Real-time, in vivo skin cancer triage by laser-induced plasma spectroscopy combined with a deep learning-based diagnostic algorithm.

BACKGROUND: Although various skin cancer detection devices have been proposed, most of them are not used owing to their insufficient diagnostic accuracies. Laser-induced plasma spectroscopy (LIPS) can noninvasively extract biochemical information of skin lesions using an ultrashort pulsed laser. OBJECTIVE: To investigate the diagnostic accuracy and safety of real-time noninvasive in vivo skin cancer diagnostics utilizing nondiscrete molecular LIPS combined with a deep neural network (DNN)-based diagnostic algorithm. METHODS: In vivo LIPS spectra were acquired from 296 skin cancers (186 basal cell carcinomas, 96 squamous cell carcinomas, and 14 melanomas) and 316 benign lesions in a multisite clinical study. The diagnostic performance was validated using 10-fold cross-validations. RESULTS: The sensitivity and specificity for differentiating skin cancers from benign lesions using LIPS and the DNN-based algorithm were 94.6% (95% CI: 92.0%-97.2%) and 88.9% (95% CI: 85.5%-92.4%), respectively. No adverse events, including macroscopic or microscopic visible marks or pigmentation due to laser irradiation, were observed. LIMITATIONS: The diagnostic performance was evaluated using a limited data set. More extensive clinical studies are needed to validate these results. CONCLUSIONS: This LIPS system with a DNN-based diagnostic algorithm is a promising tool to distinguish skin cancers from benign lesions with high diagnostic accuracy in real clinical settings.

Safety, Efficacy, and Tolerability of Simultaneous Bilateral Cryolipolysis Using a Rapid Cycling Contoured Cup Applicator for Noninvasive Fat Reduction in the Enlarged Male Breast: A Pilot Study.

BACKGROUND: A previous study using a parallel cooling plate cryolipolysis applicator demonstrated the efficacy of cryolipolysis for pseudogynecomastia. Although the procedure was safe and effective, treatment times were prolonged and anesthetic was needed to reduce treatment discomfort. OBJECTIVE: To evaluate the safety, efficacy, and tolerability of a short cycle, reduced vacuum contoured cup cryolipolysis applicator for the treatment of pseudogynecomastia. MATERIALS AND METHODS: Twelve male subjects received simultaneous bilateral treatment consisting of a 35-minute cryolipolysis cycle, followed by a short manual massage, and a second 35-minute cycle with 50% treatment area overlap in a single treatment visit. At the 6-week follow-up, a second treatment was performed with up to 2 overlapping cycles per side. Efficacy was assessed after the second treatment using transcutaneous ultrasound, standardized clinical photography, and subject surveys. RESULTS: Ultrasound analysis showed a mean fat layer reduction of 5.1 ± 2.3 mm (p < .001). Blinded, independent reviewers correctly identified 97% of baseline/treatment photography results. Surveys revealed 100% subject satisfaction with 91% reporting visible fat reduction and 100% stating they would recommend treatment. Transient side effects included mild intratreatment discomfort, paresthesia, and tenderness. CONCLUSION: A rapid cycling, reduced vacuum cryolipolysis applicator provides rapid, safe, effective, and tolerable treatment of pseudogynecomastia.

A Randomized Controlled Pilot Study: Combined 595-nm Pulsed Dye Laser Treatment and Oxymetazoline Hydrochloride Topical Cream Superior to Oxymetazoline Hydrochloride Cream for Erythematotelangiectatic Rosacea.

BACKGROUND AND OBJECTIVES: We evaluated if oxymetazoline therapy combined with 595-nm pulsed dye laser (PDL) will be more beneficial than topical oxymetazoline alone for the improvement of erythematotelangiectatic rosacea. STUDY DESIGN/MATERIALS AND METHODS: This was a randomized, controlled, prospective clinical trial approved by an independent Institutional Review Board, which enrolled 34 patients with moderate to severe clinical erythema (CEA) into a two-arm study of PDL with concomitant oxymetazoline cream (Arm 1) and oxymetazoline cream alone (Arm 2). Patients in Arm 1 were treated with 3 monthly laser sessions, which were started after 1 month of topical oxymetazoline cream. Thirty subjects continued with the study, and 25 subjects (Arm 1: 14, Arm 2: 11) completed the 6-month follow-up. With photographic comparison to baseline images, efficacy endpoints were based on clinical on-site grading by both the investigator and the patient, using the grading tools for CEA, Global Aesthetic Improvement (GAI) assessment, vessel size improvement, and subject self-assessment. These scales were assessed at baseline and/or at each clinical follow-up at 1, 2, 3, and 6 months. Subject satisfaction as well as post-treatment immediate response and treatment-associated pain scores were also evaluated. RESULTS: Statistically significant improvement in CEA was seen in both arms at the 1-, 2-, and 3-month post-baseline visits (P < 0.01). Only Arm 1 presented statistically significant improvement in CEA (P < 0.001) at 6 months post baseline with a mean score of 1.6 (almost clear-mild) compared with 3.2 at baseline. Arm 1 showed significantly greater mean vessel size improvement at 3 months (P < 0.01) and 6 months (P < 0.05) post baseline compared to Arm 2. Significantly greater improvement (P < 0.05) in the investigator GAI score was reported at the 2- and 6-month follow-ups compared with Arm 2. Subject GAI scores showed statistically significant greater improvement in Arm 1 compared with Arm 2 at both the 3- and 6-month follow-ups (P < 0.01). There were no complications or long-term effects associated with PDL or topical oxymetazoline treatments. CONCLUSION: The prospective trial verifies a safe, enhanced clinical outcome with the combination of PDL therapy and topical oxymetazoline for the treatment of erythematotelangiectatic rosacea patients. Lasers Surg. Med. © 2021 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC.

Safety and Efficacy of Nanosecond Pulsed Electric Field Treatment of Sebaceous Gland Hyperplasia.

BACKGROUND: Nanosecond pulsed electric field (nsPEF) technology involves delivery of ultrashort pulses of electrical energy and is a nonthermal, drug-free technology that has demonstrated favorable effects on cellular structures of the dermis and epidermis. OBJECTIVE: Determine the tolerability and effectiveness of nsPEF treatment of sebaceous gland hyperplasia (SGH). METHODS: This study was a prospective, randomized, open-label, multisite, nonsignificant risk trial in which each subject served as their own control. After injection of local anesthetic, high-intensity, ultrashort pulses of electrical energy were used to treat 72 subjects resulting in a total of 222 treated lesions. Subjects returned for 3 to 4 follow-up evaluations with photographs. RESULTS: At the final study visit, 99.6% of treated SGH lesions were rated clear or mostly clear and 79.3% of the subjects were satisfied or mostly satisfied with the outcome. At 60 days after nsPEF treatment, 55% of the lesions were judged to have no hyperpigmentation and 31% exhibited mild post-treatment hyperpigmentation. At the last observation for all lesions, 32% of the 222 lesions were noted as having slight volume loss. CONCLUSION: Nanosecond pulsed electric field procedure is well tolerated and is very effective in the removal of SGHs. TRIAL REGISTRATION: ClinicalTrials.gov NCT03612570.

Fractional high intensity focused radiofrequency in the treatment of mild to Moderate laxity of the lower face and neck: A pilot study.

BACKGROUND AND AIMS: The aging process is commonly associated with skin laxity in the lower face and neck. Conventional surgery can correct this at least to some extent, but is invasive. Fractional high-intensity focused radiofrequency delivered to the dermis with insulated microneedles has recently attracted attention in facial rejuvenation. The present pilot study was designed to assess the efficacy of HiFR for skin laxity of the lower face and neck. METHODS: Thirty-three patients (7 males, 26 females, age range 37-74 years) with mild to moderate skin laxity of the lower face/neck participated in the study. Three treatments were given at monthly intervals with protocols developed by the authors, three passes per session, at decreasing dermal depths for each pass. Histologic assessment of skin immediately after treatment was performed to identify the site and area of damage in the dermis. Clinical digital photography was taken at baseline and at 6 months after the final treatment session, based on which standardized computer measurement of improvement in the gnathion and cervicomental angles was the primary objective evaluation. A global assessment of improvement was graded by blinded assessors based on the photography. A telephone survey of patient satisfaction was performed at 12 months post-treatment. RESULTS: A significant post-treatment decrease in the cervicomental and gnathion angles was seen of 28.5° and 16.6°, respectively (P < 0.0001 for both). Histology immediately post-treatment showed a clear demarcated and roughly oval area of coagulation associated with the tip of the needle, confined to the dermis and not involving the epidermis. In the global assessment 81.8% of the patients achieved moderate or higher results, and 87% of patients were very satisfied or better. Downtime was minimal, lasting 3-4 days, and no persistent adverse events were recorded. CONCLUSIONS: Fractional HiFR proved safe and effective in the treatment of neck laxity in a large age range of patients, including the elderly. Lasers Surg. Med. 48:461-470, 2016. © 2016 Wiley Periodicals, Inc.

Photodynamic Therapy: A Clinical Consensus Guide.

BACKGROUND: The American Society of Dermatologic Surgery (ASDS) periodically develops consensus documents for its members concerning various aspects of dermatologic surgery. Advances in photodynamic therapy (PDT) have been many and PDT use has been established in a variety of skin conditions. OBJECTIVE: The ASDS board of directors proposed a committee of experts in the field to develop consensus documents on different treatments. An expert panel reviewed the literature on PDT and discussed the findings. The consensus was reached with evidence-based recommendations on different clinical applications for PDT. PATIENTS AND METHODS: This consensus document includes discussions regarding PDT, including different photosensitizers and various light source activators, historical perspective, mechanism of action, various therapeutic indications and expected outcomes, pre- and post-care, and management of adverse outcomes. RESULTS: Photodynamic therapy is highly effective for pre-cancerous lesions, superficial nonmelanoma skin cancers, inflammatory acne vulgaris and other conditions. New protocols including laser mediated PDT significantly improve results for several indications. CONCLUSION: The ASDS consensus document on PDT will be helpful for educating members on safe and effective PDT for a variety of indications.

Fractional 1,550 nm Ytterbium/Erbium fiber laser in the treatment of lichen amyloidosis: clinical and histological study.

BACKGROUND AND OBJECTIVE: Lichen amyloidosis is characterized by amyloid deposition in the papillary dermis, presenting clinically with intensely pruritic hyperkeratotic papules. Various treatment modalities have been used but the results are generally unsatisfactory. Several studies show that non-ablative fractional lasers can be used to treat depositional diseases due to their capability of inducing transepidermal elimination of the dermal content. To investigate the efficacy and safety of a non-ablative fractional 1,550 nm Yttrium/Erbium fiber laser for the treatment of lichen amyloidosis. MATERIALS AND METHODS: Ten subjects with a clinical and histological diagnosis of lichen amyloidosis were treated with fractional non-ablative laser using a 7-cm tip, with the parameter of 30 mJ/cm2 and 1,000 microscopic treatment zones (MTZ)/cm2 for three sessions at 4-week intervals. Clinical improvement (in terms of global improvement score, brownish/hyperpigmentation, thickness, and number of papules) was evaluated using a quartile grading scale at baseline, and 4, 12, and 24 weeks after the last treatment. Itch score and subjective satisfaction rates were also assessed. Adverse events were recorded, and pain was scored using a visual analog scale (VAS). Histologic changes were observed using standard staining with hematoxylin and eosin, as well as special stains of alkaline congo red and crystal violet at baseline and 4 weeks after treatment. RESULTS: At 4 and 24 weeks after treatment, the lichen amyloid lesions had statistically significantly improved in all aspects compared to baseline (P = 0.01 and P = 0.016, respectively; Wilcoxon signed-rank test). However, partial recurrence was reported in 2 out of 10 subjects. All subjects rated itching symptom significantly improved after only the first treatment (P < 0.05). Minimal side effects were recorded, including a burning sensation, transient erythema, and edema. Histological evaluation demonstrated decreased epidermal thickness, and degeneration and shrinkage of amyloid material deposition in the papillary dermis. There was no amyloid material deposition noted in two out of eight histopathology studies. CONCLUSIONS: The non-ablative fractional 1,550 nm Ytterbium/Erbium fiber laser is safe and effective for the treatment of lichen amyloidosis. However, larger controlled studies are required to further establish the efficacy of this treatment.

Cryolipolysis for Targeted Fat Reduction and Improved Appearance of the Enlarged Male Breast.

BACKGROUND: Pseudogynecomastia refers to benign male breast enlargement due to excess subareolar fat. Standard treatment is surgical excision under general anesthesia, liposuction, or a combination of both. OBJECTIVE: The safety and efficacy of cryolipolysis was investigated for nonsurgical treatment of pseudogynecomastia. METHODS AND MATERIALS: Enrollment consisted of 21 males with pseudogynecomastia. Subjects received a first treatment consisting of a 60-minute cryolipolysis cycle, followed by a two-minute massage, and a second 60-minute cycle with 50% treatment area overlap. At 60 days of follow-up, subjects received a second 60-minute treatment. Safety was evaluated by monitoring side effects and adverse events. Efficacy was assessed by ultrasound, clinical photographs, and subject surveys. RESULTS: Surveys revealed that 95% of subjects reported improved visual appearance and 89% reported reduced embarrassment associated with pseudogynecomastia. Ultrasound showed mean fat layer reduction of 1.6 ± 1.2 mm. Blinded reviewers correctly identified 82% of baseline photographs. Side effects included mild discomfort during treatment and transient paresthesia and tenderness. One case of paradoxical hyperplasia (PH) occurred but likelihood of PH in the male breast is not believed to be greater than in any other treatment area. CONCLUSION: This study demonstrated feasibility of cryolipolysis for safe, effective, and well-tolerated nonsurgical treatment of pseudogynecomastia.

Pilot Study to Demonstrate Improvement in Skin Tone and Texture by Treatment with a 1064 nm Q-Switched Neodymium-Doped Yttrium Aluminum Garnet Laser.

BACKGROUND: The 1064 nm Q-switched neodymium-doped yttrium aluminum garnet (QS Nd:YAG) laser was developed to treat unwanted pigmentation in the skin such as lentigines caused by photoaging, and tattoos from dye/ink insertion. This laser has also been used for non-ablative epidermal rejuvenation (skin toning). OBJECTIVE: To evaluate changes in skin tone, skin texture and overall improvement after a series of treatments with the QS Nd:YAG laser. METHODS: Participants received seven full-face treatments with M22 or Stellar M22, a 1064 nm QS Nd:YAG laser, at 2-week intervals. The investigators and participants evaluated the improvement in skin tone and texture at 1, 3 and 6 months after the last treatment. Patient satisfaction, patient discomfort, downtime and adverse events were recorded. Histological changes in the treated area were also evaluated. RESULTS: Thirteen women with a median age of 45 years (range, 34-61 years) were included in the study. The majority of the participants (53.9%) had skin type VI. One month after the last treatment session, 38% of participants reported good to very good improvement. This value increased to 100% participant improvement at both the 3-month and 6-month follow-up visits. The reduction in melanin index and the histological analysis demonstrated that the laser procedure contributed to a reduction in epidermal melanin content. Treatments were not associated with high levels of pain or discomfort. The most common immediate post-treatment response was erythema and edema. Most participants were satisfied with the resulting treatment outcome. CONCLUSION: Skin treatment with the 1064 nm QS Nd:YAG laser module on the M22 and Stellar M22 devices, using a large spot size, low fluence, moderately high repetition rate, improves skin tone and texture in patients with skin types II-VI.

Successful treatment of depressed, distensible acne scars using autologous fibroblasts: a multi-site, prospective, double blind, placebo-controlled clinical trial.

BACKGROUND: A previous clinical trial evaluating autologous fibroblasts (human dermal) injections for the treatment of facial contour deformities found significantly greater improvements in wrinkle and acne scar appearance than with placebo treatment. OBJECTIVE: To compare the efficacy and safety of autologous fibroblast treatment of moderate to severe, depressed, distensible facial acne scars with that of vehicle control. METHODS: This was a randomized multicenter, double-blind, placebo-controlled trial in subjects with bilateral moderate to severe acne scarring; subjects served as their own controls. Skin biopsies were obtained from randomized subjects for fibroblast production. Subjects (n = 99) underwent three intradermal injection sessions with 2 mL of autologous fibroblast suspension (10-20 million cells/mL) on one cheek and vehicle control (cell culture medium) on the other at 14-day intervals. Efficacy was based on the blinded subject's, evaluator's, and independent photographic viewer's (IPR) assessment of acne scarring 1 to 4 months after the last treatment. RESULTS: Autologous fibroblast treatment was associated with significantly greater treatment success than vehicle control for the subject (43% vs.18%), evaluator (59% vs. 2%), and IPR assessments. Autologous fibroblast injections were well tolerated, without permanent adverse effects. CONCLUSIONS: Autologous fibroblast injections safely and effectively improved the appearance of depressed distensible acne scars.

Developing relationships with patients, staff, and industry in dermatology.

Maintaining a thriving dermatology practice requires thoughtful and intentional investment in relationships with patients, staff, and industry. Growing the patient-physician relationship involves optimizing patient satisfaction and outcomes, which can provide improved ratings and reimbursement. Cultivating an environment of employee engagement is also essential for promotion of patient satisfaction, employee satisfaction, and practice productivity. Additionally, relationships with industry require careful navigation to maximize its great potential for medical advancement and benefit for all parties. There are inherent conflicts of interest between physician motivation for improved patient outcomes and industry goals of increased profits. Successful management of these relationships can be a difficult task, but it remains important.

Exosomes: the latest in regenerative aesthetics.

Regenerative aesthetics is a burgeoning field for skin rejuvenation and skin health restoration. Exosomes, or extracellular vesicles, represent a new and minimally invasive addition to the regenerative aesthetic toolbox. These nano-sized vesicles contain bioactive cargo with crucial roles in intercellular communication. Exosome technology, while still in its infancy, is now leveraged in regenerative aesthetic medicine due to its multifaceted role in targeting root causes of skin aging and improving overall tissue homeostasis. The main considerations for practice utilization include variation in exosome purification, isolation, storage, scalability and reproducibility. This review aims at highlighting the current and emerging landscape of exosomes in aesthetic medicine including skin rejuvenation and hair restoration.

What is this article about? The purpose of this paper is to review available studies that look at the effects of exosomes in aesthetic medicine and cosmetic surgery. A thorough literature search of all available studies was performed. What were the results? Topical exosomes, although variable in source and method of isolation, are generally considered safe in humans on intact skin. The current published research literature does not yet provide a clear consensus on long-term use for skin rejuvenation or hair restoration, nor does it delineate which patients would benefit most from this technology. There are no currently US FDA-approved exosome products on the market for medical indications. What do the results of this literature review mean? More clinical studies with proper regulatory oversight are needed.

Submental Area Treatment with ATX-101: Relationship of Mechanism of Action, Tissue Response, and Efficacy.

ATX-101 is an injectable, synthetically derived formulation of deoxycholic acid used for submental fat reduction. Methods: A narrative review of references relevant to the mechanism of action of ATX-101 and its relationship to efficacy and inflammatory adverse events was conducted. Results: When injected into subcutaneous fat, deoxycholic acid physically disrupts adipocyte cell membranes, leading to local adipocytolysis, cell death, and a mild, local inflammatory reaction consisting of macrophage infiltration and fibroblast recruitment. At Day 28 postinjection, inflammation largely resolves, and key histologic features include fibrotic septal thickening, neovascularization, and atrophy of fat lobules. Based on the mechanism of action of ATX-101 and the demonstrated inflammatory response, localized inflammation and swelling are expected following treatment. Indeed, postinjection swelling and other local injection-site events, including pain, erythema, and bruising, are common during and after treatment. Because of inflammatory sequelae following injection, reduction in submental fat is gradual and may require months before the full response is apparent. Patients may also require multiple treatment sessions to achieve their treatment goals. Repeated treatments may result in less pain and swelling over time owing to a combination of factors, including less target tissue allowing for lower doses/injection volumes, persistent numbness, and greater tissue integrity from thickened fibrous septa. Conclusions: Physicians can manage expectations by counseling patients that, based on the mechanism of action of ATX-101 and data from pivotal clinical trials, ATX-101 treatment results in localized inflammation/swelling and gradual submental fat reduction. Patient education about common local adverse events is critical.

Trends in cosmetic consumer preferences during COVID-19 pandemic: Comparing 2021 to 2020.

This commentary evaluates trends in the factors influencing consumer decision-making for cosmetic dermatologic procedures during the COVID-19 pandemic in the United States. This is a follow-up national survey to one that was published 1 year ago. This study compares the data from Summer 2020 to early Summer 2021, which presents a stark contrast. Our results demonstrate that consumers are now more interested in cosmetic dermatologic procedures compared to 1 year prior. Additionally, they still value the overall safety of the clinic, so physicians should ensure that certain safety measures remain in place despite any decreasing rates of COVID-19 positivity. Our survey sheds more light on current consumer perspectives, which may in turn help physicians adjust their practices to meet current demand. It is important for physicians to be knowledgeable regarding the patterns of consumer decision-making in order to deliver appropriate patient education and provide proper patient outreach during the COVID-19 pandemic.

Optimizing skin tightening in aesthetics in men.

The field of cosmetic dermatology has recently witnessed unbridled growth in the past several years. Part of this has been due to the increasing popularity of aesthetic treatments in men, who represent a growing patient population. Men tend to have higher levels of collagen density and greater skin thickness, but these begin to decrease earlier on. They can also more frequently have severe photodamage. Their clinical presentations can affect the selection of treatments. Physicians should be familiar with the subtle differences between treating men and women. Early studies and literature are beginning to shed more light on these important distinctions. We review the notable differences in facial aging, pathophysiology, and patient selection and discuss available treatment options with these factors in mind.

Combining confluent and fractionally ablative modalities of a novel 2790nm YSGG laser for facial resurfacing.

BACKGROUND: Several laser technologies exist for improving rhytides, pigmentation, and skin texture. Recent advances in technology introduced a new wavelength, 2,790 nm, erbium:yttrium-scandium-galium-garnet (Er:YSGG) for treatment of photoaging. 2,790 nm Er:YSGG has a water absorption coefficient between CO(2) laser and Er:YAG laser and has both ablative and fractional-ablative capabilities. OBJECTIVES: To evaluate the efficacy and safety of combining the ablative (confluent) and fractional-ablative modes of 2,790 nm Er:YSGG laser for treatment of photoaging. STUDY DESIGN/MATERIALS AND METHODS: In this uncontrolled, open label, prospective study, 10 subjects were enrolled and had a single treatment of combined confluent and fractional-ablative 2,790 nm lasers for photoaging. The primary clinical end point of the study was the change in Fitzpatrick wrinkle score from baseline at different time points as determined by blinded reviewer assessments. Secondary clinical end points were the improvement in fine lines, tone/texture, and pigmentation; the subjects' self assessment; the incidence of side effects; and the tolerability of treatments. RESULTS: Based on blinded photo-assessments by two independent dermatologists, subjects showed clinically and statistically significant mean improvement of 1.9 (95% CI: 1.1-2.6), 1.6 (95% CI: 0.8-2.3), and 1.2 (95% CI: 0.5-2.0) in Fitzpatrick wrinkle scores at 6 weeks, 3 and 6 months, respectively. Of the 90% of subjects who showed improvement in Fitzpatrick wrinkle scores, 78% continued to have improvement at the 6-month follow-up visit. Mild erythema observed post-treatment was resolved by the 6-week follow-up visit in all subjects. No transient or permanent post-inflammatory hyperpigmentation (PIH); or serious adverse events were reported. CONCLUSION: A combined confluent and fractional-ablative 2,790 nm Er:YSGG laser treatment improves photodamaged skin for at least 6 months. The treatment was well-tolerated and PIH was not found in our study.