Utilization of Laser Therapy During Pregnancy: A Systematic Review of the Maternal and Fetal Effects Reported From 1960 to 2017.

BACKGROUND: Due to concerns regarding maternal and fetal safety and the absence of evidence to the contrary, laser treatment during pregnancy has traditionally been limited to situations of absolute necessity. OBJECTIVE: This review seeks to examine the available evidence to determine the safety of laser therapy during pregnancy. METHODS: Medical databases were searched for relevant reports from all specialties regarding the use of lasers during pregnancy from 1960 to 2017. A legal case review was also performed. RESULTS: Twenty-two publications in the literature reported the use of various laser wavelengths in 380 pregnant women during all trimesters. Other than 1 case of premature rupture of membranes questionably related to the laser treatment, there were no cases of maternal or fetal morbidity or mortality, premature labor, or identifiable fetal stress. CONCLUSION: The available evidence, limited to low evidence level case reports and series, indicates cutaneous laser treatment during pregnancy is safe for both mother and fetus. Furthermore, laser physics and optics dictate there should theoretically be no risk of fetal laser exposure from commonly used cutaneous lasers.

Clinical study to evaluate the performance of a noninvasive focused ultrasound device for thigh fat and circumference reduction compared to control.

BACKGROUND AND OBJECTIVES: An FDA-cleared focused ultrasound device (UltraShape, Syneron Candela® , Yokneam, Israel) for noninvasive abdominal fat reduction produces localized mechanical cellular membrane disruption in adipocytes. This study seeks to determine the safety and efficacy of this device for use on the thighs. STUDY DESIGNS/MATERIALS AND METHODS: Fourteen women aged 33-60 were selected to receive 3 biweekly treatments to one thigh with the other thigh serving as an internal control. The subjects had a BMI range of 18-30 kg/m2 and a weight range of 54-83 kg. After the third treatment, patients were followed at 4, 8, and 16 weeks. Fat thickness was measured by both caliper and ultrasound. In addition, thigh circumference and the patient's weight were measured. Pain, edema, erythema, and adverse events as well as investigator and patient overall satisfaction were recorded at all visits. RESULTS: In comparison with the control, there was a statistically significant average reduction in fat thickness measured by calipers at all time points with a 22.20% (P = .0165) improvement in 16 weeks. By ultrasound, there was a 19.23% (4.03 mm P = .0051) reduction in fat thickness at 16 weeks with statistically significant improvement at the other follow-up visits. At 16 weeks, thigh circumference improved, on average, 2.8 cm (P = .0059) at the midline. 90.0% of the subjects were satisfied with the results at 16 weeks, and the investigator was 100% satisfied. No adverse events were reported; no edema was observed in any subject. All subjects experienced mild erythema. All reported zero pain on a 0-10 scale. CONCLUSION: Focused ultrasound is safe, effective, and well tolerated to improve the circumference and fat thickness of the thighs without significant side effects. There were no significant adverse events. Investigators and subjects were highly satisfied with the results.

Small-Particle Hyaluronic Acid Gel Treatment of Photoaged Hands.

BACKGROUND: Aging hands tend to lose subcutaneous volume resulting in prominence of the underlying vessels, tendons, and bone contributing to an aged appearance. Dermal fillers have been successfully used to improve the appearance of the aging dorsal hand. OBJECTIVE: The objective is to evaluate the safety and efficacy of a small-particle hyaluronic acid (SPHA) injectable gel for the treatment of photoaged volume loss of the hands. MATERIALS AND METHODS: This is an open-label, prospective, randomized, interventional, study. Twenty-five healthy female volunteer subjects aged 40 to 70 years with photoaged thinning of the hands received an injection of an SPHA gel to the dorsal aspect of 1 hand. Subjects were followed up for 6 months. The hands were evaluated at regular intervals according to a 5-point validated hand grading scale. RESULTS: The average hand grading scores demonstrated statistically significant improvement at all time points compared with baseline. Eighty-eight percent to 100% of subjects achieved improvement at 1 month after treatment, and 50% to 83% maintained at least 1 point improvement at 6 months. There were no adverse events reported. CONCLUSION: The investigated SPHA is a safe and effective method for improving the thinned and photoaged appearance of the hands.

Poly-L-lactic acid for the Improvement of photodamage and rhytids of the décolletage.

BACKGROUND: Poly-L-lactic acid (PLLA) is a biostimulatory filler approved for use in HIV lipoatrophy as well as cosmetic improvement in facial folds and wrinkles in immunocompetent patients. Similar to the face and hands, the décolletage is commonly subject to photodamage and the resulting appearance of rhytids and crepiness, which could benefit from PLLA treatment. OBJECTIVES: The objective of the study was to assess the safety and efficacy of injected PLLA for the improvement in rhytids and crepiness of the décolletage. METHODS: In this open-label, prospective, interventional study, 25 healthy female volunteers aged 40-to-70 years with moderate-to-severe crepiness and wrinkling of the décolletage were injected with 1 vial of PLLA at each of three treatments. The Fabi-Bolton 5-point chest wrinkling scale was used by both investigators and subjects to assign pretreatment and post-treatment follow-up scores at 1 month, 3 months, and 6 months. Adverse events were reported at each visit. RESULTS: All post-treatment mean scores had statistically significant improvement compared to the pretreatment baseline means as rated by both investigators and subjects. At 1 month following the last treatment, compared to baseline, investigators rated 83% of subjects had improved by at least one point on the scale. Subjects rated 74% of subjects improved by at least one point. At 6 months, 90% of subjects, as rated by the investigators, and 57% of subjects, as rated by the subjects, had improvement from baseline. CONCLUSION: PLLA is safe and effective for improvement in the rhytids and skin quality of the photodamaged décolletage.

2015 Arte Poster Competition First Place Winner: Assessing the Correlation Between Patient Anxiety and Satisfaction for Mohs Surgery.

Skin cancer and the surgical treatment thereof have the potential to be sources of great anxiety for patients. Examination of patient satisfaction, anxiety, and contributing factors has the potential to provide information surgeons can use to implement practices that have an impact on patient anxiety and satisfaction regarding dermatologic surgery. This study used a prospective interview to catalog patients' anxiety and experiences before and during the surgical process. Our results indicate that several pre- and perioperative factors have the potential to decrease a patient's overall anxiety. Notably, 33% of surgical patients reported a decrease in anxiety from the time of diagnosis until the day of surgery. Factors that contributed to this included a call discussing the diagnosis and what to expect on the day of surgery as well as reading written material or searching the internet for more information regarding the procedure. Furthermore, a call from the physician compared to a call from a nurse or other team member showed a greater effect on decreasing anxiety. During the surgical procedure, our results highlight several factors that can decrease a patient's anxiety. Most notably, eating, watching TV, bringing a guest, and engaging in small talk with surgeon and staff during the procedure subjectively decreased patients' anxiety. In summary, our results suggest that patients respond to a variety of factors to reduce anxiety and that each patient derives relief from anxiety in different manners. Therefore, offering a spectrum of comforting or distracting activities during the Mohs procedure is ideal and may reduce the need for pharmacologic anxiolytics.

A review of traditional and novel oral anticoagulant and antiplatelet therapy for dermatologists and dermatologic surgeons.

BACKGROUND: Dermatologic surgeons will increasingly encounter patients on novel oral antiplatelet and anticoagulant medications. OBJECTIVES: We conducted a complete overview of the pharmacokinetics, pharmacodynamics, and side effects of traditional and novel oral anticoagulant and antiplatelet therapies along with dietary supplements with anticoagulant or antiplatelet properties. METHODS: A PubMed search was completed for "aspirin," "warfarin," "clopidogrel," "dabigatran," "rivaroxaban," "apixaban," "prasugrel," and "ticagrelor." Review articles and publications emphasizing perioperative management of oral anticoagulant or antiplatelet medications were selected. An additional PubMed search was completed for "hemorrhage," "bleeding," and "thrombosis" in conjunction with "dermatology," "dermatologic surgery," and "cutaneous surgery." RESULTS: Aspirin, clopidogrel, and warfarin have shortfalls in dosing, monitoring, and efficacy. Several trials show superior efficacy with dabigatran, rivaroxaban, and apixaban, with equal or reduced risk of bleeding compared with warfarin. Prasugrel and ticagrelor may be associated with an increased bleeding risk. Many over-the-counter medications also have anticoagulant properties with associated bleeding risks that cannot be overlooked. LIMITATIONS: There are few publications evaluating the novel oral anticoagulants' effects on outpatient surgical procedures. CONCLUSION: Novel anticoagulant and antiplatelet drugs are revolutionizing therapy for cardiovascular diseases. As these medications become more prevalent, dermatologists and dermatologic surgeons must be mindful of the bleeding risk that will apply in our everyday practices.

Golimumab-exacerbated subacute cutaneous lupus erythematosus.

BACKGROUND: Subacute cutaneous lupus erythematosus (SCLE) is characterized by annular, nonscarring, photodistributed, or papulosquamous lesions. The disease may be idiopathic, drug induced, or drug exacerbated. OBSERVATIONS: A 66-year-old woman with a history of hypertension, parkinsonism, rheumatoid arthritis, anxiety and depression, and symptoms of Sjögren syndrome was seen with a 1-month history of an eruption on her upper extremities and upper trunk. The eruption had begun 2 to 3 weeks after subcutaneous injection of golimumab for rheumatoid arthritis. She had developed SCLE 2 years previously due to furosemide use and 10 years previously due to hydrochlorothiazide use. Physical examination revealed scaly, annular, erythematous plaques photodistributed on the arms, legs, and upper trunk. A punch biopsy specimen demonstrated vacuolar interface dermatitis and lymphohistiocytic perivascular inflammation. Serological abnormalities included a positive antinuclear antibody, an elevated anti-La/SS-B antibody level, and an elevated anti-Ro/SS-A antibody level. She was diagnosed as having SCLE and was initially treated with desonide lotion, photoprotection, prednisone (40 mg/d) tapered over 6 weeks, and hydroxychloroquine sulfate (200 mg twice daily). Because of persistent disease, methotrexate sodium (12.5 mg/wk) was subsequently added to the regimen, and her eruption cleared completely. CONCLUSIONS: Golimumab should be added to the list of medications capable of inducing or exacerbating SCLE. Our patient demonstrated variable times to the resolution of SCLE, possibly attributable in part to the different half-lives of the agents administered.