Fractional ablative CO2 laser and oral isotretinoin-A prospective randomized controlled split-face trial comparing concurrent versus delayed laser treatment for acne scars.

BACKGROUND: Therapeutic dogma has been to treat acne scars with ablative fractional laser no less than 6 months after isotretinoin (ITN) cessation. OBJECTIVE: To evaluate the safety and efficacy of fractional ablative CO2 laser (FACL) in patients treated concurrently with ITN. METHODS: We conducted a prospective split-face randomized control trial in patients treated with FACL concurrently with ITN versus patients treated with FACL 6 months post-ITN treatment. Patients received 3 monthly sessions of FACL with concurrent ITN treatment on half of the face; the other side of the face received the same FACL treatment regimen 6 months post-ITN cessation. Patients were followed for adverse effects up to 6 months post-FACL treatment. Final cosmesis was scored using the Quantitative Global Acne Scarring Grading System (GASGS) by three independent dermatologists. RESULTS: The GASGS of the concurrent ITN-FACL treated side of the face was significantly lower than the side treated with delayed laser therapy (4.7 ± 2.5 vs. 7.7 ± 2.9, respectively, p < 0.001). LIMITATIONS: The laser's settings were standardized, and not adjusted per patient skin type. CONCLUSION: Per our prospective trial, concurrent treatment of FACL -ITN is superior to delayed FACL treatment 6 months post-ITN cessation. Fractional ablative laser treatment is effective in improving acne scars, which persist despite isotretinoin therapy.

Dermal Filler Injections in Patients With Autoimmune and Inflammatory Rheumatic Diseases-The Patients' Perspective.

BACKGROUND: Injecting dermal fillers in patients with autoimmune inflammatory rheumatic diseases (AIIRDs) is controversial. OBJECTIVE: To evaluate the attitudes of patients with AIIRDs regarding the use of dermal fillers and the side effects of those who underwent them. METHODS: Patients with AIIRDs who attended a rheumatology outpatient clinic between 2016 and 2018 filled in a questionnaire about their attitudes toward dermal filler injections. The questionnaire evaluated information received from professionals and the factors that influenced their decision of whether or not to undergo the procedures. RESULTS: Overall, 194 patients with AIIRDs (mean age 56.5 ± 14.0, 99% women) responded. Forty-two of them had previously undergone the injections and intended to repeat them (Group A), 37 had not received filler injections but intended to do so (Group B), and 114 who had never undergone them did not intend to undergo them. The major motivation for undergoing filler injections was social. Patients treated with dermal fillers refrained from informing their rheumatologist about their injections. They were, however, highly satisfied with the procedure and reported negligible side effects. CONCLUSION: The use of dermal fillers was apparently safe and well received by patients with AIIRDs. Physicians' recommendations to refrain from injecting them with dermal fillers should be reconsidered and evaluated in clinical studies.

A review of combined treatments for melasma involving energy-based devices and proposed pathogenesis-oriented combinations.

BACKGROUND: Melasma is an acquired disorder of hyperpigmentation, affecting a million individuals worldwide. Energy-based devices (EBDs) employed to treat melasma include various types of lasers, intense pulsed light (IPL), and radiofrequency (RF). Recent studies have attempted to address recalcitrant and recurring melasma by combining energy-based devices with topical or oral medications. OBJECTIVE: This article reviews EBDs-based augmented treatment for melasma and suggests practical pathogenesis-oriented treatment regimens. Treatment algorithms are proposed to address various components of melasma. METHODS: A systematic PubMed search was conducted acquiring information from various studies on combination treatments of melasma involving EBDs. RESULTS: The 286 retrieved articles were filtered by title to contain at least one type of energy-based modality such as laser, IPL, or RF along with at least one other treatment method. Based on their subject matter, combinations were further categorized into the subheadings: laser plus medication, laser plus laser, and IPL- and RF-containing treatment methods. CONCLUSION: There are many energy-based combination treatments that have been explored for mitigation of melasma including laser therapy with medication, multi-laser therapies, IPL, RF, and microneedling devices. Melasma is an exceedingly difficult condition to treat, however, choosing the appropriate tailor-made treatment combination can improve the final outcome.

Painting CROSS TCA technique: Modification of the CROSS method for the treatment of atrophic acne scars-Case series.

BACKGROUND: The Chemical Reconstruction of Skin Scars (CROSS) technique was first described in 2002 and has since demonstrated safety and efficacy in multiple studies. We describe the treatment of six patients with a modified version of the CROSS method-the Painting CROSS trichloroacetic acid (TCA) technique. This technique has the advantage of offering even higher tissue selectivity and better control of the scar edges, enhancing both safety and efficacy. METHODS: We retrospectively evaluated 31 scars of six patients who underwent a single treatment by the Painting CROSS TCA method. A 0.3 ml insulin syringe with a 30-gauge needle was filled with 0.05 ml of 85% TCA solution and then applied to the scar base with slight pressure until frosting was achieved. Patients were evaluated before and 3 months after treatment for scar volume deficit by a high-resolution three-dimensional imaging system. RESULTS: The average volume of the 31 scars assessed in our study was 2.71 mm3 before treatment and 1.96 mm3 after treatment. There was a 26.3% average decrease in the volume of the scars after one treatment. Transient mild hyperpigmentation was noted in two patients after the treatment. CONCLUSION: Painting CROSS TCA technique has demonstrated efficacy in the treatment of acne scars after a single treatment.

The pathogenesis of melasma and implications for treatment.

BACKGROUND: Melasma is a complex and poorly understood disorder, with high rates of treatment failure and recurrences. OBJECTIVES: We aimed to review the current knowledge of the pathogenesis of melasma and apply this knowledge to clinical implications on relevant therapeutic interventions. METHODS: A systematic PubMed search was performed using the search term "((melasma[Text Word]) OR facial melanosis[Text Word]) AND (pathogenesis OR causality[MeSH Terms])" for articles published between 1990 and 2020. Included articles were then evaluated by two authors and assessed for relevant pathomechanistic pathways, after which they were divided into groups with minimal overlap. We then reviewed current treatment modalities for melasma and divided them according to the involved pathomechanistic pathway. RESULTS: A total of 309 search results were retrieved among which 76 relevant articles were identified and reviewed. Five main pathomechanisms observed in melasma were identified: (1) melanocyte inappropriate activation; (2) aggregation of melanin and melanosomes in dermis and epidermis; (3a) increased mast cell count and (3b) solar elastosis; (4) altered basement membrane; and (5) increased vascularization. Treatment modalities were then divided based on these five pathways and detailed in 6 relevant tables. CONCLUSION: The pathophysiology of melasma is multifactorial, resulting in treatment resistance and high recurrence rates. This wide variety of pathomechanisms should ideally be addressed separately in the treatment regimen in order to maximize results.

A split-face clinical trial of conventional red-light photodynamic therapy versus daylight photodynamic therapy for acne vulgaris.

BACKGROUND: Photodynamic therapy (PDT) is considered an effective treatment for acne vulgaris. A significant drawback is pain during illumination. Daylight PDT (DL-PDT) is more tolerable. OBJECTIVE: To assess and compare the efficacy and tolerability of DL-PDT and C-PDT for acne vulgaris through a prospective split-face trial. METHODS AND MATERIALS: Fifteen patients underwent 4 treatment sessions at 3-week intervals. First, 5-aminolevulinic acid (ALA) was applied to the entire face, after which the face was divided into 2 symmetrical areas: The right side was exposed to sunlight, and the left half was illuminated with red light. Photographs were obtained and evaluated by two dermatologists blinded to the study protocol. The patients reported side effects and downtime. RESULTS: There was a statistically significant decrease in the number and percent change of inflammatory and non-inflammatory lesions on both sides. Adverse effects were markedly decreased on the DL-PDT side compared to the C-PDT side (p < .01). The average downtime duration was longer for the C-PDT side (p < .001). CONCLUSION: DL-PDT was at least as effective as C-PDT with fewer adverse effects and a shorter downtime duration.

Quasi long-pulsed 1064nm Nd:YAG (micro pulsed) technology for the treatment of active acne: A case series.

BACKGROUND: Acne vulgaris is common dermatologic condition with an estimated prevalence of 80%. Acne has been shown to have a significant impact on patient quality of life and mental health, especially as inflammatory lesions typically occur on cosmetically sensitive areas with the potential for permanent scarring. There have been numerous advances in the treatment of inflammatory acne with light-based and laser devices. This technology permits effective treatment of active acne and scarring, with a short recovery and a decreased side effect profile as compared to medicinal standard-of-care and photodynamic therapies. OBJECTIVE: The case series study was aimed at evaluating the safety and efficacy of a 1064 nm Nd: YAG Quasi-longed pulse laser treatment for acne vulgaris. METHODS: This was a prospective study of 19 subjects with moderate to severe. All subjects received 1064 nm Nd: YAG Quasi-longed pulse laser treatments, at 8 J/cm2 fluence and accumulated 1000-4000 kJ according to treatment area at two weeks intervals. Primary end point was reaching a minimal AGSS score of between 1 and 2. Acne severity was assessed by two independent dermatologists according to AGSS scale before each treatment session and at the follow-up visit (8 weeks following last treatment). Subjects' self-assessment of Patient Global Impression of Change (PGIC) and overall satisfaction were also recorded. Safety was assessed by recording pain, adverse events, and downtime throughout the trial. RESULTS: Investigator's US FDA AGSS scoring of acne appearance improvement shows an average of 6.6 treatments were required to reach the minimal AGSS score endpoint. Significant reduction in AGSS scores was recorded after 2 treatments (4.21 ± 0.65 vs 3.05 ± 0.83 p = 1.63E-05 ), and maintained a statistically significant reduction rate throughout the trial. Minimal AGSS scores were still detected after 8 weeks following final treatment. Subjects scored high satisfaction rates and PGIC scores (2.9 and 5.3, respectively). Some patients reported transient erythema as only adverse events recorded in the study. CONCLUSION: The 1064 nm Nd: YAG Quasi-longed pulse laser was found to be safe and highly effective for the treatment of facial acne. The treatments were well tolerated, and the subjects experienced no pain and no downtime. Light-based treatments do and will probably continue to play an important and enlarging role in acne management.

Enhanced Percutaneous Delivery of Beta-Blockers Using Thermal Resurfacing Drug Delivery System for Topical Treatment of Infantile Hemangiomas.

BACKGROUND: Infantile hemangiomas (IHs) are the most common vascular tumors in children. In the past few years, topical beta-blockers (bBs) have been reported to be an effective treatment of superficial IHs. OBJECTIVE: We sought to evaluate the clinical effectiveness and safety profile of enhanced percutaneous delivery of bBs for the treatment of IH. METHODS: A retrospective study of all cases of IHs treated with enhanced percutaneous delivery of bBs between 2018 and 2019 was performed. Epidemiologic, clinical, and treatment data, including effectiveness score and safety, were reviewed. RESULTS: The study included 11 patients with a total of 11 IHs. Of the total number of IHs, 7 (63.7%) showed a good response to treatment and 4 (36.3%) had a partial response; thus all patients (100%) had good or partial response to treatment. No systemic or local adverse effects were reported. LIMITATIONS: This is an uncontrolled retrospective study. CONCLUSION: Enhanced percutaneous delivery of bBs is a safe and efficient topical therapy for IH.

Thermomechanical Ablation-Assisted Photodynamic Therapy for the Treatment of Acne Vulgaris. A Retrospective Chart Review of 30 Patients.

BACKGROUND AND OBJECTIVES: Acne vulgaris, a chronic inflammatory disease, affects more than 90% of teenagers. The first-line treatments for acne vulgaris are topical and oral medications, mainly antibiotics and retinoids. However, antibiotic resistance of Propionibacterium acnes, contraindications, partial response, significant adverse effects, or recurrence creates demand for novel treatment options in acne. Aminolevulinic acid (ALA) photodynamic therapy (PDT) is a well-established modality in the treatment of acne. Nevertheless, PDT has limitations: it may not be effective for every patient; several treatments are usually required to achieve sufficient outcome; incubation time is 1-3 hours; treatment pain and post-treatment downtime may be difficult for some patients to endure; and adverse effects may occur. This retrospective chart review was conducted to evaluate the efficacy and safety of PDT, assisted by a thermomechanical ablation (TMA) fractional injury device in the treatment of patients with moderate to severe acne. STUDY DESIGN/MATERIALS AND METHODS: We conducted a retrospective chart review of 30 acne patients treated with TMA immediately before 5% ALA application with an incubation time of 1 hour and exposure to 60 J/cm2 red light (630 nm). Patients received up to three monthly treatments and were followed for 16 weeks. Two independent investigators evaluated the subject outcomes according to high definition photographs taken at baseline, before each treatment and at follow-up visits. Three acne grading methods were used: Acne Grading Scoring System (AGSS), the Leeds revised acne grading system, and the general response to the treatment score. Patients also provided self-assessments of improvement using the patient global impression of change (PGIC). RESULTS: Compared with baseline, the AGSS has showed a statistically significant reduction of 26.7% and 23.7%, respectively, at weeks 8 and 16 after final treatment. The Leeds score showed 65.2% and 60.6% improvement at the respective visits. The overall response rate was graded 3.3 ± 0.5 out of 4. PGIC score given by the patients was 5.5 out of 7, reflecting high satisfaction. CONCLUSION: TMA used immediately prior to ALA application may enhance the effectiveness of PDT in the treatment of acne with minimal side effects, reduced downtime, and fewer sessions. The exact mechanism of TMA-assisted PDT is still to be understood. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

Intense focused ultrasound for neck and lower face skin tightening a prospective study.

BACKGROUND: Intense focused ultrasound (IFUS) is a Nonablative skin tightening technology with good safety profile, but limited efficacy. Most clinical studies have been performed to evaluate the efficacy of the Ulthera IFUS (Ulthera, Mesa, AZ) in treating redundant skin. OBJECTIVE: To report our experience with Doublo IFUS (Doublo™, HIRONIC Co.) for treating neck and lower face laxity. METHODS: This is a prospective study of 43 patients with neck and lower facial laxity treated using IFUS. Response was assessed by two independent dermatologists and graded on a scale of 0 (exacerbation) to 5 (75%-100% improvement). Patient's level of "sagging" and "volume loss", satisfaction and tolerance were documented. RESULTS: Nine subjects (52.9%) mentioned some improvement. Erythema and edema were acute and transient responses. CONCLUSION: Ultrasound appears to be a safe modality for facial skin tightening in selected patients with minor skin sagging and no volume discrepancy.

Dual-plane hyaluronic acid treatment for atrophic acne scars.

BACKGROUND: Acne is a common condition that affects up to 80% of all adolescents. Scarring may affect some 95% as a function of severity and delay before treatment. The pathogenesis includes enzymatic degradation of collagen fibers and subcutaneous fat. OBJECTIVE: This study aimed to treat atrophic acne scars using the Dual-Plane injection of Hyaluronic Acid. METHODS: A total of 12 patients with moderate-to-severe atrophic acne scars were treated with a novel NAHYCO™ based Hyaluronic Acid filler, using a dual-plane technique for two treatment sessions at a 4-week interval. Results were objectively assessed by two blinded Dermatologists and subjectively evaluated by the patients themselves. RESULTS: A total of 8 out of the 12 patients reported moderate improvement, two indicated marked improvement and two rated minimal improvement. Dermatologists' mean global evaluation score was 2.5 ± 0.43. LIMITATIONS: The small sample size and regional nature of a single-center study. Nevertheless, both the expert dermatologists' and the patients' evaluations of standardized high-resolution medical photographs were consistent, suggesting that this inherent bias was negligible. CONCLUSION: The treatment led to impressive improvement in the depth of the scars, suggesting that this technique can result in safe and rapid amelioration of atrophic acne scars in only two sessions.

An enhanced transcutaneous delivery of botulinum toxin for the treatment of Hailey-Hailey disease.

Successful treatment of Hailey-Hailey disease with intradermal botulinum toxin injections has been previously reported. The main disadvantages of this treatment are the excruciating pain and the risk of infections due to the numerous injections. We sought to evaluate the clinical effectiveness and safety profile of a novel approach using an energy-based device (Tixel, Novoxel, and Israel), followed by the topical application of botulinum toxin Type A for the treatment of Hailey-Hailey disease. A retrospective study of all cases of histologically diagnosed cases of Hailey-Hailey disease treated with Tixel device followed by topical application of botulinum toxin between 2018 and 2019 was performed. Epidemiologic, clinical, and treatment data, including effectiveness score and safety, were reviewed. The study included eight patients, of whom seven patients (87.5%) showed good or partial response. No systemic or local adverse effects were reported. There was no difference in effectivity between different body areas. Response to treatment ranged between patients with an average duration of 7.125 months after the second treatment. Tixel treatment followed by topical application of botulinum toxin can be considered in the treatment of Hailey-Hailey disease. This approach is less invasive, less painful, and yet effective as well as safe.

A new approach in the treatment of pediatric hypertrophic burn scars: Tixel-associated topical triamcinolone acetonide and 5-fluorouracil delivery.

BACKGROUND: Pediatric hypertrophic burn scars are challenging to treat due to their widespread nature and pain associated with the treatment. Intralesional triamcinolone acetonide (TAC) injection with or without 5-fluorouracil (5FU) is considered first-line treatment for severe hypertrophic scars. The pain associated with the procedure, the uneven topography, and epidermal atrophy, all limit the application of this treatment modality. AIMS: We sought to evaluate the clinical effectiveness and safety profile of a novel thermomechanical system (Tixel, Novoxel) for transdermal delivery of a topical solution containing TAC and 5-FU in the treatment of hypertrophic scars. PATIENTS/METHODS: A retrospective study of pediatric hypertrophic burn scars treated between 2015 and 2017 was performed. Epidemiologic, treatment data, effectiveness score, and safety were reviewed. RESULTS: Four children (one male and three females, ages 3-10 years old) with hypertrophic burn scars treated with the Tixel device were evaluated. Mean scar VSS was reduced from 8.4 ± 0.8-5.2 ± 0.5 (P-value - .001) after eight treatments. The mean improvement of toughness, thickness, color, and general aesthetic impression was 3.1 ± 0.43 â†’ 2.2 ± 0.31, 3.4 ± 0.5 â†’ 1.9 ± 0.63, 2.7 ± 0.21 â†’ 2.4 ± 0.25, and 3.23 ± 0.44 â†’ 1.6 ± 0.64, respectively. Mean treatment pain VAS score was 1.74 ± 0.9. Patient's parents rated their satisfaction level as "moderate-high." No topical or systemic complications were observed. CONCLUSION: Thermomechanical decomposition of the stratum corneum, in combination with topical application of TAC and 5-FU, is a safe, relatively painless, and efficient modality for the treatment of pediatric hypertrophic burn scars.

Evaluation of subject response following treatment for pigmentation or wrinkles using a diode laser.

BACKGROUND: Pulsed diode array laser systems are utilized extensively for various aesthetic indications such as removal of unwanted hair, treatment of vascular and pigmented lesions, and wrinkle reduction. OBJECTIVE: The purpose of this study was to report and assess the experience of using a diode laser system delivering pulsed infrared laser light at the near-infrared (NIR) spectrum at wavelengths of 805 and 1060 nm. METHODS: The study was a retrospective analysis of treatment outcomes in adult subjects treated at the clinic between January 2017 and April 2018 for wrinkles and pigmentation with a noninvasive aesthetic diode laser system. Subjects were treated at nominal wavelengths of 805 nm for pigmentation and 1060 nm for wrinkles reduction. Improvement in pigmentation and wrinkles, adverse events, and patient tolerability to treatment and satisfaction were evaluated. RESULTS: Of 44 subjects with Fitzpatrick skin types II-IV, eight were treated for pigmentation and 36 for wrinkles. For both treatments, subjects reported tolerable pain levels. All immediate responses resolved within 48 hours post-treatment. Evaluation of treatment outcomes by two blinded evaluators demonstrated significant pigmentation clearance mean of 2.50 ± 0.15, (P < .05) in subjects treated for pigmentation, as well as significant improvement mean of 0.46 ± 0.12 (P = .005) in wrinkles in 13 subjects (41%) whose "before" and "after treatment" photographs were correctly identified by both blinded evaluators. Subjects were satisfied with the treatments. CONCLUSIONS: Use of the Diode laser effectively resulted in improvement in pigmentation and wrinkles, while maintaining a high safety profile with limited downtime.

The Scar Bane, Without the Pain: A New Approach in the Treatment of Elevated Scars: Thermomechanical Delivery of Topical Triamcinolone Acetonide and 5-Fluorouracil.

INTRODUCTION: Keloids are challenging to treat due to their inadequate response to treatment and high recurrence rate. Intralesional triamcinolone acetonide (TAC) injection with or without 5-fluorouracil (5FU) is considered the first-line treatment for keloids. Three significant disadvantages of intralesional injections are the pain associated with the procedure, the uneven topography, and epidermal atrophy. Fractionated ablative carbon dioxide (CO2) laser-assisted drug delivery (LADD) of the topical solution can help facilitate transdermal drug delivery and shows promise in scar remodeling. This study examined the use of a thermomechanical device (Tixel, Novoxel) to facilitate the transdermal delivery of TAC and 5-FU in the treatment of keloid scars. METHODS: Seven patients each received eight topical thermal ablations, with one ablation performed every 2-3 weeks. TAC and 5FU were applied after each ablation. Outcomes were evaluated using the Vancouver Scar Scale (VSS), and pain was assessed using the Visual Analog Scale (VAS). RESULTS: Mean keloid VSS reduced from 8.6 ± 1.2 to 5 ± 2.7 after the eight treatments. Mean treatment pain VAS score was 2.4 ± 0.7. Patients rated their satisfaction level as moderate-high. No severe adverse reactions were noted. CONCLUSION: Thermomechanical drug delivery of TAC and 5-FU is safe and effective. This is a promising option for the treatment of keloid scars, particularly in the pediatric population.

Early intervention with pulse dye and CO2 ablative fractional lasers to improve cutaneous scarring post-lumpectomy: a randomized controlled trial on the impact of intervention on final cosmesis.

Light-based modalities appear to be effective for ameliorating surgical scar appearance; however, protocols for achieving such outcomes have yet to be established. We studied the safety and efficacy of a combination of pulsed dye laser (PDL) and fractional ablative CO2 laser (FACL) for the attenuation of post-lumpectomy scarring. We conducted a prospective, evaluator-blinded, comparative split-scar study in post-lumpectomy patients. One-half of the scar was treated with three sessions of 595-nm PDL and FACL at 1-month intervals, starting within 6 weeks after suture removal. The entire scar was also treated with standard moisturizers and silicone gels. Six months after the last treatment, the two halves of the scar were assessed by three uninvolved physicians who used the Observer Scar Assessment Scale as well as by the patients who used the Patient and Observer Scar Assessment Scale. Eighteen female patients (mean age, 51.3 years) with a mean scar length of 7.8 cm completed the treatment and follow-up. Six months after the last treatment, both the physician evaluators and the patients noted significant improvements for all assessed scar parameters in the laser-treated scar area compared with the untreated scar area. The treatment was well tolerated, and no remarkable adverse events were reported. All 18 participants were satisfied with the treated scar areas. A combination PDL and FACL protocol starting up to 6 weeks after suture removal is a safe and effective method for the attenuation of post-lumpectomy scar formation.

A 1064-nm Neodymium-doped Yttrium Aluminum Garnet Picosecond Laser for the Treatment of Hyperpigmented Scars.

BACKGROUND: Pigmentation is one of the few major characteristics according to which scars are evaluated. Data on the treatment of the hyperpigmented component of scars are sparse. OBJECTIVE: The authors aimed at evaluating the efficacy of the fractional 1,064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) picosecond laser in the treatment of the hyperpigmented component of scars. METHODS: Sixteen patients with hyperpigmented scars underwent 3 to 8 treatment sessions at 3- to 6-week intervals with the 1,064-nm Nd:YAG picosecond laser (PicoWay, Candela, Resolve handpiece). The treatment response was evaluated by 2 noninvolved dermatologists on a global assessment scale (GAS) of 1 to 4. A Mexameter quantitatively evaluated the melanin content of the scar before and after laser treatments. RESULTS: The average GAS score of the 2 noninvolved dermatologists was 3.31 ± 0.57. The patients assessed their level of tolerance as good or excellent and their satisfaction level as moderate or high. The Mexameter showed that the melanin index decreased considerably (by 39.11 ± 11.58%) in all patients after treatment. CONCLUSION: The fractionated nonablative picosecond Nd:YAG laser was effective for the treatment of the hyperpigmented component of scars.

The toxic edge-A novel treatment for refractory erythema and flushing of rosacea.

PURPOSE: Rosacea is a common, chronic facial skin disease that affects the quality of life. Treatment of facial erythema with intradermal botulinum toxin injection has previously been reported. The primary objective of the study was the safety and efficacy of thermal decomposition of the stratum corneum using a novel non-laser thermomechanical system (Tixel, Novoxel, Israel) to increase skin permeability for Botulinum toxin in the treatment of facial flushing of rosacea. METHODS: A retrospective review of16 patients aged 23-45 years with Fitzpatrick Skin Types II to IV and facial erythematotelangiectatic rosacea treated by Tixel followed by topical application of 100 U of abobotulinumtoxin. A standardized high-definition digital camera photographed the patients at baseline and 1, 3, and 6 months after the last treatment. Objective and subjective assessments of the patients were done via Mexameter, the Clinicians Erythema Assessment (CEA), and Patients self-assessment (PSA) scores and the dermatology life quality index (DLQI) validated instrument. RESULTS: The average Maxameter, CEA, and PSA scores at 1, 3, and 6 months were significantly improved compared with baseline (all had a P-value <0.001). DLQI scores significantly improved with an average score of 18.6 at baseline at 6 months after treatment (P < 0.001). Self-rated patient satisfaction was high. There were no motor function side-effects or drooping. CONCLUSION: Thermal breakage of the stratum corneum using the device to increase skin permeability for botulinum toxin type A in the treatment of facial flushing of rosacea seems both effective and safe. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.

Fractional Ablative CO2 Laser Followed by Topical Application of Sodium Stibogluconate for Treatment of Active Cutaneous Leishmaniasis: A Randomized Controlled Trial.

Conventional treatment of cutaneous leishmaniasis often leaves permanent scars with frequent psychosocial sequelae. The aim of this study was to compare the efficacy, safety, associated pain and final cosmetic outcome of fractional carbon dioxide (CO2) laser followed by topical application of sodium stibogluconate vs. sodium stibogluconate injections for the treatment of cutaneous leishmaniasis. A total of 181 lesions (20 patients) were randomly assigned to receive intralesional injections of sodium stibogluconate (control group) or fractional CO2 laser treatment followed by topical application of sodium stibogluconate (study group). The visual analogue scale (VAS) score of the control group was much higher than that of the study group (6.85 vs. 3.5, respectively, p<0.001). Both the patients and 2 blinded dermatologists found the final cosmetic outcome to be superior for laser-treated lesions (p = 0.001 vs. p =0.008 for controls). Fractional CO2 laser treatment followed by topical application of sodium stibogluconate is less painful and leads to a better final cosmetic outcome compared with intralesional injections of sodium stibogluconate.

Novel Stereoscopic Optical System for Objectively Measuring Above-Surface Scar Volume-First-Time Quantification of Responses to Various Treatment Modalities.

BACKGROUND: Current approaches use subjective semiquantitative or cumbersome objective methodologies to assess physical characteristics of hypertrophic and keloid scars. OBJECTIVE: This pilot study aimed to evaluate the accuracy and feasibility of a new stereoscopic optical and high-resolution 3-dimensional imaging system, for objectively measuring changes in above-surface scar volume after various interventions. METHODS: Feasibility and accuracy were assessed by monitoring the above-surface scar volume of 5 scars in 2 patients for 5 successive months. Above-surface scar volume and Vancouver Scar Scale scores and the investigator and patient volume improvement assessment scores were assessed before and 12 weeks after last intervention. RESULTS: Scar volume measured by the imaging system correlated significantly with the gold standard (actual weight). The greatest volume reduction followed a combination of cryotherapy and intralesional triamcinolone acetonide and 5-fluorouracil injections in Patient 1 and a combination of pulse dye laser and intralesional triamcinolone acetonide injections in Patient 2. CONCLUSION: The new stereoscopic optical system is a valid, accurate, and practical objective method for assessing scar volume and for monitoring treatment response. It is more sensitive and accurate than semiquantitative objective scales. Further studies with a higher number of patients and scars are required to increase the measurement validity of the system.