Clinical experience with light-emitting diode (LED) photomodulation.

BACKGROUND: Light-emitting diode (LED) photomodulation is a novel nonthermal technology used to modulate cellular activity with light. OBJECTIVE: We describe our experience over the last 2 years using 590 nm LED photomodulation within a dermatologic surgery environment. METHODS: Practical use of nonthermal light energy and emerging applications in 3,500 treatments delivered to 900 patients is detailed. RESULTS: LED photomodulation has been used alone for skin rejuvenation in over 300 patients but has been effective in augmentation of results in 600 patients receiving concomitant nonablative thermal and vascular treatments such as intense pulsed light, pulsed dye laser, KTP and infrared lasers, radiofrequency energy, and ablative lasers. CONCLUSION: LED photomodulation reverses signs of photoaging using a new nonthermal mechanism. The anti-inflammatory component of LED in combination with the cell regulatory component helps improve the outcome of other thermal-based rejuvenation treatments.

Improvement of atrophic acne scars with a 1,320 nm Nd:YAG laser: retrospective study.

BACKGROUND: Facial acne scarring has been treated with multiple methods with varying degrees of improvement. Although the 1,320 nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser has been widely used to improve photoaging, studies analyzing its effects on atrophic acne scarring are limited. OBJECTIVE: To evaluate the efficacy of a dynamic cryogen-cooled 1,320 nm Nd:YAG laser for the treatment of atrophic facial acne scars in a larger cohort of patients with long-term follow-up. METHODS: Twenty-nine patients (skin phototypes I-IV) with facial acne scarring received a mean of 5.5 (range 2-17) treatments with a 1,320 nm Nd:YAG laser. Objective physician assessment scores of improvement were determined by side-by-side comparison of preoperative and postoperative photographs at a range of 1 to 27 months (mean 10.4 months) postoperatively. Subjective patient self-assessment scores of improvement were also obtained. RESULTS: Acne scarring was significantly improved by both physician and patient assessment scores. Mean improvement was 2.8 (p < .05) on a 0- to 4-point scale by physician assessment and 5.4 (p < .05) on a 0- to 10-point scale by patient assessment. No significant complications were observed. CONCLUSIONS: Nonablative laser skin resurfacing with a 1,320 nm Nd:YAG laser can effectively improve the appearance of facial acne scars with minimal adverse sequelae.

Comparison of intense pulsed light to 595-nm long-pulsed pulsed dye laser for treatment of hypertrophic surgical scars: a pilot study.

BACKGROUND: The short-pulsed pulsed dye laser (PDL) has been previously reported to improve the appearance of hypertrophic scars. Prolonged purpura following treatment led to the development of the newer long-pulsed pulsed dye laser (LPDL). Intense pulsed light (IPL) has been extensively used to improve the various components of photo damage and to reduce the incidence of purpura, but its effect on scars has not been analyzed. The objective of this pilot study was to prospectively determine and compare the safety and efficacy of LPDL and IPL on surgically induced scars. METHODS: Breast reduction scars (N = 10 scars) and abdominoplasty scars (N=5 scars) were treated using both LPDL and IPL. For breast reduction scars, one side was treated with each technique. For abdominoplasty scars, one half of the scar was treated with each device. Two treatments were performed 2 months apart. Physician global assessment scores of improvement were determined by side-by-side comparison of preoperative and randomly presented postoperative photographs. Patient pain scores during treatment were also obtained and the presence of post, treatment purpura was assessed. RESULTS: Mean improvement on a 0 to 3 point scale was 2.2 (55%) after the first LPDL treatment and 3.2 (80%) after the second. Mean improvement was 1.8 (45%) after the first IPL treatment and 2.6 (65%) after the second. Differences in improvement between the LPDL and IPL sides were not statistically significant. Patients rated IPL as more painful than LPDL. The incidence of post-treatment purpura was lower with IPL. CONCLUSIONS: This pilot study suggests that LPDL and IPL are equally effective in improving the appearance of hypertrophic surgical scars. IPL offers a novel method of treating scars that minimizes the risk of purpura.

Sterility of stored nonanimal, stabilized hyaluronic acid gel syringes after patient injection.

BACKGROUND: Restylane (Restylane; Q-Medical, Uppsala, Sweden) is a nonanimal stabilized hyaluronic acid (NASHA) that has become increasingly popular for soft tissue augmentation and volume correction because of its greater longevity and lower rate of hypersensitivity reactions when compared with collagen. Despite manufacturer warnings, the remaining material in the syringe is commonly stored for subsequent treatment in the same patient. OBJECTIVE: Our purpose was to determine the incidence of bacterial contamination of NASHA stored after initial patient injection. METHODS: After use of a specific sterile sequence, NASHA from previously used syringes stored at room temperature for 2 to 9 months was cultured under aerobic (n = 20) and anaerobic conditions (n = 10). RESULTS: No bacteria were cultured from any of the samples. LIMITATIONS: Limitations of this study include sample size and storage period for a maximum of 9 months. CONCLUSIONS: NASHA remaining in syringes after patient injection was not contaminated with bacteria. Our study raises the possibility that re-use of the remaining portion of material in the syringe may be safe and is more economical than discarding it.

Childhood warts: an update.

Warts are benign intraepidermal neoplasms that are caused by infection with human papillomavirus and commonly affect children and adolescents. The 4 most common types of cutaneous warts are common warts, plantar warts, flat warts, and genital warts. Although they rarely pose a serious health problem, warts can result in physical impairment and psychosocial discomfort. A variety of treatment modalities are employed to treat these growths in children.

Improvement of dermatochalasis and periorbital rhytides with a high-energy pulsed CO2 laser: a retrospective study.

BACKGROUND: Upper eyelid dermatochalasis is typically treated with excisional blepharoplasty. The role of the CO2 laser previously had been confined to that of a vaporizing, incisional, or hemostatic tool. Over the past several years, however, ablative CO2 laser skin resurfacing has been popularized as an adjunctive treatment to blepharoplasty to minimize periorbital rhytides through its vaporizing as well as skin-tightening action. OBJECTIVE: To evaluate the safety and efficacy of a high-energy pulsed CO2 laser as a stand-alone treatment for dermatochalasis and periorbital rhytides. METHODS: Sixty-seven patients (skin phototypes I-IV) with mild-to-severe upper eyelid dermatochalasis and periorbital rhytides received periocular CO2 laser skin treatment. Global assessment scores of dermatochalasis and rhytides were determined by a side-by-side comparison of periocular photographs preoperatively and 1, 3, and 6 months postoperatively. In addition, caliper measurements of upper eyelids before and 1, 3, and 6 months after treatment were obtained. RESULTS: Both dermatochalasis and periorbital rhytides were significantly improved after periocular CO2 laser skin resurfacing. Patients with more severe dermatochalasis and rhytides showed greater improvement after CO2 laser treatment than did those with mild or moderate involvement. Side effects were limited to erythema and transient hyperpigmentation. No scarring, hypopigmentation, or ectropion were observed. CONCLUSIONS: Periocular skin resurfacing with a CO2 laser can safely and effectively improve upper eyelid dermatochalasis and periorbital rhytides.

Treatment of exogenous ochronosis with a Q-switched alexandrite (755 nm) laser.

BACKGROUND: Exogenous ochronosis is a cutaneous disorder characterized by blue-black or slate-gray hyperpigmentation resulting from the prolonged use of certain topical agents, most commonly hydroquinones. It is notoriously difficult to treat. OBJECTIVE: To report the effectiveness of a quality-switched (QS) 755-nm alexandrite laser in treating hydroquinone-induced exogenous ochronosis. METHODS: Hydroquinone-induced exogenous ochronosis in two patients was treated with a QS alexandrite laser. The first patient received six treatments (average fluence=7.8 J/cm(2)) at 2-month intervals. The second patient received four treatments (average fluence=6.9 J/cm(2)) at 4-month intervals. Biopsies of lesional skin were obtained before and after laser treatment for histologic evaluation. RESULTS: Significant lightening of the pigmented skin areas was achieved in both patients without scarring or textural changes. Decreased dermal pigmentation was observed on histologic examination of treated skin specimens. CONCLUSION: The QS alexandrite laser can effectively treat exogenous ochronosis without untoward side effects.

Successful treatment of recalcitrant dissecting cellulitis of the scalp with complete scalp excision and split-thickness skin graft.

BACKGROUND: Dissecting cellulitis of the scalp (DCS) is a therapeutically challenging, chronic, progressive, suppurative disease of the scalp that is of unknown etiology. In addition to causing considerable discomfort and cosmetic disfigurement, long-standing lesions may result in the development of squamous cell carcinoma. Several treatment modalities for DCS have been employed with variable results. OBJECTIVE: To report the successful treatment of an aggressive, refractory case of DCS with complete scalp excision and split-thickness skin graft. METHODS: A 25-year-old black male with DCS was treated with complete scalp excision and split-thickness graft from the anterior thighs. RESULTS: The patient has remained free of disease activity and is satisfied with the cosmetic result. CONCLUSION: Complete scalp excision with split-thickness skin graft may be curative in patients with DCS and should be considered in recalcitrant cases that fail to respond to medical therapy.