Topical stabilized hypochlorous acid: The future gold standard for wound care and scar management in dermatologic and plastic surgery procedures.

BACKGROUND: Hypochlorous acid (HOCl), a naturally occurring molecule produced by the immune system, is highly active against bacterial, viral, and fungal microorganisms. Moreover, HOCl is active against biofilm and increases oxygenation of the wound site to improve healing. Natural HOCl is unstable; through technology, it can be stabilized into an effective topical antiseptic agent. AIM: This paper focuses on the use of topical stabilized HOCl in wound and scar management for pre-, peri-, and postprocedures-including its ability to reduce the occurrence hypertrophic scars and keloids. The role of the product in other skin conditions is beyond the scope of this article. METHODS: A panel comprising clinicians with experience in cosmetic and surgical procedures met late 2018 to discuss literature search results and their own current clinical experience regarding topical stabilized HOCl. The panel of key opinion leaders in dermatology and plastic surgery defined key insights and consensus statements on the direction of use for the product. RESULTS: Topical stabilized HOCl provides an optimal wound healing environment and, when combined with silicone, may be ideal for reducing scarring. Additionally, in contrast to chlorhexidine, HOCl, used as an antiseptic skin preparation, raises no concerns of ocular- or ototoxicity. CONCLUSIONS: For wound care and scar management, topical stabilized HOCl conveys powerful microbicidal and antibiofilm properties, in addition to potency as a topical wound healing agent. It may offer physicians an alternative to other less desirable wound care measures.

Broad Band Light and Skin Rejuvenation.

Pulsed light has proven its usefulness, effectiveness, and versatility in treating a multitude of skin problems, delaying skin aging, maintaining healthy skin, and as an adjunct to a cosmetic surgical practice in the treatment of postsurgical scars. Practitioners contemplating adding a pulsed light device to their practice should choose a device that has at least 4 important features: a large spot size, variable-sized smaller spot adaptors, pulse rates of at least 1 pulse per second, a wide range of cutoff filters, including 515 nm, 560 nm, 590 nm, 640 nm, and 695 nm, to treat most skin types.

Acne Treatment With 3-Step Broadband Light Protocol.

BACKGROUND AND OBJECTIVE: A new 3-step protocol using broadband light allows patients with moderate to severe in ammatory acne to avoid potential side effects of systemic acne treatments and the risks and uncertainties associated with laser and light treatments to date. The protocol also addresses acne scarring and, with appropriate modi cations, all skin types. METHODS: The protocol consists of 6 to 8 treatments performed with a single device that allows the user to select wavelength, spot size, uence, and pulse duration. Step 1 uses blue light with a large spot size and low uence to kill Propionibacterium acnes. Step 2 features red and yellow light with a smaller spot size and higher uence, which together exert anti-in ammatory effects and trigger neocollagenesis. Step 3 employs visible and infrared (IR) light with a high uence and 12-second pulse length, delivered with a constant motion technique, to enhance previous results while also targeting areas of frequent breakouts. RESULTS: Challenging cases treated with the protocol include a young adult female with a nearly decade-long history of in ammatory and cystic acne. Her skin remained clear more than 6 months post-treatment. She reported her scarring reduction at 90%. Having treated more than 100 patients with the protocol, the author reports that approximately 80% of patients clear completely or achieve at least a 75% improvement in their in ammatory acne. Acne improvements start appearing 2 to 3 days after a treatment session. Red, purple, raised, or depressed acne scars less than 1 to 2 years old begin to fade 1 to 3 weeks post-treatment. CONCLUSION: The 3-step protocol is safe and effective for patients with moderate to severe in ammatory acne and acne scarring. J Drugs Dermatol. 2016;15(11):1382-1388..

Rejuvenation of gene expression pattern of aged human skin by broadband light treatment: a pilot study.

Studies in model organisms suggest that aged cells can be functionally rejuvenated, but whether this concept applies to human skin is unclear. Here we apply 3'-end sequencing for expression quantification ("3-seq") to discover the gene expression program associated with human photoaging and intrinsic skin aging (collectively termed "skin aging"), and the impact of broadband light (BBL) treatment. We find that skin aging was associated with a significantly altered expression level of 2,265 coding and noncoding RNAs, of which 1,293 became "rejuvenated" after BBL treatment; i.e., they became more similar to their expression level in youthful skin. Rejuvenated genes (RGs) included several known key regulators of organismal longevity and their proximal long noncoding RNAs. Skin aging is not associated with systematic changes in 3'-end mRNA processing. Hence, BBL treatment can restore gene expression pattern of photoaged and intrinsically aged human skin to resemble young skin. In addition, our data reveal, to our knowledge, a previously unreported set of targets that may lead to new insights into the human skin aging process.

Enhanced full-face skin rejuvenation using synchronous intense pulsed optical and conducted bipolar radiofrequency energy (ELOS): introducing selective radiophotothermolysis.

BACKGROUND: The authors previously reported their experience achieving non-ablative skin enhancement with serial, full-face, intense pulsed light treatments in a large series of patients. A new method for skin renewal electro-optical synergy (ELOS), which combines intense pulsed optical energy and conducted bipolar radiofrequency (RF) energy into a single pulse, has been recently introduced. Intense pulsed optical energy and bipolar RF energy have been used in dermatologic surgery for many years; however, this study represents the therapeutic impact of the combined energies. OBJECTIVE: The authors report their experience using an ELOS system (Aurora SR, Syneron, Yokneam, Israel) on 108 consecutive patients treated with a series of full-face procedures. METHODS: Patients received 5 full-face treatments every 3 weeks. Each treatment consisted of 1 to 8 full-face and segmental passes. The number of passes, specific wavelength of pulsed optical energy, and RF energy were determined by the patient's skin type, dyschromia, wrinkle pathology, and presence of a tan. A total of 540 treatments were performed on 108 subjects. All patients had pre- and post-procedural photographs. Results were assessed by double-blinded physician photographic evaluation and patient satisfaction scales. RESULTS: Overall skin improvement was rated at 75.3%. Overall average wrinkle improvement was 41.2%, with an average Class 1 wrinkle improvement of 64.7%, Class 2 wrinkle improvement of 38.6%, and Class 3 wrinkle improvement of 20.4%. Improvement in skin laxity was rated at 62.9%. Skin texture was reported to improve 74.1%. Improvement in the appearance of pore size was rated at 65.1%. Average improvement in erythema and telangiectasia was 68.4%. Average improvement in hyperpigmentation and dyschromia was 79.3%. Overall patient satisfaction was 92%. The overall minor complication rate, including blistering, crusting, and stripping was 8.3%, and the major complication rate was less than 1%. One small, depressed nasal scar was observed in one patient. CONCLUSIONS: This study demonstrates the safety and efficacy of a new technology using combined optical and conducted bipolar RF energies for noninvasive skin rejuvenation. The results show improvement in wrinkle reduction and amelioration of erythema, telangiectasia, and hyperpigmentation comparable to that reported for other intense pulsed light technologies.

Photorejuvenation with intense pulsed light: results of a multi-center study.

This multi-center study evaluating the role of Intense Pulsed Light (IPL) in the non-ablative rejuvenation of Type I and Type II photoaged skin study was conducted in order to evaluate the clinical efficacy and safety of using IPL in treating clinical indications associated with photoaged skin. Ninety-three patients of Fitzpatrick skin phenotypes I-III, Fitzpatrick Wrinkle Classes I-II, and Elastosis Scores 1-6 were enrolled in the study. Up to five treatments were performed at 4-week intervals with follow-up visits at 4 and 6 months after the last treatment. Patients received full-face treatments using the recommended parameters of the Quantum SR/HR (Lumenis Ltd.) with the 560 or 640 nm cutoff filter. Parameters of elastometry, physicians' evaluation of the Elastosis Score ('W/ES'), and global improvement as well as patient satisfaction were analyzed. Results showed that the average Fitzpatrick W/ES improved significantly (p<0.001) by 1.39 and 1.32 units at the 4 and 6 months follow-ups, respectively; an improved W/ES evaluation was recorded for 82% and 75% of the patients at each of these time points. In conclusion, IPL treatment is an effective non-invasive, non-ablative method for rejuvenating photoaged skin with minimal adverse events, no downtime, excellent long-term results, and a very high measure of patient satisfaction.