The 1440 nm and 1927 nm Nonablative Fractional Diode Laser: Current Trends and Future Directions.

Clinical characteristics of skin exposed to ultraviolet and infrared radiation include dryness, dyschromia, laxity, roughness, sallowness, scaling, telangiectasia, and wrinkles. Fractional photothermolysis promotes skin remodeling by formation of new dermal collagen. The nonablative fractional diode laser (NFDL) system employs fractional photothermolysis to rejuvenate the skin, using 2 distinct handpieces for wavelengths of 1440 nm and 1927 nm. Fractional photothermolysis from nonablative fractional diode lasers facilitates delivery of small molecular-weight compounds, such as L-ascorbic acid, through the skin without compromising barrier function of the stratum corneum. Both handpieces of the NFDL system are effective for rejuvenation of photodamaged facial skin, providing clinical improvement in skin tone, skin texture, fine lines, and dyschromia and reducing the number of detectable skin pores. Application of the 1927 nm wavelength handpiece has shown clinical improvement of hyperpigmentation, melasma, and postinflammatory hyperpigmentation, which have been challenging to treat effectively with other laser devices. With a target chromophore of water, the infrared energy of the 1440 nm and 1927 nm NFDL system is appropriate for skin rejuvenation and treatment of dyschromia in skin of color, with a reduced risk of the adverse events observed with other nonablative and ablative fractional lasers. Clinical data have demonstrated that both the 1440 nm and 1927 nm wavelengths are effective, with high levels of patient satisfaction, transient side effects, and minimal patient downtime.

Treatment of macular seborrheic keratoses using a novel 1927-nm fractional thulium fiber laser.

OBJECTIVES: Macular seborrheic keratoses (SK) are common, benign growths. A novel fractionated 1927-nm thulium fiber laser was selected to investigate efficacy and safety in the clearance of macular SK in nonfacial areas at a private dermatologic laser center. STUDY DESIGN: Six subjects (average age 56.8 ± 9.5) with at least four 3-mm or larger macular SK on one extremity, neck, or chest were enrolled and provided informed consent. Subjects received three treatments at 3- to 4-week intervals. Subjects were treated at settings of 10 to 20 mJ with 30% to 55% surface area coverage and four to eight passes at each session. Investigators performed a global extremity SK count, an SK count within a 5- by 5-cm (25 cm(2)) square on transparency mapping, and lesion thickness grading. Side effects were assessed. Patients rated pain using a visual analog scale. RESULTS: At baseline, average global SK count was 43.2 ± 27.3. At 1-month follow-up, 20.7 ± 16.6 lesions remained. At 3- and 6-month follow-up, 17.7 ± 23.8 and 14.7 ± 18.6 lesions remained, respectively. A decrease in thickness and SK counts within the 5- by 5-cm square was also observed. Moderate erythema and mild edema were post-treatment responses. CONCLUSION: Nonablative fractional resurfacing using the 1927-nm thulium fiber laser is a safe and effective treatment modality to decrease nonfacial macular SK.

Treatment of melasma using a novel 1,927-nm fractional thulium fiber laser: a pilot study.

BACKGROUND: A 1,927-nm wavelength was recently added to the 1,550-nm erbium-doped fiber laser. This wavelength possesses a higher absorption coefficient for water than the 1,550-nm, conferring greater ability to target epidermal processes such as dyschromia. OBJECTIVE: To evaluate the efficacy and safety of a novel 1,927-nm fractional thulium fiber laser in the treatment of melasma. METHODS: Fourteen patients underwent three to four laser treatments (at 4-week intervals) at pulse energies of 10 to 20 mJ and total densities of 252 to 784 microscopic treatment zones per cm(2) (6-8 passes) using a 1,927-nm thulium fiber laser. Three blinded assessors and the patients evaluated clinical improvement of treatment areas at 1-, 3-, and 6-month follow-ups. Side effects were assessed, and pain was scored using a visual analog scale (0-10). RESULTS: A statistically significant 51% reduction in MASI score was observed at 1-month post 3 to 4 laser treatments. A 33% (p = .06) and 34% (p = .07) reduction in Melasma Area and Severity Index score was observed at the 3- and 6-month follow-up visits, respectively. Skin responses observed after treatment were moderate erythema and mild edema. No scarring or postinflammatory hyper- or hypopigmentation was observed. CONCLUSION: The 1,927-nm fractional thulium fiber laser is a safe, effective treatment for melasma.

Radiofrequency: Thermage.

Nonablative procedures for facial rejuvenation have become increasingly popular. One such method to improve laxity and diminish rhytids is monopolar capacitively coupled radiofrequency (MRF). The authors discuss clinical studies using MRF. The authors also discuss their clinical experiences as well as recommendations for optimal results. MRF using the Thermage CPT system (Solta Medical, Hayward, California) offers minimal downtime with a favorable side-effect profile. Although there are many radiofrequency devices on the market for aesthetic use, MRF has the most clinical trials to date to support its use as an effective, evidence-based modality to improve rhytids and tighten the skin.

Nonablative fractional photothermolysis for facial actinic keratoses: 6-month follow-up with histologic evaluation.

BACKGROUND: A number of epidermal and papillary dermal skin conditions can be treated safely and effectively with fractional photothermolysis (FP). OBJECTIVE: We sought to evaluate the effectiveness of FP with a 1550-nm fractionated erbium-doped fiber laser for the treatment of facial actinic keratoses (AKs). METHODS: Fourteen men, ages 59 to 79 years, underwent 5 laser treatments (2- to 4-week intervals) at an energy fluence of 20 to 70 mJ and treatment level of 11 (8-10 passes), corresponding to 32% to 40% surface area coverage. AK counts and photographs were taken at baseline, before each treatment, and at 1-, 3-, and 6-month follow-ups after the last treatment. Biopsies were performed at baseline and at the 3-month follow-up. The clinical improvement of the actinic lesions was evaluated by a dermatologist using digital photography and lesion counts at all 3 follow-up visits. RESULTS: The AK count for each patient was reduced on average by 73.1% (67.5%-77.7%) at the 1-month, 66.2% (60.0%-71.5%) at the 3-month, and 55.6% (43.9%-64.8%) at the 6-month follow-up visit. Excluding two cases, all biopsy specimens (baseline and at the 3-month follow-up) were positive for histologic features of AK and/or squamous cell carcinoma. LIMITATIONS: This study is limited by a small number of patients; therefore further clinical studies are warranted. CONCLUSIONS: FP decreases the number of clinical AKs; however, posttreatment biopsy specimens indicate the histologic persistence of AKs (epidermal tumors). FP is not an adequate single-treatment modality for AKs.

Laser eradication of pigmented lesions: a review.

BACKGROUND: Pigmented lesions include solar lentigines, seborrheic keratoses, dermatosis papulosa nigra, ephelides, café-au-lait macules, nevus spilus, Becker's nevus, postinflammatory hyperpigmentation, melasma, nevocellular nevi, congenital nevi, junctional and compound melanocytic nevi, nevus of Ota and Ito, Hori's nevus, and blue nevi. Advances in laser technology have resulted in the ability to treat pigmented lesions with greater safety and efficacy. OBJECTIVE: To review the literature on the use of cutaneous laser treatments for pigmented lesions using Medline. RESULTS: The literature cited the use of various lasers to treat pigmented lesions, including argon, carbon dioxide, erbium-doped yttrium aluminum garnet, Q-switched, long-pulsed ruby, alexandrite, diode, and fractional lasers. For each lesion, we describe the efficacy of laser treatments, treatment intervals, and settings used for a variety of diagnoses. CONCLUSION: The treatment of pigmented lesions continues to evolve as new laser technology emerges and improvements in existing devices are made. The ability to treat pigmented lesions with greater efficacy and safety has resulted from recent advances in laser technology.

1,927-nm fractional thulium fiber laser for the treatment of nonfacial photodamage: a pilot study.

BACKGROUND: A 1,927-nm wavelength was recently added to the 1,550-nm erbium-doped fiber laser. This wavelength possesses a higher absorption coefficient for water than the 1,550-nm, conferring greater ability to target epidermal processes. OBJECTIVE: To evaluate the efficacy and safety of a novel 1,927-nm fractional thulium fiber laser in the treatment of nonfacial photodamage. METHODS: Nine participants with nonfacial photodamage underwent three laser treatments (at 3- to 4-week intervals) at pulse energies of 10 to 20 mJ and 30% to 55% surface area coverage (4-8 passes) with a 1,927-nm thulium fiber laser. A blinded assessor and participants evaluated clinical improvement of treatment areas at 1-month follow-up using a quartile grading scale (0-4). RESULTS: Nine participants with a total of 12 treatment areas completed three treatments and the 1-month follow-up visit. At follow-up, a blinded assessor rated mean improvement in photodamage as 3.25 ± 1.0 and lentigines as 3.33 ± 0.9 on a scale of 0 to 4 (0=none, 1=1-25%, 2=26-50%, 3=51-75%, and 4=76-100% improvement). Skin responses observed after treatment were moderate erythema, mild edema, itching, and desquamation. No scarring or postinflammatory hyper- or hypopigmentation was observed. CONCLUSION: The 1,927-nm fractional thulium fiber laser is a safe, effective treatment for nonfacial photodamage. Dr. Polder is a principal investigator and Dr. Suzanne Bruce is a consultant for Solta Medical.

CD4+ CD56+ hematodermic/plasmacytoid dendritic cell tumor with response to pralatrexate.

The CD4(+) CD56(+) hematodermic/plasmacytoid dendritic cell tumor is a rare, highly aggressive, systemic neoplasm for which effective therapies have not yet been established. These tumors express CD4, CD56, CD123, and T-cell leukemia/lymphoma (TCL)-1 and are clinically characterized by cutaneous involvement with spread to bone marrow and blood, and poor prognosis with current chemotherapy regimens. We describe a Caucasian woman who presented with plasmacytoid dendritic cell tumor, but an absence of systemic symptoms. Clinically, multiple cutaneous lesions were brown to violaceous firm nodules on the face, arms, and trunk. The patient underwent two courses of cyclophosphamide, Adriamycin, vincristine, and prednisone chemotherapy but relapsed quickly. The investigational agent, pralatrexate (30 mg/m(2)) was given weekly with vitamin B12 and folic acid and resulted in remarkable clinical response with regression of skin tumors. Our observation highlights pralatrexate as a promising therapeutic option for hematodermic/plasmacytoid dendritic cell lymphoma/leukemias.

Thyrotoxicosis after denileukin diftitox therapy in patients with mycosis fungoides.

CONTEXT: Denileukin diftitox is a recombinant novel fusion protein of diphtheria toxin and the ligand-binding domain of human IL-2. Denileukin diftitox binds to the high-affinity IL-2 receptor on the cell surface, and it is internalized by endocytosis and enzymatically cleaved. The cytotoxic A-fragment of the toxin inhibits protein synthesis and causes cell death. OBJECTIVE: The objective of this study was to recognize thyrotoxicosis in association with denileukin diftitox therapy. DESIGN: This study was a retrospective case series. SETTING: The setting of this study was a comprehensive cancer center. PATIENTS: Eight mycosis fungoides patients who were receiving 9 or 18 microg/kg.d iv denileukin diftitox for 5 d every 3 wk were identified with thyrotoxicosis. INTERVENTION(S): Thyroid testing was performed. Hypothyroidism after thyrotoxicosis was treated. RESULTS: In eight mycosis fungoides patients who developed transient thyrotoxicosis during therapy, thyroid function tests were normal before onset of therapy. Clinical thyrotoxicosis developed within days of the first cycle of denileukin diftitox therapy in four patients and after the second cycle in the other four patients. Symptoms included tremors, nervousness, tachycardia, diarrhea, and weight loss. After cessation of denileukin diftitox, thyrotoxicosis resolved in all patients; two became euthyroid, and five became hypothyroid, requiring levothyroxine therapy. One patient was lost to follow-up. CONCLUSIONS: Monitoring thyroid function before and during treatment with denileukin diftitox is recommended. Symptomatic thyrotoxicosis may be missed due to other acute reactions to the drug, and subsequent hypothyroidism may develop.