Enhanced Pulsed Dye Laser for Facial Rejuvenation.

BACKGROUND AND OBJECTIVES: To evaluate the efficacy of an enhanced pulsed dye laser (PDL) for treatment of facial-dyschromia. STUDY DESIGN/MATERIALS AND METHODS: Thirteen patients were enrolled in the study. Nine patients were female, four were male, with a mean age of 61 years. All patients presented with either facial telangiectasia, rosacea, pigment, or a combination thereof. At the initial evaluation, test spots were performed to determine the subject's response to selected treatment parameters. In the study, the enhanced 595 nm PDL deployed a spot size range of 5-12 mm with fluences ranging from 8 to 18 J/cm2 . Pulse duration was 10 milliseconds. Enhancements in this device included the option for contact or cryogen spray cooling, increased maximum pulse energy, increased repetition rate, option for addition of radiofrequency (RF), an option for a 15 mm spot size, and longer dye life. The smaller spots were used only for focal low contrast pigmented lesions that persisted after overall facial treatment with the larger spot. Smaller fluences were applied for general rejuvenation with the 12 mm spot (mean ~9 J/cm2 ). Sapphire contact cooling was applied at 10°C. A smaller area of the skin was reserved (typically pre-auricular area) for addition of RF energy just before the pulse (40-70 J/cm3 ) over 100 milliseconds with a 20 milliseconds delay between the end of the RF pulse and beginning of the laser pulse. The minimum fluence that achieved vessel closure/vessel bluing and/or slight immediate pigment darkening was applied based on test spots performed just before treatment to the entire face. Determinations of improvement were made by evaluation of photographs with standard settings using polarized and nonpolarized images. Up to three treatments were performed approximately 1 month apart with follow-up visits 1 and 3 months after the final treatment. RESULTS: Evaluation by a panel of blind observers determined a mean clearance of at least 50% in all lesions, while 77% of lesions had 50-75% clearance, and 23% of lesions had 76-100% clearance. Pain was approximately 4/10. Subjective lesion improvement and satisfaction rates were 3 out of 4 and 3.6 out 4, respectively. CONCLUSION: An enhanced PDL is effective in one pass treatments for facial rejuvenation with considerably less operative time than previous commercially available systems. A second pass applied to focal challenging lesions results in even more improvement, in a single treatment session. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Patient satisfaction and our clinical experience with 459 microfocused ultrasound treatments.

PURPOSE: Microfocused ultrasound (MFUS) is a safe and effective method for noninvasive skin tightening. Previous clinical studies demonstrate a 60-100% patient satisfaction after MFUS. We used an anonymous online platform after MFUS to assess patient satisfaction. DESIGN: Patients treated with MFUS between January 2013 and 2016 were invited to complete an anonymous online survey at least 4 months post-treatment. Patients were asked to rate improvement in skin tightening as none (0%), mild (0-25%), moderate (26-50%), significant (51-75%), or dramatic (76-100%) and treatment satisfaction as disappointed, neutral, satisfied, or extremely satisfied. SUMMARY: Between January 2013 and 2016, 253 patients received 459 MFUS treatments at our center. A total of 83 surveys were received with data. Nearly 80% of responders reported at least mild improvement, with 14.5% indicating significant improvement, 27.7% indicating moderate, 37.3% indicating mild, and 20.5% indicating none. In addition, 53.1% of responders reported being satisfied or extremely satisfied with the results. 44.6% of responders did not feel treatment results met expectations. CONCLUSION: Patient satisfaction with elective cosmetic procedures is an important indicator of success. Our current study demonstrates a high response rate, with almost 80% of responders indicating at least mild tightening with MFUS treatment. Interestingly, only 53.1% of patients reported satisfaction after treatment, a lower satisfaction rate than reported in previous non-anonymous studies and lower than patients report in our office follow-up appointments. This discrepancy may be due to gratitude bias. Anonymous surveys likely provide a more accurate assessment of patients' perceptions and will improve physician's future counseling efforts. Lasers Surg. Med. 51:495-499, 2019. © 2019 Wiley Periodicals, Inc.

Response of tufted angiomas to low-dose aspirin.

Tufted angioma (TA), also known as angioblastoma of Nakagawa, is an uncommon vascular tumor. Clinical presentation and evolution of TA can vary. There are many treatment modalities, but none are uniformly effective. We present two patients with TA without Kasabach-Merritt phenomenon (KMP) treated with low dose aspirin, which resulted in improved appearance, decreased bulk, and resolution of symptoms. Low-dose aspirin should be considered as a treatment option for large or symptomatic TA that are not associated with KMP.

Linear rays of hypopigmentation following intra-articular corticosteroid injection for post-traumatic degenerative joint disease.

Intra-articular and intralesional glucocorticoid injections are commonly used by dermatologists, orthopedic surgeons, and rheumatologists because they offer many advantages over oral or parenteral dosage forms. Triamcinalone acetonide is a frequently utilized glucocorticosteroid for intra-articular injections, yet there are a limited number of case reports describing cutaneous hypopigmentation as an adverse effect. Here we present a unique case of hypopigmentation with a linear ray distribution demonstrating lymphatic collection and spread of the triamcinalone acetonide.

Patch testing with methyldibromoglutaronitrile in a localized population in the United States.

BACKGROUND: in Europe, methyldibromoglutaronitrile (MDGN) was banned because of excessive rates of contact allergy. However, it is unclear whether the concentrations used for testing MDGN are optimal, as different groups have used varying concentrations with quite different rates of positive reactions. OBJECTIVES: to report patch-test results with MDGN in a localized US population, to compare these results with those of other studies, and to evaluate any association between contact allergy to MDGN and atopic dermatitis. METHODS: a retrospective analysis of 1,753 patients tested with various concentrations of MDGN was conducted. RESULTS: Four percent (4.0%) of patients had positive reactions to MDGN, of which 1.2% were ++/+++ reactions and 2.8% were + reactions. Among patients with ++/+++ reactions, 9.5% had a reaction of definite relevance; of patients with + reactions, only 2.0% had a reaction of definite relevance. Irritant reactions were had by 3.2% of patients; none of these were relevant. The North American Contact Dermatitis Group had a positive reaction rate of 6.2%; European groups had rates of 1.6 to 5.0%. No significant association was found between atopic dermatitis and positive patch-test reactions to MDGN. CONCLUSION: owing to the number of irritant reactions observed, we suspect that many reactions to MDGN are falsely positive, underscoring the importance of careful interpretation of reactions less than or equal to +.