Nonablative infrared skin tightening in Type IV to V Asian skin: a prospective clinical study.

BACKGROUND: Nonablative skin tightening devices have been developed to treat facial and neck skin laxity without damage to the epidermis. There are at present two main approaches: the pioneer method by monopolar radiofrequency and the second by infrared light. OBJECTIVE: This study aims to determine the clinical efficacy and safety of nonablative infrared light in the treatment of facial and neck skin laxity in Type IV to V Asian skin. METHODS: This is a prospective noncomparative open study. Adult patients with facial and neck skin laxity were recruited for the study. Three treatment sessions spaced 4 weeks apart were performed. Photographic documentation was performed serially during the study period. Final clinical assessment was performed 6 months after the last treatment. Response parameters included patient self-assessment as well as doctor's assessment. RESULTS: Twenty-one patients were evaluated. All patients were of Fitzpatrick skin types IV and V. Patient assessments of response at 6 months after treatment were as follows: 19% reported mild improvement, 38% reported moderate improvement, and 43% reported good improvement. Doctor's assessments of photographs before and 6 months after treatment showed observable lifting of sagging skin folds in 86% of patients. Of these, 28% were assessed as significant-mild, 38% as significant-moderate, and 19% as significant-excellent. The treatments were associated with minimal pain and edema. The main side effect was isolated superficial blistering in 7 episodes of 63 treatments performed, which resolved without scarring in all patients. CONCLUSION: Direct application of infrared light with epidermal cooling is effective in achieving mild to moderate gradual clinical improvement in the treatment of facial and neck skin laxity. The procedure is associated with minimal downtime and is safe for use in darker skin, Types IV and V.

Characteristics of basal cell carcinoma amongst Asians in Singapore and a comparison between completely and incompletely excised tumors.

BACKGROUND: Most published series of basal cell carcinomas (BCCs) are based on Caucasian populations. Very little is known about the characteristics of incompletely excised BCCs in Asians. OBJECTIVES: This study examines the characteristics of BCCs in Asian residents in Singapore, and compares incompletely with completely excised tumors after conventional surgical excision. PATIENTS AND METHODS: A retrospective study was conducted using the case records of patients who had a primary BCC excised at the National Skin Centre between 1991 and 1995. RESULTS: A total of 185 histologically confirmed BCCs were recorded in 166 patients (male to female ratio, 0.95; mean age, 70.9 years). The highest proportion (27.1%) was in the 81-90-year age group. Compared with census data, a significantly higher proportion of patients with BCCs were Chinese (P < 0.001). The tumors averaged 12.0 mm in diameter and the majority (84.3%) were located on the head and neck. In 28 lesions (15.1%), the tumors were incompletely excised, with those on the nose and nasolabial folds being most frequent. Incompletely excised BCCs were more likely than completely excised lesions to be located on the mid-face and trunk (P = 0.003), but there was no significant correlation with tumor size, tumor duration, or patient age, race, and gender. The overall recurrence rate was 1.6% over a mean follow-up time of 74 months. CONCLUSIONS: BCCs are more common amongst Chinese in Singapore and occur chiefly in the elderly. Conventional surgical excision with margin control achieves a satisfactory tumor clearance rate of 84.9%. Incomplete excision is associated with tumor location on the mid-face and trunk rather than tumor size or duration.

Treatment of acquired bilateral nevus of ota-like macules (Hori's nevus) with a combination of the 532 nm Q-Switched Nd:YAG laser followed by the 1,064 nm Q-switched Nd:YAG is more effective: prospective study.

BACKGROUND: Acquired bilateral nevus of Ota-like macules (Hori's nevus) is a common dyschromatosis among Asian women. Q-switched lasers have been used successfully as a treatment modality. OBJECTIVE: The purpose of this study was to compare the efficacy of using the Q-switched 532 nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser followed by the 1,064 nm laser versus the Q-switched 1,064 nm Nd:YAG laser alone in the treatment of Hori's nevus. METHODS: This is a prospective left-right comparative study. Ten women with bilateral Hori's nevus were recruited and treated with a combination of the Q-switched 532 and 1,064 nm Nd:YAG lasers on the right cheek and the Q-switched 1,064 nm Nd:YAG laser alone on the left cheek. Only one laser treatment session was performed. The degree of pigmentation was objectively recorded with a mexameter. Subjective assessment was made by both patients and two blinded, nontreating dermatologists. RESULTS: At 6 months, there was a statistically significant difference (p = .009) of 35.10 points using objective mexameter measurements between the two sides, favoring the side treated with a combination of 532 and 1,064 nm laser treatment. Subjective grading by the patients and blinded dermatologists also confirmed that combination therapy was more successful after one treatment. Although combination treatment had a higher incidence of mild postinflammatory changes, this disappeared within 2 months. CONCLUSIONS: Concurrent use of the Q-switched 532 nm Nd:YAG laser in combination with the 1,064 nm laser is more effective in pigment clearance than the Q-switched 1,064 nm Nd:YAG laser alone for Hori's nevi.

Nonablative 1450-nm diode laser in the treatment of facial atrophic acne scars in type IV to V Asian skin: a prospective clinical study.

BACKGROUND: There is presently little published data on the clinical effectiveness of nonablative lasers in the treatment of atrophic acne scars and the safety of their use in patients with darker skin types. OBJECTIVE: This study aims to determine the clinical effectiveness and safety of the nonablative 1450 nm diode laser with cryogen cooling spray in the treatment of facial atrophic acne scars in Type IV-V Asian skin. METHODS: This is a prospective non-comparative open study. 4 to 6 laser treatment sessions were performed on patients with atrophic acne scars. Final clinical assessment was performed 6 months after the last treatment. RESULTS: 57 patients were evaluated. Patient's self-assessment of scar improvement as compared with doctor's assessment was as follows: patients who completed 4 treatments (15.7% vs 6.6%), patients who completed 5 treatments (20% vs 7.9%) and patients those who completed 6 treatments (17.3% vs 5.0%). Main side effects were mild to moderate pain during the procedure, transient erythema, and hyperpigmentation which occurred in 39% of treated patients. CONCLUSION: The nonablative 1450 nm diode laser may be effective in achieving mild to moderate gradual clinical improvement in the treatment of facial atrophic acne scars. The procedure is associated with minimal downtime and is safe for use in darker skin types IV and V.

Infantile myofibromatosis: a case report and review of the literature.

Infantile myofibromatosis is a rare mesenchymal disorder of infancy and childhood characterized by the formation of tumors in the soft tissues, muscle, bone, and viscera. Disease limited to the soft tissues, muscle, and bone has a good prognosis, and excision is curative; however, visceral involvement may be fatal. We present a case of infantile myofibromatosis in a 1-year-old boy and review the literature.

Fatal Lucio's phenomenon in 2 patients with previously undiagnosed leprosy.

We report 2 cases of Lucio's phenomenon, a rare, aggressive, occasionally fatal type 2 reaction occurring in the diffuse nonnodular type of lepromatous leprosy. The clinical diagnosis of Lucio's phenomenon is difficult, and there are no known predictive or prognostic factors. Despite institution of aggressive treatment after diagnosis, our 2 cases had fatal outcomes.