN
BACKGROUND: Previous data indicate that injections of autologous fibroblasts increase collagen formation, accompanied by a concomitant increase in thickness and density of dermal collagen. OBJECTIVE: The purpose of this study was to determine efficacy and side effects of autologous living fibroblast injections versus placebo in a randomized Phase III trial for the treatment of various facial contour defects. METHODS: This was a double-blind, randomized comparison of injectable living autologous fibroblast cells and placebo for the treatment of facial contour defects (N=215). Live fibroblasts (20 million/mL) or placebo (the transport medium without living cells) were given as three doses administered at 1- to 2-week intervals. Efficacy evaluations were performed 1, 2, 4, 6, 9, and 12 months after the first injection. RESULTS: Living fibroblasts produced statistically significantly greater improvements in dermal deformities and acne scars than did placebo. The difference between live fibroblast injections and placebo achieved statistical significance at 6 months (p<.0001). At 9- and 12-month follow-up, live fibroblast-treated patients continued to demonstrate benefit from treatment with response rates of 75.0 and 81.6%, respectively. No serious treatment-related adverse events were reported. CONCLUSIONS: Our results indicate that autologous fibroblast injections can safely and effectively produce improvements in rhytids, acne scars, and other dermal defects continuing for at least 12 months after injection.
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Cicatriz/terapia , Fibroblastos/trasplante , Ingeniería de Tejidos/métodos , Acné Vulgar/complicaciones , Células Cultivadas , Cicatriz/etiología , Método Doble Ciego , Cara , Dermatosis Facial/terapia , Humanos , Inyecciones Intradérmicas , Estudios Prospectivos , Envejecimiento de la Piel , Trasplante AutólogoRESUMEN
BACKGROUND AND OBJECTIVE: To describe the introduction and use of intense pulsed light (IPL) to treat vascular and pigmented lesions comprising photorejuvenation and its use in photodynamic therapy. METHODS: Review of the medical literature and the authors' experience with IPL. RESULTS AND CONCLUSIONS: IPL is an excellent treatment modality for vascular and pigmented manifestations of photoaging and can be combined with photodynamic therapy for the treatment of early forms of skin cancer.