Fractional 532-nm Q-switched Nd:YAG laser: One of the safest novel treatment modality to treat café-au-lait macules.

Café-au-lait macules (CALMs) are benign epidermal basilar hyperpigmentations that can be found in an isolated form or in association with neurocutaneous syndromes. Frequency-doubled Q-switched neodymium-doped yttrium aluminum garnet laser (532-nm QSNYL) does not penetrate deeply into the skin and is therefore suitable for epidermal pigmented lesion. Fractional photothermolysis (FP) targets only very small areas of the skin, without injuring adjacent areas of healthy, normal skin. Herein, we report a case of CALMs successfully treated with fractional 532-nm QSNYL. By applying FP to 532-nm QSNYL, we could treat CALMs safely with less downtime as compared to conventional laser treatments and expect more energy delivery for each microscopic hole, thereby allowing higher response rate.

A prospective, split-face, double-blinded, randomized study of the efficacy and safety of a fractional 1064-nm Q-switched Nd:YAG laser for photoaging-associated mottled pigmentation in Asian skin.

BACKGROUND: Laser toning using low-fluence 1064-nm Q-switched neodymium-doped yttrium aluminum laser (QSNY) has gained popularity in the treatment of photoaging-associated mottled pigmentation (PMP). However, hypopigmentation or lack of efficacy has been reported depending on the fluences used. OBJECTIVE: To compare a novel fractional 1064-nm QSNY with conventional 1064-nm QSNY for the treatment of photoaging-associated mottled pigmentary lesions except epidermal lesions of lentigines and freckles through a randomized, split-face, double-blind study. MATERIALS AND METHODS: Thirteen Asian women were treated every week for 6 weeks with fractional 1064-nm QSNY on one side of the face and conventional 1064-nm QSNY on the other side. We evaluated the pigmentation area and severity index (PSI), melanin index, erythema index, and the patient's global assessment of improvement. RESULTS: At three months post-treatment, the PSI score improved compared with baseline, by 14.48% on the conventional 1064-nm QSNY side and 21.81% on the fractional 1064-nm QSNY side. Both groups showed improvements in the melanin index. CONCLUSION: Both fractional 1064-nm QSNY and strictly low-fluence conventional 1064-nm QSNY are moderately effective against PMP and other photoaging signs. Fractional laser toning shows better subjective outcomes than conventional toning.

Histological and molecular analysis of the long-pulse 1,064-nm Nd:YAG laser irradiation on the ultraviolet-damaged skin of hairless mice: In association with pulse duration change.

BACKGROUND: Nonablative lasers have been widely used to improve photodamaged skin, although the mechanism underlying dermal collagen remodeling remains unclear. OBJECTIVE: To investigate the effects and the molecular mechanisms of long-pulse neodymium-doped yttrium aluminum garnet (Nd:YAG) laser irradiation on dermal collagen remodeling in association with different pulse durations. MATERIAL AND METHODS: Five hairless mice were pretreated with ultraviolet B irradiation for 8 weeks. The dorsal quadrant of each mouse was then irradiated twice at 1-week intervals at a pulse duration of 1 ms, 12 ms, or 50 ms, and a constant fluence of 20 J/cm(2). The levels of dermal collagen, mRNAs of procollagens, matrix metalloproteinases (MMPs), tissue inhibitor of metalloproteinases (TIMPs), and various growth factors were analyzed after 4 weeks. RESULTS: Long-pulse Nd:YAG treatment increased the dermal collagen level. A substantial increase in the level of procollagens, MMPs, TIMPs, and various growth factors was also observed irrespective of pulse duration, with a trend toward maximal increase at a pulse duration of 12 ms. CONCLUSION: Long-pulse 1,064-nm Nd:YAG laser irradiation promotes wound-healing process, which is characterized by the induction of growth factor expression and subsequent increase in MMPs and TIMPs, followed by matrix remodeling as confirmed by new procollagen production.

The natural yeast extract isolated by ethanol precipitation inhibits melanin synthesis by modulating tyrosinase activity and downregulating melanosome transfer.

This study was conducted to examine the effects of EP-2, a natural yeast extract isolated by ethanol precipitation from Saccharomyces cerevisiae, on melanogenesis and to determine its underlying mechanism of action. Our results show that although EP-2 is not a direct tyrosinase inhibitor, when EP-2 was added to the culture media of B16F10 melanoma cells, intracellular tyrosinase activity was decreased. However, EP-2 had no effect on the expression of microphthalmia-associated transcription factor or tyrosinase. EP-2 was found to inhibit melanogenesis and melanosome transfer when it was added to melanocytes and keratinocytes in coculture. In addition, protease-activated receptor 2, a key protein associated with melanosome transfer from melanocytes to keratinocytes, was downregulated in the presence of EP-2. In conclusion, EP-2 is a potent inhibitor of melanogenesis and its hypomelanogenic effect is related to the inhibition of tyrosinase activity and transfer of melanosomes.

Effect of an epidermal growth factor-containing cream on postinflammatory hyperpigmentation after Q-switched 532-nm neodymium-doped yttrium aluminum garnet laser treatment.

BACKGROUND: Topical application of epidermal growth factor (EGF) promotes wound healing and may reduce the risk of laser-induced postinflammatory hyperpigmentation (PIH). OBJECTIVE: To investigate the effect of an EGF-containing cream on the incidence of laser-induced PIH. METHODS: Twenty-five Korean patients with senile lentigines were recruited and underwent 532-nm Q-switched Nd:YAG laser treatment. Postoperatively, patients applied either an EGF-containing cream or a control cream to the laser-treated area. Skin color and transepidermal water loss (TEWL) were measured on Days 0, 3, 7, and 35 using a Mexameter and Tewameter, respectively. RESULTS: The EGF-containing cream resulted in a nonsignificant reduction in the laser-induced increase in TEWL (p = .052 on Day 7) but significantly decreased the melanin index and incidence of PIH on Day 35 (p = .031 and p = .027, respectively). CONCLUSION: Epidermal growth factor-containing creams may be an effective measure to prevent laser treatment-induced PIH in Asian patients.

High-Intensity Focused Ultrasound Increases Collagen and Elastin Fiber Synthesis by Modulating Caveolin-1 in Aging Skin.

Caveolin-1 (Cav-1) induces cellular senescence by reducing extracellular signal-regulated kinase (ERK)1/2 phosphorylation and activating p53 via inhibition of mouse double minute 2 homolog (MDM2) and sirtuin 1 (Sirt1), promoting cell cycle arrest and decreasing fibroblast proliferation and collagen synthesis. High-intensity focused ultrasound (HIFU) treatment increases collagen synthesis, rejuvenating skin. Using H2O2-induced senescent fibroblasts and the skin of 12-month-old mice, we tested the hypothesis that HIFU increases collagen production through Cav-1 modulation. HIFU was administered at 0.3, 0.5, or 0.7 J in the LINEAR and DOT modes. In both models, HIFU administration decreased Cav-1 levels, increased ERK1/2 phosphorylation, and decreased the binding of Cav-1 with both MDM2 and Sirt1. HIFU administration decreased p53 activation (acetylated p53) and p21 levels and increased cyclin D1, cyclin-dependent kinase 2, and proliferating cell nuclear antigen levels in both models. HIFU treatment increased collagen and elastin expression, collagen fiber accumulation, and elastin fiber density in aging skin, with 0.5 J in LINEAR mode resulting in the most prominent effects. HIFU treatment increased collagen synthesis to levels similar to those in Cav-1-silenced senescent fibroblasts. Our results suggest that HIFU administration increases dermal collagen and elastin fibers in aging skin via Cav-1 modulation and reduced p53 activity.

A case of tinea manuum caused by Trichophyton mentagrophytes var. erinacei: the first isolation in Korea.

Hedgehogs have recently become popular exotic pets in Korea. Several diseases may be acquired from these animals including dermatophytosis, Salmonella infections, contact urticaria and possibly Mycobacterium infections. We describe here a 15-year-old girl who developed tinea manuum after keeping a hedgehog for 4 months. Diagnosis was confirmed by histopathologic and mycological examination. The causative agent was identified as Trichophyton mentagrophytes var. erinacei, a zoophilic dermatophyte.

Successful treatment of multiple vemurafenib-induced keratoacanthomas by topical application of imiquimod cream: Confirmation of clinical clearance by dermoscopy.

Keratoacanthomas (KAs) are a well-known cutaneous side effect of BRAF inhibitors and multiple lesions continue to develop throughout the course of therapy. We present a case of an 81-year old women diagnosed with metastatic melanoma who underwent six weeks of vemurafenib therapy. She developed multiple vemurafenib-induced KAs and applied a 5% imiquimod cream three times a week. KAs successfully treated with topical application of imiquimod cream and clearance of these lesions was further confirmed by dermoscopic examination. Topical imiquimod can be an effective treatment option for the noninvasive management of multiple KAs induced by vemurafenib treatment.

Efficacy and safety of a new monophasic hyaluronic acid filler in the correction of nasolabial folds: a randomized, evaluator-blinded, split-face study.

BACKGROUND: Hyaluronic acid (HA) fillers are frequently used for the correction of facial soft-tissue defects. OBJECTIVE: To compare the efficacy and safety of a novel monophasic HA filler (mono-HA), and a well-studied biphasic HA filler (bi-HA), in the treatment of moderate to severe nasolabial folds. METHODS: In this randomized, evaluator-blinded, split-face comparative study, subjects were randomized for injections with mono-HA or bi-HA on the left or right side of the face. Efficacy was determined by calculating the change in the Wrinkle Severity Rating Score (WSRS) relative to baseline. Local safety was assessed on the basis of subject diary entries which recorded erythema, swelling, induration, pruritus, irritation, mass, hematoma, pain, and dryness. RESULTS: At week 24, the mean improvement in the WSRS from baseline was 2.18 ± 0.42 for the mono-HA side and 2.16 ± 0.41 for the bi-HA side. Both fillers were well-tolerated and adverse reactions were mild and transient in most cases. CONCLUSIONS: Mono-HA has a non-inferior efficacy to bi-HA in the treatment of moderate to severe nasolabial folds.

Treatment of atrophic scars with fractional photothermolysis: short-term follow-up.

BACKGROUND: Various modalities have been used to treat scars, but limited efficacy and problematic side effects have restricted their application. OBJECTIVE: To determine the effectiveness and safety of fractional photothermolysis treatment of various atrophic scars in Korean patients. METHODS: Fifty-nine patients with atrophic scars (caused by acne, trauma, herpes zoster, and burns) were treated with fractional photothermolysis using either Fraxel™ SR 750 or Fraxel™ SR 1500 instruments. Each patient underwent one to three treatment sessions 3-4 weeks apart. The assessment of treatment response was conducted by three dermatologists, who independently evaluated a series of photographs using a quartile grading scale. Skin biopsies were taken before treatment and 4 weeks after the final treatment, and were examined for procollagen-1, matrix metalloproteinase-1 (MMP-1), and elastin by immunofluorescence staining. RESULTS: Four weeks after the final treatment, the mean overall improvement in objective grade was 2.0 when the Fraxel SR 750 was employed and 2.9 when the Fraxel SR 1500 was used. Confocal microscopy revealed an increase in procollagen-1 in dermis, with no difference or a slight increase in the levels of elastin and MMP-1. Side effects were minimal. CONCLUSIONS: After short-term follow-up, fractional photothermolysis appeared to be a safe and effective option for atrophic scar treatment of Asian skin.

Treatment of facial acne papules and pustules in Korean patients using an intense pulsed light device equipped with a 530- to 750-nm filter.

BACKGROUND: A rising number of laser- or light-based therapies are addressing the need for effective acne treatments with minimal downtime. OBJECTIVE: The purpose of this study is to evaluate an intense pulsed light (IPL) equipped with a 530- to 750-nm filter for inflammatory acne treatment. PATIENTS AND METHODS: Thirty female patients (mean age, 25.7 years) with mild-to-moderate acne were enrolled. While using benzoyl peroxide (BP) gel, one side of the face was treated with the PR filter (acne filter) of the IPL. RESULTS: All patients experienced the reduction of inflammatory lesion counts in both sides of face. There was no significant difference between IPL-treated and untreated sides of the face for mean papule plus pustule counts, 3 weeks after three sessions. As to red macules, 63% were good or excellent on the laser-treated side compared to 33% on the untreated side. Improvement of irregular pigmentation and skin tone was detected on the laser-treated side than the untreated side. CONCLUSION: This new wavelength band of IPL system was safe and effective in improving acne red macules, irregular pigmentation, and skin tone but did not affect inflammatory acne lesion counts on the skin of Asian persons.