Development of a core outcome domain set for clinical research on capillary malformations (the COSCAM project).

BACKGROUND: Due to a large variety in treatment outcomes reported in therapeutic trials and lacking patient-relevant outcomes, it is hard to adequately compare and improve current therapies for patients with capillary malformations (CMs). The Core Outcome Set for Capillary Malformations (COSCAM) project aims to develop a core outcome set (COS) for use in future CM trials, in which we will first develop a core outcome (sub)domain set (CDS). Here, we describe the methods for the development of a CDS and present the results of the first development stage. METHODS: The COSCAM project is carried out according to the recommendations of the Cochrane Skin Core OUtcomes Set INitiative (CS-COUSIN) and the Core Outcome Measures in Effectiveness Trials (COMET) initiative. During the first stage, we identified all potentially relevant outcome subdomains based on a systematic review, two focus group sessions and input from patient representatives of Dutch patient organizations and the COSCAM-founding group. In stage two, we will present the subdomains in a three-round e-Delphi study and online consensus meeting, in which CM patients, parents/caregivers and CM experts worldwide rate the importance of the proposed subdomains, hereby finalizing the core outcome (sub)domains of the CDS. RESULTS: A total of 67 potential outcome subdomains were included; sixteen were previously used in the literature, 20 were proposed by Dutch patients and their parents/caregivers (n = 13) in focus group sessions and 38 were suggested by the experts of the COSCAM-founding group. Seven were excluded because of overlap. CONCLUSION: The final CDS may serve as a minimum standard in future CM trials, thereby facilitating adequate comparison of treatment outcomes. After this CDS development, we will select appropriate outcome measurement instruments to measure the core outcome subdomains.

The efficacy in treatment of facial atrophic acne scars in Asians with a fractional radiofrequency microneedle system.

BACKGROUND: Treatment of acne scars remains a challenge to dermatologists. Multiple modalities have been employed with variable results and adverse effects. OBJECTIVE: To determine the efficacy and adverse effects of a fractional radiofrequency microneedle system (FRMS) on acne scars in Asians at 1-, 3- and 6-month follow-up visits after treatment. METHODS: Thirty subjects with atrophic acne scars for more than 6 months were enrolled in the study. All volunteers were treated with a FRMS on affected areas. The subjects were treated for a total number of three treatment sessions at 1-month intervals. Subjective assessments were obtained at baseline, 1, 3 and 6 months after the last treatment session by self-evaluation and two blinded dermatologists. Objective evaluation using an ultraviolet A-light video camera was also performed. In addition, pain scores, immediate reactions, healing times and other adverse effects were evaluated. RESULTS: Twenty-six subjects with skin phototypes III-V completed treatment protocol. The average mean scar age was 7 years (range: 0.5-15 years). At 6-month follow-up visit, the majority of the subjects (42.3%) reported a 26-50% improvement on their acne scars. Percent reduction in scar volume corresponded to clinical evaluation. Adverse reactions of the treatment included pain, immediate oedema/erythema, minimal scabbing and transient pigmentary alteration on treated areas. The average pain score was 5.6 of 10. Worsening of skin texture or new scar formation was not observed in any subjects. CONCLUSION: Fractional radiofrequency microneedle system is a safe and effective device for treating acne scars in Asians with minimal risk of downtime and adverse effects.

Therapeutic outcome of melasma treatment by dual-wavelength (511 and 578 nm) laser in patients with skin phototypes III-V.

BACKGROUND: Recent evidence suggests that vascular abnormalities are involved in the pathogenesis of melasma. Copper bromide (CuBr) laser, which emits dual wavelengths (511 and 578 nm), enabling simultaneous and selective destruction of melanin-containing cells and blood vessels, may be of benefit in the treatment of melasma. AIM: To investigate the efficacy and adverse effects (AEs) of CuBr laser for melasma treatment in patients with skin phototypes III-V. METHODS: We enrolled 24 Thai women with melasma to receive six CuBr laser treatments, 2 weeks apart. Objective (colour measurement) and subjective (clinical evaluation of photographs by three dermatologists blinded to the order of the photographs) assessments were obtained at baseline, after three and six treatments, and at the 3-month follow-up visit. A visual analogue scale (VAS) was used for patient assessment of change at baseline, after six treatments and at the 3-month follow-up. AEs were recorded at every follow-up visit. RESULTS: Of the 24 patients, 20 completed the study. Mean melanin index (MI) showed no statistically significant improvement compared with baseline measurements at any of the follow-up visits. There were significant improvements in clinical evaluation after three treatments (P = 0.00); however, this difference was no longer visible after six treatments. At follow-up 1 week after the end of the full course of six treatments, there was an improvement in VAS (P = 0.02). However, there was no improvement as measured by clinical evaluation or MI. Mild, transient AEs including erythema, burning sensation, scaling, hyperpigmentation and crusting were noted. CONCLUSIONS: CuBr laser did not show effectiveness in improving melasma in patients with skin phototypes III-V.

The efficacy in melasma treatment using a 1410 nm fractional photothermolysis laser.

BACKGROUND: Melasma treatment modalities including topical and procedural therapy have been employed with variable results and high recurrence rate. OBJECTIVE: To quantitatively assess improvement in melasma and side effects after 1410 nm fractional photothermolysis laser treatments and to determine efficacy at 1-, 2- and 3-month follow-up after treatment. METHODS: Thirty volunteers with melasma were treated with 1410 nm fractional photothermolysis for four passes on full face and additional four passes on melasma area. They were randomly treated on one side of their face with 20 mJ at 5% coverage and the other side of their face with 20 mJ at 20% coverage. All subjects were treated monthly for five times. Melanin index, Visual analogue scale and Melasma Area and Severity Index score were measured at baseline and 1-, 2- and 3-month follow-up after complete treatment protocol. RESULTS: There was statistically significant improvement of Melanin index at 2- and 3-month follow-up visits, but not at 1-month follow-up visit. Visual analogue scale and Melasma Area and Severity Index score improved significantly on both sides at 1-, 2- and 3-month follow-ups. The overall patients' satisfaction was significantly higher on the side treated with 20 mJ, 5% coverage. Adverse reactions included erythema, dryness and post-inflammatory hyperpigmentation on melasma area. Those side effects were significantly more intense on the side treated with 20 mJ, 20% coverage. CONCLUSIONS: 1410 nm fractional photothermolysis laser treatment is a safe and temporary effective procedure for melasma; however, long-term follow-up is still needed. Only 5% coverage should be used to minimize risks of adverse effects.

The use of sunscreen starting on the first day after ablative fractional skin resurfacing.

BACKGROUND: The most common side-effect of ablative fractional skin resurfacing in Asians is post inflammatory hyperpigmentation (PIH). Various attempts have been made to reduce the occurrence of PIH after laser treatment including sun avoidance, the use of preoperative and postoperative treatment regimens, and treatment using conservative energy settings and epidermal protection. OBJECTIVES: To determine whether the use of broad-spectrum sunscreen with anti-inflammatory agents starting on the first day after fractional CO2 laser skin resurfacing reduces the incidence of post laser PIH. MATERIALS AND METHODS: Thirty patients were treated with ablative fractional CO2 resurfacing on both sides of their faces at 10 mJ and 10% density. Each subject was randomly treated on one side of the face with petrolatum ointment four times a day for the first week after laser treatment and on the other side of the face with petrolatum ointment four times a day plus broad-spectrum sunscreen with anti-inflammatory agents in the morning starting on the first day after laser treatment. Transepidermal water loss was recorded at baseline and every day for 1 week. Melanin and erythema indexes were measured at baseline, 1-, 2-week, 1-, 2- and at 3-month post treatment. RESULTS: Of the 30 patients involved in the study, 26 received the treatment and attended 1-, 2-week, 1-, 2- and 3-month post-treatment visits. Four patients were withdrawn from the study because they could not attend every follow-up visit. There was no statistically significant difference in transepidermal water loss at baseline, immediately after laser treatment, or at the D1 to D7 follow-up visits. Erythema index had no significantly statistical difference at baseline, 1-, 2- and at 3-month after laser treatment. Furthermore, there was a statistically significant difference in melanin index at 1-week post laser treatment between both sides (P = 0.001). Melanin index at the 1-week follow-up visit on the side treated with broad-spectrum sunscreen with anti-inflammatory agents starting on the first day after laser treatment was significantly less than the control side. CONCLUSION: The use of broad-spectrum sunscreen with anti-inflammatory agents starting on the first day after ablative fractional skin resurfacing can decrease the incidence of PIH after laser treatment at 1-week postoperatively.

A focused review on acne-induced and aesthetic procedure-related postinflammatory hyperpigmentation in Asians.

Postinflammatory hyperpigmentation (PIH) is a common consequence following cutaneous inflammation in dark-skinned individuals with Fitzpatrick skin phototypes (SPTs) III-VI. The exact pathogenesis of this condition is unknown, but is believed to be an integral part of the normal response of the skin to inflammatory stimuli. PIH can last from months to years and may significantly impair quality of life of affected individuals. The primary treatment of PIH is prevention and treatment of the underlying inflammatory condition. In addition to prevention, there are a variety of medication and procedures used to treat PIH. Although topical skin-depigmenting agents remain the treatment of choice for PIH, lasers and light sources may be an effective adjunctive therapy or alternative for treatment failures. When treating PIH, any treatment options selected should be optimized and utilized carefully because the treatments itself may worsen the PIH.

A split axilla comparison study of axillary hair removal with low fluence high repetition rate 810 nm diode laser vs. high fluence low repetition rate 1064 nm Nd:YAG laser.

BACKGROUND: A low fluence, high repetition rate 810 nm diode laser using constant motion technique has been recently introduced with advantages of less treatment discomfort and fewer side effects compared with traditional laser hair removal. OBJECTIVE: To compare hair reduction and side effects of low fluence high repetition rate 810 nm diode with high fluence low repetition rate 1064 nm Nd:YAG lasers. METHODS: Forty-nine subjects were randomly received five monthly treatments with diode laser on one side of their axilla and long-pulsed Nd:YAG laser on the other side. Hair count was recorded at baseline, 1- and 6-month follow-up visits. RESULTS: Percentage of axillary hair reduction at 1-month follow-up visit after receiving diode and Nd:YAG laser treatment were 71.0% and 82.3%, respectively, and at 6-month follow-up were 35.7% and 54.2%, respectively. There were significant differences in hair reduction between both laser systems at 1- and 6-month follow-ups (P < 0.001 and P < 0.001, respectively). Patients reported lower pain on the diode laser side (P < 0.001). Side effects of both laser systems were mild and transient erythema and swelling. CONCLUSIONS: High fluence low repetition rate Nd:YAG laser was superior in hair reduction and provided higher patient satisfaction. However, low fluence high repetition rate diode laser was less painful.

Circumference reduction and cellulite treatment with a TriPollar radiofrequency device: a pilot study.

BACKGROUND: A wide variety of treatments for circumference reduction and cellulite are available, but most procedures offer suboptimal clinical effect and/or delayed therapeutic outcome. Objective To determine the safety and efficacy of the TriPollar radiofrequency device for cellulite treatment and circumference reduction. METHODS: Thirty-nine females with cellulite received eight weekly TriPollar treatments. Treatment areas included the abdomen, thighs, buttocks and arms. Subjects were evaluated using standardized photographs and measurements of body weight, circumference, subcutaneous thickness, and skin elasticity of the treatment sites at baseline, immediately after and 4 weeks after the final treatment. Physicians' evaluation of clinical improvement scores using a quartile grading scale was recorded. RESULTS: Thirty-seven patients (95%) completed the treatment protocol. There was significant circumference reduction of 3.5 and 1.7 cm at the abdomen (P = 0.002) and thigh (P = 0.002) regions, respectively. At 4 weeks after the last treatment, the average circumferential reductions of the abdomen and thighs were sustained. No significant circumferential reductions of the buttocks and arms at the last treatment visit compared to baseline were demonstrated (P = 0.138 and 0.152, respectively). Quartile grading scores correlating to approximately 50% improvement in cellulite appearance were noted. CONCLUSIONS: Tripollar radiofrequency provided beneficial effects on the reduction of abdomen and thigh circumference and cellulite appearance.

Energy density and numbers of treatment affect response of keloidal and hypertrophic sternotomy scars to the 585-nm flashlamp-pumped pulsed-dye laser.

BACKGROUND: The 585-nm flashlamp-pumped pulsed-dye laser (PDL) has proven to be the treatment of choice for certain keloids and hypertrophic scars, but the precise fluence, numbers of treatment, and treatment interval remain anecdotal. OBJECTIVE: This study was performed to determine whether the therapeutic outcome of the PDL varies with the energy density (fluence) of the laser pulses and numbers of treatment. METHOD: Ten previously untreated, erythematous, keloidal or hypertrophic median sternotomy scars of 10 patients were divided into 4 segments and were randomly treated with a 585-nm PDL at a fluence of 3, 5, and 7 J/cm(2) to 3 of 4 segments every 4 weeks for a total of 6 treatment sessions. One segment of each patient's scars was untreated and served as a control. Clinical improvement including scar height, erythema, and pliability was evaluated before treatment and every 8 weeks for a total period of 32 weeks. Self-assessment was also determined by patients on a 25% increment of improvement scale comparing week 0 and week 32. RESULTS: A significant improvement in scar height, erythema, and pliability was noted in all laser-treated scar areas. There was no significant difference in treatment outcome versus the fluence of the laser (3, 5, and 7 J/cm(2)), although there was a trend for lower fluences to show more improvement. Objective clinical improvement was seen as early as week 16, after more than two treatments were given. Multiple treatments (>2) appeared to provide a greater percentage of scar resolution. CONCLUSIONS: The clinical improvement of scars after PDL treatment demonstrates no statistically significant fluence dependence in this study, but a trend toward better response with lower fluences is seen. In addition, multiple treatment sessions are suggested for achieving greater response.

Hair removal with an 800-nm pulsed diode laser.

BACKGROUND AND OBJECTIVE: Laser hair removal is a relatively new procedure. Our purpose was to study the efficacy and safety of a high-power, pulsed diode laser array for removing unwanted hair. METHODS: A total of 38 subjects were treated with a prototype of the 800-nm diode laser system. Fluences ranging from 10 to 40 J/cm(2) (mean, 33.4 J/cm(2)) were used and 1 to 4 treatments (mean, 2.7) were performed. Evaluation of hair loss was performed at least 4 months after the last treatment (mean, 8.7 months) by a blinded assessment of clinical photographs. RESULTS: A total of 59% of the subjects had only sparse hair regrowth at the final follow-up. Higher fluences and multiple treatments produced greater long-term efficacy. Transient pigmentary changes occurred in 29% of the subjects and were more common in darker skin types IV to VI (P =. 047). CONCLUSION: The 800-nm diode laser is an efficient and safe technique for hair reduction. Adverse pigmentary effects occur, but are transient.

Ruby laser hair removal: evaluation of long-term efficacy and side effects.

BACKGROUND AND OBJECTIVE: Although several studies on laser-assisted hair removal have been published, data on long-term follow-up are few. The present study investigated the long-term efficacy and safety of normal-mode ruby laser pulses on hair removal. STUDY DESIGN/MATERIALS AND METHODS: The normal-mode ruby laser (Epilaser; 694 nm, 3 msec) was used to treat a wide range of body sites in 51 volunteers. The mean follow-up after the last treatment was 8.37 months. RESULTS: Sixty-three percent of the patients had sparse regrowth. The mean fluence used was 46.5 J/cm(2) in patients who had sparse hair regrowth and 39.3 J/cm(2) in patients who had moderate hair regrowth (P = 0.0127). Transient pigmentary changes occurred most frequently in patients with skin type 4. CONCLUSION: The normal-mode ruby laser is an efficient and safe method for long-term hair reduction, especially in fair-skinned individuals with dark hair. Higher fluences produce greater long-term efficacy. Adverse effects are minimal and transient.

Treatment of facial skin using combinations of CO2, Q-switched alexandrite, flashlamp-pumped pulsed dye, and Er:YAG lasers in the same treatment session.

BACKGROUND: Many patients who seek facial CO2 laser resurfacing for improvement of photodamage are also concerned with "dark circles" under their eyes (periorbital hyperpigmentation) and/or telangiectasia as well as various types of deep scars on their faces. CO2 laser resurfacing alone provides limited improvement for these problems. OBJECTIVE: The purpose of this study was to demonstrate the conjunctive therapeutic effects of the CO2, Q-switched alexandrite, Er:YAG, and/or flashlamp-pumped pulsed dye lasers on facial skin treatments. METHOD: Thirty patients who underwent CO2 laser resurfacing were treated with additional lasers specific for their cosmetic concerns. Twenty patients with facial telangiectasias were treated with the pulsed dye laser immediately prior to CO2 laser resurfacing. Eleven patients with periorbital hyperpigmentation were treated with the Q-switched alexandrite laser immediately following use of the pulsed CO2 laser. Eight patients having sharply defined acne scars were treated with the Er:YAG laser following use of the CO2 laser. All patients had peripheral feathering performed with the Er:YAG laser. Nine patients were treated with all four lasers. RESULTS: In addition to significant improvement of the wrinkle scores from the CO2 laser resurfacing, patients had 75-100% clearing of the periorbital hyperpigmentation. All patients with facial telangiectasia showed virtually 100% improvement. All deep wrinkles and sharply defined scars responded with combined CO2/Er:YAG laser better than with CO2 laser resurfacing alone. All feathering was more uniform, with a more subtle transition to nontreated skin. There were no complications that could be attributed to the simultaneous use of multiple lasers. CONCLUSIONS: For patients who present with multiple cosmetic complaints, combined treatment using appropriate lasers offers excellent therapeutic outcome.

Laser hair removal affects sebaceous glands and sebum excretion: a pilot study.

BACKGROUND: During laser-assisted hair removal, sebaceous glands closely associated with hair follicles might also be affected. OBJECTIVE: We investigated the effect of the long-pulsed ruby laser on sebaceous glands. METHODS: Sebum excretion rates (SERs) of 16 subjects were measured quantitatively by means of sebum-absorbent tape and analyzed by means of image analysis techniques on laser-treated sites, compared with adjacent untreated areas. Evaluation was done at an average of 9 months (range, 4.5 to 12 months) after the last treatment. Histologic examinations were performed on 3 representative subjects before treatment, immediately after treatment, and 9 months after the last treatment. RESULTS: Significant increases in SERs were observed in 11 of 16 subjects (68.75%). Three subjects (18.75%) showed lower SERs, whereas 2 subjects (12.5%) demonstrated no difference in SERs between treated and untreated areas. Biopsy specimens showed an apparent reduction in sebaceous gland size. Specimens taken immediately after laser irradiation revealed sporadic damage to sebaceous glands. CONCLUSION: In some patients a variable but statistically significant increase in sebum excretion occurs 4 to 12 months after ruby-laser hair removal treatment at high fluences. A reduction in sebaceous gland sizes on laser-treated areas was observed. We hypothesize that decreased resistance to sebum outflow may explain this result, following miniaturization or absence of hair shaft after ruby laser treatment. Further study is needed to assess mechanisms for this interesting response.

Combined laser resurfacing with the 950-microsec pulsed CO2 + Er:YAG lasers.

INTRODUCTION: Laser resurfacing with the 950 microsec pulsed CO2 laser has been proven to be efficacious in improving photodamaged skin and acne scarring. Unfortunately, prolonged erythema and delayed wound healing are common adverse sequelae, which require intensive patient education and intervention. These adverse effects may be due to the degree of nonspecific thermal damage present after resurfacing with the CO2 laser. Since erbium: YAG (Er:YAG) laser vaporization leaves far less thermal damage, it is hypothesized that its use after CO2 laser resurfacing will decrease the extent of nonspecific damage and result in improved wound healing. METHODS: Ten patients were randomized to receive laser resurfacing of one-half of the face with the 950 Msec pulsed CO2 laser with 3 passes at 300 mJ, utilizing the computer pattern generator (CPG) at settings of 596, 595, 584, and the other half of the face (randomly chosen) resurfaced with the 950 Msec pulsed CO2 laser 2 passes with the CPG at 300 mJ at settings of 596 and 595, followed by 2 passes with the Er:YAG laser (Derma-20 or Derma-K, ESC Medical Systems, Inc., Needham, MA) with a 4 mm diameter spot size at 1.7 J (approximately 14 J/cm2). Patients were evaluated in a "blinded" manner clinically and histologically before resurfacing, immediately after resurfacing, 2 to 3 days postoperatively, 1 week postoperatively, and, 4 to 8 weeks postoperatively. RESULTS: There was slightly less inflammation with the CO2/Er:YAG-treated patients. The epidermis re-formed 1 to 2 days faster with combination (UPCO2)/Er:YAG treatment than with UPCO2 laser treatment alone. In 7 of 10 patients, Er:YAG erythema resolved within 2-3 weeks with CO2 x 3 erythema persisting at the 8-week follow-up period in all patients. Three of 10 patients had no difference in the degree of erythema between the 2 treatment areas. Clinical findings correlated with histologic findings of vascularity. There was no difference in the extent or time of edema between techniques. The usual demarcation line between cheek and neck at the mandibular angle was less apparent when the UPCO2/Er:YAG combination was used. Two of 10 patients noted quicker healing with the combination laser technique. CONCLUSION: Treating a patient with the Er:YAG laser after treatment with the UPCO2 laser results in a decreased incidence of adverse sequelae without a noticeable difference in the degree of wrinkle improvement.

Laser resurfacing of the neck with the Erbium: YAG laser.

BACKGROUND: Laser resurfacing of the face is widely used to correct the effects of photoaging. The neck also develops a similar degree of photoaging, but is not usually treated because a higher incidence of adverse effects can occur with laser treatment. OBJECTIVE: To present a new method for treating photoaged skin of the neck with an erbium:yttrium aluminum garnet (Er:YAG) laser. METHODS: Twenty patients underwent Er:YAG laser resurfacing of the neck with one of two methods. Method 1 consisted of using the Er:YAG with a 5-mm diameter collimated beam at a fluence of 8.7 J/cm2 followed by a second pass using a 0.2 mm diameter non-collimated spot at 1.7 J in a defocused mode with spot sizes ranging from about 5 to 10 mm in diameter (fluences from 2-9 J/cm2). Method 2 consisted of treating the entire neck with a single pass of the Er:YAG laser with a 4 mm diameter non-collimated spot at 1.7 J (fluence of 13.5 J/cm2). A second pass at identical settings was made on the upper half of the neck with a more defocused pass using a 6-10 mm diameter spot (fluence of 2-6 J/cm2) on the lower half of the neck. Patients were evaluated by two nontreating physicians as to overall satisfaction and improvement in skin texture and color. RESULTS: Overall, 51% of patients were satisfied with their results. Skin texture improved an average of 39%. Method 1 produced a 28% improvement, Method 2 a 48% improvement. Skin color improved an average of 37%. Method 1 produced a 28% improvement, Method 2 a 45% improvement. CONCLUSION: Photoaged skin of the neck can be effectively treated with the Er:Yag laser with minimal adverse effects.

Long-term effectiveness and side effects of carbon dioxide laser resurfacing for photoaged facial skin.

BACKGROUND: Laser resurfacing has been used for treatment of photoaged facial skin since late 1993. Very few long-term follow-up studies regarding the effectiveness and side effects of this procedure have been reported. METHOD: Patients who received carbon dioxide laser resurfacing for facial photoaging and wrinkling from Dec 17, 1993, to Nov 30, 1996, were followed up with clinical evaluation and patient questionnaires. Histologic study was also performed in 10 representative patients who had had preoperative biopsies. All treatments were performed by 2 experienced laser surgeons (R. E. F. and M. P. G.). RESULTS: One hundred four patients were examined and interviewed with an average 24-month postoperative follow-up (range 12 to 44 months). We observed high patient satisfaction ratings and significant persistence of wrinkle score improvement. Long-term histologic features confirmed the long-lasting nature of the clinical improvement and demonstrated continuing, progressive improvement in solar clastosis deep in the dermis for an average follow-up period of 2 years. Prolonged use of topical tretinoin (retinoic acid) postoperatively may contribute to continued improvement. The incidence of long-term side effects, including pigmentary changes and scarring, was generally very low and these side effects were usually not noticed by the patients. CONCLUSION: Improvement from cutaneous laser resurfacing has persisted for an average 24-month postoperative period with a low incidence of side effects. Hypopigmentation is the most common long-term side effect and appears to be related to the degree of pre-existing photodamage as it contrasts with the newly healed undamaged skin.

Prophylactic antibiotics in patients undergoing laser resurfacing of the skin.

BACKGROUND: Carbon dioxide (CO2) laser resurfacing produces a superficial second-degree burn that needs to be protected from bacterial and fungal infections. OBJECTIVE: We investigated the effects of various systemic and topical antimicrobial regimens. METHODS: Four different regimens using oral ciprofloxacin, topical antibiotics (intranasal mupirocin ointment and otic solution), oral ketoconazole, and oral fluconazole were tested in four time periods. The frequency and types of the infections with various regimens was compared. RESULTS: The study included 356 sequential patients who underwent facial CO2 laser resurfacing. Infections occurred in 27 patients (7.6%). Without antibiotic prophylaxis, 8.2% of patients had bacterial infections from days 3 to 12 after the procedure (average, day 5). With prophylactic ciprofloxacin only, 4.3% of patients had bacterial infections; these occurred almost exclusively after ciprofloxacin was discontinued. For 7 months, patients were randomly assigned to either receive or not receive mupirocin intranasally. All Staphylococcus aureus infections that occurred were seen in patients who had used intranasal mupirocin. Yeast infections were seen in 6 patients (1.7%), but mostly occurred more than 10 days after the procedure. Yeast infections were of approximately equal occurrence in the ciprofloxacin group (2.2%) and in the non-ciprofloxacin group (1.8%). No yeast infections occurred in patients who had undergone antifungal prophylaxis. CONCLUSION: Post-CO2 resurfacing infections are not rare but can appear subtly and might only be noticeable in the second postoperative week. Prophylactic intranasal mupirocin is ineffective, but ciprofloxacin is effective in preventing infection with both gram-positive and gram-negative bacteria. Oral ketoconazole and fluconazole are effective in preventing yeast infections.

Influence of age, anatomic site and race on skin roughness and scaliness.

BACKGROUND: Variations in skin roughness and scaliness between age groups, anatomic sites and race have been assumed but minimally quantified. OBJECTIVE: We quantitatively investigated skin roughness, scaliness and stratum corneum hydration as a function of age, anatomic site and race (white and black). METHODS: Skin roughness, scaliness and stratum corneum hydration were determined in vivo by noninvasive bioengineering and image analysis techniques in 22 female subjects grouped according to age (young and aged) and race (white and black). RESULTS: Skin roughness, scaliness and stratum corneum hydration varied significantly in different anatomic areas and age groups. There was no racial variation in skin hydration between any anatomic site, nor significant differences in roughness and scaliness between races, except for the preauricular area. Skin roughness was significantly increased in the aged, compared to the young at the preauricle, volar forearm, lower back, thigh and lower leg. Older women demonstrated significantly more scaling at the preauricle than younger women. Stratum corneum hydration correlated with scaliness. No significant correlation between stratum corneum hydration and skin roughness was observed. CONCLUSION: Age and anatomic site but not race demonstrated a significant influence on skin roughness and scaliness. The desquamation index appears a good indicator of the status of stratum corneum hydration.

Hair growth cycle affects hair follicle destruction by ruby laser pulses.

It has been shown that normal mode ruby laser pulses (694 nm) are effective in selectively destroying brown or black pigmented hair follicles in adult Caucasians. This study investigated how the various stages of the hair follicle growth cycle influence follicle destruction by ruby laser treatment, using a model of predictable synchronous hair growth cycles in the infantile and adolescent mice. A range of ruby laser pulse fluences was delivered during different stages of the hair growth cycle, followed by histologic and gross observations of the injury and regrowth of hair. Actively growing and pigmented anagen stage hair follicles were sensitive to hair removal by normal mode ruby laser exposure, whereas catagen and telogen stage hair follicles were resistant to laser irradiation. Selective thermal injury to follicles was observed histologically, and hair regrowth was fluence dependent. In animals exposed during anagen, intermediate fluences induced nonscarring alopecia, whereas high fluences induced scarring alopecia. The findings of this study suggest treatment strategies for optimal laser hair removal.