Efficacy and Safety of Ablative Resurfacing With A High-Energy 1,064 Nd-YAG Picosecond-domain Laser for the Treatment of Facial Acne Scars in Asians.

OBJECTIVES: There have been few studies regarding the use of a picosecond-domain laser for acne scars in Asians. This prospective study evaluated the efficacy and safety of a high-energy 1,064 nm Nd:YAG picosecond-domain laser for ablation and resurfacing of facial acne scars in Asians. METHODS: Subjects were treated with a 1,064 nm picosecond laser (8 mm spot, 0.7-1.0 J/cm2 , 5 Hz) every 4 weeks for three sessions. Two blinded dermatologists evaluated the pre- and 3-month post-treatment images with a 10-point improvement scale. Subject pain, global improvement, and satisfaction were also assessed. The Facial Acne Scar Quality of Life (FASQoL) questionnaire was used to evaluate the subjects' quality of life. RESULTS: Twenty subjects aged 18-50 years with Fitzpatrick skin type III-V were enrolled. The median dermatologist-rated improvement score was 3 out of 10. Subjects were satisfied to very satisfied with global improvement. Subjects' quality of life significantly improved with a median FASQoL score of 10 after treatment compared with 21 before treatment (P < 0.001). Adverse effects were limited to erythema, pain, and edema without postinflammatory hyperpigmentation. CONCLUSIONS: The 1,064 nm picosecond-domain laser with ablative resurfacing parameters is safe and effective for the treatment of acne scars in Asians. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Treatment of atrophic acne scarring with fractional micro-plasma radio-frequency in Chinese patients: A prospective study.

BACKGROUND: Acne scarring is a common disfiguring sequela of acne vulgaris which can lead to serious psychosocial problems and have a negative effect on patients' quality of life. Although a variety of approaches can be used to treat atrophic acne scars, disadvantages such as long-healing time, dyspigmentation, infections, and prolonged erythema make these treatments unsatisfactory especially for Asians. Fractional micro-plasma radio-frequency is a novel technology that produces minor ablation to the epidermis to promote rapid re-epithelialization, while the radio-frequency evoked thermal effect can stimulate regeneration and remodeling of dermal fibroblasts. OBJECTIVE: To evaluate the clinical effectiveness and safety of micro-plasma radio-frequency for the treatment of facial acne scars in Chinese patients. MATERIALS AND METHODS: A total of 95 patients with facial atrophic acne scars were treated by micro-plasma radio-frequency using three sessions at 2-month intervals. Patients were seen 1 week after each treatment and 1, 3, 6 months after the final treatment. Improvement was assessed by three independent dermatologists who compared photographs taken before the first treatment and 6 months after the last treatment. Adverse effects were evaluated by a dermatologist who did not participated in the study. Patients also provided self-evaluation of satisfaction levels at the last follow-up visit. RESULTS: A total of 86 patients with atrophic acne scars completed the entire study. There was a significant improvement in acne scars after three treatments. The mean score of ECCA grading scale (Echelle d'Evaluation Clinique des Cicatrices d'Acné) was reduced from 107.21 to 42.27 (P < 0.05). A total of 15 of 86 patients showed more than 75% improvement, 57 patients showed 50-75% improvement, and 14 patients showed 25-50%. After three treatments, all subjects showed improvements in spots, large pores, texture, UV damage, red areas, and porphyrin fluorescence. Pain, erythema, edema, effusion, and scab formation were observed in all patients. The average pain score on a visual analog scale was 6.14 ± 1.12 and all patients tolerated the treatments. The average duration of erythema was 6.26 ± 0.92 days. Hyperpigmentation, hypopigmentation, infections, and worsening of scarring were not seen. All patients were either "very satisfied" or "satisfied" with the treatment outcomes. CONCLUSIONS: Fractional micro-plasma radio-frequency is an effective and safe treatment for acne scars, and might be a good choice for patients with darker skin. Lasers Surg. Med. 50:844-850, 2018. © 2018 Wiley Periodicals, Inc.

Fractional microplasma radiofrequency technology for non-hypertrophic post-burn scars in Asians: A prospective study of 95 patients.

BACKGROUND: Laser and other energy devices are emerging, minimally invasive treatments for scars. Among the various techniques, fractional microplasma radiofrequency technology (FMRT) has proven to be an effective treatment option for various types of scars and skin conditions such as rhytids, striae distensae, and hyperpigmentation. OBJECTIVE: This prospective clinical trial was designed to evaluate the efficacy and safety of FMRT for treating non-hypertrophic post-burn scars in the Asian population. METHOD: All patients underwent three to five treatment sessions at various intervals of 8-16 weeks. The Patient and Observer Scar Assessment Scales (POSAS) [20] were used to evaluate changes in burn scars pre-and post-FMRT treatment. RESULTS: A total of 95 patients completed the study. The overall response rate was 86.3% (82/95). The total POSAS scores before and after 6 months of treatment were 53.41 ± 6.28 and 46.35 ± 5.30, respectively. There was statistically significant improvement in scar color, thickness, and pliability. There was no improvement in vascularization, pain, or itching. Complications included prolonged post-inflammatory hyperpigmentation, acne eruption, herpes simplex eruption, and abnormal hair growth. No severe adverse events, such as acute skin infection, hypertrophic scarring, or depigmentation, were observed. CONCLUSION: FMRT is an efficacious, safe treatment for non-hypertrophic burn scars in the Asian population. Lasers Surg. Med. 49:563-569, 2017. © 2017 Wiley Periodicals, Inc.

Treatment of Facial Acne Scarring With Fractional Carbon Dioxide Laser in Asians, a Retrospective Analysis of Efficacy and Complications.

BACKGROUND: Fractional carbon dioxide (CO2) laser resurfacing unites the idea of fractional photothermolysis with an ablative 10,600-nm wavelength. This technology permits effective treatment of acne scarring, with shorter recovery and a decreased side effect profile as compared to traditional CO2 laser resurfacing. OBJECTIVE: The aims of this study were to study the efficacy and safety of fractional CO2 laser for acne scars in Asian patients. METHODS: This was a retrospective study of all patients treated with the fractional CO2 laser for facial acne scarring between January 2, 2008, and December 31, 2010, at the National Skin Centre, Singapore. Data reviewed included sex, age, and severity of acne, type of scarring, previous treatment history, frequency of treatments, adverse events, and efficacy. RESULTS: Two hundred and ten fractional CO2 laser treatments for facial acne scars were performed on 107 patients (65 men and 42 women, Fitzpatrick skin Types II to V) during the study period. Sixteen of 107 patients experienced (15.0%) adverse events. The adverse events include hyperpigmentation (6.4%), blistering (4.0%), crusting (2.9%), aggravation of inflammatory acne lesions (1.7%), and scarring (0.6%). There were no reported side effects of hypopigmentation, bacterial or viral infection. Follow-up results after final laser treatment showed that 66.4% of patients reported Grade 1 skin texture improvement, that is, <25% (n = 71); 30.0% had Grade 2 improvement, that is, 25% to 50% improvement (n = 31); 3.7% had Grade 3 improvement, that is, 51% to 75% improvement (n = 4); and 0.9% had Grade 4 improvement, that is, >75% improvement (n = 1). CONCLUSION: The study demonstrated the efficacy and safety of a fractional CO2 laser in the treatment of acne scars in Asian. Future studies are required to establish optimum treatment parameters and achieve better clinical results.

Topical corticosteroids minimise the risk of postinflammatory hyper-pigmentation after ablative fractional CO2 laser resurfacing in Asians.

Postinflammatory hyperpigmentation (PIH) is the most common adverse effect of laser treatment in dark-skinned individuals. Little is known whether PIH can be prevented or minimised. The objective of this study was to investigate the effect of short-term application of topical corticosteroids on the incidence of PIH after ablative fractional resurfacing in Asians. Forty subjects with skin phototype IV and atrophic acne scars were treated with a fractional CO2 laser on both sides of the face. Post-operatively, clobetasol propionate 0.05% ointment was applied to one randomly selected side of the face for the first 2 days, followed by an application of petrolatum jelly for the rest of the week (petrolatum was applied to the other side for 7 days). Assessments on the clinical outcome, the wound healing process and the occurrence of PIH were obtained once weekly for the first month and at 2 and 3 months post-treatment. The side of the face treated with petrolatum alone had significantly (p < 0.001) higher incidence of PIH (75%) after laser irradiation than the side of the face treated with topical corticosteroids and petrolatum (40%). The PIH occurring on the petrolatum-treated sides had significantly higher intensity (p < 0.001) and was spread over a significantly larger area (p < 0.001), compared with the corticosteroid- and petrolatum-treated sides. In conclusion, a short-term application of topical corticosteroids postoperatively is associated with a decreased risk of PIH after ablative fractional resurfacing.

Prevalence and Correlates of Myocardial Scar in a US Cohort.

IMPORTANCE: Myocardial scarring leads to cardiac dysfunction and poor prognosis. The prevalence of and factors associated with unrecognized myocardial infarction and scar have not been previously defined using contemporary methods in a multiethnic US population. OBJECTIVE: To determine prevalence of and factors associated with myocardial scar in middle- and older-aged individuals in the United States. DESIGN, SETTING, AND PARTICIPANTS: The Multi-Ethnic Study of Atherosclerosis (MESA) study is a population-based cohort in the United States. Participants were aged 45 through 84 years and free of clinical cardiovascular disease (CVD) at baseline in 2000-2002. In the 10th year examination (2010-2012), 1840 participants underwent cardiac magnetic resonance (CMR) imaging with gadolinium to detect myocardial scar. Cardiovascular disease risk factors and coronary artery calcium (CAC) scores were measured at baseline and year 10. Logistic regression models were used to estimate adjusted odds ratios (ORs) for myocardial scar. EXPOSURES: Cardiovascular risk factors, CAC scores, left ventricle size and function, and carotid intima-media thickness. MAIN OUTCOMES AND MEASURES: Myocardial scar detected by CMR imaging. RESULTS: Of 1840 participants (mean [SD] age, 68 [9] years, 52% men), 146 (7.9%) had myocardial scars, of which 114 (78%) were undetected by electrocardiogram or by clinical adjudication. In adjusted models, age, male sex, body mass index, hypertension, and current smoking at baseline were associated with myocardial scar at year 10. The OR per 8.9-year increment was 1.61 (95% CI, 1.36-1.91; P < .001); for men vs women: OR, 5.76 (95% CI, 3.61-9.17; P < .001); per 4.8-SD body mass index: OR, 1.32 (95% CI, 1.09-1.61, P = .005); for hypertension: OR, 1.61 (95% CI, 1.12-2.30; P = .009); and for current vs never smokers: 2.00 (95% CI, 1.22-3.28; P = .006). Age-, sex-, and ethnicity-adjusted CAC scores at baseline were also associated with myocardial scar at year 10. Compared with a CAC score of 0, the OR for scores from 1 through 99 was 2.4 (95% CI, 1.5-3.9); from 100 through 399, 3.0 (95% CI, 1.7-5.1), and 400 or higher, 3.3 (95% CI, 1.7-6.1) (P ≤ .001). The CAC score significantly added to the association of myocardial scar with age, sex, race/ethnicity, and traditional CVD risk factors (C statistic, 0.81 with CAC vs 0.79 without CAC, P = .01). CONCLUSIONS AND RELEVANCE: The prevalence of myocardial scars in a US community-based multiethnic cohort was 7.9%, of which 78% were unrecognized by electrocardiography or clinical evaluation. Further studies are needed to understand the clinical consequences of these undetected scars.

The impact of skin damage due to cutaneous lupus on quality of life.

BACKGROUND: Patients with more severe cutaneous lupus erythematosus (CLE) have a poorer quality of life (QoL). Racial and ethnic disparities have been reported in disease activity and outcomes in systemic lupus erythematosus, but similar information is not available for CLE. OBJECTIVES: To evaluate the impact of lupus-related skin damage on skin-specific QoL, and to analyse differences stratified by ethnic background. METHODS: Data collected included sex, race, diagnosis and Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) and Skindex-29 scores. These parameters were analysed at the initial and last visits. CLASI damage scores (dyspigmentation and scarring) and activity scores were collected, grouped by ethnicity, and correlated with Skindex-29. Overall, 223 patients were analysed at baseline, with 141 completing more than one study visit. RESULTS: The majority of patients were white (63·7%), followed by African American (29·1%) and Asian American (4·0%). African American patients accounted for a disproportionate percentage of both localized (50%) and generalized discoid lupus erythematosus (DLE) (49%). Median CLASI damage scores differed significantly between the African American, white and Asian American patients, at both the first (8·5, 4·0, 7·0, respectively; P < 0·0001) and last visit (10·0, 6·0, 8·5, respectively; P < 0·01). CLASI damage scores in African Americans correlated with CLASI activity scores (Spearman r = 0·45, P = 0·0003). CONCLUSIONS: There was no significant correlation between CLASI damage scores and Skindex domains overall. Individually, dyspigmentation and scarring also did not have a significant effect on QoL. Ethnic differences in patients with CLE were found: African American patients exhibited a high rate of DLE and experienced damage early in their disease course, frequently in conjunction with disease activity.

Autosomal dominant inheritance of central centrifugal cicatricial alopecia in black South Africans.

BACKGROUND: Central centrifugal cicatricial alopecia (CCCA) is the commonest type of primary scarring alopecia in women of African descent. Little is currently known about the disease genetics. OBJECTIVE: We sought to investigate patterns of inheritance in CCCA and ascertain the contribution of nongenetic factors such as hair-grooming habits to the pathogenesis of the disease. METHODS: Affected individuals with at least 1 available family member were recruited from 2005 through 2012 inclusive for pedigree analysis. CCCA was diagnosed on clinical and histopathological grounds. RESULTS: Fourteen index African families with 31 immediate family members participated in the initial screening. The female to male ratio was 29:2 with an average age of 50.4 years. All patients displayed histologic features typical for CCCA. Pedigree analysis suggested an autosomal dominant mode of inheritance. Hair-grooming habits were found to markedly influence disease expression. LIMITATIONS: Small number of patients is a limitation. CONCLUSION: CCCA can be inherited in an autosomal dominant fashion, with partial penetrance and a strong modifying effect of hairstyling and gender.

Pathologic diagnosis of central centrifugal cicatricial alopecia on horizontal sections.

The pathologic findings in Central Centrifugal Cicatricial Alopecia (CCCA) have not been studied systematically in horizontal sections. Our objective was to establish the pathologic features, and their frequency in horizontal sections of scalp biopsies obtained from patients with clinically and histologically proven CCCA. Serial horizontal sections of 51 cases were evaluated retrospectively. All biopsies were assessed at 4 levels and at least on 24 horizontal sections. The most common pathologic findings were follicular miniaturization (81% of the cases); premature desquamation of the inner root sheath (96%), focal preservation of the sebaceous glands (94%), which in most of these cases appeared as surrounding "in a hug" an intact vellus follicle; compound follicular structures with perifollicular fibrosis and/or inflammation (89%), lamellar hyperkeratosis/parakeratosis in the hair canal (79%), absent or mild inflammation (77%), and naked hair shafts (68%). Horizontal sections are useful in CCCA to identify early or focal disease and to provide the clinician with better information on the presence of follicular miniaturization, inflammation, and scarring, which can be used to tailor the treatment to the individual patient.

Improved scar appearance with combined use of silicone gel and vitamin C for Asian patients: a comparative case series.

BACKGROUND: In Asians, facial scars, even fine surgical scars, often can be conspicuous and uncomfortable. The authors used a topical silicone gel containing vitamin C on facial scars for the purpose of making the scar less distinct. METHODS: The study enrolled 80 patients. For the experimental group, the topical silicone gel mixture containing vitamin C was applied from the time of stitch removal to 6 months after the operation. The control group did not undergo any adjunctive treatment. Each participant was evaluated using the modified Vancouver Scar Scale (VSS) as well as erythema and melanin indices by spectrophotometer. RESULTS: With the modified VSS, the experimental group showed a significant decrease in scar elevation (p = 0.026) and erythema (p = 0.025). The hypo- or hyperpigmentation of the scars was more normalized in the experimental group. In the measured results via spectrophotometer, the experimental group showed a significant decrease in the melanin index (p = 0.045). The erythema index showed a statistically significant difference between the time of stitch removal and 6 months after the operation in the experiment group only. CONCLUSIONS: Topical use of silicone gel containing vitamin C has the effect of improving the appearance of fine surgical scars in Asian facial skin. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Worse Itch and Fatigue in Racial and Ethnic Minorities: A Burn Model System Study.

Racial and ethnic minority patients experience worse hypertrophic scars after burn injury than White patients. Subsequently, minority patients encounter differences in scar-related recovery domains such as itch and fatigue. This study examines disparities regarding postburn injury itch and fatigue in minority patients to better inform counseling and treatment considerations. From the multicenter National Institute of Disability, Independent Living and Rehabilitation Research Burn Model System Database (2015-2019), outcomes were analyzed at three time-points (discharge from index hospitalization, 6- and 12-months post-injury) using the 5D Itch and PROMIS-29 Fatigue measures. Multilevel linear mixed effects regression modeling analyzed associations between race/ethnicities and outcomes over time. Of 893 total patients, minority patients reported higher/worse itch scores at all time points compared to White patients. Itch scores were significantly higher for Black patients at 6 months (ß = 1.42, P = .03) and 12 months (ß = 3.36, P < .001) when compared to White patients. Black patients reported higher fatigue scores than White patients at all time points. Fatigue scores were significantly higher for Hispanic/Latino patients at discharge (ß = 6.17, P < .001), 6 months (ß = 4.49, P < .001), and 12 months (ß = 6.27, P < .001) than White patients. This study supports investigation of potential factors leading to increased itch and fatigue such as sociocultural factors, disparities in healthcare access, and psychosocial impacts of these symptoms. In the short-term, minority patients may benefit from additional counseling and focused treatments addressing itch and fatigue after burn injury.

Clinical factors and hair care practices influencing outcomes in central centrifugal cicatricial alopecia.

Central centrifugal cicatricial alopecia (CCCA) is the most common form of primary scarring alopecia in women of African descent, negatively impacting their quality of life. Treatment is often challenging, and we usually direct therapy to suppress and prevent the inflammation. However, factors affecting clinical outcomes are still unknown. To characterize medical features, concurrent medical conditions, hair care practices, and treatments used for patients with CCCA and assess their relationship with treatment outcomes. We analyzed data from a retrospective chart review of 100 patients diagnosed with CCCA who received treatment for at least one year. Treatment outcomes were compared with patient characteristics to determine any relationships. P-values were calculated using logistic regression and univariate analysis with 95% CI P < 0.05 was considered significant. After one year of treatment, 50% of patients were stable, 36% improved, and 14% worsened. Patients without a history of thyroid disease (P = 0.0422), using metformin for diabetes control (P = 0.0255), using hooded dryers (P = 0.0062), wearing natural hairstyles (P = 0.0103), and having no other physical signs besides cicatricial alopecia (P = 0.0228), had higher odds of improvement after treatment. Patients with scaling (P = 0.0095) or pustules (P = 0.0325) had higher odds of worsening. Patients with a history of thyroid disease (P = 0.0188), not using hooded dryers (0.0438), or not wearing natural hairstyles (P = 0.0098) had higher odds of remaining stable. Clinical characteristics, concurrent medical conditions, and hair care practices may affect clinical outcomes after treatment. With this information, providers can adjust proper therapies and evaluations for patients with Central centrifugal cicatricial alopecia.

[Scarification in children hospitalized in Congo]. / Scarifications chez l'enfant hospitalisé au Congo.

OBJECTIVE: The purpose of this report is to describe the epidemiologic, prognostic and clinic features of scarification in children in Congo. MATERIAL AND METHOD: A transversal study of scarification was conducted from January 1, 2006 to December 31, 2008 in children hospitalized in neonatology and pediatrics department of Loandjili General Hospital. RESULTS: During the study period, therapeutic scarifications were observed in 130 patients including 74 (56.9%) girls. Median age was 17 months (range, 1 month to 9 years). Multiple scarifications were observed in 31.5% of cases. The main site of scarification was the hypochondrias (82.4%) followed by the flanks (14.6%) and hemithorax (13.8%). Scarification was performed for curative purposes in 114 cases (88%; p 0.001) and prophylaxis in the remaining cases. The main indications for curative scarifications were big belly in 46 cases, ponderal stagnation in 23 and recurrent bronchitis in 22. The most frequently used scarification instrument was a razor blade in 102 cases (78.5%). Risk factors included being the oldest sibling child and low socioeconomic level. In all cases, the influence of the grandparents was clear. Complications were treated in 34 cases including local infection in 26 cases, distant infection (particularly severe sepsis) in 7 cases and pulmonary-pleurostaphylococci in one case. CONCLUSION: These findings show that scarification is still common in the Congo. Because of potential complications and therapeutic inefficiency of scarification, an effort should be made to eliminate this practice.

Efficacy and safety of a carbon-dioxide ablative fractional resurfacing device for treatment of atrophic acne scars in Asians.

BACKGROUND: Treatment of atrophic scars with a fractional laser resurfacing technique has demonstrated favorable outcomes, although data on the efficacy and adverse effects of this procedure in persons with dark-skinned phototypes are limited. OBJECTIVE: This study was conducted to evaluate the efficacy and safety of carbon-dioxide ablative fractional resurfacing on atrophic acne scars in Asian individuals. METHODS: Thirteen subjects (8 female and 5 male, aged 25-52 years) with skin phototype IV and atrophic acne scars were treated with 3 sessions of carbon-dioxide ablative fractional resurfacing laser on an average of 7-week interval. Objective (ultraviolet A-light video camera) and subjective (clinical evaluation by two blinded dermatologists) assessments were obtained at baseline and at 1, 3, and 6 months after the final treatment. RESULTS: At the 6-month follow-up, 85% of the subjects were rated as having at least 25% to 50% improvement of scars. Improvement significantly progressed from the 1-month follow-up to the 6-month follow-up (P = .002). At 1 month after 3 treatments, surface smoothness (P = .03) and scar volume (P < .001) significantly improved, compared with baseline measurements. Of the subjects, 62% rated themselves as having at least 50% improvement in their scars. Mild postinflammatory hyperpigmentation was the most common adverse effect observed in 92% of the subjects or 51% of treatment sessions, and was completely resolved in an average of 5 weeks. LIMITATION: The small sample size was a study limitation. CONCLUSIONS: Carbon-dioxide ablative fractional resurfacing appears to be effective and well tolerated for the treatment of atrophic acne scars in Asians.

The use of non-ablative fractional resurfacing in Asian acne scar patients.

BACKGROUND AND OBJECTIVES: Non-ablative fractional resurfacing (NA FR) has been shown to be effective for photorejuvenation and acne scarring. Previous studies indicated that density, more than pulse energy, was associated with post-inflammatory hyperpigmentation (PIH) in Asians. The objective of this retrospective study was to assess the efficacy and complications of eight passes of NA FR ('full-NA FR') with the 1,550 nm erbium-doped fibre fractional laser (Fraxel SR laser system, Solta Medical, Hayward, CA) versus four passes ('mini-NA FR') with comparable pulse energy and treatment level as 'full-NA FR', but double the number of treatment sessions in Asian acne scar patients. MATERIALS AND METHODS: Forty-seven Asian atrophic facial acne scar patients who received full-face full-NA FR or mini-NA FR treatments between December 2005 and February 2009 were included. All photographic images captured with the Canfield Visia CR system at baseline and follow-ups were assessed for clinical efficacy and complications by an independent, non-treating and blinded physician. RESULTS: The total treatment densities for full-NA FR and mini-NA FR were 442.5 and 210.5 MTZ/cm(2), respectively. For full-NA FR, the PIH risk was 18.2% with cross-polarized images compared to 6.0% for mini-NA FR. This difference was statistically significant (P < 0.001). Improvement in skin texture, acne scarring, enlarged pores and overall pigmentation irregularity all reached statistical significance at last follow-up compared to baseline. There was no statistically significant difference in clinical efficacy between three full-NA FR and six mini-NA FR treatments. CONCLUSIONS: NA FR was effective and safe in Asians. By reducing the number of passes and the total treatment density, the risk of PIH could be reduced. Meanwhile, clinical efficacy could be maintained by increasing the total number of treatment sessions.

Fractional ablative carbon dioxide laser resurfacing for skin rejuvenation and acne scars in Asians.

BACKGROUND AND OBJECTIVES: Ablative fractional resurfacing (AFR) is a new modality for photorejuvenation and acne scars which combines carbon dioxide (CO2) laser ablation with fractional photothermolysis. The objective is to evaluate the efficacy and side effects of a new fractional CO2 ablative device (Fraxel Re:pair) for skin rejuvenation and acne scars in Asians. MATERIALS AND METHODS: Nine patients underwent one full-face treatment. The energy levels ranged from 30-70 mJ with coverage between 30% and 45%. Improvement in skin texture, laxity, wrinkles, enlarged pores, overall pigmentation irregularity, and adverse effects were assessed up to 6 months post-treatment. Standardized photographs using the Canfield Visia CR system® were assessed by two independent observers. Subjective improvement was assessed by patient questionnaires. RESULTS: Nine Chinese patients (skin types III and IV, mean age 44.8) were included. Statistically significant improvements were seen for skin texture, skin laxity, wrinkles, enlarged pores, and acne scars. The post-inflammatory hyperpigmentation rate was 55.5% and 11.1% at 1 and 6 months post-treatment, respectively. Eighty-six percent of patients were overall satisfied to very satisfied with the treatment. CONCLUSION: Ablative fractional CO2 laser resurfacing was overall safe and effective for skin rejuvenation and acne scars in Asians. However, in view of the high post-inflammatory rate and the statistically significant but only mild to moderate improvement after a single treatment as observed in this study, there is a need to review the current role of fractional ablative CO2 laser treatment as compared to fractional non-ablative for skin rejuvenation and acne scar treatment in Asians.

Squamous cell carcinoma in an African American with discoid lupus erythematosus: a case report and review of the literature.

Discoid lupus is an autoimmune disorder with primarily cutaneous manifestations. Carcinomatous changes in discoid lupus can lead to the development of squamous cell carcinoma. While this most often occurs in Caucasians, the presented patient is an African American. She developed numerous squamous cell carcinomas in areas of scarring from discoid lupus. This case illustrates the need for careful observation of discoid lupus for the development of squamous cell carcinoma in the African American patient.

Association of African-American ethnicity and smoking status with total and individual damage index in systemic lupus erythematosus.

INTRODUCTION: Smoking has been associated with increased incidence, severity of cutaneous lupus, and lupus activity. We looked at the association of both smoking and ethnicity with the individual damage items from the SLICC/ACR Damage Index. METHODS: Poisson regression was used to model the total SLICC/ACR Damage Index score against ever smoking. Cox regression was used to assess the relationship between time to individual damage items and ever smoking. Furthermore, we compared SLICC/ACR Damage Index items among African-American and Caucasian ever smokers. RESULTS: The study included 2629 patients, 52.6% Caucasian and 39.3% African-American. The prevalence of ever smokers was 35.8%. There was no significant difference in total SLICC/ACR Damage Index score between ever smokers and never smokers after adjustment for ethnicity, gender, age at diagnosis, and years of education. Ever smokers had more atherosclerotic cardiovascular damage and skin damage compared to non-smokers. Caucasian SLE patients who ever smoked were more likely to have muscle atrophy and atherosclerosis compared to Caucasian non-smokers. African-American patients who ever smoked were more likely to have skin damage compared to African-American non-smokers. African-Americans who smoked were more likely to have many more damage items (cataract, renal damage, pulmonary hypertension, cardiomyopathy, deforming or erosive arthritis, avascular necrosis, skin damage, and diabetes) compared to Caucasians who smoked. CONCLUSION: Our analysis proved the major effect of smoking on cardiovascular and cutaneous damage. Surprisingly, cardiovascular damage items had higher hazard ratios in Caucasian smokers than non-smokers while skin damage items hazard ratios were higher in African-American smokers compared to non-smokers.Key Points• This study is the largest cohort study to date evaluating the effect of smoking on the cumulative SLICC/ACR Damage Index and its individual damage items.• It is the only study that examined the effect of smoking on individual items of the SLICC/ACR Damage Index in terms of Caucasians vs. African-American ethnicity.• Our analysis proved the major effect of smoking on cardiovascular and cutaneous damage. Compared to non-smokers, Caucasian smokers had higher risk of cardiovascular damage while African-American smokers had more skin damage.• African-Americans who smoked were more likely to have many more damage items (cataract, renal damage, pulmonary hypertension, cardiomyopathy, deforming or erosive arthritis, avascular necrosis, skin damage, and diabetes) compared to Caucasians who smoked.