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At least 847 records · Page 47Linked to original sources
PubMed1997

A peeler's thoughts on skin improvement with chemical peels and laser resurfacing.

The new pulsed CO2 lasers are an exciting modality. They have the ability to do what no other procedure can do with the same safety profile. The drawbacks of cost, pain and prolonged healing, however, serve to limit the lasers use to a niche, rather than replacing all other means of skin resurfacing. Skin problems of the epidermis and superficial papillary dermis are more easily and less expensively treated with chemical peeling. This includes most types of hyperpigmentation as well as actinic keratoses and poorly textured skin. This is especially true of postinflammatory hyperpigmentation, in which any procedure that creates prolonged erythema dramatically increases the risk of increased pigmentation. In these patients, the use of CO2 laser resurfacing is risky, if not even contraindicated. Skin problems of the deeper papillary dermis and reticular dermis, such as rhytides and scars, however, respond as well to laser resurfacing as they do to deep chemical peels, but with a better safety profile and a more natural clinical appearance of the healed skin. In many cases, the patient would be better served with a medium depth chemical peel of the entire face and laser resurfacing of the rhytides in the perioral or periorbital areas. This would give the patient the best clinical result with the fastest recovery. The major drawback to this type of therapy has been that the postoperative care of the two treatment regions is different. This may cause some logistical difficulties for the patient, as well as some confusion. Certainly, another option is to treat the patient on two separate occasions; that is, first peel the entire face and then later go back and laser resurface the areas of the remaining rhytides. Although this approach creates more healing time for the patient, it minimizes the areas of prolonged erythema, thereby allowing the patient a faster return to normal. As laser technology continues to advance, we can expect faster healing times and less expensive machinery. Presumably, with our current understanding of the wound healing process, we should expect better post laser treatment regimens, with associated faster healing. Therefore, it is distinctly possible that the current niche for pulsed CO2 lasers will be expanded greatly in the next year or two.

Chemexfoliation↗
PubMed1998

Dyskeratosis congenita with linear areas of severe cutaneous involvement.

Dyskeratosis congenita (DC) is a rare hereditary disorder of skin which may be associated with aplastic anemia. The pattern of inheritance is X-linked recessive in most instances, but autosomal dominant and autosomal recessive types have been documented. Reticulated hyperpigmentation usually is the first manifestation. The pigmentary changes may be limited to neck, upper chest, and proximal parts of the limbs initially but within affected areas the involvement is always diffuse. We report on a patient with typical diffuse cutaneous signs of dyskeratosis congenita superimposed with hyperpigmentation that was more pronounced along Blaschko's lines. To explain this phenomenon, we assume that the patient has the autosomal dominant type and that loss of heterozygosity occurred in a somatic cell giving rise to a population of cells that migrated along these lines during embryogenesis.

Adolescent↗
PubMed1998

The application of antioxidants in investigations and optimization of photochemotherapy.

Psoralens (furocoumarins) are photosensitizers of plant origin. They are used in combination with near-ultraviolet (320-400 nm) light for the treatment of vitiligo, psoriasis, cutaneous T-cell lymphoma (CTCL), alopecia areata, eczema, and other skin diseases. Photobiological effects of psoralens in humans are numerous. They photosensitize erythema, hyperpigmentation, and skin aging, affect immune system, etc. Molecular mechanisms of photochemical reactions of psoralens with substrates are also numerous. The molecular basis and the relationships between different photobiological effects of psoralens remain the subject of discussion. The use of antioxidants is an essential instrument for clearing up these problems as well as for the progress of photochemotherapy. It was found that antioxidants (alpha-tocopherol, butylated hydroxytoluene, etc.) selectively inhibited the photochemical stage of erythema and hyperpigmentation but had no impact on the post-irradiation stages of these processes. Evidently, the basis of these processes is the reaction of psoralen-photosensitized oxidation of unsaturated lipids and the impairment of barrier functions of biomembranes, since the photochemical stage of these reactions is inhibited by the antioxidant. At the same time, antioxidants did not inhibit the therapeutic effect in the cases of psoriasis and CTCL. Thus, antioxidants can be used as a tool for improvement of psoralen photochemotherapy.

Animals↗
PubMed2001

Tazarotene cream for the treatment of facial photodamage: a multicenter, investigator-masked, randomized, vehicle-controlled, parallel comparison of 0.01%, 0.025%, 0.05%, and 0.1% tazarotene creams with 0.05% tretinoin emollient cream applied once daily for 24 weeks.

OBJECTIVE: To assess the safety and efficacy of 4 concentrations of tazarotene cream in the treatment of facial photodamage. DESIGN: Prospective weekly multicenter, investigator-masked, randomized, parallel-group study. SETTING: University hospitals and clinical research centers. PATIENTS: Three hundred forty-nine subjects with facial photodamage. INTERVENTION: Daily topical application of tazarotene cream (0.01%, 0.025%, 0.05%, and 0.1%) compared with its vehicle and with 0.05% tretinoin emollient cream. RESULTS: Tazarotene cream and tretinoin cream significantly improved mottled hyperpigmentation and fine wrinkles. At week 24, treatment success rates based on global responses were 67% (39 of 58 subjects) with 0.1% tazarotene, 52% (30 of 58 subjects) with 0.05% tazarotene, 36% (21 of 58 subjects) with 0.025% tazarotene, 41% (24 of 59 subjects) with 0.01% tazarotene, 55% (32 of 58 subjects) with 0.05% tretinoin, and 22% (13 of 58 subjects) with vehicle. Local adverse events, although more frequent with tazarotene at higher concentrations, were generally mild to moderate. CONCLUSIONS: Tazarotene in a cream formulation is safe and is associated with positive changes in the treatment of photodamaged facial skin.

Administration, Cutaneous↗
PubMedDate not supplied

Management of infraorbital dark circles. A significant cosmetic concern.

Despite the frequency with which it occurs, little has been written in the scientific literature on the treatment of infraorbital dark circles. I have developed a technique that simultaneously treats the 2 contributing causes of these circles: hyperpigmentation of skin and pseudoherniation of orbital fat. The technique involves simultaneous transconjunctival blepharoplasty and deep-depth phenol chemical peel. Successful outcomes have been obtained in patients with Fitzpatrick classification skin types 1 to 5, with a low incidence of complications. Adequate preoperative counseling regarding prolonged erythema and careful postoperative monitoring with, if necessary, medical intervention are essential if both surgeon and patient are to be satisfied with the outcomes.

Adipose Tissue↗
PubMed1999

Epidermolysis bullosa simplex with mottled pigmentation: clinical aspects and confirmation of the P24L mutation in the KRT5 gene in further patients.

Epidermolysis bullosa simplex with mottled pigmentation (EBS-MP) is a rare dermatologic disorder of autosomal dominant inheritance with intraepidermal blistering after minor trauma, reticular hyperpigmentation unrelated to the blistering, nail dystrophy, and mild palmoplantar keratosis. Keratin 5 and keratin 14 are known to be essential for the basal keratinocyte cytoskeleton and are defective in several forms of epidermolysis bullosa simplex. Recently, a 71C-->T transition in the keratin 5 gene (KRT5) causing a P24L substitution was identified in some patients with EBS-MP. We present a family with three affected members and a sporadic patient with EBS-MP. They exemplify clinically mild expression with intrafamilial variability and the possibility of improvement with time. In all of them, mutation analysis of the KRT5 gene showed the P24L mutation. So far, other mutations in the same or in other genes have not been reported in patients with EBS-MP.

Adult↗
PubMed2000

Q-switched Nd:YAG laser treatment for acquired bilateral nevus of ota-like maculae: a long-term follow-up.

BACKGROUND AND OBJECTIVE: Acquired bilateral nevus of Ota-like maculae (ABNLM) is not an uncommon dermal melanosis in Asian people. It is known for its recalcitrance to conventional treatment. We proposed Q-switched Nd:YAG laser for the treatment of this entity. STUDY DESIGN/PATIENTS AND METHODS: Seventy female patients with ABNLM, who were 25-40 years old (mean, 37 years), were included in a prospective clinical study. Q-switched Nd:YAG laser at fluence of 8-10 J/cm(2), spot size 2 or 4 mm, and a repetition rate of 10 Hz was used to treat the lesions. RESULTS: Two patients were lost to follow-up. In the remaining 68 cases, all lesions attained a 100% clearance after two to five treatment sessions (mean, 2.8 sessions). The results had persisted at 3-4 years follow-up (mean, 42 months). Temporary hyperpigmentation was found in 50% of patients; there was no scarring or changing of skin texture. CONCLUSION: Q-switched Nd:YAG laser is a safe and effective noninvasive alternative treatment for ABNLM.

Adult↗
PubMed1997

Cutaneous toxicity following the administration of dactinomycin.

Dactinomycin (AMD) is an effective drug in the management of several malignant disorders and has been used for almost 40 years. Skin and subcutaneous toxicities following extravasation are well known and can be harmful. Similarly radiation-recall is a well established phenomenon following the administration of AMD. We report a patient who developed a localized brawny erythema in the crural folds and the axillae, likely due to AMD. This rare skin complication of AMD seems to benefit from topical corticosteroid treatment, although postinflammatory hyperpigmentation may take months to disappear.

Administration, Cutaneous↗
PubMed2004

Transmission of ring chromosome 13 from a mother to daughter with both having a 46,XX, r(13)(p13q34) karyotype.

Ring chromosomes are thought to be the result of breakage in both arms of a chromosome, with fusion of the points of fracture and loss of the distal fragments. Another mechanism of ring formation is believed to be the simple fusion of chromosome ends with preservation of telomeric and subtelomeric sequences. Ring chromosome 13 was first described in 1968 and its incidence estimated at 1 in 58,000 live births. Severe phenotypes associated with large deletions of 13q have been described as "ring chromosome 13 syndrome." Features of the "ring chromosome 13 syndrome" include mental retardation (often severe), growth retardation, microcephaly, facial dysmorphism, and hand, foot or toe abnormalities. We report on a case of a mother and daughter with r(13) and mild phenotypes. Our patient, IA, had chromosome analysis performed at about 4(1/2) years of age due to some developmental delay. This revealed 46,XX, r(13)(p13q34) karyotype with no loss of any chromosomal band. Her mother, EA, was subsequently found to have the same ring 13. IA's maternal grandmother had a normal karyotype while her maternal grandfather was unavailable for testing. Fluorescence in situ hybridization (FISH) analysis showed loss of a specific subtelomeric 13q region in r(13) in the mother. Clinically, IA had macular hyperpigmentation on the chin and mild delay in speech and fine motor skills. EA, 22 years of age, had mild short stature and borderline mental retardation. To our knowledge, this is the first report of a case of familial transmission of r(13). We compare phenotypes of our cases with those from other reported cases of r(13) and discuss the possible mechanism of formation of this ring chromosome.

Black or African American↗
PubMed2002

Facial resurfacing in patients with Fitzpatrick skin type IV.

BACKGROUND AND OBJECTIVES: Though post-inflammatory hyperpigmentation (PIH) is probably the most common complication of laser resurfacing and appears to correlate directly with the intensity of the patient's natural pigmentation, there is very little data that specifically addresses the risks of dyspigmentation in more darkly pigmented patients (Fitzpatrick skin types IV and above). The objective of this study was to evaluate the long-term dyspigmentation of patients with skin type IV having radial laser resurfacing. STUDY DESIGN/MATERIALS AND METHODS: A retrospective review of the clinical efficacy, incidence of dyspigmentation and other adverse effects, as well as the pre/post-operative protocol of 22 patients with Fitzpatrick skin type IV who were a minimum of 1 year post-operative following facial laser resurfacing. RESULTS: The average patient achieved greater than 50% improvement, indicating adequate treatment being delivered. PIH occurred in 68% of patients, starting 1 month post-operative and lasting 3.8 months. There was no correlation to pre-treatment or type of laser used as far as incidence of PIH. True hypopigmentation was not seen in this group of 22 patients. CONCLUSIONS: PIH is the most common complication of facial resurfacing in patients with skin type IV. It is not preventable by choice of laser or skin care regimen pre-operative, but appears to respond to appropriate treatment once it has developed.

Adult↗
PubMed2002

Treatment of spider leg veins with the KTP (532 nm) laser--a prospective study.

BACKGROUND AND OBJECTIVES: Spider leg veins are telangiectasias located intracutaneously. This condition poses a cosmetic problem. STUDY DESIGN/PATIENTS AND METHODS: The purpose of this study was to determine what influence the KTP (532 nm) laser has on spider leg veins dependent on the vascular diameter and to what extent the skin has been affected. Seventy female patients were treated in three laser sessions. Analysis was done 30 weeks after the last laser treatment session. RESULTS: Fifty-six patients completed the study. In group 1 (vascular diameter < or = 0.6 mm), spider leg veins were no longer visible in 33%; in 40%, a decrease in vascular diameter could be observed; in 27%, no change in size occurred. In group 2 (vascular diameter 0.7-1.0 mm), laser-treated spider leg veins were visible in all patients. Hyperpigmentation occurred in 13 patients. CONCLUSIONS: The KTP (532 nm) laser is an effective for treating spider leg veins having a vascular diameter under 0.7 mm.

Adolescent↗
PubMed2003

Using a "non uniform pulse sequence" can improve selective coagulation with a Nd:YAG laser (1.06 microm) thanks to Met-hemoglobin absorption: a clinical study on blue leg veins.

BACKGROUND AND OBJECTIVES: Evaluation of the efficacy, on 1-2 mm blue leg telangiectasia, of a 1,064 nm Nd:YAG laser emitting in a non uniform pulse sequence calculated to consider Met-Hb formation during laser irradiation of a blood vessel. MATERIALS AND METHODS: A 1,064 nm Nd:YAG laser (Quantel Medical, Athos, France) was used in a non uniform pulse sequence mode, fluences: 300-360 J/cm(2) spot: 2 mm, + 5 degrees C contact cooling. The clinical evaluation was performed on 11 female patients, average age: 43 (25-57) years, phototype I-VI. All subjects were previously examined with Doppler ultrasound. A treatment site (6 x 4 cm) was selected on each patient. The topography of the vessels network was reported on a tracing plastic frame before each session and 6 weeks after the last one. These frames were digitized and the number of vessels was determined using the Digitized Tracing Frames Technique. Side effects were noted before and after every treatment, and 6 weeks after the last one. This study lasted for 10 months. RESULTS AND DISCUSSIONS: Patients tolerated the procedure without anesthesia. Moderate pain, transient erythema and edema, one hyperpigmentation and one matting were noted. There was no hypopigmentation. 55% (P < 0.002) vessels clearance after one session, 86% after two sessions (P < 0.001), and 98% (P < 0.001) after three sessions were obtained. On two patients, the treatment was completed after two sessions with a full clearance. Data reported in this study were obtained thanks to a computerized calculation of vessels clearance. They are similar or superior to those reported in the literature about 1,064 nm Nd:YAG lasers and leg telangiectasia. CONCLUSIONS: Since, it was developed to consider the modification of blood absorption and the methemoglobin formation which leads to an increase of the 1.06 microm wavelength absorption, the non uniform pulse mode emphasizes the efficacy of this 1,064 nm Nd:YAG laser concerning the treatment of blue leg veins telangiectasia between 1 and 2 mm. This mode gives the possibility to deliver high energy while preserving the surrounding tissue and leads to a rapid vessel clearance with reduced pain and few side effects when compared to previously published clinical studies using a 1.06 microm laser.

Adult↗
PubMed1992

Pulsed dye laser treatment of benign cutaneous pigmented lesions.

Superficial benign cutaneous pigmented lesions that commonly present to the dermatologists and plastic surgeons have been treated by many conventional modalities such as dermabrasion, depigmenting creams as well as several types of lasers. Many of these treatment modalities lack specificity of injury, which has meant that normally pigmented and even non-pigment containing structures such as collagen as well as the hyperpigmented lesion itself have all been indiscriminately destroyed. This has resulted variously in hypopigmentation, hyperpigmentation, in addition to scar formation in some cases. A coaxial 504 nm laser with a pulse duration of 300 nsec was used to treat fifty two patients with superficial benign cutaneous pigmented lesions. Although the number of treatments required to clear the lesion varied according to the type of lesions being treated, on average, between 2 and 4 treatments were required to completely eradicate the superficial benign cutaneous pigmented lesions using 504 nm pulsed dye laser. The skin at the site successfully cleared of the pigmented lesion remained normal in skin color, texture, markings, and mobility.

Child, Preschool↗
PubMed1993

Comparison of the flashlamp pulsed dye laser with the argon tunable dye laser with robotized handpiece for facial telangiectasia.

This prospective study compares the efficacy, side effects, and patient acceptance of the flashlamp pulsed dye laser (FPDL) with the argon tunable dye laser with robotized handpiece (ATDL/H) for facial telangiectasias. Seventeen adult patients with bilaterally symmetric facial telangiectasias were enrolled. The right cheek on each patient was treated in one session with the FPDL at a fluence of 6.0-6.75 J/cm2 and a spot size of 5 mm. The left cheek was treated at the same session with the ATDL/H at a power of 1 W, a fluence of 26-27 J/cm2, and a hexagonal treatment area of 13 mm (127 individual 1 mm spots grouped mechanically by the handpiece). Patients were evaluated subjectively and by the investigators at 2, 4, and 6 weeks for blistering, swelling, bruising, changes in pigment, scarring, overall efficacy, and patient preference. Average treatment times were 5.4 minutes for FPDL and 9.4 minutes for ATDL/H. Blistering, crusting, and discomfort were completely resolved on both sides by week 2 in all patients. Bruising occurred in all patients with FPDL but had resolved in 62.5% of patients at 2 weeks and 100% at 4 weeks. There was no bruising with ATDL/H. Postinflammatory hyperpigmentation was much more prominent with FPDL but had resolved in 88% of cases by week 6. As rated by the investigators 100% of the FPDL treated areas showed excellent clearing of telangiectasias, compared with 47% of ATDL/H treated areas.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

CO2 laser-resurfacing: increased risk of side effects after uv-exposure-an experimental animal study.

BACKGROUND AND OBJECTIVES: Carbon dioxide (CO(2)) laser resurfacing is primarily performed on photodamaged facial skin where patients are further exposed to ultraviolet radiation (UVR) postoperatively. We examined whether pre- and postoperative UVR influences the development of CO(2) laser-induced side effects. STUDY DESIGN/MATERIALS AND METHODS: Hairless mice (n = 211) were treated with a Sharplan CO(2) laser with FeatherTouch scanner. Simulated solar irradiation was administered either preoperatively or pre- and postoperatively. Skin end-points (wounds, texture changes, and pigmentary changes) were evaluated blinded by clinical evaluations, skin reflectance spectroscopy, and histological examinations. RESULTS: Pre- and postoperative UVR exposed mice obtained higher clinical scores of wounds (P < 0.02) and texture changes (P < 0.01) and developed more heavy fibrosis than mice treated with laser but no UVR. UVR exposure after CO(2) laser treatment induced significant hyperpigmentation compared to unexposed control mice (P < 0.003), whereas CO(2) laser treatment itself did not induce pigmentary changes. CONCLUSIONS: UVR increases in an animal model the occurrence of postoperative side effects from CO(2) laser resurfacing.

Animals↗
PubMed2005

Effective and safe use of lasers, light sources, and radiofrequency devices in the clinical management of Asian patients with selected dermatoses.

BACKGROUND AND OBJECTIVES: The use of lasers, light sources, and radiofrequency devices in Asian patients differs from their use in Caucasians in several respects. STUDY DESIGN/MATERIALS AND METHODS: The disease spectrum is very different with pigmentary disorders being more commonly encountered in Asian populations. Asian skin, with its higher epidermal melanin content, is more likely to develop adverse reactions, especially post-inflammatory hyperpigmentation (PIH), following treatment. RESULTS AND CONCLUSIONS: The purpose of this article is to discuss the effective and safe use of lasers, light sources, and radiofrequency devices in the clinical management of Asian patients with selected dermatoses.

Acne Vulgaris↗
PubMed2006

Comparison study of a traditional pulsed dye laser versus a long-pulsed dye laser in the treatment of early childhood hemangiomas.

BACKGROUND AND OBJECTIVE: The role of pulsed dye laser (PDL) in the treatment of childhood hemangiomas is still controversial because of the inherent characteristics of hemangiomas as well as the side effects of the PDL. Recently, the long pulsed dye laser (LPDL) with cryogen spray cooling (CSC) has been found relatively more effective and safer than the PDL in the treatment of port-wine stains and telangiectasia. This study was designed to compare the efficacy and complication rate of PDL versus LPDL for treating childhood hemangiomas. STUDY DESIGN/MATERIALS AND METHODS: We did a prospective, randomized, controlled trial in which we enrolled 52 Asian infants, aged 1-3 months, with early hemangiomas. These infants were assigned to PDL treatment (n = 26) or LPDL treatment (n = 26) and followed to age 1 year. A PDL with a wavelength of 585 nm and spot size of 7 mm and a LPDL with a wavelength of 595 nm and spot size of 7 mm were used. Each patient in the PDL group was treated with energy fluence between 6 and 7 J/cm(2) and a pulse duration of 0.45 milliseconds without epidermal cooling. Each patient in the LPDL group was treated with energy fluence between 9 and 15 J/cm(2) and a pulse duration of 10-20 milliseconds, utilizing CSC to protect the epidermis. Each group was treated at 4-week intervals until the lesion cleared. When each patient reached an age of 1 year, outcome measures such as clearance rate, time period of maximum proliferation, and complications were assessed. RESULTS: The number of children whose lesions showed complete clearance or minimal residual signs at 1 year of age was 14 (54%) in the PDL group and 17 (65%) in the LPDL group (P = 0.397). Compared with the LPDL, PDL treated children had more hypopigmentation (3, 12% vs. 8, 31%; P = 0.001), more hyperpigmentation (2, 8% vs. 4, 15%; P = 0.005), and more textural changes (1, 4% vs. 6, 23%; P = 0.001). The average time period of maximum proliferation in the LPDL group was significantly shorter than that of the PDL group (106 days vs. 177 days; P = 0.01). CONCLUSION: Early treatment of childhood hemangiomas with the LPDL is safer and more effective than the PDL.

Asian People↗
PubMed2006

Non-ablative 1,450-nm diode laser treatment of striae distensae.

BACKGROUND AND OBJECTIVES: Striae distensae are dermal scars with flattening and atrophy of the epidermis. Successful treatment of these stretch marks has been disappointing. The non-ablative 1,450-nm diode laser has been shown to improve atrophic scars and may be expected to improve striae. As yet, no study has been published to document the effects of this laser on striae. Our aim is to evaluate the efficacy of the 1,450-nm diode laser in the treatment of striae rubra and striae alba in Asian patients with skin types 4-6. STUDY DESIGN/MATERIALS AND METHODS: Striae on one half of the body in 11 patients were treated with the 1,450-nm diode laser with cryogen cooling spray with the other half serving as a control. The following parameters were used: 6 mm spot size and dynamic cooling device (DCD) for 40 milliseconds to protect the epidermis. Patients were randomly assigned to receive either 4, 8, or 12 J/cm2. A total of three treatments were given at 6-week intervals. The following sites were treated: abdomen, arms, back, buttocks, and thighs. Two patients had striae rubra and nine striae alba. Clinical photographs were taken before and after each treatment and analysis was undertaken through photographic evaluation by non-treating physicians. RESULTS: At 2 months after the last treatment, no patients showed any noticeable improvement in the striae on the treated side compared to baseline and to the control areas. Side effects were limited to transient erythema and postinflammatory hyperpigmentation (PIH), which occurred in seven (64%) patients. CONCLUSIONS: The non-ablative 1,450-nm diode laser is not useful in the treatment of striae in patients with skin types 4, 5, and 6.

Adult↗