Efficacy and Safety of Intense Pulsed Light With a KTP/PDLlike Filter for the Treatment of Facial Telangiectasias.

BACKGROUND: An intense pulsed light (IPL) narrowband "KTP/PDL-like" filter (525–585 nm) may combine the tolerability of the IPL with the precision of KTP and PDL lasers. This study evaluated the impact of IPL with a KTP/PDL-like filter on telangiectasias. METHODS: This was a single-center, prospective study of 17 subjects with facial telangiectasias and skin types I–III. Three monthly treatments were performed using this specific filter, with follow-up visits at 1, 3, and 6 months. Telangiectasia improvement was assessed by the investigator and subjects using a 5-point scale. Facial photographs and safety assessments were obtained at each visit. Subject discomfort was evaluated using a visual analog scale (VAS) immediately posttreatment, and subject downtime was recorded at each subsequent visit. RESULTS: All facial telangiectasias significantly improved. At 1-month follow-up, >50% lesion clearance was noted in 97.1% of facial (n=36) and 85.7% of non-facial (n=7) lesions, with 73% of subjects satisfied or very satisfied. An increase in mean social downtime (0, 2.3, and 3 days) and VAS scores (3.5, 4.5, and 4.8) with treatments 1, 2, and 3, respectively, mirrored a stepwise increase in fluence with subsequent sessions. CONCLUSIONS: The use of a novel IPL narrowband KTP/PDL-like filter can significantly improve facial and non-facial telangiectasias with minimal downtime. J Drugs Dermatol. 2020;19(9):844-850. doi:10.36849/JDD.2020.4834.

Efficacy and safety of intense pulsed light with a KTP filter for the treatment of solar lentigines.

BACKGROUND: Optical energy-based devices, including intense pulsed light (IPL) and potassium titanyl phosphate (KTP) lasers achieve reduction of pigmented and vascular lesions in a relatively similar number of treatments. This study aimed to evaluate the efficacy and safety of an IPL with a "KTP-like" filter emitting a wavelength of 525-585 nm for the treatment of solar lentigines on the hands and face. METHODS: This was a single center, prospective, open-label clinical trial including 16 healthy Caucasian subjects (15 females, mean age, 55 years; skin types II and III) with hand and facial solar lentigines. Subjects were treated with three IPL treatment sessions with a KTP-like filter conducted at monthly intervals. Follow-up evaluations were performed 1, 3, and 6 months after the last treatment session. Overall pigmentation improvement, pigmentation clearance per lesion, adverse events, and subject tolerability to treatment were evaluated. RESULTS: Significant improvements in facial and hand pigmentation were noted at all follow-up visits (P < 0.0001). One month after the last treatment session, good to excellent outcomes were noted in 74.6% of treated facial areas and 90% of treated hand regions. Although the effect of treatment gradually declined in both treatment regions over the 6-month follow-up period, over 60% of subjects demonstrated good to excellent results at the study end. Clinical effectiveness was further confirmed by the reduction in Melanin Index (MI) following each treatment as compared to baseline. Downtime and complications were minimal. CONCLUSIONS: IPL treatment with a KTP-like filter is a well-tolerated and effective method for reducing facial and hand pigmentation. Lasers Surg. Med. 51:500-508, 2019. © 2019 Wiley Periodicals, Inc.

Three-Dimensional Rejuvenation of the Décolletage.

BACKGROUND: Photodamaged skin of the chest is characterized by skin laxity, lines/wrinkles, hyperpigmentation, erythema, tactile roughness, atrophy, and telangiectasias. METHODS: A MEDLINE search was performed on combination treatments in chest rejuvenation, and the results are summarized. Practical applications for these combinations of procedures are discussed. RESULTS: Reports of injectable poly-L-lactic acid (PLLA), hyaluronic acid (HA), and chemical peels, along with lasers and light therapies such as intense pulsed light (IPL), vascular lasers, photodynamic therapy (PDT), nonablative fractionated lasers (NAFLs), ablative fractionated lasers (AFLs), and microfocused ultrasound (MFU) have been reported for chest rejuvenation. Few articles were discovered pertaining to combination therapy. The authors review their approaches to combination therapy. CONCLUSION: Multiple options exist alone or in combination for minimally invasive rejuvenation of the skin of the chest including PLLA, HA, chemical peels, IPL, vascular lasers, PDT, NAFL, AFL, and MFU. Little was found in the literature pertaining to the safety and efficacy of combining such procedures and devices. The authors' experience in clinical practice is that combination, same day chest rejuvenation techniques can be performed safely. A combination approach often produces the most optimal outcome for the patient seeking chest rejuvenation.

The Effects of Filtrate of the Secretion of the Cryptomphalus Aspersa on Photoaged Skin

BACKGROUND: Growth factors (GFs) are chemical messengers that regulate specific cellular activities such as cell proliferation and formation of the extracellular matrix. GFs may be derived from a variety of sources, including animals. OBJECTIVE: Evaluate the safety and efficacy of a topical antiphotoaging product containing secretions of the snail Cryptomphalus aspersa (SCA) for the improvement of facial rhytides. MATERIALS AND METHODS: This was a 2-center, double-blind, randomized, 14-week study in which 25 patients with moderate to severe facial photodamage were treated with an emulsion (with 8% SCA) and liquid serum (with 40% SCA) on one side of the face and placebo on the contralateral side for 12 weeks. Silicone skin impressions of periocular rhytides were performed at baseline and after 12 weeks of treatment. Patient and physician assessments were also performed at 8, 12, and 14 weeks. RESULTS: Periocular rhytides on the active ingredient side showed significant improvement after 12 weeks (P=.03) and improved texture to a greater degree than placebo at 8 and 12 weeks, as well as 2 weeks after discontinuing the product (14 weeks). CONCLUSION: Daily application of topical products containing SCA proved effective and well tolerated for improvement in coarse periocular rhytides and fine facial rhytides. Subjects noted a significant degree of improvement in fines lines at the 8-week time point on the SCA-treated side (P≤.05) but did not report a significant difference in the quality of their skin.

Unilateral presentation of disseminated candidiasis: case report and review of the literature.

Candidiasis is the most common fungal infection in immunocompromised patients who are at greater risk for developing disseminated disease. Renal transplant recipients often are administered immunosuppressants and therefore are at an increased risk for developing disseminated candidal infections. Disseminated candidiasis generally does not present with cutaneous lesions, but when present, lesions usually are generalized or limited to the trunk and limbs. We describe the case of an immunosuppressed renal transplant recipient who developed a disseminated Candida kefyr infection and presented with oral mucosal lesions and cutaneous lesions limited to the left lower extremity. The lesions were localized due to a thrombus that was subsequently found in the patient's left external iliac artery.

Treatment of reticular and telangiectatic leg veins: double-blind, prospective comparative trial of polidocanol and hypertonic saline.

BACKGROUND: Sixty-three subjects' legs were randomized to receive treatment with polidocanol (POL) or hypertonic saline (HS) for telangiectasias and reticular leg veins. OBJECTIVE: To compare the safety and efficacy of two sclerosing agents in three dermatologic surgery practices. METHODS: After exclusion of saphenofemoral junction incompetence, each subject's veins were categorized (telangiectasias <1 mm and reticular veins 1-3 mm) and randomized. Telangiectasias were treated with POL 0.5% or 11.7% HS and reticular veins with POL 1% or 23.4% HS. An independent, blinded physician determined efficacy and adverse events. Subject satisfaction questionnaires were administered and global clinical improvement assessments performed. RESULTS: All patients completed four visits at 0, 1, 4, and 12 weeks. Patients reported significantly greater pain during treatment with HS (2.42) than POL (1.03) (p < .001). There were no significant differences in physician-assessed improvement of reticular leg veins or telangiectasias; subject- or physician-assessed overall improvement; or physician-assessed phlebitis, pigmentation, edema, or matting in either of the three practices or the entire cohort. Two subjects developed ulcerations with HS. No ulcerations or allergic reactions developed after POL injections. CONCLUSION: Both agents provided effective treatment, but HS caused 2.35 times as much pain during injections and resulted in two episodes of tissue necrosis.

An investigation of coagulation cascade activation and induction of fibrinolysis using foam sclerotherapy of reticular veins.

BACKGROUND: Coagulation parameters have not been investigated when foam sclerotherapy is used to treat reticular leg veins. OBJECTIVE: To evaluate the effect of foam bubbles on coagulation and fibrinolysis by measuring platelet count and concentrations of clotting factors and fibrinogen after foam sclerotherapy with sodium tetradecyl sulfate (STS) mixed with room air. MATERIALS AND METHODS: Patients with reticular veins received treatment with up to 30 mL of foam sclerotherapy prepared with STS and room air in a 1:4 ratio (1 mL STS, 4 mL room air) using the double-syringe technique. Venous blood was drawn immediately beforesclerotherapy and 15 minutes after the procedure. Pre- and post-treatment laboratory values were compared. RESULTS: Subjects treated with up to 30 mL of foam (30 mL foam = 6 mL sclerosing solution and 24 mL air) showed no statistically significant difference in coagulation or fibrinolysis, as measured according to platelet count and concentrations of clotting factors and fibrinogen, after foam sclerotherapy with STS mixed with room air. CONCLUSION: STS foam made with room air, up to 30 mL, when injected into reticular veins does not affect coagulation parameters.

Evaluation of the effect of fractional laser with radiofrequency and fractionated radiofrequency on the improvement of acne scars.

BACKGROUND: Options for acne scar reduction include peels, subcision, fillers, lasers, dermabrasion, and surgical excision, although not all are applicable in darker skin types. A novel device with a handpiece combining optical and radiofrequency (RF) energies along with a fractionated RF handpiece is available for nonablative resurfacing. OBJECTIVES: Our primary objective was to evaluate the improvement in acne scars and skin texture. Secondary objectives were determination of patient satisfaction and comfort and evaluation of scar pigmentation improvement. Patients received five treatments at 30-day intervals. Post-treatment follow-up visits were performed 30 and 90 days after the last treatment. RESULTS: A 72.3% decrease (p<.001) was observed on the acne scar scale from day 1 to 210. From day 30 to 210, investigator-rated changes in scarring, texture, and pigmentation improved 68.2% (p<.001), 66.7% (p<.001), and 13.3% (p=.05), respectively. Patient satisfaction scores showed no significant change over time, although patient-evaluated overall improved scores increased 60% over baseline (p=.02). CONCLUSION: This technology may be a useful, nonablative resurfacing treatment for acne scarring. Scarring, texture, and pigmentation improved significantly according to investigator-rated assessment parameters. Although patient satisfaction scores did not improve, overall improvement scores did.

Laser, light, and energy devices for cellulite and lipodystrophy.

Cellulite affects all races, and it is estimated that 85% of women older than 20 years have some degree of cellulite. Many currently accepted cellulite therapies target deficiencies in lymphatic drainage and microvascular circulation. Devices using radiofrequency, laser, and light-based energies, alone or in combination and coupled frequently with tissue manipulation, are available for improving cellulite. Laser assisted liposuction may improve cellulite appearance. Although improvement using these devices is temporary, it may last several months. Patients who want smoother skin with less visible cellulite can undergo a series of treatments and then return for additional treatments as necessary.

The adverse events of deep fractional CO(2): a retrospective study of 490 treatments in 374 patients.

BACKGROUND: Fractionated carbon dioxide CO(2) laser resurfacing unites the idea of fractional photothermolysis with an ablative 10,600-nm wavelength. This technology permits effective treatment of deeper rhytides, photodamaged skin, and scars, with shorter recovery and a decreased side effect profile as compared to traditional CO(2) laser resurfacing. OBJECTIVES: To study the rate of the adverse events associated with the use of deep fractional CO(2) laser. METHODS: A retrospective study of 490 fractionated CO(2) laser treatments in 374 patients by ten physicians within one practice was performed between March 3, 2008 and July 28, 2010. Treatment areas included the face, neck, chest, hands, back, and abdomen. RESULTS: Of the 490 treatments, 365 were of both superficial and deep fractional treatments while 125 treatments were deep. Patients treated were of Fitzpatrick skin types I-IV. Four hundred ninety treatments resulted in 67 adverse events (13.6%) in 63 patients (16.8%), the most frequent adverse events were acneiform eruption (5.3%), herpes simplex outbreak (2.2%), bacterial infections (1.8%), yeast infections (1.2%), hyperpigmentation (1.2%), prolonged erythema beyond 1 month (0.8%), and (0.8%) contact dermatitis. There were no reports of scarring or hypopigmentation. CONCLUSIONS: Fractional deep CO(2) laser is a safe method for treating rhytides, photodamaged skin, and scars with a low incidence of adverse events.

A two-phase, retrospective analysis evaluating efficacy of and patient satisfaction with abobotulinumtoxina used to treat dynamic facial rhytides.

BACKGROUND: Numerous studies on cosmetic uses of the two major forms of botulinum type A toxin-onabotulinumtoxinA and abobotulinumtoxinA--have been reported, but there is a lack of published, non-industry-funded data regarding efficacy and patient satisfaction with abobotulinumtoxinA. OBJECTIVES To evaluate the efficacy of and patient satisfaction with abobotulinumtoxinA injections. METHODS: Retrospective, two-phase study of 185 patients treated with abobotulinumtoxinA for dynamic facial rhytid reduction over an 8-month period. Data were gathered using chart review and patient follow-up. RESULTS: The average total amount of abobotulinumtoxinA injected per visit was similar in each phase (93.7 U in phase I, which used a ratio of 2.5 abobotulinumtoxinA units to 1 onabotulinumtoxinA unit, and 99.6 U in phase II, which used a ratio of 3:1). Of patients with a history of onabotulinumtoxinA injections (89.1% in phase I and 91% in phase II), the majority preferred onabotulinumtoxinA. A similar percentage in each group reported overall satisfaction with abobotulinumtoxinA (70.9% in phase I and 68% in phase II). CONCLUSION: Although generally satisfied with abobotulinumtoxinA, when given a choice between abobotulinumtoxinA and onabotulinumtoxinA, the majority of patients favored the latter. This preference remained even after the dilution of abobotulinumtoxinA was decreased.

Rejuvenation of the aging chest: a review and our experience.

BACKGROUND: Photo-damaged skin of the chest is characterized by skin laxity, lines and wrinkles, hyperpigmentation, erythema, tactile roughness, atrophy, and telangiectasias. STUDY DESIGN: A Medline search was performed on rejuvenation of the chest from 1960 to 2010. Practical applications to these procedures are also provided. RESULTS: Chest-based reports of injectable poly-L-lactic acid (PLLA), botulinum toxin, sclerotherapy, and chemical peels, along with lasers and light therapies such as intense pulsed light (IPL), photodynamic therapy (PDT), nonablative fractionated lasers, and ablative fractionated lasers were identified. CONCLUSION: Review of the literature revealed that options for minimally invasive treatment options for rejuvenation of the skin of the chest include injectable PLLA, botulinum toxin, sclerotherapy, and chemical peels, along with lasers and light therapies such as IPL, PDT, and nonablative fractionated lasers. For more dramatic results, ablative fractional lasers can be safely used, although longer healing times and potential adverse effects are to be expected. Adverse events are often due to the thinness of the dermis and epidermis and the lower concentration of pilosebaceous units. If treatments are tailored to the skin of the chest, the incidence of adverse events is lower, and patients can be safely treated.

An investigation into the influence of various gases and concentrations of sclerosants on foam stability.

BACKGROUND: Foam sclerotherapy is an increasingly popular modality in varicose vein treatment. Our previous work showed that the half-life of room air foam varied according to the percentage and type of sclerosant solution. MATERIALS AND METHODS: A plastic connector was used to create foam made from a combination of 0.25%, 0.50%, and 1% sodium tetradecyl sulfate (STS) and room air, carbon dioxide (CO(2)), oxygen (O(2)), or a mixture of CO(2) and O(2). To measure foam stability, the foam half-life was defined as the time it took for half the original volume of sclerosing solution to settle. RESULTS: Half-life varied according to sclerosant concentration when room air, O(2), or a mixture of CO(2) and O(2) was used for foam creation but not when CO(2) was used. Room air foam is more than 3 times as stable as CO(2) foam and 1.5 times as stable as a mixture of CO(2) and O(2). CONCLUSIONS: CO(2) foam half-life did not vary according to sclerosant solution concentration, though room air, O(2) , and CO(2)/O(2) did. The half-life of room air foam is more than 3 times as long as that of CO(2) and 1.5 times as long as that of a mixture of CO(2) and O(2). Foam half-life for room air and O(2) are similar at low concentrations of STS but differ at higher concentrations.

Effectiveness and side effects of anti-CD20 therapy for autoantibody-mediated blistering skin diseases: A comprehensive survey of 71 consecutive patients from the Initial use to 2007.

In order to examine the efficacy and side effects of the monoclonal antibody anti-CD20 (rituximab) on autoimmune blistering skin diseases, we performed a comprehensive survey of 71 consecutive patients from initial use up to 2007, using the PubMed database. A heterogeneous group of patients, including 51 patients with pemphigus vulgaris, one with pemphigus vegetans, nine with pemphigus foliaceus, five with paraneoplastic pemphigus, four with epidermolysis bullosa acquisita, and one with both bullous pemphigoid and graft vs host disease was included in this survey. Overall the monoclonal antibody seems to be effective in that 69% of patients showed complete response, 25% of patients showed partial response, whereas 6% of patients showed progressive disease. Six deaths occurred in association with the treatment, with four of these deaths in patients with paraneoplastic pemphigus, a disease characteristically resistant to conventional medication and with a high mortality rate. Of note, 11 patients who received combined rituximab and intravenous immune globulin treatments had the best outcome: complete response without any serious side effects. Therefore further investigation on rituximab with controlled clinical trial is a worthy pursuit.

The progression of inflammation parallels the dermal angiogenesis in a keratin 14 IL-4-transgenic model of atopic dermatitis.

The role angiogenesis plays in atopic dermatitis is not well understood. The authors previously demonstrated ultrastructurally dermal microvascular angiogenesis in the IL-4-transgenic mouse model of atopic dermatitis. Here, they determine the angiogenic factors involved in dermal microvascular angiogenesis, regulatory function of inflammatory cytokines on the VEGF-A production, and microvascular permeability in this model. Computer-assisted photometric analyses for immunofluorescence-labeled CD31 demonstrated a progressive increase in blood vessel number, diameter, and percent dermal areas occupied by CD31(+) vessels as the disease evolves in transgenic mice from before disease onset through early and late skin lesions. Similar findings were documented for VEGR2(+) vessels. Quantification of skin angiogenic factor mRNAs showed progressive increase of transcripts of VEGF-A, but not VEGF-B, VEGF-C, or VEGF-D. ELISA showed a similar increase of VEGF-A in the serum and skin of transgenic mice. IL-6 and IFN-gamma stimulated VEGF-A mRNA production in the skin and in primary keratinocytes of transgenic mice. Other skin angiogenic factors that increased included Ang-1, Ang-2, GBP-1, and VE-cadherin. Microvascular leakage began in the transgenic mouse skin before disease onset and peaked in the late stage. In conclusion, IL-6 and IFN-gamma may play important roles in upregulation of VEGF-A, along with other pro-angiogenic factors, to induce dermal microvascular angiogenesis.

An erythrodermic variant of pemphigus foliaceus with puzzling histologic and immunopathologic features.

BACKGROUND: Pemphigus foliaceus is an autoimmune blistering disorder that affects the skin owing to autoantibodies against desmoglein 1. METHODS: We employed clinical, histologic, immunopathologic, and serum laboratory studies to investigate a case of an erythrodermic variant of pemphigus foliaceus in an elderly man following treatment with bisoprolol-hydrochlorothiazide. RESULTS: Early histopathology revealed psoriasiform dermatitis, but later biopsies showed subcorneal and granular layer separation with neutrophilic infiltrate. Direct immunofluorescence showed intercellular deposits of immunoglobulin G throughout the epidermis, granular staining of C3 along the basement membrane zone, and fibrin and C3 deposition around the blood vessels. Indirect immunofluorescence on monkey esophagus showed a titer of greater than 1:1,280. Indirect immunofluorescence on rat bladder, antinuclear antibody, lupus panel, and kidney function panel were all negative. CONCLUSION: There are no reports in the literature of pemphigus foliaceus being induced by bisoprolol, but reports exist of propanolol resulting in drug-induced pemphigus foliaceus.