Efficacy and Tolerability of a Procedure Enhancement System with TriHex Technology®as a Pre- and Post-Radiofrequency Microneedling Regimen.

Postoperative recovery is an important consideration for patients planning dermal rejuvenation procedures. A topical procedure enhancement system (PES) containing a tripeptide and hexapeptide (TriHex Technology®; Alastin Skincare®, Carlsbad, CA) hastens recovery from facial rejuvenation procedures, such as laser resurfacing. We assessed the efficacy and tolerability of the PES compared to a standard-of-care antioxidant regimen for improving recovery following three monthly facial radiofrequency (RF) microneedling treatments. Assessments included grading pre- and posttreatment digital images by two blinded physicians and a subject satisfaction questionnaire. Digital images revealed significantly less post-RF erythema following the introduction of the PES in a crossover study. Similarly, the side treated with the PES in a split-face study demonstrated significantly less post-RF erythema than the antioxidant regimen. Participants expressed preference for the PES. Expected adverse effects included immediate, posttreatment erythema, edema, and burning/stinging. Other adverse effects included acneiform eruptions in patients treated with the antioxidant regimen (n = 2) and the PES regimen (n = 1) and mild dermatitis in another PES-treated patient. A topical PES containing a tripeptide and hexapeptide appears to be a safer and effective regimen for reducing posttreatment erythema and accelerates recovery following RF microneedling.

Split-Sided Chest Study of Skin Rejuvenation Comparing Low-Energy, 1,927-nm Thulium Fractional Laser Treatment Prior to Photodynamic Therapy Versus Photodynamic Therapy Alone.

BACKGROUND AND OBJECTIVES: Treatment of photoaging and intrinsic aging of the chest, with the associated concerns of skin roughness, uneven pigmentation, laxity, atrophy, and telangiectasias, can be problematic because of the potential for worsened esthetic outcomes with existing treatments. This study assessed the efficacy and safety of using nonablative fractional laser therapy (FLT) pretreatment with photodynamic therapy (PDT) versus PDT alone for chest rejuvenation. STUDY DESIGN/MATERIALS AND METHODS: In a randomized, evaluator-blinded, split-sided study, adult female patients with photodamage to the chest received three treatment courses over an 8-week period with follow-up visits at Weeks 12 and 20. FLT was applied to one side of the chest, randomly assigned at baseline, followed by aminolevulinic acid-based PDT, delivered using a thermal, short incubation, broad area technique, to both sides of the chest. In-person and photographic assessments were conducted using five-point scales to evaluate outcomes including rhytides, pigmentation, skin texture, and telangiectasias. RESULTS: Eleven adults completed the study, of whom 11 had improved scores for rhytides and 10 had improved scores for skin texture at Week 20. There was no significant difference in any efficacy outcome between FLT and PDT and standard PDT alone. The severity of adverse events was rated significantly greater with the combined FLT-PDT treatment vs PDT alone. CONCLUSIONS: Significant improvements were observed vs baseline for both sides of the chest treated with FLT-PDT or standard PDT following three treatment sessions. No significant difference in efficacy was observed between treatment approaches, although adverse events were more severe on the FLT-pretreated side. This study was not registered as it qualified as a nonsignificant risk study. Lasers Surg. Med. © 2019 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

An Evaluation of Efficacy and Tolerability of Novel Enzyme Exfoliation Versus Glycolic Acid in Photodamage Treatment.

BACKGROUND: Glycolic acid acts by chemical destruction of adhesions between skin cells to exfoliate superficial skin layers and excess pigmentation. It is well known to improve the appearance of photoaged skin, but is associated with varying degrees of skin irritation. Hydrolyzed salmon roe proteins destroy cell adhesions enzymatically with potentially less irritation than acid treatments. This double-blind prospective study assesses the efficacy and tolerability of hydrolyzed roe versus glycolic acid, and glycolic acid with citric acid. METHODS: 75 female subjects with mild to moderate photodamage, all skin types, and ages 31-70 years, were enrolled. In this 12 week study of twice daily self-treatments, patients were assigned to one of 3 groups; Group 1 (n-19) was assigned hydrolyzed roe cream, Group 2 (n=17), 4% glycolic acid, or Group 3 (n-16), 8% glycolic acid plus 2% citric acid. All patients used the same mild face wash and SPF 30 sunscreen throughout the study. Patients were evaluated at weeks 0, 8 and 12 for objective and subjective tolerability, improvement in photodamage by VISIA Complexion Analysis, modified Packman and Gans method, Visual Analog Scale (VAS), and answered an opinion questionnaire. RESULTS: Group 1 improved in skin clarity from a VAS 44.1 to 55.7 (P=0.0317) at week 12. VISIA mean scores correlated with office evaluation showing improvement in brown spots from 453 to 417 (P = 0.0115) at 12 weeks. Group 2 improved in superficial fine lines at week 8 (-5.9, P=0.0428) and week 12 (-9.1, P=0.0019). Group 3 improved at week 12 in skin clarity (11.5, P = 0.0469) and skin roughness (-13.3, P = 0.0426), and in hyperpigmentation at week 8 (-9.4, P = 0.0462) and week 12 (-14.6, P= 0.0019). CONCLUSION: Topical hydrolyzed roe protein used twice daily improves skin clarity. It has good tolerability with fewer instances of stinging and burning than the other glycolic acid containing creams. Patient's opinions of the 3 products were similar.

Ablative skin resurfacing.

Ablative skin resurfacing has remained the gold standard for treating photodamage and acne scars since the development of the first CO(2) lasers. CO(2) and Er:YAG lasers emit infrared light, which targets water resulting in tissue contraction and collagen formation. The first ablative laser systems created significant thermal damage resulting in unacceptably high rates of scarring and prolonged healing. Newer devices, such as high-energy pulsed lasers and fractional ablative lasers, are capable of achieving significant improvements with fewer side effects and shorter recovery times. While ablative resurfacing has become safer, careful patient selection is still important to avoid post-treatment scarring, dyspigmentation, and infections. Clinicians utilizing ablative devices need to be aware of possible side effects in order to maximize results and patient satisfaction. This chapter reviews the background of ablative lasers including the types of ablative lasers, mechanism of action, indications for ablative resurfacing, and possible side effects.

308-nm Excimer laser treatment of palmoplantar psoriasis.

Psoriasis is a chronic inflammatory condition affecting 1-3% of the population. The incidence of palmoplantar involvement has been estimated to be between 2.8% and 40.9%. Significant psychosocial distress and difficulty performing activities of daily living can result. Treatment is often challenging. Traditional treatments include topical steroids, anthralin, calcipotriene, PUVA, methotrexate, cyclosporine, retinoids and biologics. In this case series, we report our success with the 308-nm excimer laser in the treatment of palmoplantar psoriasis.

Efficacy and safety of mycophenolate mofetil for lichen planopilaris.

BACKGROUND: Lichen planopilaris (LPP) is a chronic inflammatory disorder that causes permanent scalp hair loss and significant patient discomfort. OBJECTIVES: We sought to determine the efficacy and safety of mycophenolate mofetil (MMF) for treatment of LPP in patients who had failed prior topical, intralesional, or oral anti-inflammatory medications such as hydroxychloroquine or cyclosporine. METHODS: We conducted a retrospective chart review of 16 adult patients with LPP treated with at least 6 months of MMF in an open-label, single-center study from 2003 to 2007. Subjective and objective end points were quantified using the LPP Activity Index (LPPAI) and scores before and after treatment were assessed using a paired t test. Adverse events were monitored. RESULTS: Patients who completed treatment with MMF had significantly decreased signs and symptoms of active LPP despite having failed multiple prior therapies (P < .005). Five of 12 patients were complete responders (LPPAI score decreased>85%), 5 of 12 patients were partial responders (LPPAI score decreased 25%-85%), and two of 12 patients were treatment failures (LPPAI score decreased<25%). Four patients withdrew from the trial because of adverse events. LIMITATIONS: Retrospective analysis and small sample size were limitations. CONCLUSIONS: MMF was effective at reducing the signs and symptoms of active LPP in 83% of patients (10 of 12) who had failed multiple prior treatments after at least 6 months of treatment.