Skin cancer concerns particular to women.

BACKGROUND: Skin cancer has reached epidemic proportions, with more new cases diagnosed annually than the combined incidence of cancers of the breast, prostate, lung, and colon. Estimates show 2 to 3 million new cases of non-melanoma skin cancer (NMSC) every year, and, among women, it is the young (younger than 45 years) who are disproportionately affected. OBJECTIVE: This article aims to address questions and concerns pertinent to skin cancer in a woman-centric way. An updated landscape of causative factors, the latest detection/treatment methods, and ultimately the preventative measures available to them are described. METHODS: A broad literature search was conducted using the PubMed database with search terms focusing on female gender. Additional articles were identified from cited references. CONCLUSIONS: The published findings on causation of melanoma skin cancer and non-melanoma skin cancer in females are outlined, as well as current detection methods and treatment options. Furthermore, a variety of preventative measures specific to women that can reduce the chance of being diagnosed with skin cancer are discussed.

Novel method for facial rejuvenation using Er:YAG laser equipped with a spatially modulated ablation module: An open prospective uncontrolled cohort study.

Facial aging is a complex biological process that affects the skin and superficial musculoaponeurotic system (SMAS). A new technology (RecoSMA) for skin rejuvenation based on acoustic-interference method using Er:YAG laser (2936 nm) equipped with a special module SMA that targets both the dermis and SMAS was evaluated in an open-label prospective cohort study of 100 female patients treated for facial rejuvenation. Measure of clinical improvement included investigator-rated clinical photography using the Modified Fitzpatrick Wrinkle Scale, and ultrasound measurements in the dermis a week, 30 days and six months post treatment. All patients completed the study and no complications were noted. Improvements in skin tone and texture were noted in all participants and significant decrease in wrinkle depth was demonstrated at the six-month follow-up that was confirmed by ultrasound skin measurements. Data presented herein confirm the safety and efficacy of RecoSMA treatment for facial rejuvenation.

Skin cancer concerns particular to women.

BACKGROUND: Skin cancer has reached epidemic proportions, with more new cases diagnosed annually than the combined incidence of cancers of the breast, prostate, lung, and colon. Estimates show 2 to 3 million new cases of non-melanoma skin cancer (NMSC) every year, and, among women, it is the young (younger than 45 years) who are disproportionately affected. OBJECTIVE: This article aims to address questions and concerns pertinent to skin cancer in a woman-centric way. An updated landscape of causative factors, the latest detection/treatment methods, and ultimately the preventative measures available to them are described. METHODS: A broad literature search was conducted using the PubMed database with search terms focusing on female gender. Additional articles were identified from cited references. CONCLUSIONS: The published findings on causation of melanoma skin cancer and non-melanoma skin cancer in females are outlined, as well as current detection methods and treatment options. Furthermore, a variety of preventative measures specific to women that can reduce the chance of being diagnosed with skin cancer are discussed.

Expression of androgen receptor coactivator ARA70/ELE1 in androgenic alopecia.

BACKGROUND: Androgens have been implicated in androgenic alopecia as evidenced by the increased cutaneous expression of androgen receptor (AR), 5alpha-reductase, and decreased aromatase. Abnormalities of the AR-signal transduction pathway probably participate in the development of androgenic alopecia. ARA70/ELE1 is an AR coactivator with two isoforms, one full-length form (ARA70alpha/ELE1alpha), and an internally deleted form (ARA70beta/ELE1beta). We decided to examine the cutaneous expression of both isoforms in male androgenic alopecia. METHODS: Formalin-fixed, paraffin-embedded tissue sections from seven subjects with androgenic alopecia with matched punch biopsies from non-balding and balding areas were examined by in situ hybridization. RESULTS: Expression of at least one of the two probes for ARA70/ELE1 was present in all phases of the hair-growth cycle in all epithelial hair structures except for the inner root sheath. The dermal papilla and hair bulb expressed only the short (beta) but not the long (alpha) form of ARA70/ELE1. In situ labeling for ARA70beta/ELE1beta was weaker in the dermal papilla of balding recipient areas than those from donor ones. CONCLUSIONS: Our data further support that the hair growth is regulated by androgens. The differential expression pattern of ARA70/ELE1 suggests that this key androgen receptor coactivator is involved in androgenic alopecia. Lee P, Zhu C-C, Sadick NS, Diwan AH, Zhang PS, Liu JS, Prieto VG. Expression of androgen receptor coactivator ARA70/ELE1 in androgenic alopecia.

Laser treatment of leg veins.

The role of lasers and intense pulsed light sources has gained increasing popularity in the management of both cosmetic telangiectasias and medically significant symptomatic varicose vein disease. These advances include endovascular technologies, novel cooling technologies, variable spot sizes and pulse durations, as well as the ability to deliver high-energy fluences. These advances have allowed the delivery of sufficient energy allowing more efficient pan-endothelial necrosis without affecting epidermal structures, and yielding a lower complication profile such as post-inflammatory hyperpigmentation and epidermal surface irregularities. The advent of extended-pulse, longer wavelength technologies such as the 1064 Neodymium:Yttrium Aluminum Garnet (Nd:YAG) laser have allowed the treatment of individuals with darker skin phenotypes, as well as treatment of deep blue reticular veins up to 3 mm in diameter in a monomodal fashion. Combined approaches of sclerotherapy plus laser treatments performed during the same treatment session may produce synergistic results in selected individuals.

A comparative clinical and histologic study of hair transplantation using Er:YAG, Er:YAG/CO2, and standard punch techniques.

BACKGROUND: This study compares the effects of Er:YAG laser alone, Er:YAG/CO2 laser at 5 W (low power), Er:YAG/CO2 at 10 W (high power), and standard punch techniques in 10 men with androgenetic alopecia. OBJECTIVE: To study the clinical and histologic features of hair transplantation with recipient graft defects created by a new hybrid Er:YAG and CO2 laser. METHODS: Ten male patients (mean age 34 y) with Norwood IV-VI androgenetic alopecia had hair replacement surgery with the recipient sites divided into four quadrants comparing cold stell, erbium, combined erbium low-power CO2, and combined erbium high-power CO2 technologies. Hair growth, intraoperative procedure, lateral thermal damage, and patient satisfaction were compared, utilizing each of the four stated technologies. RESULTS: The addition of CO2 laser at both low and high power settings resulted in improved hemostasis when compared with standard punch or Er:YAG laser alone. The mean hair counts were similar for the Er:YAG laser, Er:YAG/CO2 (5 W) laser, and standard punch at both 3 and 6 months after treatment. Lateral thermal damage was not significantly increased by the addition of low-power CO2 to Er:YAG. The addition of high-power CO2 (10 W) laser resulted in slightly lower mean hair counts at 3 months, but significantly decreased at 6 months (P =.05). Also, high-power CO2 laser caused significantly increased lateral damage. There were no detectable differences in hsp70 expression among the groups. CONCLUSION: The addition of 5 W CO2 laser to Er:YAG laser results in better hemostasis than Er:YAG laser alone, while not significantly diminishing mean hair counts or inducing increased lateral thermal damage.

Fatty acid analysis of transplanted adipose tissue.

OBJECTIVE: To determine whether autologously transferred human adipose tissue maintains viability in vivo for prolonged periods. DESIGN: Six healthy female patients (mean age, 61.5 years; mean body mass index, 23.4 kg/m2) received autologous fat transplants from the gluteus to the nasolabial folds. Subcutaneous fat was sampled from facial and gluteal sites 4 times in 1 year. SETTING: Private practice, basic science research center. INTERVENTION: After local anesthesia, 10 g of subcutaneous adipose tissue was harvested from the right buttock of each patient. Ten milligrams of adipose tissue was aspirated from the right nasolabial fold. Five grams of gluteal fat was then injected into each nasolabial fold using a uniform monolayer threading technique with no overcorrection. As controls, 10 mg of adipose tissue was obtained from the opposite left buttock and left cheek. Adipose tissue from the transplanted and control facial and gluteal sites was sampled at 4, 6, and 12 months after transplantation. MAIN OUTCOME MEASUREMENTS: Gluteal fat has more monounsaturated fatty acids and less saturated fatty acids than facial fat. This unique site-specific fatty acid pattern was used to assess the course of the survival of transplanted adipose tissue in the nasolabial region. In all fat samples, the percent area (weight percentage) was obtained for each fatty acid (C12:0 to C22:6 omega-3) using capillary gas chromatography. Clinical results were also analyzed by macrophotographs. RESULTS: As expected, gluteal fat had significantly more monounsaturated fatty acids and less saturated fatty acids than facial fat. In 5 of 6 patients, at 4, 6, and 12 months after transplantation, the fatty acid pattern at the transplanted recipient site was similar to the pattern of the control facial site. However, at 4 months, 1 patient had a fatty acid pattern in the transplant recipient site that was similar to the pattern of her gluteal fat. This pattern persisted for 1 year. Fat retention at the transplant site was corroborated by photographic assessment. CONCLUSIONS: Long-term adipocyte survival is an achievable goal following fat transfer. The importance of harvesting and injection techniques as well as adipose tissue characteristics require further study.

Clinical and pathophysiologic correlates of 1064-nm Nd:Yag laser treatment of reticular veins and venulectasias.

BACKGROUND: The goal of sclerotherapy, laser therapy, and intense pulsed-light therapy is to produce long-term, cosmetically significant elimination of disfiguring leg veins. This study examines the histologic and clinical effects of using a 1064-nm Nd:YAG laser system on lower extremity vessels. DESIGN: A single treatment using the following parameters: wavelength, 1064 nm (multiple synchronized pulsing); spot size, 6 mm; pulse duration, 14 milliseconds (single pulse); and fluence, 130 J/cm(2). SETTING: Private dermatology practice. PATIENTS: Thirteen women (mean age, 38.5 years) with blue venulectasia, 0.5 to 1.5 mm in diameter (class 2), and reticular veins, 1.5 to 3.0 mm in diameter (class 3), on the thighs. MAIN OUTCOME MEASURES: Examination of treated and untreated areas by 2 masked observers using macrophotography (1, 2, 3, and 6 months after treatment), Doppler, and optical chromatographic changes. Findings from three 2-mm punch biopsies from treated (immediately and 4 weeks after treatment) and untreated sites. Routine histologic examination; special stains (for elastic and connective tissue and for mucopolysaccharides); and immunohistochemical analysis for expression of the heat shock protein hsp70, tie2 (an endothelial cell-specific receptor tyrosine kinase), and transforming growth factors beta1 and beta2. RESULTS: Eight patients (62%) manifested 75% to 100% clearing of treated vessel surface area. Treated areas revealed perivascular hemorrhage, thrombi, fragmentation and homogenization of elastic fibers, and eosinophilia of vessel walls. Expression of hsp70 and transforming growth factor beta was increased in treated vessels. CONCLUSIONS: Our data confirm the effectiveness of 1064-nm Nd:YAG laser treatment in clearing dilated lower extremity veins, probably by heat-induced vessel damage and subsequent fibrosis. Maintenance of clearing was achieved for up to 6 months. However, the presence of recanalized thrombi in some of the specimens suggests the potential for long-term vessel reappearance.

Long-term results with a multiple synchronized-pulse 1064 nm Nd:YAG laser for the treatment of leg venulectasias and reticular veins.

BACKGROUND: The long-pulsed Nd:YAG (1064 nm) laser has been shown to be effective in the treatment of blue venulectasias and reticular veins. OBJECTIVE: The present study examined the clinical efficacy and long-term follow-up (12 months) of patients treated with the 1064 nm Nd:YAG laser technology. METHODS: Twenty-five female patients (mean age 37.6 years, Fitzpatrick skin types II-V) were treated with up to three treatment sessions at 6-week intervals on a 5 cm2 surface area of vessels utilizing the 1064 nm Nd:YAG laser with a circulating cooling device. Treatment parameters were vessel size 0.2-2.0 mm treated with a double pulse of 7 msec at 120 J/cm2 and vessel size 2.0-4.0 mm treated with a single pulse of 14 msec, fluence 130 J/cm2, with a spot size of 6 mm. Improvement was judged by double-blinded observer evaluation, macrophotographic imaging, optical chromatography, and a patient evaluation scale. RESULTS: Sixty-four percent of patients treated in the present study achieved 75% or greater clearing of vessels after a maximum of three treatment sessions. Optical chromatography revealed statistically significant decreased chromophore intensity (mean blueness reduction index of 41.2b-). Sixty-four percent of patients were greatly satisfied with the results of the laser treatment. Two patients manifested vessel recurrence when examined at 6 and 12 months, respectively. CONCLUSION: The 1064 nm Nd:YAG laser can produce effective long-term photosclerosis of blue venulectasia and reticular veins. The potential for recurrence should be recognized by the vascular laser surgeon.

Overview of complications of nonsurgical facial rejuvenation procedures.

An in-depth understanding of potential adverse sequelae related to aesthetic facial rejuvenation and available management modalities, should such a complication occur, enables the aesthetic surgeon to reduce his or her complication profile and also minimize the results of such adverse sequelae, eventuating improved patient care and satisfaction.

Systemic antibiotic agents.

Understanding the breadth of systemic antimicrobial agents available for use by the dermatologist and their associated side-effect profiles and drug interactions allows the clinician to offer patients optimal care in the management of cutaneous infectious disease.

Long-term photoepilation using a broad-spectrum intense pulsed light source.

BACKGROUND: The goal of laser or flashlamp photoepilation is to produce long-term, cosmetically significant hair removal. We document the long-term efficacy achieved with an intense pulsed light source for photoepilation. DESIGN: Prospective study comparing long-term results of single vs multiple treatments, and effects of anatomic site and skin type on efficacy of photoepilation with a device emitting broad-spectrum, noncoherent (nonlaser) radiation from 550- to 1200-nm wavelengths, in macropulses divided into 2 to 5 minipulses. SETTING: Private dermatology practice. PATIENTS: Thirty-four patients (8 men, 26 women) with hirsutism. INTERVENTIONS: Parameters for the study were wavelength of 615 to 695 nm, pulse duration of 2.6 to 3.3 milliseconds, fluence of 34 to 42 J/cm(2), 10 x 45-mm exposure field, and application of 1 degrees C cooling gel. MAIN OUTCOME MEASURES: Hair removal efficiency, calculated as percentage ratio of the number of hairs present compared with baseline counts, and patient satisfaction questionnaire completed at last follow-up. RESULTS: The mean hair removal efficiency achieved was 76% after a mean of 3.7 treatments. More than 94% of the sites reached mean hair removal efficiency values greater than 50%. Hair removal efficiency was not significantly related to skin type, hair color, anatomic site, or number of treatments. Side effects were mild and reversible and occurred in a minority of patients (hyperpigmentation in 3 and superficial crusting in 2). CONCLUSIONS: Our data document the long-term clinical efficacy of intense pulsed light source-induced hair removal in light and dark skin phenotypes. Maximal photoepilation was achieved from the initial 1 to 3 treatments; only a small added benefit was seen after more treatments.

Epidermal cooling crystal collar device for improved results and reduced side effects on leg telangiectasias using intense pulsed light.

BACKGROUND: Intense pulsed light (IPL), utilizing noncoherent yellow, red, and near-infrared wavelengths can be used to treat telangiectasias. In order to circumvent epidermal heating and allow greater fluence to be delivered safely, a new device that circulates water around the IPL crystal in contact with the skin to provide continuous cooling at 1 degrees C-4 degrees C range was developed. OBJECTIVE: To observe the effects of contact cooling on IPL treatment of leg telangiectasias. METHODS: A total of 25 patients were treated using two similar sites of matted telangiectasias on the leg, one site was treated without epidermal cooling and the other with the epidermal cooling crystal collar device. Results were evaluated by comparison with pretreatment photographs at 1 month. At one treatment center, a crossover was performed at the 1-month visit in which the non-E3C site was treated by cooling. Parameters consisted of a 570 nm filter, coupled pulses of 2-2.5 msec/6-7 msec with a 10-msec delay with fluences of 38-40 J. On the site receiving contact cooling the fluence was increased by 10% (4 J/mm2). Sites were graded worse, unchanged, or improved (RAW) or on a numerical scale of 1-4 (NSS). RESULTS: Compared to the contact cooling sites, uncooled sites showed 7 were improved, 5 were unchanged, and 3 were worsened, but cooled sites showed 10 were improved, 5 were unchanged, and none were worsened (P<.05). The grading scale on 10 patients revealed a mean improvement of 1.7 for noncooled sites and 2.7 for cooled sites (P<.001). For crossover treatment, eight noncooled sites (unchanged or worsened) were subsequently treated with cooling, demonstrating six improved (P<.001) and two with no change. Less erythema and edema was noted at all cooled sites. Furthermore, pain was significantly reduced with cooling (P<.003). Epidermal injury involving hyper- or hypopigmentation, crusting, or vesiculation was not observed in any of the cooled sites, but was recorded in three of the noncooled sites. CONCLUSIONS: These data indicate that continuous epidermal cooling with IPL allows delivery of higher fluences with less pain and fewer side effects. Efficacy is significantly improved using the coupled short pulse/long pulse protocol. An additional benefit is that IPL treatment becomes less operator dependent because the chilled crystal may be placed directly in contact with the skin.

Estrogen and progesterone receptors: their role in postsclerotherapy angiogenesis telangiectatic matting (TM).

BACKGROUND: Postsclerotherapy neoangiogenesis telangiectatic matting (TM) occurs in up to 24% of individuals treated by sclerotherapy. Although the etiology is unknown, obstructive flow factors, angiogenic factors, estrogen, inflammatory, and endogenous factors have all been postulated to play a role in its pathogenesis. OBJECTIVE: The aim of the study was to ascertain the presence or absence of estrogen and progesterone receptors in postsclerotherapy TM lesions and thus substantiate their possible role in the pathogenesis of TM. METHODS: Ten women, median age 37.7 years, were included in the study population who developed TM following a single sclerotherapy treatment session employing Sotradecol 0.25% for class I-II telangiectasia/venulectasia. Four of 10 patients had a history of previous hormonal therapy or pregnancy in the previous 12 months prior to entering into the study. Three millimeter punch biopsies were taken at 12 weeks posttreatment and assayed for estrogen and progesterone receptors by the ERICA and PRICA (estrogen/progesterone immune cytochemical assay) techniques. RESULTS: Zero of 10 patients were positive for estrogen/progesterone receptors as assayed by the ERICA/PRICA technique in biopsied sites of postsclerotherapy TM. CONCLUSION: Although estrogen and progesterone may play an indirect role in the development of postsclerotherapy TM via vasodilatory or secondary angiogenic or cytokine release mechanisms, they do not appear to play a primary role in promoting postsclerotherapy neoangiogenesis as demonstrated in this study.

The role of lasers and light sources in the treatment of leg veins.

Telangiectasia of the legs occurs in 29% to 41% of women in the United States. The variation in size, flow, depth, and type preclude the possibility of a single effective treatment modality. When a systematic approach is used where feeder vessels are first surgically removed and sclerotherapy proceeds from largest to smallest vessels, 80-90% of vessels respond to a single sclerotherapy treatment. Because of the relatively modest results demonstrated with lasers and light sources and the high rate of success and the relatively low cost of ambulatory phlebectomy, compression sclerotherapy and superficial sclerotherapy, we generally recommend using lasers and light sources only for vessels that remain after this treatment approach. Lasers and light sources should be considered prior to sclerotherapy in patients who are fearful of needles, who do not tolerate sclerotherapy, who fail to respond to sclerotherapy, or who are prone to telangiectatic matting. Carefully monitored, controlled studies are essential to better define the role of the available laser and light sources in the treatment of leg veins.

High-intensity flashlamp photoepilation: a clinical, histological, and mechanistic study in human skin.

OBJECTIVE: To examine the clinical, histological, and immunohistological effects of flashlamp photoepilation. DESIGN: Nonrandomized control trial with blinded histological study and follow-up of 1 to 20 months. SETTING: Private academic practice. SUBJECTS: Sixty-seven subjects (10 males and 57 females) with areas of excess body hair. INTERVENTIONS: Single (9 subjects) or multiple (58 subjects) treatments (noncoherent, 590-1200 nm, 2.9-3.0 milliseconds, 40-42 J/cm2) to hairy skin. From subjects given a single treatment, biopsy samples were taken immediately after treatment and at different intervals for up to 20 months. MEAN OUTCOME MEASURES: Clinical measures include hair counts and morphologic features before and after treatment. Histological measures include terminal-vellus and anagen-other ratios, hair shaft diameter, and morphologic features (routine and immunohistochemical detection of bcl-2, bax, p53, Ki67, cyclin D1, and hsp70) before and after treatment. RESULTS: Mean hair loss after photoepilation was 49%, 57%, and 54% for a single treatment and 47%, 56%, and 64% for multiple treatments at follow-up of less than 3 months, 3 to less than 6 months, and 6 months or longer, respectively (P<.05 for all comparisons). Transient erythema was seen in all subjects; no scarring occurred. Histologically, treatment caused morphologic damage confined to hair follicles and shafts. Terminal-vellus and anagen-telogen ratios, mean hair shaft diameter, and immunohistochemical profiles were not significantly modified by treatment. Treatment did not alter other skin adnexa, epidermis, or vessels. CONCLUSIONS: Flashlamp treatment leads to significant, longlasting epilation. The predominant mechanism seems to be via selective photothermal damage to large, pigmented hair follicles rather than induction of a programmed state of follicular cycle arrest or follicular miniaturization.

Post-sclerotherapy compression: controlled comparative study of duration of compression and its effects on clinical outcome.

BACKGROUND: Although much has been published on the effects of compression on the venous system, relatively few studies address the duration of compression following sclerotherapy of telangiectatic webs associated with reticular veins. OBJECTIVE: To perform a controlled study comparing the effects of different durations of compression following sclerotherapy of reticular veins and telangiectasias in similar locations. METHOD: This study consisted of a total of 40 patients, 30 patients who received compression therapy and 10 control patients who did not receive compression therapy. The compression group consisted of 10 in each of three duration groups: 3 days, 1 week, and 3 weeks. Patients were evaluated at 1 week, 2 weeks, 6 weeks, 12 weeks, and 24 weeks for degree of improvement and side effects. RESULTS: The three compression groups showed significantly greater improvement at 6 weeks (p = .004). There was a strong correlation between the length of time compression was applied and degree of improvement at 6 weeks, 12 weeks, and 24 weeks of clinical follow-up; r = .74, p = .0006, r = .59, p = .006, r = .66, p = .0001, respectively. The patients treated with compression for 3 days and 1 week had more improvement than the control patients while the patients treated for 3 weeks of continuous compression had the most improvement. In terms of side effects, the 1 week and 3 week compression groups experienced the least amount of post-sclerotherapy hyperpigmentation. CONCLUSIONS: Compression enhances the results following sclerotherapy in a statistically significant way and is directly correlated with duration of compression. Three weeks of continuous compression leads to the best results, although even 3 days of compression results in greater improvement than no compression. Compression leads to a statistically significant reduction of post-sclerotherapy hyperpigmentation.