Cutaneous adverse effects associated with LAG-3 inhibitor use in cancer treatment: A systematic review.

Immunotherapy has become a mainstay of treatment for many cancers. Multiple immune checkpoint inhibitors have been used to treat malignancies, including anti-programed death-1 (PD1) and anti-cytotoxic T-lymphocyte-associated protein (anti-CTLA4). However, a significant percentage of patients develop resistance to these immunotherapy drugs. Therefore, novel strategies were developed to target other aspects of the immune response. Lymphocyte activation gene-3 (LAG-3) is a cell-surface molecule found on natural killer cells and activated T-cells which negatively regulates T-cell proliferation and function. LAG-3 inhibitors interact with LAG-3 ligands on the surface of T-cells to block T-regulatory (Treg) cell activity, suppress cytokine secretion and restore dysfunctional effector T-cells which subsequently attack and destroy cancer cells. This review reports the dermatologic side effects associated with LAG-3 inhibitors used in the treatment of melanomas. Using PRISMA 2022 guidelines, a comprehensive literature review of PubMed, Google Scholar, Embase, Cochrane, and Web of Science databases was conducted. Three studies were identified that demonstrated that the use of LAG-3 inhibitors, whether as a single agent or in combination with other immune checkpoint inhibitors, resulted in stomatitis, pruritus, rash, dry skin, erythema, and vitiligo. Further research is warranted to assess the cutaneous adverse events observed with LAG-3 inhibitors in treating melanoma and to identify populations most vulnerable to such side effects.

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients.

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA-compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms "ablative laser" and "skin resurfacing" from March 2002 until July 2020. Studies included meta-analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self-resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.

Concomitant use of isotretinoin and lasers with implications for future guidelines: An updated systematic review.

It is generally believed that intervention on skin while on isotretinoin or within 6 to 12 months after treatment can lead to prolonged healing and abnormal scarring. The objective of this systematic review is to evaluate the body of evidence on concomitant use of isotretinoin and lasers for adverse events as a consequence of treatment. A PRISMA-compliant systematic review (Systematic Review Registration Number: CRD42017056492) of 12 electronic databases was conducted for the terms "laser" and "isotretinoin" or associated brand names from inception until June 2020. Subsequent reference search of studies meeting predefined inclusion criteria were conducted, and all articles were evaluated for bias and assigned levels of evidence to facilitate data synthesis. The search strategy produced 29 studies. Of 871 patients included in the studies of interest, 12 experienced transient adverse effects that resolved spontaneously, and only two presented with keloid formation, both from case reports. This systematic review suggests the risk associated with concomitant isotretinoin and laser use is small to absent. Further studies are needed, but these results suggest that current contraindications may be overly cautious.

The use of lasers in the treatment of skin cancer: A review.

BACKGROUND: In considering skin cancer, a number of factors-including effectiveness, simplicity of treatment, cost, and esthetic outcomes-are important to ensure patient's satisfaction. There are several existing interventions, such as electrodessication and curettage, excision, Mohs surgery, radiation therapy, cryotherapy, and topical/oral treatments. Laser therapy has emerged as a new promising alternative that should be explored. OBJECTIVE: To review the literature on the dermatological use of laser therapy in the treatment of skin cancer. RESULTS: A review of articles available on the MEDLINE and Web of Science databases until May 2017 yielded 24 and 6 studies, respectively, on laser therapy in the treatment of skin cancers, particularly melanoma, basal cell carcinoma, and squamous cell carcinoma. The four laser subtypes included solid-state, diode, dye, and gas lasers. CONCLUSION: Review of the literature demonstrates the progress of dermatological understanding of the clinical implications of laser therapy in the treatment of premalignant and malignant neoplasms of the skin, and suggests that this treatment modality might be a viable option for some patients.

High-fluence fractional treatment of photodamaged facial skin using a 2940 nm erbium:yttrium-aluminum-garnet laser.

INTRODUCTION: Fractional resurfacing with an Erbium:yttrium-aluminum-garnet (Er:YAG) 2940 nm laser is an increasingly popular option for the treatment of the signs of facial photoaging, which include wrinkles as well as pigmentation issues and unwanted textural changes. Fractional treatment has produced favorable clinical responses, but with less complications and shorter recovery times than traditional laser resurfacing. This study was conducted to evaluate a fractionated Er:YAG treatment regimen of 1-2 higher fluence sessions with a multiple-pass technique. MATERIALS AND METHODS: Eight subjects with moderate to severely photodamaged facial skin received one to two full-face laser treatments. Multiple-pass (MP) treatment results were evaluated in terms of procedure time, discomfort, social downtime and effectiveness. A photographic evaluation, subject improvement assessments and a subject satisfaction assessment were performed. RESULTS: An investigator's photographic review showed a 26-75% improvement in the signs of overall photoaging. Subjects treated with the MP technique exhibited a relatively short 3-4 day downtime and ratings of mostly moderate discomfort with the use of topical anesthetic cream only. Subjects treated with higher fluences demonstrated the highest average improvement in specific features of photoaging. Two laser treatments resulted in substantially higher improvement scores than those received just one laser treatment.

Laser scar revision: A review.

Surgery, burns, wounds, and inflammatory processes can lead to the development of a variety of different scars. Scars are categorized as hypertrophic, keloid, atrophic and acne scars. Different treatments are utilized for each scar type. The evolution of scar treatment has led to the advancement of lasers for the improvement of all scar types. Non-ablative lasers such as the pulsed dye laser have been shown to be effective in the treatment of hypertrophic and erythematous scars. Ablative lasers, the carbon dioxide (CO(2)) and erbium:YAG (Er:YAG), were some of the first lasers that were proven to be effective in the treatment of atrophic acne scars. Further developments in laser technology have led to non-ablative and ablative fractional devices that improve scar appearance and are better tolerated than ablative CO(2) and Er:YAG. This article will review scars and the laser options for scar revision.

Reduction in thigh circumference and improvement in the appearance of cellulite with dual-wavelength, low-level laser energy and massage.

OBJECTIVES: This study evaluated the efficacy and safety of a low-level, dual-wavelength laser energy and massage device for improving the appearance of cellulite and reducing thigh circumference. METHODS: Subjects (n = 83) with mild to moderate cellulite enrolled in this IRB-approved, open-label, multicenter study. Their right or left thighs received eight treatments with a low-level, dual-wavelength laser and massage device. The untreated contralateral thigh served as a control. Circumferences of the upper, middle, and lower thighs (treated and untreated) were measured before the fifth and eighth treatments and 1 month after the final treatment. RESULTS: Reduction in thigh circumference of the treated areas exceeded those of the control areas for the upper, middle, and lower thigh in most subjects. The maximum reduction (-0.82 cm) occurred in the upper thigh at 1 month. The mean reduction of the upper, middle, and lower thigh circumferences was -0.64 cm for the treated thighs compared to -0.20 cm for untreated thighs. The difference was significant (p < 0.0001). Fifty-nine (71.1%) treatment thighs lost circumference compared to 44 (53.0%) control thighs. Resolution of adverse effects including erythema, swelling, and increased urination was seen within 30 minutes after treatment. All were resolved without sequelae and within the expected duration. CONCLUSION: The low-level, dual-wavelength laser energy and massage device safely improves the appearance of cellulite while reducing thigh circumference.

Treatment of cutaneous lesions with a novel erbium-doped yttrium aluminum garnet laser with micron tips.

BACKGROUND AND OBJECTIVE: The water content of epidermis below the stratum corneum is more than 70%. The 2,940-nm wavelength is at the peak of water absorption, making it an ideal wavelength for ablation of skin. The purpose of this study was to determine the effectiveness and safety of a novel erbium-doped yttrium aluminum garnet (Er:YAG) laser with micron tips in the removal of cutaneous lesions. METHODS: Fourteen subjects with various cutaneous lesions received a single treatment with an Er:YAG laser, using an average fluence of 104.7 J/cm² (range 99-314 J/cm²), a mean repetition rate of 11.7 Hz, and straight and curved tips with a 400- to 600-µm spot size. One subject received two treatments with a 1-month interval. The majority of subjects (80%, n = 12) did not require anesthesia. RESULTS: Clearance of 76% to 100% was obtained in 33% (n = 5) of subjects 1 month after treatment, 67% (n = 10) of subjects at 3 months, and 100% (n = 15) of subjects at 6 months. Investigators noted complete lesion clearance in all subjects 6 months after treatment. Ninety-three percent of subjects (n = 14) reported satisfaction with the procedure and its outcome. CONCLUSION: The 2,940-nm wavelength combined with small micron spot size tips provides safe and effective clearance of cutaneous lesions, even in hard-to-reach locations. HOYA-Con Bio supported study-related expenses.

Derm diagnoses you can't afford to miss.

Management of hereditary angioedema should include fresh frozen plasma containing C1 inhibitor (C1-INH), whenever possible; if C1-INH-containing plasma is unavailable, fresh frozen plasma can be used instead. Do not give neomycin to patients with suspected cellulitis; the drug may promote antibiotic resistance in Staphylococcus aureus, a pathogen often associated with this condition. Whenever a patient presents with erythematous skin lesions and a recent history of receiving penicillin or a cephalosporin antibiotic, a sulfa derivative, or an anticonvulsant, the suspected medication should be stopped until Stevens-Johnson syndrome is ruled out.

Efficacy and safety of a 0.65 millisecond pulsed portable ND:YAG laser for hair removal.

BACKGROUND AND OBJECTIVE: Based upon the thermal relaxation time of the hair follicle (10-50 ms), most lasers and light devices use relatively long pulse widths for hair removal. This study was conducted to evaluate a shorter pulsed, 0.65 ms Nd:YAG laser for hair removal. METHODS: One half of each axilla of six female participants was treated and the other half was monitored as a control. The treatment sites were treated with a fluence of either 21 J/cm(2) or 36 J/cm(2) using an Nd:YAG laser with a wavelength of 1064 nm and a pulse duration of 0.65 ms. A manual hair count was done before treatment and at each follow-up visit. RESULTS: Four months after four monthly treatments, the hair reduction was graded as 5 (75-100% reduction) on the high fluence side and 4 on the low fluence side (50-75% reduction) by individuals and investigators. The average hair count 4 months after four treatments in the sites treated with a high fluence went from 114 to 28 (76% reduction) and in the low fluence areas from 135 to 38 (72% reduction). CONCLUSION: This well-controlled study shows that a 0.65 ms Nd:YAG laser is effective and safe for hair removal.

Micro-fractional ablative skin resurfacing with two novel erbium laser systems.

BACKGROUND AND OBJECTIVES: Fractional ablation offers the potential benefits of full-surface ablative skin resurfacing while minimizing adverse effects. The purpose of this study was to evaluate the safety, damage profile, and efficacy of erbium fractional lasers. MATERIALS AND METHODS: Histology from animal and human skin as well as clinical evaluations were conducted with erbium YAG (2,940 nm) and erbium YSGG (2,790 nm) fractional lasers varying pulse width, microbeam (microb) energy, number of passes, and stacking of pulses. RESULTS: Single-pulse treatment parameters from 1 to 12 mJ per 50-70 microm diameter microbeam and 0.25-5 milliseconds pulse widths produced microcolumns of ablation with border coagulation of up to 100 microm width and 450 microm depth. Stacking of pulses generated deeper microcolumns. Clinical observations and in vivo histology demonstrate rapid re-epithelization and limited adverse side effects. Facial treatments were performed in the periorbital and perioral areas using 1-8 passes of single and stacked pulses. Treatments were well-tolerated and subjects could resume their normal routine in 4 days. A statistically significant reduction in wrinkle scores at 3 months was observed for both periorbital and perioral wrinkles using blinded grading. For periorbital treatments of four passes or more, over 90% had > or =1 score wrinkle reduction (0-9 scale) and 42% had > or =2. For perioral wrinkles, over 50% had substantial improvements (> or =2). CONCLUSION: The clinical observations and histology findings demonstrate that micro-fractional ablative treatment with 2,790 and 2,940 nm erbium lasers resulted in safe and effective wrinkle reduction with minimal patient downtime. The depth and width of the ablated microcolumns and varying extent of surrounding coagulation can be controlled and used to design new treatment procedures targeted for specific indications and areas such as moderate to severe rhytides and photodamaged skin.

Bilateral aberrant axillary breast tissue mimicking lipomas: report of a case and review of the literature.

A 31 year old Indian woman presented with bilateral axillary masses that became noticeable with the onset of puberty. The masses exhibited similar consistency to the adjacent normal breast tissue but lacked an associated nipple complex. The clinical impression was lipoma; however, mammography, ultrasonography and skin biopsy revealed ectopic breast tissue. These findings were consistent with the diagnosis of aberrant breast tissue. A subset of ectopic mammary tissue, aberrant breast tissue may constitute a diagnostic challenge and is often misdiagnosed as lipoma, hidradenitis, follicular cyst, or lymphadenopathy. In addition, some studies have suggested that aberrant breast tissue may be at higher risk of malignant degeneration. Therefore, it's important that physicians be familiar with this condition as this may contribute to the early detection of ectopic breast cancer.

Comparison of the open technique with a new wound dressing, H2460, in the healing of an acute wound after laser skin resurfacing.

BACKGROUND: Applying various dressings or leaving the treated area open are two techniques in use after laser skin resurfacing (LSR). OBJECTIVE: This study was conducted to compare healing of an acute wound using a new hydrocolloid dressing, H2460, with the open technique. METHODS: Immediately after LSR, one side was covered with the new hydrocolloid dressing H2460 and the other side was left open. Participants were instructed to clean the open side four times a day and replace the H2460 dressing if it was dislodged. RESULTS: In the volunteers' and investigator's evaluations, the new dressing H2460 generally outperformed the 'open' technique. At the 1-month follow-up, eight of 10 volunteers reported that the H2460 side resulted in better healing; two of 10 volunteers felt there was no difference between the two sides for final outcome and none believed that the open side had better healing. Overall, the H2460 side healed better in the majority of participants as graded by the blinded observer (60%) and participant themselves (80%). CONCLUSION: The new hydrocolloid dressing H2460 is a better and suitable alternative to the open technique to manage an acute wound after LSR.

Erbium:YAG laser resurfacing using a novel portable device.

Laser resurfacing of facial rhytids has become a popular treatment for many patients who have wrinkles, photodamage, and acne scarring. Erbium:YAG laser resurfacing has emerged as one of the safer, more effective methods of facial rejuvenation and its increasing popularity has led to its widespread use for resurfacing. However, size and high initial and maintenance cost are among the problems with currently available laser devices. The LightPod portable Erbium:YAG laser from Aerolase offers a new paradigm for more cost effective means of performing ablative resurfacing with reduced initial and maintenance cost and the ease of portability with significantly reduced size and weight. The objective of this pilot study was to analyze the efficacy of The LightPod Erbium:YAG laser in different skin types for various indications.

Laser skin resurfacing with a novel portable erbium:YAG laser.

BACKGROUND AND OBJECTIVE: The erbium:YAG laser is a popular modality for laser skin resurfacing (LSR). This study was performed to evaluate the safety and efficacy of a new portable Er:YAG laser in the treatment of photo-damaged skin. METHODS: Nine patients with skin types I-III were treated for rhytides, large pores, pigmented lesions, lentigines and photo-damage. Small facial areas such as the periorbital area, nose, cheeks, and upper lip were treated with one to six passes at 5-6 J/cm2 with a new portable Er:YAG laser. Topical and local anesthesia was used. RESULTS: All treated areas showed improvement and, depending upon the number of passes, re-epithelialization was complete within 2-7 days. The intense erythema resolved within 7 days and there was blending of treated and untreated areas within 2 weeks. CONCLUSION: The technique of applying a tailored number of 5-6 J/cm2, 300 micros pulses of a new portable Er:YAG laser to small areas appears to be safe and effective. There was minimal discomfort and a high level of patient satisfaction after a relatively short recovery time.

Comparison of two wound dressings after laser skin resurfacing.

BACKGROUND: It has been reported that the final outcome of laser resurfacing still depends to a large degree on the efficiency of the post laser resurfacing wound care in promoting wound healing and preventing early and late complications. OBJECTIVE: The objective of this study was to evaluate and compare a new hydrocolloid dressing, H2460, with Flexzan(TM) for healing of an acute wound after laser skin resurfacing (LSR). METHODS: Ten volunteers received LSR of the peri-orbital area with an erbium:YAG laser. Identical parameters were used on both sides: 2 J, 5 mm spot, 8 Hz, 300 micros pulse, two passes on the upper eyelids, four passes on the lower eyelids and six passes on the crow's feet area. Soon after the LSR, one side was covered with Flexzan dressing and the other side was covered with a new hydrocolloid dressing -- H2460. The side of the dressing was randomized by alternating both dressings. All volunteers were evaluated and digitally photographed every day for a week and at 1 month after LSR. The degree of erythema, swelling, bleeding, oozing, crusting, pigmentary changes, scarring, discomfort, itching, burning, ease of application of dressings, initial adhesion, overall adhesion, leakage of fluid, maceration of surrounding skin, ease of removal and adhesive residue upon removal were documented. RESULTS: In all volunteer and investigator's evaluations, the new dressing, H2460, achieved far better results than Flexzan in each category. After a 1-week follow-up all volunteers and the investigator evaluated the H2460 side as: healed better, simple to use, and caused less discomfort in 10 out of 10 volunteers. The blinded observer's assessment showed that the Flexzan side healed better in one volunteer. CONCLUSION: The new dressing, H2460, is a better and suitable alternative to Flexzan as a post LSR dressing.