A Combination of Non-ablative Laser and Hyaluronic Acid Injectable for Postacne Scars: A Novel Treatment Protocol.

Background: Postacne facial scars are often associated with significant patient distress. Energy-based devices, including non-ablative lasers, are commonly used for the treatment of postacne scarring. There is relatively limited data regarding the combination of non-ablative lasers with hyaluronic acid injections for postacne scarring. Objective: We aimed to evaluate the efficacy of a non-ablative 1,540-nm erbium:glass laser combined with a hyaluronic acid injectable for the treatment of postacne scars. Methods: This was a retrospective analysis of 12 patients who underwent the full treatment protocol. A before and after blinded clinical evaluation was performed independently by two dermatologists and graded on a scale from 0 (indicating a worsening of scarring) to 4 (indicating a 76-100% improvement in scarring). Pain perception, adverse effects, and patient satisfaction were evaluated. Results: A mean correct blinded before and after evaluation by two dermatologists was 96 percent. Patients demonstrated mild to moderate improvement as assessed by a quartile scale of improvement (25-50%). Mild transient pain was reported by most patients. The satisfaction level of the patients was high (4 out of 5). Limitations: The limitations of our study include the small cohort, retrospective design, and lack of a histological correlation. Conclusion: Our results suggest that this combination treatment using 1,540-nm fractional erbium:glass laser and hyaluronic acid injections is both safe and effective for patients with postacne facial scars.

1540-nm fractional erbium: Glass laser is a safe and effective modality for nonablative facial rejuvenation.

BACKGROUND: Laser treatments for facial rejuvenation are common, with ablative modalities being of more common use for this indication. Efficient nonablative modalities are of rising demand. AIM: Our aim was to determine the safety and efficacy of high-fluence, nonablative 1540-nm fractional Erbium:glass laser for facial rejuvenation. PATIENTS AND METHODS: A retrospective study of patients treated with 3-4 treatments using the 1540-nm fractional Erbium:glass laser for facial rejuvenation, using 2500-3000 mJ/stacked pulses (51-61 mJ per pixel). Patients were followed-up for 3 months following their last treatment. Before and after photos were independently blindly evaluated by 2 dermatologists, who graded them using a scale from 0 (exacerbation) to 4 (76%-100% improvement) for 2 different facial regions (frontal face region and lateral canthal region). Pain perception and adverse effects as well as patient satisfaction were documented throughout the study. RESULTS: Sixteen patients completed both treatment and follow-up period. At the 3-months posttreatment follow-up visit, moderate-to-significant improvement in rhytids appearance (mean grade of improvement: 2.93 for frontal face and 3 for lateral canthal region) was observed. Patients' satisfaction was high (4.25). Patients reported mild and transient erythema posttreatment with no other adverse effects. CONCLUSION: The high-fluence 1540-nm fractional Erbium:glass laser is a safe and effective nonablative modality for facial rejuvenation.

A combination of 1064 nm Q-switched fractional ND-YAG laser with a nonfractional microsecond pulsed technology has a synergistic effect for nonablative facial rejuvenation.

BACKGROUND: Non-ablative fractionated lasers for facial rejuvenation are increasingly preferred over ablative lasers due to their minimal downtime and fewer adverse events. The synergistic effect of the Q-switched fractional (QSF) 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, in combination with the non-fractional microsecond pulsed technology has yet to be fully evaluated. AIM: Our objective was to determine the safety and efficacy of this combination treatment for skin rejuvenation. METHODS: Patients who underwent treatment using the QSF-Nd:YAG laser, followed by the non-fractional microsecond pulsed Nd:YAG were evaluated retrospectively using a novel 3D imaging modality for degree of facial erythema, wrinkles surface area, and wrinkle depth. Pain perception, adverse effects, and patient satisfaction were assessed at the 2-month post-treatment follow-up visit, graded on a scale of 1- 5 (1 = not satisfied, 5 = very satisfied). RESULTS: Ten female patients' ages 44-67 (mean 55 years) completed both treatment and follow-up period, with an overall mild improvement in facial erythema and wrinkle surface area (mean improvement of 18% and 19.5% accordingly), as well as a mild improvement in overall wrinkle depth. Pain and adverse effects were mild and transient. Patients' satisfaction was high. CONCLUSION: The combination of the QSF-Nd:YAG laser and non-fractional microsecond pulsed technology, using a single Nd:YAG 1064 nm laser platform, was found safe and effective as a non-ablative modality for facial rejuvenation, as demonstrated by a novel 3D imaging modality.

1064-nm Q-switched fractional Nd:YAG laser is safe and effective for the treatment of post-surgical facial scars.

Post-surgical facial scars are often associated with unaesthetic outcome. Treatment of these scars using various lasers could be beneficial; however, the use of the Q-switched fractional (QSF) 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser has yet to be evaluated for this indication. Our objective was to determine the safety and efficacy of a QSF-Nd:YAG laser for the treatment of post-surgical facial scars. Eleven (5 male, 6 female) patients who underwent facial surgery with significant scarring were treated using the QSF-Nd:YAG laser. Scars were exposed to 600-1200 mJ/stacked pulses (12-24 mJ per pixel), emitted at a rate of 10 Hz for up to 2 passes per treatment session, receiving overall 3-6 treatments. Patient follow-up was 3 months. Scars' photographs were blindly assessed by two dermatologists, who graded them on a scale of scar severity from 1 to 5 (1 = least severe, 5 = most severe) before and after treatment. A blinded before/after recognition of these photographs was also performed. Patient satisfaction was assessed 3 months post-treatment and graded on a scale of 1-5 (1 = not satisfied, 5 = very satisfied). Pain perception and adverse effects were also evaluated. Patients demonstrated a decrease in scar severity score by a mean of 1.57 points (p = 0.0005). A blinded before/after recognition was correct in 86.5% of the cases. Pain and adverse effects were mild and transient. Patient satisfaction was high (4.2). QSF-Nd:YAG laser is a safe and effective modality for the treatment of post-surgical facial scars.

Picosecond lasers for tattoo removal: a systematic review.

Given that the pigment particles in tattoos have a relaxation time of <10 ns, picosecond lasers would be expected to be more effective than nanosecond lasers in tattoo removal. To systematically review the evidence regarding the effectiveness and safety of picosecond lasers for tattoo removal, Pubmed, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and reference lists were searched for relevant trials. The primary outcome was >70 % clearance of tattoo pigment. Secondary outcomes were 90-100 % clearance of tattoo pigment, number of laser sessions required, and adverse effects. Eight trials were included, six with human participants (160 participants) and 2 with animal models. Seven of the eight trials explored the usage of either 755, 758, 795, 1064, or 1064/532-nm picosecond lasers for black and blue ink tattoos. In the human trials, 69-100 % of tattoos showed over 70 % clearance of pigment after 1-10 laser treatments. Reported side effects included pain, hyperpigmentation and hypopigmentation, blister formation and transient erythema, edema, and pinpoint bleeding. Included articles varied in type of laser investigated, mostly non-comparative studies and with a medium to high risk of bias. There is sparse evidence that picosecond lasers are more effective than their nanosecond counterparts for mainly black and blue ink tattoo removal, with minor side effects.

Luminex LiquiChip System for the Evaluation of Cytokine Levels in Patients with Contact Dermatitis to Potassium Dichromate.

BACKGROUND: Allergic contact dermatitis (ACD) is associated with increased production of cytokines. The patch test is the "gold-standard" diagnostic method, but it poses a risk of false results. OBJECTIVE: To evaluate a novel laboratory technique, the Luminex LiquiChip, which simultaneously measures blood levels of multiple cytokines, as a diagnostic tool in patients with chrome-induced ACD. METHODS: The study group included 20 patients with ACD and relevant patch test results for potassium dichromate and 19 patients with ACD for nickel or fragrance as control. Peripheral blood mononuclear cells (PBMCs) were cultured in the presence and absence of potassium dichromate. The Luminex LiquiChip was used to measure levels of the following cytokines: granulocyte-macrophage colony-stimulating factor, interleukin (IL)-1ß, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, interferon-γ, and tumor necrosis factor (TNF)-α. RESULTS: Potassium dichromate-stimulated PBMCs secreted significantly higher amounts of all cytokines except TNF-α than nonstimulated PBMCs. PBMCs from patients with ACD to chromium secreted significantly higher amounts of all cytokines tested, except IL-4, compared to PBMCs from patients with ACD to nickel or fragrance. CONCLUSIONS: Potassium dichromate stimulates the production of both Th1- and Th2-type cytokines in patients with chrome allergy. The Luminex LiquiChip is a promising in vitro method and may serve as a diagnostic tool for ACD.

Trends in dermatologic surgery research over the past decade.

We aimed to study the rate of change in number and categories of publications in dermatologic surgery in dermatology versus non-dermatology journals. PubMed was searched for articles on dermatologic surgery from January 1, 1998 to December 31, 2007, using the search word "dermatology" AND "surgery". Articles were characterized by publication and journal type per year. Regression analysis was used to determine the effect of year of publication on number of publications of each type. The search yielded 7570 publications on dermatologic surgery. Seventy-three percent appeared in dermatology journals. Overall, the number of publications increased linearly with time. Most of this increase was accounted for by publications in non-dermatology journals. However, there was an increase in randomized control trials over the course of the study period in dermatology journals only, while low quality-of-evidence publications accounted for most of the increase in non-dermatology journals. Over the past 10 years the field of dermatologic surgery has had a significant yearly increase in published original studies. It appears that high quality evidence on dermatologic surgery is mostly published in dermatology journals. Current trends towards evidence-based dermatology might impact future research and publications in the field of dermatologic surgery.

Trends in dermatology publications over the past 15 years.

BACKGROUND: There is a continually increasing amount of medical literature, which makes the challenge of keeping up to date in the field of dermatology increasingly difficult. OBJECTIVE: To test the hypothesis that the total number and the number in various categories of publications in pediatric and adult dermatology have increased over time in a linear fashion. METHODS: We evaluated all MEDLINE articles from 1 January 1993 to 31 December 2007. We limited the search to 'skin' AND 'diseases' OR 'dermatology' for adults and children. We used regression analysis to determine the effect of the year of publication on the number of publications of each type. RESULTS: MEDLINE reported 17, 925 publications in adult dermatology and 9011 publications in pediatric dermatology during the evaluation period. There was a significant linear increase in the number of publications over the study period in both categories. There was a steady and similar increase over time in both pediatric and adult dermatology in total publications, randomized controlled trials, clinical trials, case reports, and letters to the editor, while there were too few meta-analyses, editorials, and clinical guidelines to make meaningful analyses of trends. CONCLUSIONS: The fields of pediatric and adult dermatology have had a significant yearly increase in studies providing a high level of scientific evidence with a much slower rise in the number of articles providing a lower level of evidence.

Capillary malformation associated with angiolipoma: analysis of 127 consecutive clinic patients.

BACKGROUND: Capillary malformations (also known as port-wine stains) are low-flow vascular malformations of the skin that occur in 0.3% of neonates. Angiolipomas are subcutaneous, benign, usually multiple, lesions, composed of adipose tissue and blood vessels, which occur in young adults. OBJECTIVE: The aims of this study were to determine whether there is an association between capillary malformations and angiolipoma, and to describe the characteristics of patients with this association. METHODS: Prompted by our finding of an accompanying subcutaneous mass in a patient with capillary malformation, we reviewed the entire pool of 127 patients (71 women, 56 men; average age 22.2 years) attending the Rabin Medical Center (Petach Tikva, Israel) for treatment of nonfacial capillary malformations. All patients underwent a detailed history and comprehensive physical examination. Biopsy samples were taken from suspect lesions. RESULTS: In addition to the index patient, four patients were found to have a subcutaneous mass beneath the capillary formation. Imaging and histologic studies identified the mass as an angiolipoma. All of the lesions were relatively refractory to pulsed dye laser or intense pulsed light treatment. CONCLUSION: This unique report of an association between capillary malformation and angiolipoma is intended to raise the index of suspicion for underlying angiolipoma in clinicians treating patients with refractory nonfacial capillary malformations.

Pain inhibition in Q-switched laser tattoo removal with pneumatic skin flattening (PSF): a pilot study.

BACKGROUND: Tattoo removal with a Q-switched laser is often a painful procedure. The sensation of pain associated with the treatment is immediate and acute. Application of topical anesthesia to the treated area of the skin is time-consuming, with only very moderate pain relief. OBJECTIVE: To determine the efficacy of pneumatic skin-flattening (PSF) technology which utilizes an evacuation chamber that generates skin compression and activates tactile neural receptors in the skin, resulting in afferent inhibition of pain transmission in the dorsal horn (the 'gate theory'). METHODS: Eleven young patients aged 17-25 years old (nine females, two males) who were treated for tattoo removal were enrolled in the study. The patients were treated by a Q-switched Nd:YAG laser. Acute pain evaluation was performed on all 11 patients: one to two sites per patient with PSF and one to two control sites without PSF. When patients were treated with PSF, they knew they were being treated with a device that might reduce pain. This may have influenced patients' perception of pain. The evaluation was based on a modified McGill pain questionnaire. RESULTS: All 11 patients completed the study. A lower pain score with PSF was observed in all but one patient (10/11 or 91%). The average reduction of pain is by two levels: from very painful to very mild pain. The energy transmission of the PSF window is 95%, resulting in essentially identical efficacy of the PSF treatment and the regular non-PSF treatment. CONCLUSION: This pilot study indicates that PSF technology may reduce pain in tattoo removal with medium energy density Q-switched lasers (3-5 J/cm(2)).

[Pemphigus vulgaris--an alternative for steroid treatment?].

Pemphigus vulgaris is an autoimmune disease with a well-established immunological basis. Treatment is based on high dose and maintenance systemic corticosteroids. We report on a patient with a recurrence of full-blown pemphigus vulgaris after a trial of alternative hypnosis therapy to replace the corticosteroids.

Cytokine gene polymorphisms in patch-stage mycosis fungoides.

Cytokine production is under genetic control and certain allelic variants of cytokine genes are associated with lower or higher cytokine production in vitro and in vivo. The general concept is that a shift from a Th1 to a Th2 cytokine profile accompanies disease progression from patch-stage mycosis fungoides to tumour stage, although the results of the studies carried out have not been entirely conclusive. We aimed to investigate whether certain cytokine polymorphisms might represent a risk factor for developing patch-stage mycosis fungoides. Genotyping for IFN-gamma (Th1 cytokine), IL-6, IL-10 (Th2 cytokines), TNF-alpha and TGF-beta 1 was undertaken for 33 patients with patch-stage mycosis fungoides and the results were compared with those in a control group. Genotype distribution showed no significant differences between the patients and the controls for any of the five cytokines studied. Our study suggests that patch-stage mycosis fungoides is not determined by a specific genotype polymorphism. However, further studies on larger numbers of cases are needed before definite conclusions can be drawn.

Intravenous immunoglobulin for treatment of pemphigus.

Pemphigus is a group of organ-specific, autoimmune, mucocutaneous blistering disorders with an established immunological basis. The goal of therapy in pemphigus is to eliminate or neutralize the pathogenic autoantibodies. As in other autoimmune diseases, early systemic therapy is important for control of the disease and for achieving sustained remissions. Because of the sparse number of controlled studies, the treatment of autoimmune bullous diseases remains controversial. In this article, we discuss the current therapeutical options in pemphigus with an emphasis on IVIg treatment and suggest guidelines for the use of IVIg in the treatment of pemphigus.