Fixed, low radiant exposure vs. incremental radiant exposure approach for diode laser hair reduction: a randomized, split axilla, comparative single-blinded trial.

BACKGROUND: Diode lasers are the most commonly used treatment modalities for unwanted hair reduction. Only a few controlled clinical trials but not a single randomized controlled trial (RCT) compared the impact of various laser parameters, especially radiant exposure, onto efficacy, tolerability and safety of laser hair reduction. OBJECTIVE: To compare the safety, tolerability and mid-term efficacy of fixed, low and incremental radiant exposures of diode lasers (800 nm) for axillary hair removal, we conducted an intrapatient, left-to-right, patient- and assessor-blinded and controlled trial. METHODS: Diode laser (800 nm) treatments were evaluated in 39 study participants (skin type II-III) with unwanted axillary hairs. Randomization and allocation to split axilla treatments were carried out by a web-based randomization tool. Six treatments were performed at 4- to 6-week intervals with study subjects blinded to the type of treatment. Final assessment of hair reduction was conducted 6 months after the last treatment by means of blinded 4-point clinical scale using photographs. The primary endpoint was reduction in hair growth, and secondary endpoints were patient-rated tolerability and satisfaction with the treatment, treatment-related pain and adverse effects. RESULTS: Excellent reduction in axillary hairs (≥ 76%) at 6-month follow-up visit after receiving fixed, low and incremental radiant exposure diode laser treatments was obtained in 59% and 67% of study participants respectively (Z value: 1.342, P = 0.180). Patients reported lower visual analogue scale (VAS) pain score on the fixed (4.26) than on the incremental radiant exposure side (5.64) (P < 0.0003). The only side-effect was mild and transient erythema. Subjects better tolerated the fixed, low radiant exposure protocol (P = 0.03). The majority of the study participants were satisfied with both treatments. CONCLUSION: Both low and incremental radiant exposures produced similar hair reduction and high and comparable patient satisfaction. However, low radiant exposure diode laser treatments were less painful and better tolerated.

Guidelines of care for vascular lasers and intense pulse light sources from the European Society for Laser Dermatology.

AIM: Lasers and non-coherent intense pulse light sources (IPLS) are based on the principle of selective photothermolysis and can be used for the treatment of many vascular skin lesions. A variety of lasers has been developed for the treatment of congenital and acquired vascular lesions which incorporate these concepts into their design. Although laser and light sources are very popular due to their non-invasive nature, caution should be considered by practitioners and patients to avoid permanent side-effects. The aim of these guidelines is to give evidence-based recommendations for the use of lasers and IPLS in the treatment of vascular lesions. METHODS: These guidelines were produced by a Consensus Panel made up of experts in the field of vascular laser surgery under the auspices of the European Society of Laser Dermatology. Recommendations on the use of vascular lasers and IPLS were made based on the quality of evidence for efficacy, safety, tolerability, cosmetic outcome, patient satisfaction/preference and, where appropriate, on the experts' opinion. The recommendations of these guidelines are graded according to the American College of Chest Physicians Task Force recommendations on Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines. RESULTS: Lasers and IPLS are very useful and sometimes the only available method to treat various vascular lesions. It is of a paramount importance that the type of laser or IPLS and their specific parameters are adapted to the indication but also that the treating physician is familiar with the device to be used. The crucial issue in treating vascular lesions is to recognize the immediate end-point after laser treatment. This is the single most important factor to ensure both the efficacy of the treatment and avoidance of serious side-effects.

Simple external manual manoeuvres to pass the radiofrequency catheter through a bending segment of a saphenous vein.

Smooth passage of a catheter through a varicose saphenous vein during radiofrequency ablation may prove a challenging task. Various types of venous bending in the transverse and sagittal planes and their combinations within the saphenous compartment may be pretty well appreciated by ultrasound examination. Several simple manual manoeuvres like stretching, pushing or lifting along with limb re-positioning may often help the surgeon to advance the catheter through the segments by temporarily changing their special configuration. In this way the number of patients otherwise considered unsuitable for endovascular catheter procedures like radiofrequency or laser ablation may be considerably reduced.

Telangiectasias resistant to sclerotherapy are commonly connected to a perforating vessel.

Leg telangiectasias resistant to repeated courses of sclerotherapy in patients without deep and superficial venous incompetence are not uncommon. Little is known about factors which may underlie the resistance. Among 26 patients with such telangiectasias we found a direct communication of the vessels with deep and saphenous veins in 65% of patients. Ultrasound-guided injection of 0.5% polidocanol foam into the feeding veins or their perforating segments led to clearance of all the telanagiectasias. In 23% of cases no feeding veins could have been identified by ultrasound. Direct injections of a sclerosant into perforating feeding veins may clear refractory telangiectasias in a majority of patients though it is obvious that other factors may contribute to the failure of sclerotherapy in others.

The actual role of hyaluronic acid-based and calcium hydroxylapatite soft tissue fillers: a guide for a practicing dermatologist.

Soft tissue fillers (STFs) together with botulinum toxin have profoundly improved our possibilities to rejuvenate the face and other parts of human body. Among many types of STFs currently used for esthetic and medical indications in routine clinical practice dominate hyaluronic acid-based STFs and calcium hydroxylapatite. Collagen fillers (bovine, porcine and human) are gradually leaving the market replaced mostly by hyaluronic acid-based STFs. This review presents an overview of the physicochemical properties, mechanisms of action and techniques used for the correct placement of hyaluronic acid-based STFs and calcium hydroxylapatite and the most common esthetic indications for these fillers. Finally, we present the recent data on their efficacy and most common complications encountered.

Polychlorinated biphenyl residues in foods from a contaminated region of Yugoslavia.

PCB levels in food and the dietary intake of PCBs from food grown in a contaminated region in Bela Krajina (Slovenia, Yugoslavia) are reported. A large variation in the contribution of PCB congeners to total PCB levels in food of animal and leafy vegetable origin was found. Although guidelines for PCB tolerances exist only for food of animal origin, it was estimated that leafy vegetables and unpeeled fruits from the contaminated region present a significant source of human exposure to PCBs. PCB residues in fish and eggs exceeded the tolerances set by the FDA. Utilizing the official statistical data on food consumption, the dietary intake of PCBs from food of animal origin decreased from 1985 to 1988 from 14.5 to 1.6 mg/year per person, respectively, after the use of PCBs ceased in the nearby plant. The dietary intake in 1988 of PCBs from foodstuffs of vegetable origin and fruits was 4.6 mg/year per person. The quantitation of PCBs was made from the sum of 36 individual PCB congeners, obtained by high resolution gas chromatography with an electron capture detector.