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Mariwalla K, Dover JS. The use of lasers in the pediatric population. SKIN THERAPY LETTER 2005; 10:7-9. [PMID: 16292457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Over the past 2 decades, there have been numerous advances in laser therapy of birth-marks in the pediatric population. Concerns regarding efficacy, overall benefit, and side-effects linger. We present our opinion, based upon decades of clinical experience, on the role of lasers to treat port wine stains, superficial hemangiomas, and café au lait macules in children.
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Dover JS, Bhatia AC, Stewart B, Arndt KA. Topical 5-Aminolevulinic Acid Combined With Intense Pulsed Light in the Treatment of Photoaging. ACTA ACUST UNITED AC 2005; 141:1247-52. [PMID: 16230562 DOI: 10.1001/archderm.141.10.1247] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The adjunctive use of 5-aminolevulinic acid (5-ALA) with intense pulsed-light (IPL) treatments has been suggested to increase the benefit of IPL for photoaging; however, to our knowledge, no controlled trials have been performed. DESIGN A prospective, randomized, controlled, split-face study was designed. Twenty subjects participated in a series of 3 split-face treatments 3 weeks apart in which half of the face was pretreated with 5-ALA followed by IPL treatment while the other half was treated with IPL alone. Two additional full-face treatments (with IPL alone) were then delivered 3 weeks apart. Assessment of global photodamage, fine lines, mottled pigmentation, tactile roughness, and sallowness (on a scale of 0-4) was performed by a blinded investigator before each treatment and 4 weeks after the final treatment. Patients also completed an assessment at the conclusion of the study comparing their results with pretreatment photographs. RESULTS All 20 volunteers completed the study. Pretreatment with 5-ALA resulted in more improvement in the global score for photoaging (16 [80%] subjects vs 9 [45%] subjects; P = .008) and mottled pigmentation (19 [95%] subjects vs 12 [60%] subjects; P = .008) than IPL treatment alone. More successful results were achieved on the side pretreated with 5-ALA compared with the side treated with IPL alone for fine lines (12 [60%] subjects vs 5 [25%] subjects; P = .008) and mottled pigmentation (17 [85%] subjects vs 4 [20%] subjects; P < .001). While there was noticeable improvement over baseline scores with respect to tactile roughness and sallowness, pretreatment with 5-ALA did not seem to enhance the results of the IPL treatment. The final investigator cosmetic evaluations (P=.0002) and subject satisfaction scores (P=.005) were significantly better for the 5-ALA-pretreated side. Both treatments were well tolerated, with little difference in the incidence or profile of adverse effects with or without 5-ALA pretreatment. CONCLUSIONS The adjunctive use of 5-ALA in the treatment of facial photoaging with IPL provides significantly greater improvement in global photodamage, mottled pigmentation, and fine lines than treatment with IPL alone, without a significant increase in adverse effects. This combination treatment enhances the results of photorejuvenation and improves patient satisfaction.
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Abstract
With the advent of short contact and pulsed light techniques, topical 5-aminolevulinic acid photodynamic therapy (5-ALA PDT) has become a viable clinical modality. Intense pulsed light, the pulsed dye laser, and blue light-emitting lamps have become the most commonly used devices in inducing a cosmetic PDT effect. More recently, by combining the photothermal effects of pulsed light with the photochemical effects of PDT, an enhanced cosmetic effect has been demonstrated in a variety of dermatologic conditions. In addition, the use of shorter 5-ALA incubation times allows for improved patient tolerance during treatment and subsequently fewer adverse effects in the postoperative period. A review of the current literature on cosmetic uses of PDT as well as our personal techniques are discussed in detail.
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Dover JS, Carruthers A, Carruthers J, Alam M. Clinical Use of RESTYLANE. SKIN THERAPY LETTER 2005; 10:5-7. [PMID: 15776203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
There is no ideal filler, nor will there be a single product that can satisfy all requirements. However, RESTYLANE, a non-animal, stabilized hyaluronic acid (NASHA, Medicis), is a very versatile augmenting agent. It has been in clinical use for 8 years and experience has shown it to be close to the ideal filler in many respects. This review will outline the background to the use of RESTYLANE, and will focus on the clinical use of this material.
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Hsu TSJ, Zelickson B, Dover JS, Kilmer S, Burns J, Hruza G, Brown DB, Bernstein EF. Multicenter Study of the Safety and Efficacy of a 585 nm Pulsed-Dye Laser for the Nonablative Treatment of Facial Rhytides. Dermatol Surg 2005; 31:1-9. [PMID: 15720087 DOI: 10.1097/00042728-200501000-00001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to assess the safety and efficacy of a 585 nm flashlamp pulsed-dye laser for the nonablative treatment of facial rhytides. METHODS A multicenter prospective randomized controlled study on 58 volunteers was performed. A split-face approach was adopted, with one periorbital region acting as a control and the other receiving either one or two treatments. Patients were photographed and imaged three-dimensionally before and after treatment. Histologic sections were analyzed. RESULTS Three-dimensional topographic evaluation showed improvements of 9.8% (p = .0022) and 15% (p = .0029) in surface roughness for single and double treatments, respectively. Histology revealed an increase in type I collagen messenger ribonucleic acid expression, type III procollagen, chondroitin sulfate, and grenz zone thickness. Two treatments resulted in greater improvement than one treatment. CONCLUSION Clinical improvement was achieved following a single treatment. Further improvement was observed following a second treatment. The subjective evaluation of clinical improvement was consistent with both histologic and topographic quantitative measurements.
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Alam M, Dover JS. Treatment of photoaging with topical aminolevulinic acid and light. SKIN THERAPY LETTER 2004; 9:7-9. [PMID: 15657634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Photodynamic therapy (PDT) has been used for several years for the treatment of actinic keratoses and prevention of invasive nonmelanoma cancers. More recently, increasing physician expertise with the topical sensitizers and light sources employed in PDT has led to expanded applications, including its use for improvement of the visible signs of photoaging. Aesthetic treatment of photoaged skin with brief application of topical 5-aminolevulinic acid followed by well-tolerated light sources, such as intense pulsed light or pulsed-dye laser, can enhance the effectiveness of nonablative laser treatment without increasing adverse effects or downtime.
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Dover JS, Bhatia A, Stewart B, Arndt K. A bilateral comparison of the efficacy and safety of photodynamic therapy with 20% aminolevulinic acid (ALA) topical solution and intense pulsed light versus intense pulsed light alone in the treatment of mild to moderate photoaging. J Am Acad Dermatol 2004. [DOI: 10.1016/j.jaad.2003.10.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tan MH, Dover JS, Hsu TS, Arndt KA, Stewart B. Clinical evaluation of enhanced nonablative skin rejuvenation using a combination of a 532 and a 1,064 nm laser. Lasers Surg Med 2004; 34:439-45. [PMID: 15216538 DOI: 10.1002/lsm.20066] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES Improvements in the physical signs of photoaging can be achieved by non-invasive laser resurfacing procedures. To evaluate the effectiveness and safety of the Nd:YAG 1,064 nm and KTP 532 nm lasers for non-invasive skin rejuvenation. STUDY DESIGN/PATIENTS AND METHODS Subjects requesting non-invasive skin rejuvenation underwent two treatments with the 532 nm laser to one side of the face and with both lasers to the other side, followed by three treatments with the 1,064 nm laser to both sides. Skin characteristics were evaluated before, during, and up to 4 months after treatment. RESULTS A >25% improvement in overall skin condition was observed for >30% of subjects at the 1 month follow-up and >40% of subjects at the 4 month follow-up. The greatest improvements were observed for visual dryness, roughness, and uneven pigmentation. No adverse events were reported. There was a trend for greater improvement in patients who received more 1,064 nm treatments but this was not statistically significant. CONCLUSIONS The 532 nm KTP and 1,064 nm Nd: YAG lasers can be effectively and safely used for non-invasive skin rejuvenation.
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Alam M, Hsu TS, Dover JS, Wrone DA, Arndt KA. Nonablative laser and light treatments: histology and tissue effects--a review. Lasers Surg Med 2003; 33:30-9. [PMID: 12866119 DOI: 10.1002/lsm.10195] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES Nonablative laser and light treatments have largely replaced ablative laser therapy in clinical use for the improvement of the visible signs of cutaneous photoaging, including rhytides, vascular lesions, and pigmentation. However, the mechanisms underlying the reported clinical efficacy of nonablative treatments are not well-understood. The purpose of this analysis is to critically evaluate what is known about histologic and tissue effects of nonablative laser therapy and suggest future directions for research. STUDY DESIGN/MATERIALS AND METHODS This is a review of the English language literature pertaining to nonablative laser and light treatments available through MEDline (1995-2002), and unpublished reports presented at major national meetings. Only studies that included harvesting and analysis of tissue samples are included. RESULTS AND CONCLUSIONS (a) Thermal injury to the dermis in association with epidermal cooling most likely affects the dermal vasculature, which initiates a cascade of inflammatory events that includes fibroblastic proliferation and apparent up-regulation of collagen expression; (b) There is no indication that nonablative treatments are harmful or able to induce skin cancer; (c) It is possible that the horizontally distributed collagen reported after nonablative treatments is a "microscar," an enlarged Grenz sone associated with repetitive photo-induced trauma; (d) Further research is needed to elucidate the biophysical mechanisms underlying nonablative treatment, as well as to distinguish the utility of different wavelengths on epidermal and dermal improvement.
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Batra RS, Jacob CI, Hobbs L, Arndt KA, Dover JS. A Prospective Survey of Patient Experiences After Laser Skin Resurfacing. ACTA ACUST UNITED AC 2003; 139:1295-9. [PMID: 14568834 DOI: 10.1001/archderm.139.10.1295] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Laser skin resurfacing (LSR) is a common cosmetic surgical procedure, yet there are no prospective long-term studies on patients' perceptions of their procedure. OBJECTIVE To prospectively document patients' subjective experiences after LSR. DESIGN Twenty-seven consecutive patients who underwent combination carbon dioxide/erbium:YAG full-face laser resurfacing for acne scarring or photodamage were surveyed at postoperative days 1 and 3, within 1 week, at 3 weeks, 6 weeks, 3 months, and 30 months and asked standardized questions. SETTING Referral-based academic practice. RESULTS One day after LSR, 10 patients (37%) were concerned about the outcome, and 3 (11%) considered it a "terrible" experience. At 2.7 days after the procedure, 23 patients (85%) would recommend LSR, and after 3.7 days, 24 (89%) would have the procedure again. At 3 months, the patients' mean rating of appearance was 2.3 (0-3 scale), and all 27 (100%) felt that their appearance had been improved by LSR. After 30 months, 18 patients (75%) would recommend the procedure, 17 (71%) would have LSR again, 21 (88%) felt that their appearance was improved, and final appearance was rated 1.8 (0-3 scale). Patients undergoing LSR to treat acne scarring were as satisfied as patients treated for photodamage. CONCLUSIONS Data on the evolution of patient perspective after LSR can improve patient preparation. This may help the surgeon and patient achieve shared, realistic expectations for the postoperative period and for long-term results.
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Alam M, Dover JS, Arndt KA. Energy Delivery Devices for Cutaneous Remodeling Lasers, Lights, and Radio Waves. ACTA ACUST UNITED AC 2003; 139:1351-60. [PMID: 14568841 DOI: 10.1001/archderm.139.10.1351a] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Alam M, Omura NE, Dover JS, Arndt KA. Clinically significant facial edema after extensive treatment with purpura-free pulsed-dye laser. Dermatol Surg 2003; 29:920-4. [PMID: 12930333 DOI: 10.1046/j.1524-4725.2003.29254.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Long-pulsed pulsed-dye lasers permit treatment of facial erythema and telangiectasia with purpura-free technique, which may be more comfortable for the patient than purpura-inducing treatment. However, there are anecdotal reports of treatment-associated discomfort even when purpura is not elicited. OBJECTIVE To determine whether patients experience clinically significant erythema, edema, and pain after purpura-free treatment with pulsed-dye laser. METHODS In this prospective, controlled study, subjects included 15 patients who were undergoing purpura-free treatment of diffuse erythema and fine telangiectasia of at least half the facial surface area with purpura-free pulsed-dye, and it included 15 age, gender, and skin-type matched control subjects who were undergoing similar treatments but with the induction of trace to mild purpura. Patients were seen in person and were surveyed by phone regarding symptoms and signs during their postoperative courses. RESULTS Postoperative erythema of a mean 3.3-days duration and 3.4/5.0 intensity was reported by 73% (11 of 15) of the purpura-free patients. Among purpura patients, the duration was 5.6 days. The intensity was 4.0, and again, 73% of patients reported this finding. Postoperative edema occurred among 87% of purpura-free patients, but such edema occurred in all of the purpura patients, in whom it lasted longer and was more intense. Symptomatic eye swelling and uncomfortable/painful edema were seen in 27% and 20%, respectively, of purpura-free patients, but in 40% and 53% of purpura patients. Among purpura-free patients receiving fewer than 250 laser pulses per treatment, erythema and edema lasted less than 1 day and 2.5 days, whereas the mean durations were 3.4 and 5.0 days for purpura-free patients receiving greater than 250 pulses. CONCLUSION Extensive purpura-free treatment for erythema and telangiectasia of the face with the long-pulsed pulsed-dye laser can lead to clinically significant erythema, edema, and discomfort in patients. The duration, magnitude, and frequency of these undesired effects are markedly less with purpura-free treatment compared with purpura-inducing treatment and are also less for less extensive purpura-free treatments.
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Abstract
The improved understanding of laser-tissue interaction along with the latest advances of laser technology have led to the development of sophisticated, safe, and user-friendly laser systems that provide effective treatment for a variety of aesthetic skin conditions. The use of lasers and their tissue-specific capabilities in the treatment of pigmented and vascular lesions has been greatly expanded to include rhytides, photoaged skin, atrophic scars, and unwanted hair. In addition, laser techniques have been employed in traditional "rejuvenating" procedures of aged skin, e.g., face-lifting, blepharoplasty, and hair transplantation, decreasing the intra-operative time and limiting the recovery period. These advances have led to a wide acceptance of cutaneous laser surgery by the dermatologic community and have created an increasing popularity among the public. The purpose of this article is to review the applications of lasers in aesthetic dermatology and discuss their limitations and potential side effects.
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Hsu TS, Dover JS, Kaminer MS, Arndt KA, Tan MH. Why make patients exercise facial muscles for 4 hours after botulinum toxin treatment? ARCHIVES OF DERMATOLOGY 2003; 139:948. [PMID: 12873906 DOI: 10.1001/archderm.139.7.948-a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Alam M, Dover JS, Arndt KA. Treatment of facial telangiectasia with variable-pulse high-fluence pulsed-dye laser: comparison of efficacy with fluences immediately above and below the purpura threshold. Dermatol Surg 2003; 29:681-4; discussion 685. [PMID: 12828690 DOI: 10.1046/j.1524-4725.2003.29181.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND : Pulsed-dye laser treatment has been shown to be highly effective for the treatment of facial telangiectasia. Posttreatment purpura after such treatment has limited patient acceptance of the procedure. OBJECTIVE : To determine whether purpura-free treatment with recently introduced variable-pulsed pulsed-dye lasers can effectively reduce facial telangiectasia. METHODS : This was a prospective, randomized, controlled, nonblinded trial. Eleven patients received variable-pulse pulsed-dye laser treatment with and without induction of purpura. Telangiectasia were graded on a "telangiectasia density scale," on which a 1 signified extremely fine, sparsely distributed telangiectasia, and 5 referred to thick, ropelike telangiectasia covering the affected area. For each subject, two areas on either side of the facial midline with equivalent telangiectasia density ratings were randomized to the purpura and purpura-free treatment groups, respectively. All treatments used a 7-mm spot size and a 10-ms pulse duration. The fluence associated with the purpura threshold for each patient was determined in test areas. Purpura-free treatment entailed a fluence 1.0 J/cm2 less than the purpura threshold, and purpura-level treatment entailed a fluence 0.5 J/cm2 greater than the threshold. RESULTS : Six weeks after a single purpura-free treatment, mean telangiectasia ratings were reduced from 2.7 to 2.4. Purpura-level treatments resulted in a decrease to 1.4 from the same baseline. Thicker, denser telangiectasia appeared to benefit more from purpura-level treatment (a mean telangiectasia density scale reduction of 1.7) than finer, sparser telangiectasia (a mean reduction of 0.8). In 81% of cases, both investigators and patients rated the side treated with purpura as undergoing a greater reduction in telangiectasia density. CONCLUSION : Although facial telangiectasia do improve after a single purpura-free treatment with the variable-pulse pulsed-dye laser, they improve more after purpura is induced. Purpura-free and purpura-level treatments may be close to equivalent for treating fine telangiectasia, but purpura-level treatments have a distinct advantage for treating thicker telangiectasia. Significantly, the variable-pulse pulsed-dye laser offers patients the option of effective treatment of some telangiectasia without bruising.
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van Laborde S, Dover JS, Moore M, Stewart B, Arndt KA, Alam M. Reduction in injection pain with botulinum toxin type B further diluted using saline with preservative: a double-blind, randomized controlled trial. J Am Acad Dermatol 2003; 48:875-7. [PMID: 12789177 DOI: 10.1067/mjd.2003.487] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Injection with botulinum A exotoxin reconstituted with preserved saline has been shown to be less uncomfortable than injection with the same toxin reconstituted with preservative-free saline. OBJECTIVE We sought to determine whether injection with botulinum toxin type B is similarly less painful when preservative-containing saline is used to further dilute the product. METHODS We conducted a double-blind, randomized controlled trial. A total of 15 consecutive adult patients presenting for treatment of upper face dynamic lines received treatment to one side (left or right) of the face with toxin type B further diluted with preservative-containing saline, and to the other side with toxin type B further diluted with preservative-free saline. RESULTS Of 15 patients, 13 (87%) reported less pain in the halves of their faces treated with the preservative-containing saline (P =.0006). Pain on the preservative-containing side was on average 32% less among patients as a whole, and 39% less among patients noting some reduction. The 95% confidence interval for pain reduction associated with preservative-containing injection was -46.9% to -16.1%. Neither investigators nor patients observed any difference in clinical efficacy between the 2 treatment sides. CONCLUSIONS Use of preservative-containing saline to further dilute botulinum toxin type B can significantly decrease patient discomfort on injection.
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Alam M, Dover JS. Nonablative laser and light therapy: an approach to patient and device selection. SKIN THERAPY LETTER 2003; 8:4-7. [PMID: 12858232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Nonablative laser and light therapy is a relatively novel modality for the improvement of the visual appearance of photodamaged, scarred, and injured skin. A number of different wavelengths and devices have been purported to be efficacious for the delivery of nonablative therapy. Among the features that can be addressed are red spots and telangiectasia, pigmentation and lentigines, and their daily routines while benefiting from the cumulative effects of skin rejuvenation.
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Alam M, Pantanowitz L, Harton AM, Arndt KA, Dover JS. A prospective trial of fungal colonization after laser resurfacing of the face: correlation between culture positivity and symptoms of pruritus. Dermatol Surg 2003; 29:255-60. [PMID: 12614419 DOI: 10.1046/j.1524-4725.2003.29060.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND After full-face laser resurfacing of the face, patients often complain of pruritus, which may be intense. It has been suggested that some cases of postresurfacing pruritus may be associated with subclinical fungal infection. OBJECTIVE To determine whether intense pruritus after laser resurfacing of the face is correlated with simultaneous fungal growth of the treated skin. METHODS Twelve adult female patients undergoing combined full-face laser resurfacing with CO2 and erbium:YAG lasers for chronic photodamage or acne scarring were enrolled in a prospective study. Fungal cultures were obtained by swabbing the facial skin of each patient immediately before, 3 days after, and 6 days after the laser procedure. At the same points in time, investigators completed objective assessments of the patients' facial skin, and patients reported the sensations that they were experiencing. RESULTS Six patients (50%) complained of significant pruritus (3 or greater on a scale of 0 to 5). In four of the six cases (67%), at least one of the three fungal cultures obtained grew fungal organisms, including Candida albicans (2 cultures), Candida parapsilosis, Aureobasidium pullulans, and Fusarium species. In no instances did culture positivity occur in the absence of significant pruritus. A statistically significant relationship (P=0.0143) was found to exist between at least one of the three cultures being positive and the emergence of significant posttreatment pruritus. Physician ratings of clinical signs did not correlate with patient reports of pruritus, other symptoms, or culture positivity. CONCLUSION Colonization or subclinical infection with fungi, particularly Candida spp., may be associated with significant postlaser resurfacing pruritus. Antifungal prophylaxis may mitigate this discomfort. Further research is required to confirm and expand these results.
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Omura NE, Dover JS, Arndt KA, Kauvar ANB. Treatment of reticular leg veins with a 1064 nm long-pulsed Nd:YAG laser. J Am Acad Dermatol 2003; 48:76-81. [PMID: 12522374 DOI: 10.1067/mjd.2003.38] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Millisecond-pulsed Nd:YAG lasers have been developed for the treatment of reticular leg veins. OBJECTIVE We evaluated the effectiveness of a single treatment with a 50 millisecond 1064 nm Nd:YAG laser in the treatment of reticular veins of the lower extremity. METHODS Twenty patients with reticular veins measuring 1.0 to 3.0 mm in diameter received one treatment with a 1064 nm Nd:YAG laser (Coolglide, Altus, Burlingame, Calif) at fluences of 100 J/cm(2) and 50 millisecond pulse duration. Symmetric matched areas that were left untreated served as the control. Eleven patients were pretreated with a topical anesthetic cream for 1 hour before treatment and wore compression stockings for 5 days after treatment. Nine patients were treated without topical anesthesia and did not wear compression stockings. Percent clearing and side effects were determined by 3 nontreating physicians (at each respective site) comparing projected Kodachrome images 1 month and 3 months after treatment. Patients also performed a self-assessment of their results. RESULTS Two-thirds of vessels measuring 1 to 3 mm in diameter cleared more than 75% with one treatment. Larger vessels appeared to improve more than smaller vessels. Immediate treatment discomfort was tolerable. Side effects were minimal and included superficial thrombosis, delayed bruising, hyperpigmentation, and matting. CONCLUSION Millisecond-pulsed Nd:YAG lasers used with 50 millisecond pulses are effective in the treatment of reticular leg veins.
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Batra RS, Dover JS, Hobbs L, Phillips TJ. Evaluation of the role of exogenous estrogen in postoperative progress after laser skin resurfacing. Dermatol Surg 2003; 29:43-8. [PMID: 12534511 DOI: 10.1046/j.1524-4725.2003.29011.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recent studies indicate that exogenous estrogens may promote wound healing. Many laser skin resurfacing (LSR) patients use hormone replacement therapy (HRT) or oral contraceptive pills (OCPs). OBJECTIVE To evaluate the effect of exogenous estrogen on LSR postoperative healing. METHODS This is a retrospective case control study of 44 female patients who underwent combination CO2/Er:YAG full-face LSR. Sixteen postmenopausal patients using oral HRT during procedure and follow-up were compared with 16 controls. Six premenopausal patients on estrogen-containing OCPs during the procedure and follow-up were compared with six controls. Case and control groups were matched by age, skin type, and treatment technique. Premenopausal and postmenopausal groups were compared. The variables evaluated included erythema, swelling, crusting, purpura, pain, pruritus, reepithelialization, complications, and patient assessment of outcome. RESULTS For premenopausal and postmenopausal women, there were no significant differences in outcome measures of postoperative morbidity between groups receiving and not receiving estrogen. The incidence of complications, time until re-epithelialization, and patient assessment of outcome were similar between groups. CONCLUSION Our findings suggest that exogenous estrogen in the form of HRT or OCPs does not clinically alter postoperative progress in combination CO2/Er:YAG LSR patients. Premenopausal women heal comparably to postmenopausal women after LSR.
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Biesman BS, Dover JS, Arndt KA, Geronemus RG. Lasers in facial plastic surgery. ARCHIVES OF FACIAL PLASTIC SURGERY 2002; 4:270-1. [PMID: 12437437 DOI: 10.1001/archfaci.4.4.270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Alam M, Dover JS, Klein AW, Arndt KA. Botulinum a exotoxin for hyperfunctional facial lines: where not to inject. ARCHIVES OF DERMATOLOGY 2002; 138:1180-5. [PMID: 12224979 DOI: 10.1001/archderm.138.9.1180] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Dover JS. My skin has become drier and more fragile as I've aged. Why is that, and what can I do about it? HEALTH NEWS (WALTHAM, MASS.) 2002; 8:12. [PMID: 12206142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Alam M, Omura NE, Dover JS, Arndt KA. Glycolic acid peels compared to microdermabrasion: a right-left controlled trial of efficacy and patient satisfaction. Dermatol Surg 2002; 28:475-9. [PMID: 12081674 DOI: 10.1046/j.1524-4725.2002.01144.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Glycolic acid peels and microdermabrasion are widely recommended by dermatologists and others for facial skin rejuvenation, but few studies have assessed their clinical efficacy. OBJECTIVE To compare the relative efficacy of glycolic acid peels and microdermabrasion for facial skin rejuvenation. METHODS An unblinded, randomized controlled trial was used. Each of 10 patients received paired treatments with glycolic acid peels (20%) and microdermabrasion (mild setting) for 6 consecutive weeks. The right and left sides of the face were treated with different modalities. Once a patient was assigned to receive a particular modality to a particular side of the face, all subsequent treatments were delivered in the same manner. Patient ratings, investigator ratings, and photographs were obtained before the first treatment and 1 week after the last treatment. RESULTS In terms of overall preference for a given type of treatment, seven patients chose glycolic acid peels, one selected microdermabrasion, and two had no favorite treatment. The relative preference for glycolic acid peels approached significance (P =.0578). Investigator ratings and photographic comparisons did not reveal treatment-specific differences or significant improvement from baseline. No serious side effects were seen with either treatment, and even mild effects were seldom reported. CONCLUSION In this study, patients appeared to prefer low-strength glycolic acid peels to low-intensity microdermabrasion for facial rejuvenation. Differences in patient satisfaction were subtle and may be technique dependent.
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