Clinical effect of a single pulsed dye laser treatment of fresh surgical scars: randomized controlled trial.

BACKGROUND: Pulsed dye laser has been used to decrease erythema and telangiectasia associated with scars, including surgical scars. There is limited evidence indicating improved surgical scar appearance if pulsed dye laser treatments are commenced immediately at the time of suture removal. OBJECTIVE: To determine whether a single one-pass pulsed dye laser treatment at the time of suture removal can improve the appearance of surgical scars. METHODS: Randomized controlled trial enrolling 20 patients (complete data for 17 patients) at two geographic sites, with blinded ratings of pre- and post-treatment photographs obtained at various time points. Included patients underwent elliptical excision for atypical nevi of the trunk and/or extremities, with at least one resulting scar of at least 5 cm in length or two scars of at least 2.5 cm in length. For each patient, each scar or half-scar (if a larger scar was used) was randomized to treatment or control groups. Treatment scars received a single one-pass treatment with a 595 nm pulsed dye laser (Vbeam, Candela Corporation, Wayland, MA, USA) at the time of suture removal (ie, 2 weeks after excision) at the following parameters: 7 J/cm2 fluence, 7 mm spot size, 1.5-millisecond pulse duration, and 30-millisecond spray, 20-millisecond delay of dynamic cooling. The treatment area included 1 cm on either side of the scar, and the round laser spots were overlapped 10%. Control scars were not treated with laser. RESULTS: Immediate purpura was induced from the laser treatment Six weeks after laser treatment, no significant difference was found in the clinical appearance of surgical scars treated with a single pulsed dye laser treatment on suture removal day versus those surgical scars not treated with laser. Parameters on which no significant difference was found included visibility of incision, erythema, hyperpigmentation, hypopigmentation, induration, and atrophy. Both sets of scars improved over time. CONCLUSIONS: A single pulsed dye laser treatment at the time of suture removal does not appear to have a beneficial effect on clinical scar appearance. The point of minimal benefit for such laser treatments may lie somewhere between one and three treatments.

Reduction in injection pain with botulinum toxin type B further diluted using saline with preservative: a double-blind, randomized controlled trial.

BACKGROUND: Injection with botulinum A exotoxin reconstituted with preserved saline has been shown to be less uncomfortable than injection with the same toxin reconstituted with preservative-free saline. OBJECTIVE: We sought to determine whether injection with botulinum toxin type B is similarly less painful when preservative-containing saline is used to further dilute the product. METHODS: We conducted a double-blind, randomized controlled trial. A total of 15 consecutive adult patients presenting for treatment of upper face dynamic lines received treatment to one side (left or right) of the face with toxin type B further diluted with preservative-containing saline, and to the other side with toxin type B further diluted with preservative-free saline. RESULTS: Of 15 patients, 13 (87%) reported less pain in the halves of their faces treated with the preservative-containing saline (P =.0006). Pain on the preservative-containing side was on average 32% less among patients as a whole, and 39% less among patients noting some reduction. The 95% confidence interval for pain reduction associated with preservative-containing injection was -46.9% to -16.1%. Neither investigators nor patients observed any difference in clinical efficacy between the 2 treatment sides. CONCLUSIONS: Use of preservative-containing saline to further dilute botulinum toxin type B can significantly decrease patient discomfort on injection.

Developments in the treatment of nail psoriasis, melanonychia striata, and onychomycosis. A review of the literature.

Nail psoriasis, melanonychia striata, and onychomycosis are relatively common nail disorders that have generated much research into their pathophysiology and treatment. The authors hope this discussion of the recent therapeutic developments for treating these disorders will not only inform but will also inspire further investigation so that therapeutic advances may continue.