Acne scar correction using calcium hydroxylapatite in a carrier-based gel.

OBJECTIVES: This study sought to determine the efficacy and safety profile of calcium hydroxylapatite filler in the treatment of acne scars. METHODS: Ten subjects with a variety of acne scars were treated with calcium hydroxylapatite filler. RESULTS: Saucerized acne scars responded to treatment; ice-pick scars did not. Results lasted, at least to some degree, for 12 months after treatment. No significant treatment complications were noted. CONCLUSIONS: Calcium hydroxylapatite is a safe and effective long-term filler for the treatment of saucerized acne scars.

Combined 633-nm and 830-nm led treatment of photoaging skin.

OBJECTIVES: To evaluate the clinical efficacy and ultrastructural changes in photodamaged skin after combined 633-nm and 830-nm light-emitting diode (LED) treatments. METHODS: Thirty-six subjects received 9 LED treatments over the course of 5 weeks and were subsequently evaluated for final clinical improvement 12 weeks after treatment. Five subjects were also biopsied to determine the ultrastuctural posttreatment changes in collagen fibers. RESULTS: A statistically significant improvement in wrinkles was seen after profilometric analysis. The majority of subjects reported improvements in softness, smoothness, and firmness at all time points. Electron microscopic analysis showed evidence of post-LED treatment of thicker collagen fibers. CONCLUSIONS: 633-nm and 830-nm LED treatments play a role in the treatment of photodamaged skin. LED treatments can be used as either a primary or adjunctive treatment modality.

Clinical comparison of four hair removal lasers and light sources.

BACKGROUND AND OBJECTIVE: There are few clinical studies directly comparing the efficacy of multiple hair removal systems in the same individual. This study evaluates the efficacy of four highly popular systems for laser hair removal. METHODS: In this prospective comparison study, 10 subjects underwent treatment of unwanted hair on the back or thigh. Subjects were skin types I-III, aged 18-55 years. All were treated twice with (1) an intense pulsed light with a red filter; (2) an intense pulsed light with a yellow filter; (3) an 810 nm diode laser; and (4) a 755 nm alexandrite laser. Four treatment areas, using commonly accepted parameters for permanent hair reduction, as well as a control non-treated area were selected. Each treatment area was evaluated with a camera system specifically designed for hair counts at 1, 3, and 6 months after the second treatment by a blinded non-treating physician. Clinical results and adverse events were also noted. RESULTS: Evaluation of photographs at 1, 3, and 6 months revealed a significant decrease in hair counts (approximately 50%) and hair coverage (approximately 55%). In the hairs that remained after two treatments, no statistical difference was noted in hair length or diameter. There was no statistical difference in efficacy between the four different light devices. Minimal transient adverse effects were noted from all systems. The cryogen spray-based alexandrite laser showed the highest pain scores. CONCLUSION: Although hair removal with commonly used systems is, as expected, highly effective, treatment with light-based devices can cause less pain, yet show efficacy similar to laser systems.

Mutations in the desmoglein 4 gene underlie localized autosomal recessive hypotrichosis with monilethrix hairs and congenital scalp erosions.

Localized autosomal recessive hypotrichosis (LAH) is a recently defined disorder characterized by fragile, short, sparse hairs on the scalp, trunk, and extremities. Mutations in desmoglein 4 (DSG4), a novel member of the desmosomal cadherin family that is expressed in the hair follicle as well as the suprabasal epidermis, have been found to underlie LAH. Thus far, the allelic series includes a recurrent intragenic deletion identified in affected Pakastani kindreds and a missense mutation detected in an Iraqi family. We report three siblings of Iraqi and Iranian origin with LAH that presented with congenital scalp erosions and monilethrix-like hairs, features that have not been previously described in this disorder. Follicular hyperkeratotic papules and marked pruritus were also prominent clinical findings. Novel compound heterozygous DSG4 mutations, including a splice-site mutation and a missense mutation that disrupts a conserved calcium-binding site in the extracellular (EC)2-EC3 interface, were found to underlie the disease in this family. These observations broaden the phenotypic and genotypic spectrum of LAH, further illustrating the consequences of DSG4 dysfunction on epidermal and hair shaft integrity.

Comparative treatment of small diameter (< or =400 microm) vascular lesions using extended pulse dye lasers.

BACKGROUND AND OBJECTIVES: Extended-pulse dye lasers (EPDL) are commonly used to treat a variety of vascular lesions. This study evaluated whether differences in pulse formats and cooling methods might affect outcome in the treatment of small facial telangictasia. STUDY DESIGN/MATERIALS AND METHODS: Ten subjects presenting with symmetric, bilateral facial telangiectasia were studied. Each side of the face was treated with either the V-Startrade mark smart-cool air cooling (Cynosure, Inc.) (VS) or V-beam DCD cooling (Candela, Inc.) (VB) EPDL treatments with both systems were undertaken with a 10-milliseconds pulse duration, 1 J/cm(2) below the purpuric threshold, with up to three passes. RESULTS: Treatment clearance with the VS EPDL occurred with a lower fluence, using fewer passes than with the VB EPDL (P < 0.05). CONCLUSIONS: Although both the currently popular EPDL systems are highly effective in the treatment of small facial telangiectasia, clinical differences can be seen between these two systems.

Mesotherapy for facial skin rejuvenation: a clinical, histologic, and electron microscopic evaluation.

BACKGROUND AND OBJECTIVE: Mesotherapy, as broadly defined, represents a variety of minimally invasive techniques in which medications are directly injected into the skin and underlying tissue in order to improve musculoskeletal, neurologic, and cosmetic conditions. There are few clinical studies evaluating the efficacy and safety of mesotherapy in any form. This study evaluates the histologic and clinical changes associated with one of the simplest formulations of mesotheraphy commonly used for skin rejuvenation. STUDY DESIGN: Ten subjects underwent four sessions of mesotherapy involving multiple injections of a multivitamin and hyaluronic acid solution. Treatment was conducted at 4 monthly intervals. All subjects had pre- and post-treatment photographs and skin biopsies. Skin biopsies were evaluated with routine histology, mucin and elastin stains, and electron microscopy. Patient surveys were also evaluated. RESULTS: Evaluation of photographs at 0, 3, and 6 months revealed no significant clinical differences. Light microscopic examination of pre- and posttreatment specimens showed no significant changes. Electron microscopic analysis of collagen fibers measurements did show smaller diameter fibres posttreatment. CONCLUSION: No significant clinical or histologic changes were observed after multivitamin mesotherapy for skin rejuvenation. Multivitamin and hyaluronic acid solution facial mesotherapy does not appear to provide any significant benefit.

Topical anesthetics for cosmetic and laser dermatology.

Many effective and simple topical anesthetic products are available today and commonly used in medical and non-medical settings. The increased use of topical anesthetics, especially by non-physicians in the medical and non-medical settings, has resulted in increased rates of complications including ineffective anesthesia, allergy, and even potential fatalities. This review focuses on various techniques and formulations for topical anesthesia and their appropriate applications in cosmetic and laser dermatology. In addition, the history, pharmacology, and clinical complications of topical anesthetics are discussed.

Complications from injectable polyacrylamide gel, a new nonbiodegradable soft tissue filler.

BACKGROUND: Polyacrylamide gels, containing a hydrogel composed of polyacrylamide and water, are used for soft tissue augmentation and contour correction. There are no reports of significant complications after injection of this material into the face. OBJECTIVE: We report an inflammatory reaction after injection of polyacrylamide gels for zygomatic facial augmentation. METHODS: A retrospective chart review of single case is presented. RESULTS: An inflammatory reaction at the sites of polyacrylamide gels injection was noted at 1 month after initial injection. Despite two ensuing courses of broad-spectrum antibiotics, the patient presented to us with persistent draining nodules. Intralesional steroid injections resulted in prompt resolution and no recurrence. CONCLUSION: Inflammatory reactions have been noted in patients receiving polyacrylamide gels for breast augmentation. Facial polyacrylamide gels injections may also be associated with an inflammatory reaction that responds to intralesional steroids. With increasing availability of a variety of soft tissue fillers, dermatologists should be aware of this delayed complication from polyacrylamide gels.

Multiple subclinical syringomatous proliferations encountered during Mohs surgery for basal cell carcinoma.

BACKGROUND: Examination of Mohs surgery frozen sections may lead to discovery of incidental benign neoplasms such as syringomas. OBJECTIVE: An unusual occurrence of numerous subclinical syringomatous proliferations discovered during Mohs surgery for a basal cell carcinoma that posed a diagnostic and management dilemma is reported. METHODS: Clinical records and histologic sections are examined. RESULT: Multiple syringomatous proliferations were noted around a basal cell carcinoma during Mohs surgery. A few foci were atypical appearing and focally extending into the deep dermis causing a diagnostic dilemma. All atypical syringomatous proliferations were excised. Evaluation of final Mohs margins by permanent sections and biopsies of normal-appearing facial skin showed multiple benign syringomas. CONCLUSION: Although solitary subclinical syringomas have been described in association with basal cell carcinomas, the occurrence of multiple syringomas and syringomatous proliferations has not been previously reported. Dermatologists should be aware of the existence of this phenomenon and consider permanent section evaluation to better determine nature of unusual incidental tumors identified in frozen sections during Mohs surgery.