Vibration Anesthesia for Pain Reduction During Intralesional Steroid Injection for Keloid Treatment.

BACKGROUND: Patients suffer significant pain during intralesional steroid injection treatment for keloids and hypertrophic scars. Vibration anesthesia has been shown to effectively and safely alleviate pain sensations, likely by reducing pain transmission from peripheral receptors to the brain. OBJECTIVE: The objective was to evaluate the efficacy, safety, and patient satisfaction associated with vibration anesthesia for reducing pain during intralesional corticosteroid injection. METHODS: The authors recruited 40 patients with 58 keloids who were scheduled to undergo intralesional triamcinolone acetonide (TA) injections. Half of each keloid was injected with concomitant vibration anesthesia, whereas the other half was injected without vibration anesthesia. Pain experienced by patients during both procedures was assessed according to visual analog scale (VAS) score. The authors also assessed procedure safety. RESULTS: The mean VAS score during intralesional TA injection therapy without vibration was 5.88 ± 2.34. By contrast, the same patients yielded a mean VAS score during intralesional TA injection therapy with vibration of 3.28 ± 1.85; the difference between the mean scores was significant (p < .05). Thirty-nine (97.5%) patients tolerated this therapy well. CONCLUSION: Vibration anesthesia is a promising option for reducing pain during keloid treatment with intralesional steroid injection.

Treatment of hesitation marks on the forearm by the pinhole method.

Scars from self-inflicted wounds, referred to as "hesitation marks," are usually linear, flat, poorly oriented, white in color, and often located on the forearm. Many patients do not undergo treatment for these due to limited available modalities. The aim of this study was to evaluate the efficacy and safety of the pinhole method using a 10,600 nm carbon dioxide (CO2) laser for treating hesitation marks on the forearm. We conducted a retrospective chart review of patients with hesitation marks treated by the pinhole method from March 2010 to April 2014. Eleven patients with hesitation marks (mean age 37.8 years; range, 23-67 years) were treated with the pinhole method over the 4-year study period. Subjects were treated via the pinhole method in one to six treatment sessions at 4- to 8-week intervals. Two blinded observers evaluated photographs taken at baseline and 3 months after the final treatment and assessed improvement using a quartile grading scale. Compared with baseline, there was mild to moderate improvement in all patients (mean score 3.0). The patient satisfaction survey revealed a mean improvement score of 2.82. The pinhole method using a CO2 laser may be an effective treatment option in patients with hesitation marks on the forearm.

Treatment of periorbital syringoma by the pinhole method using a carbon dioxide laser in 29 Asian patients.

BACKGROUND: Pinhole method has been used to treat various types of scars and dermal tumors by making multiple small holes in target tissues of the deep dermis using an ablative 10,600-nm carbon dioxide (CO2) laser. OBJECTIVES: We prospectively investigated the efficacy and safety of using a CO2 laser to treat periorbital syringomas via the pinhole method. METHODS: A total of 29 patients with periorbital syringomas were treated with two sessions of CO2 laser treatment using the pinhole method at two-month intervals. Laser fluences were delivered under the following settings: pulse duration of 200 µs, frequency of 50 Hz, on time of 0.04, and an off time of 0.01. RESULTS: Among the 29 patients, 13 patients (44.8%) presented with small discrete papular syringomas, 10 (34.5%) had plaque-type lesions, and six (20.7%) had mixed lesions. Evaluation of the clinical results at 2 months after the second treatment session revealed marked clinical improvement (51-75%) in 10 of the 29 patients (34.5%), moderate clinical improvement (26-50%) in eight (27.6%), near-total improvement (≥ 75%) in seven (24.1%), and minimal improvement (0-25%) in four patients (13.8%). CONCLUSIONS: Our observations indicated that application of the pinhole method using a CO2 laser exerts positive therapeutic effects in Asian patients with periorbital syringomas.

Treatment of hypertrophic burn scars by combination laser-cision and pinhole method using a carbon dioxide laser.

BACKGROUND: Hypertrophic burn scars induce cosmetic and functional complications. Although there are various treatment modalities, an ideal method has not yet been found. Recently, numerous laser treatment modalities have been introduced with encouraging results. OBJECTIVE: To assess the efficacy and safety of combination therapy with laser-cision and pinhole method using a carbon dioxide (CO2 ) laser. METHODS: We conducted retrospective chart review of patients with hypertrophic burn scars treated by combination laser-cision and pinhole method from January 2007 to December 2012. RESULTS: Nine patients with hypertrophic burn scars (mean age 31.2 years; range, 13-52 years) were treated with combination therapy over the past 6 years. Subjects were treated with one to three treatment sessions at 1-year intervals by laser-cision and five to eight treatment sessions at 2- to 3-month intervals by pinhole method. Two blinded observers evaluated photographs taken at baseline and 6 months after the final treatment. Compared with baseline, there was a mild to moderate improvement in all the patients (Grades 1-4; mean score: 2.89). The patient satisfaction survey revealed a mean improvement score of 3.11. CONCLUSION: Combination laser-cision and pinhole method using a CO2 laser may be a new effective treatment option for patients with hypertrophic burn scars.

A patient with cupping-related post-inflammatory hyperpigmentation successfully treated with a 1,927 nm thulium fiber fractional laser.

Post-inflammatory hyperpigmentation is a rare complication following cupping therapy. We report a case of a 26-year-old woman who presented with hyper-pigmented skin lesions on her lower back which was persistent for 6 months following cupping therapy. The 1,927 nm thulium fiber laser (Fraxel re:store Dual, Solta Medical Inc., Hayward, CA) was tested leading to near complete resolution within four sessions.

Ablative non-fractional lasers for atrophic facial acne scars: a new modality of erbium:YAG laser resurfacing in Asians.

Atrophic facial scars which commonly occur after inflammatory acne vulgaris can be extremely disturbing to patients both physically and psychologically. Treatment with fractional laser devices has become increasingly popular, but there has been disappointment in terms of effectiveness. The objective of this study was to assess the safety and efficacy of ablative full-face resurfacing on atrophic acne scars in the Korean population. A total of 22 patients, aged 25-44 years, underwent a new modality of resurfacing combining both short-pulsed and dual-mode erbium:yttrium-aluminum garnet (Er:YAG) laser. The patients had Fitzpatrick skin types ranging from III to V. Photographs were taken before and up to 6 months after treatment. Results were evaluated for the degree of clinical improvement and any adverse events. Degree of improvement was graded using a four-point scale: poor (1) = <25%, fair (2) = 25-50%, good (3) = 51-75%, and excellent (4) = >75%. Based on the blinded photo assessments by two independent reviewers, clinically and statistically significant mean improvement of 3.41 was observed (one-sample Wilcoxon signed rank test, P < 0.001). Complete wound healing occurred between 6 and 9 days. Erythema occurred in all patients and lasted longer than 3 months in two patients (9.1%). Postinflammatory hyperpigmentation occurred in ten patients (45.5%) and lasted longer than 3 months in one patient (4.5%). One patient experienced mild hypopigmentation (4.5%). Mild to moderate acne flare-up occurred in five patients (22.7%). No other adverse effects were observed. A new modality of Er:YAG laser resurfacing combining short-pulsed and dual-mode Er:YAG laser is a safe and very effective treatment modality for atrophic facial acne scars in Asians with darker skin tones.

Combination of 595-nm pulsed dye laser, long-pulsed 755-nm alexandrite laser, and microdermabrasion treatment for keratosis pilaris: retrospective analysis of 26 Korean patients.

Keratosis pilaris (KP) has beenpresented as small keratotic follicular papules with or without surrounding erythema. Various treatments with laser or light therapy have been used for the management of KP with various clinical outcomes. In the present study, we investigated the efficacy and safety of a combination therapy for KP. A total of 29 anatomical sites with KP in 26 patients were treated using a 595-nm pulsed dye laser (PDL) with nonpurpuragenic fluences, a long-pulsed 755-nm alexandrite laser, and microdermabrasion. Clinical improvement was assessed by comparing preand posttreatment clinical photographs and patient satisfaction rates. Evaluation of the clinical results three months after the treatments showed that 12 of the 29 anatomical sites (41.4%) demonstrated Grade 3 clinical improvement, ten (34.5%) had Grade 2 clinical improvement, four (13.8%) showed Grade 1 improvement, and three (10.3%) showed Grade 4 improvement. We observed that KP lesions improved not only in erythema and skin texture, but also in brownish dyschromias. Potential adverse events were not observed, except prolonged posttherapy scaling. Our observations demonstrate that combination therapy using a 595-nm PDL, a long-pulsed 755-nm alexandrite laser, and microdermabrasion can have a positive therapeutic effect on KP.

Use of fractionated microneedle radiofrequency for the treatment of inflammatory acne vulgaris in 18 Korean patients.

BACKGROUND: Nonablative radiofrequency (RF) devices have been shown to be clinically effective for the treatment of moderate to severe acne lesions. OBJECTIVE: To evaluate the efficacy and safety of a fractionated microneedle RF device in the treatment of inflammatory acne vulgaris. METHODS: Eighteen patients (15 male, 3 female; mean age 27, range: 19-33; Fitzpatrick skin type IV) with moderate to severe acne vulgaris who were treated with two sessions of fractionated microneedle RF at 1-month intervals were enrolled in this study. RESULTS: Evaluation of improvement, which took into account number of inflammatory acne lesions, showed that two of the 18 patients had grade 4 clinical improvement, eight had grade 3 improvement, and six had grade 2 improvement. Improvement scores in terms of lesion severity were also evaluated. One of the 18 patients had grade 4 clinical improvement, eight grade 3, and seven grade 2. No patient had worsening of inflammatory acne lesions. CONCLUSION: Fractionated microneedle RF can have a positive therapeutic effect on inflammatory acne vulgaris and related scars. In addition, this technique does not worsen active acne lesions.

Treatment of burn scar using a carbon dioxide fractional laser.

In Asian patients, ablative laser therapies are seldom used to treat burn scars due to posttreatment dyschromia, especially when nonfacial areas are treated. The non-ablative 1550-nm erbium-doped fractional photothermolysis system, although effective, requires multiple treatment sessions. In the authors hands, a 34-year-old Korean woman achieved improved atrophy, contracture, texture and color of a burn scar on her chest after two treatments spaced six weeks apart with an ablative 10,600 nm CO2 fractional laser system (Ultrapulse Encore Laser, Lumenis Inc., Santa Clara, CA).

The efficacy and safety of 10,600-nm carbon dioxide fractional laser for acne scars in Asian patients.

BACKGROUND: The nonablative 1,550-nm erbium-doped fractional photothermolysis system (FPS) has been effectively used for scar treatments, but it seems that several sessions of treatment must be delivered to achieve satisfactory improvement. OBJECTIVES: To evaluate the efficacy and safety of the combined use of two treatment modes of an ablative 10,600-nm carbon dioxide fractional laser system (CO(2) FS) on acne scars. METHODS: Twenty Korean patients with atrophic acne scars treated with a single session of Ultrapulse Encore laser (Lumenis Inc., Santa Clara, CA) were enrolled. The laser fluences were delivered to the scars using the Deep FX mode. Additional treatment using the Active FX mode was performed throughout the entire face. RESULTS: Follow-up results revealed that one patient had clinical improvement of 76% to 100%, nine had improvements of 51% to 75%, seven had moderate improvements of 26% to 50%, and three had minimal to no improvements. The mean duration of post-therapy crusting or scaling was 6.3+/-3.0 days, and post-therapy erythema lasted 2.8+/-4.6 days. CONCLUSION: We suggest that CO(2) FS used with a combination of two different treatment modes may provide a new treatment algorithm for acne scars in Asians.

Scar characteristics and treatment expectations: a survey of 589 patients.

BACKGROUND: Scar tissue formation by skin injury is common and patients need treatments for cosmetic or functional improvement. OBJECTIVE: To determine the relationship between various characteristics of scars and patients' treatment expectations. METHODS: The subjects were patients who had one or more scars regardless of their intention for treatment between August 2007 and February 2008. The survey was conducted using paper forms on patients' first visits. RESULTS: A total of 589 patients (mean age 29 years) with various types of scars participated in this survey. Of the causes described by the patients, trauma was the most common (681 answers), followed by cutaneous diseases (189), and surgery (133). The treatment history of scars was recorded in 233 patients (39.6%), namely topical agents in 146 (62.7%), laser therapies in 79 (33.9%), and skin grafts or surgical scar revisions in eight (3.4%). Patients with a treatment history showed a more prominent expectation for the next treatment outcome (p < 0.05) and were willing to spend more time on scar treatment (p < 0.05). CONCLUSION: Although it could not play a major role in choosing treatment modalities, treatment expectations can be significant as a part of a healthy doctor-patient relationship, of which the ultimate goal is always the best outcome for the patient.

Pigmentary disorders in the South East.

In this article, new information is introduced regarding vitiligo and melasma based on clinical studies of Korean patients and specific pigmentary disorders that occur in Asians. These disorders can be psychologically distressing because of their visible nature. They are especially resistant to various kinds of conventional treatments and tend to have a chronic progression that makes patients doubt the results and the prognosis.

Human papillomavirus type 59 identified in a verrucous cyst of the flank.

The verrucous cyst is a non-plantar epidermoid cyst with histopathological features of human papillomavirus (HPV) infection, including papillomatosis and hypergranulosis of the cyst lining. We report the first case of a verrucous cyst demonstrating not only the histopathological and immunohistochemical features of HPV infection, but also homology with HPV type 59 on HPV genotyping. A 28-year-old male developed a palpable mass in his right flank. Histological examination revealed an intradermal cyst lined by an acanthotic and papillomatous squamous epithelium with prominent keratohyaline granules and squamous eddies. The keratinocyte nuclei were positive for papillomavirus antigens on immunohistochemistry and HPV genotyping demonstrated a homology to HPV type 59, a high-risk genital type. Although we only experienced a single case with such a finding, we suggest that it may be necessary to subject patients with verrucous cysts to a closer follow up for better characterization of their clinical behavior.