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Patel AD, Chopra R, Avram M, Sakamoto FH, Kilmer S, Anderson RR, Ibrahimi OA. Updates on Lasers in Dermatology. Dermatol Clin 2024; 42:33-44. [PMID: 37977682 DOI: 10.1016/j.det.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
The introduction of selective photothermolysis by Drs. John Parrish and Rox Anderson in 1983 revolutionized how lasers are used in dermatology. The theory allowed for lasers to be used in a variety of applications both safe and effectively, and the number of applications has only expanded with time. From the first application on vascular birthmarks to more recent applications for acne, this review covers the evolution of lasers from the beginning to where we are headed.
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Affiliation(s)
- Ashaki D Patel
- Department of Dermatology, Massachusetts General Hospital Laser and Cosmetic Center, 50 Staniford Street, Suite 250, Boston, MA 02114, USA; Wellman Center for Photomedicine, Massachusetts General Hospital, 15 Parkman Street, Wang Ambulatory Care Center - Suite 435, Boston, MA 02114, USA.
| | - Rishi Chopra
- Department of Dermatology, Massachusetts General Hospital Laser and Cosmetic Center, 50 Staniford Street, Suite 250, Boston, MA 02114, USA; Wellman Center for Photomedicine, Massachusetts General Hospital, 15 Parkman Street, Wang Ambulatory Care Center - Suite 435, Boston, MA 02114, USA
| | - Mathew Avram
- Department of Dermatology, Massachusetts General Hospital Laser and Cosmetic Center, 50 Staniford Street, Suite 250, Boston, MA 02114, USA; Wellman Center for Photomedicine, Massachusetts General Hospital, 15 Parkman Street, Wang Ambulatory Care Center - Suite 435, Boston, MA 02114, USA
| | - Fernanda H Sakamoto
- Department of Dermatology, Massachusetts General Hospital Laser and Cosmetic Center, 50 Staniford Street, Suite 250, Boston, MA 02114, USA; Wellman Center for Photomedicine, Massachusetts General Hospital, 15 Parkman Street, Wang Ambulatory Care Center - Suite 435, Boston, MA 02114, USA
| | - Suzanne Kilmer
- Wellman Center for Photomedicine, Massachusetts General Hospital, 15 Parkman Street, Wang Ambulatory Care Center - Suite 435, Boston, MA 02114, USA; Laser & Skin Surgery Center of Northern California, 3837 J Street, Sacramento, CA 95816, USA
| | - Richard Rox Anderson
- Department of Dermatology, Massachusetts General Hospital Laser and Cosmetic Center, 50 Staniford Street, Suite 250, Boston, MA 02114, USA; Wellman Center for Photomedicine, Massachusetts General Hospital, 15 Parkman Street, Wang Ambulatory Care Center - Suite 435, Boston, MA 02114, USA
| | - Omar A Ibrahimi
- Wellman Center for Photomedicine, Massachusetts General Hospital, 15 Parkman Street, Wang Ambulatory Care Center - Suite 435, Boston, MA 02114, USA; Connecticut Skin Institute, Stamford, CT, USA
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Thalheimer RD, Merker VL, Ly KI, Champlain A, Sawaya J, Askenazi NL, Herr HP, Da JLW, Jordan JT, Muzikansky A, Pearce EM, Sakamoto FH, Blakeley JO, Anderson RR, Plotkin SR. Validating Techniques for Measurement of Cutaneous Neurofibromas: Recommendations for Clinical Trials. Neurology 2021; 97:S32-S41. [PMID: 34230197 DOI: 10.1212/wnl.0000000000012428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 05/11/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the reliability and variability of digital calipers, 3D photography, and high-frequency ultrasound (HFUS) for measurement of cutaneous neurofibromas (cNF) in patients with neurofibromatosis type 1 (NF1). BACKGROUND cNF affect virtually all patients with NF1 and are a major source of morbidity. Reliable techniques for measuring cNF are needed to develop therapies for these tumors. METHODS Adults with NF1 were recruited. For each participant, 6 cNF were assessed independently by 3 different examiners at 5 different time points using digital calipers, 3D photography, and HFUS. The intraclass correlation coefficient (ICC) was used to assess intrarater and interrater reliability of linear and volumetric measurements for each technique, with ICC values >0.90 defined as excellent reliability. The coefficient of variation (CV) was used to estimate the minimal detectable difference (MDD) for each technique. RESULTS Fifty-seven cNF across 10 participants were evaluated. The ICC for image acquisition and measurement was >0.97 within and across examiners for HFUS and 3D photography. ICC for digital calipers was 0.62-0.88. CV varied by measurement tool, linear vs volumetric measurement, and tumor size. CONCLUSIONS HFUS and 3D photography demonstrate excellent reliability whereas digital calipers have good to excellent reliability in measuring cNF. The MDD for each technique was used to create tables of proposed thresholds for investigators to use as guides for clinical trials focused on cNF size. These criteria should be updated as the performance of these end points is evaluated.
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Affiliation(s)
- Raquel D Thalheimer
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vanessa L Merker
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - K Ina Ly
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amanda Champlain
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer Sawaya
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Naomi L Askenazi
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hamilton P Herr
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer L W Da
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Justin T Jordan
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alona Muzikansky
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elizabeth Morehouse Pearce
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Fernanda H Sakamoto
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jaishri O Blakeley
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - R Rox Anderson
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Scott R Plotkin
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD.
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Purschke M, Elsamaloty M, Wilde JP, Starr N, Anderson RR, Farinelli WA, Sakamoto FH, Tung M, Tam J, Hesselink L, Baer TM. Construction and validation of UV-C decontamination cabinets for filtering facepiece respirators. Appl Opt 2020; 59:7585-7595. [PMID: 32902458 DOI: 10.1364/ao.401602] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/12/2020] [Indexed: 06/11/2023]
Abstract
We present evidence-based design principles for three different UV-C based decontamination systems for N95 filtering facepiece respirators (FFRs) within the context of the SARS-CoV-2 outbreak of 2019-2020. The approaches used here were created with consideration for the needs of low- and middle-income countries (LMICs) and other under-resourced facilities. As such, a particular emphasis is placed on providing cost-effective solutions that can be implemented in short order using generally available components and subsystems. We discuss three optical designs for decontamination chambers, describe experiments verifying design parameters, validate the efficacy of the decontamination for two commonly used N95 FFRs (3M, #1860 and Gerson #1730), and run mechanical and filtration tests that support FFR reuse for at least five decontamination cycles.
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Garibyan L, Kroshinsky D, Freeman E, Sakamoto FH, Anderson RR. A strategy for empowering clinicians and increasing innovation: the Magic Wand Initiative. Arch Dermatol Res 2020; 313:599-602. [PMID: 32761381 DOI: 10.1007/s00403-020-02111-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/23/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022]
Abstract
Clinicians play a critical role in recognizing, initiating, and adopting innovative solutions to clinical problems. Increasing clinician involvement in problem-based innovation will help identify and solve unmet medical needs. The overall objective of our program was to increase clinician involvement in problem-based innovation. We pioneered and piloted the "Magic Wand" Initiative (MWI) at Massachusetts General Hospital Department of Dermatology, by inviting clinical faculty to voluntarily participate in problem-driven innovation. The primary outcome was the number of unmet clinical needs identified and pursued by clinicians, who were 'activated' to initiate problem-based innovation. Other objectives were to enhance clinician-to-clinician dialogue and to develop specific strategic framework for clinician-led, problem-driven research. This pilot MWI was started in 2013 with an announcement at dermatology faculty meeting inviting all clinical faculty to participate on volunteer basis. Academic dermatologists were the main participants in this program. They also contacted, collaborated and worked with research faculty, industry experts and lawyers. Out of 30 unmet needs identified by clinicians participating in MWI, eight are actively being pursued by clinicians. Three of those cases presented here have achieved publications, grant funding, prototype devices and product for patient use. In conclusion, MWI is an innovative approach that educates and equips clinician to identify and solve problems and engages them as leaders in their healthcare ecosystem. MWI has achieved concrete measurable success, affirming that if clinicians are empowered and supported to identify and solve existing unmet medical problems, new and innovative solutions can be invented to improve patient care.
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Affiliation(s)
- Lilit Garibyan
- Department of Dermatology, Harvard Medical School, Boston, USA. .,Wellman Center for Photomedicine, Massachusetts General Hospital, 50 Blossom Street-Thier 2, Boston, MA, 02114, USA.
| | | | - Esther Freeman
- Department of Dermatology, Harvard Medical School, Boston, USA
| | - Fernanda H Sakamoto
- Department of Dermatology, Harvard Medical School, Boston, USA.,Wellman Center for Photomedicine, Massachusetts General Hospital, 50 Blossom Street-Thier 2, Boston, MA, 02114, USA
| | - Richard Rox Anderson
- Department of Dermatology, Harvard Medical School, Boston, USA.,Wellman Center for Photomedicine, Massachusetts General Hospital, 50 Blossom Street-Thier 2, Boston, MA, 02114, USA
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Bouthillette M, Beccati D, Akthakul A, Ramadurai N, Nashat A, Langer R, Anderson RR, Sakamoto FH. A crosslinked polymer skin barrier film for moderate to severe atopic dermatitis: A pilot study in adults. J Am Acad Dermatol 2019; 82:895-901. [PMID: 31589946 DOI: 10.1016/j.jaad.2019.09.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/05/2019] [Accepted: 09/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Occlusive treatments are a mainstay in atopic dermatitis (AD) management but may not be well tolerated or lack compliance. A comfortable, semiocclusive, artificial skin barrier that is well tolerated, provides protection, and reduces water loss is needed. OBJECTIVE To evaluate the potential tolerability and therapeutic benefits of a crosslinked polymer layer (XPL) in adults with AD. METHODS A single-center, open-label pilot study was conducted involving 10 subjects with moderate to severe AD. Subjects applied XPL up to twice daily for 30 days on a selected treatment area. Investigator's Global Assessment, clinical signs of eczema, and pruritus were assessed on days 1, 3, 5, 15, and 30. Film durability and patient satisfaction were also evaluated. RESULTS Investigator's Global Assessment scores improved from moderate to severe at baseline to clear to almost clear in 8 of 9 patients at day 30. Pruritus improved from trace to severe itching (baseline) to all subjects having trace to no itching at day 30. There was 1 adverse event of mild exudative dermatitis. LIMITATIONS The study was limited by small sample size, open-label design, and lack of control. CONCLUSION XPL may be an effective adjuvant in AD treatment. A larger study with a control group is warranted.
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Affiliation(s)
- Melaney Bouthillette
- Shiseido Americas Corporation, Cambridge, Massachusetts; Olivo Laboratories, LLC, Watertown, Massachusetts.
| | - Daniela Beccati
- Shiseido Americas Corporation, Cambridge, Massachusetts; Olivo Laboratories, LLC, Watertown, Massachusetts
| | - Ariya Akthakul
- Shiseido Americas Corporation, Cambridge, Massachusetts; Olivo Laboratories, LLC, Watertown, Massachusetts
| | - Nithin Ramadurai
- Shiseido Americas Corporation, Cambridge, Massachusetts; Olivo Laboratories, LLC, Watertown, Massachusetts
| | - Amir Nashat
- Olivo Laboratories, LLC, Watertown, Massachusetts
| | - Robert Langer
- Harvard-MIT Division of Health Science and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts; David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts; Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - R Rox Anderson
- Harvard-MIT Division of Health Science and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts; Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Fernanda H Sakamoto
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Dermatology, Harvard Medical School, Boston, Massachusetts.
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Russe E, Purschke M, Herold M, Sakamoto FH, Wechselberger G, Russe‐Wilflingseder K. Evaluation of Safety and Efficacy of Laser Hair Removal With the Long‐Pulsed 755 nm Wavelength Laser: A Two‐Center Study With 948 Patients. Lasers Surg Med 2019; 52:77-83. [DOI: 10.1002/lsm.23160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Elisabeth Russe
- Center for Plastic Surgery and Lasers in Surgery and MedicinePlastische Chirurgie und Laserzentrum InnsbruckInnsbruck 6020 Austria
- Department of Plastic and Reconstructive Surgery, Hospital of the Barmherzige BrüderTeaching Hospital of the Paracelsus Medical University Salzburg5020 Salzburg Austria
| | - Martin Purschke
- Wellman Center for Photomedicine, Massachusetts General HospitalHarvard Medical SchoolBoston Massachusetts
| | - Manfred Herold
- Center for Plastic Surgery and Lasers in Surgery and MedicinePlastische Chirurgie und Laserzentrum InnsbruckInnsbruck 6020 Austria
| | - Fernanda H. Sakamoto
- Wellman Center for Photomedicine, Massachusetts General HospitalHarvard Medical SchoolBoston Massachusetts
| | - Gottfried Wechselberger
- Department of Plastic and Reconstructive Surgery, Hospital of the Barmherzige BrüderTeaching Hospital of the Paracelsus Medical University Salzburg5020 Salzburg Austria
| | - Katharina Russe‐Wilflingseder
- Center for Plastic Surgery and Lasers in Surgery and MedicinePlastische Chirurgie und Laserzentrum InnsbruckInnsbruck 6020 Austria
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Russe E, Purschke M, Limpiangkanan W, Farinelli WA, Wang Y, Doukas AG, Sakamoto FH, Wechselberger G, Anderson RR. Significant skin-tightening by closure of fractional ablative laser holes. Lasers Surg Med 2017; 50:64-69. [DOI: 10.1002/lsm.22748] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Elisabeth Russe
- Wellman Center for Photomedicine, Massachusetts General Hospital; Harvard Medical School; Boston Massachussetts
- Department of Plastic and Reconstructive Surgery, Hospital of the Barmherzige Brüder; Paracelsus Medical University Salzburg; Kajetanerplatz 1 5020 Salzburg Austria
| | - Martin Purschke
- Wellman Center for Photomedicine, Massachusetts General Hospital; Harvard Medical School; Boston Massachussetts
- Department of Dermatology; Harvard Medical School; Boston Massachussetts
| | - Wikunda Limpiangkanan
- Wellman Center for Photomedicine, Massachusetts General Hospital; Harvard Medical School; Boston Massachussetts
| | - William A. Farinelli
- Wellman Center for Photomedicine, Massachusetts General Hospital; Harvard Medical School; Boston Massachussetts
- Department of Dermatology; Harvard Medical School; Boston Massachussetts
| | - Ying Wang
- Wellman Center for Photomedicine, Massachusetts General Hospital; Harvard Medical School; Boston Massachussetts
- Department of Dermatology; Harvard Medical School; Boston Massachussetts
| | - Apostolos G. Doukas
- Wellman Center for Photomedicine, Massachusetts General Hospital; Harvard Medical School; Boston Massachussetts
- Department of Dermatology; Harvard Medical School; Boston Massachussetts
| | - Fernanda H. Sakamoto
- Wellman Center for Photomedicine, Massachusetts General Hospital; Harvard Medical School; Boston Massachussetts
- Department of Dermatology; Harvard Medical School; Boston Massachussetts
| | - Gottfried Wechselberger
- Department of Plastic and Reconstructive Surgery, Hospital of the Barmherzige Brüder; Paracelsus Medical University Salzburg; Kajetanerplatz 1 5020 Salzburg Austria
| | - Richard Rox Anderson
- Wellman Center for Photomedicine, Massachusetts General Hospital; Harvard Medical School; Boston Massachussetts
- Department of Dermatology; Harvard Medical School; Boston Massachussetts
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Yu B, Kang SY, Akthakul A, Ramadurai N, Pilkenton M, Patel A, Nashat A, Anderson DG, Sakamoto FH, Gilchrest BA, Anderson RR, Langer R. An elastic second skin. Nat Mater 2016; 15:911-918. [PMID: 27159017 DOI: 10.1038/nmat4635] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 03/31/2016] [Indexed: 06/05/2023]
Abstract
We report the synthesis and application of an elastic, wearable crosslinked polymer layer (XPL) that mimics the properties of normal, youthful skin. XPL is made of a tunable polysiloxane-based material that can be engineered with specific elasticity, contractility, adhesion, tensile strength and occlusivity. XPL can be topically applied, rapidly curing at the skin interface without the need for heat- or light-mediated activation. In a pilot human study, we examined the performance of a prototype XPL that has a tensile modulus matching normal skin responses at low strain (<40%), and that withstands elongations exceeding 250%, elastically recoiling with minimal strain-energy loss on repeated deformation. The application of XPL to the herniated lower eyelid fat pads of 12 subjects resulted in an average 2-grade decrease in herniation appearance in a 5-point severity scale. The XPL platform may offer advanced solutions to compromised skin barrier function, pharmaceutical delivery and wound dressings.
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Affiliation(s)
- Betty Yu
- Living Proof, Inc., Cambridge, Massachusetts 02142, USA
| | | | - Ariya Akthakul
- Olivo Laboratories, LLC, Cambridge, Massachusetts 02142, USA
| | | | | | - Alpesh Patel
- Living Proof, Inc., Cambridge, Massachusetts 02142, USA
| | - Amir Nashat
- Olivo Laboratories, LLC, Cambridge, Massachusetts 02142, USA
| | - Daniel G Anderson
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
- Harvard-MIT Division of Health Science and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Fernanda H Sakamoto
- The Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Barbara A Gilchrest
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
| | - R Rox Anderson
- Harvard-MIT Division of Health Science and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
- The Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Robert Langer
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
- Harvard-MIT Division of Health Science and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
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Wanner M, Sakamoto FH, Avram MM, Anderson RR. Immediate skin responses to laser and light treatments. J Am Acad Dermatol 2016; 74:807-19; quiz 819-20. [DOI: 10.1016/j.jaad.2015.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 05/29/2015] [Accepted: 06/03/2015] [Indexed: 12/23/2022]
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Russe E, Purschke M, Farinelli WA, Wang Y, Doukas AG, Limpiangkanan W, Sakamoto FH, Tam J, Wechselberger G, Anderson RR. Micro-fractional, directional skin tightening: A porcine model. Lasers Surg Med 2015; 48:264-9. [PMID: 26627306 DOI: 10.1002/lsm.22444] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Skin changes are among the most visible signs of aging. Fractional ablative lasers improve skin quality by making small skin wounds that heal rapidly without scarring. While they improve skin texture and discoloration, there is minimal effect on skin laxity. This study was performed to assess skin shrinkage performed by removing multiple small full-thickness skin columns with coring needles combined with wound closure. MATERIALS AND METHODS In 5 swine 116 squares (3 cm(2) ) were demarcated for treatment and control sites. In treatment sites 10% of the skin was removed by full-thickness skin coring needles (19 gauge) and afterwards closed and compressed with an elastic adhesive dressing. This procedure was compared to puncturing the skin with standard hypodermic needles (without tissue removal) and subsequent closure with compressive dressing. Area and shape of sites were measured before and 28 days after treatment. RESULTS Test and control sites healed within a week without scarring. Coring with wound closure caused significant shrinkage after 28 days. The treated skin area was reduced by 9% (P < 0.0001) and the direction of shrinkage was influenced by the direction of wound closure. Coring without wound closure and puncturing the skin without tissue removal produced an insignificant 3% decrease in area. CONCLUSION Significant minimally invasive skin tightening in a preferred direction can be achieved by removing skin with coring needles followed by wound closure. The direction of shrinkage is influenced by the direction of micro-hole closure, irrespective of the skin tension lines. This approach may allow reshaping the skin in a desired direction without scarring.
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Affiliation(s)
- Elisabeth Russe
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, Massachusetts 02114
- Department of Plastic and Reconstructive Surgery, Hospital of the Barmherzige Brüder, Teaching Hospital of the Medical University Salzburg, Kajetanerplatz 1, 5020 Salzburg, Austria
| | - Martin Purschke
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, Massachusetts 02114
| | - William A Farinelli
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, Massachusetts 02114
| | - Ying Wang
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, Massachusetts 02114
| | - Apostolos G Doukas
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, Massachusetts 02114
| | - Wikunda Limpiangkanan
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, Massachusetts 02114
| | - Fernanda H Sakamoto
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, Massachusetts 02114
| | - Joshua Tam
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, Massachusetts 02114
| | - Gottfried Wechselberger
- Department of Plastic and Reconstructive Surgery, Hospital of the Barmherzige Brüder, Teaching Hospital of the Medical University Salzburg, Kajetanerplatz 1, 5020 Salzburg, Austria
| | - Richard Rox Anderson
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, Massachusetts 02114
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Paithankar DY, Sakamoto FH, Farinelli WA, Kositratna G, Blomgren RD, Meyer TJ, Faupel LJ, Kauvar ANB, Lloyd JR, Cheung WL, Owczarek WD, Suwalska AM, Kochanska KB, Nawrocka AK, Paluchowska EB, Podolec KM, Pirowska MM, Wojas-Pelc AB, Anderson RR. Acne Treatment Based on Selective Photothermolysis of Sebaceous Follicles with Topically Delivered Light-Absorbing Gold Microparticles. J Invest Dermatol 2015; 135:1727-1734. [PMID: 25748556 PMCID: PMC4580730 DOI: 10.1038/jid.2015.89] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 12/15/2014] [Accepted: 01/11/2015] [Indexed: 11/09/2022]
Abstract
The pathophysiology of acne vulgaris depends on active sebaceous glands, implying that selective destruction of sebaceous glands could be an effective treatment. We hypothesized that light-absorbing microparticles could be delivered into sebaceous glands, enabling local injury by optical pulses. A suspension of topically applied gold-coated silica microparticles exhibiting plasmon resonance with strong absorption at 800 nm was delivered into human pre-auricular and swine sebaceous glands in vivo, using mechanical vibration. After exposure to 10-50 J cm(-2), 30 milliseconds, 800 nm diode laser pulses, microscopy revealed preferential thermal injury to sebaceous follicles and glands, consistent with predictions from a computational model. Inflammation was mild; gold particles were not retained in swine skin 1 month after treatment, and uptake in other organs was negligible. Two independent prospective randomized controlled clinical trials were performed for treatment of moderate-to-severe facial acne, using unblinded and blinded assessments of disease severity. Each trial showed clinically and statistically significant improvement of inflammatory acne following three treatments given 1-2 weeks apart. In Trial 2, inflammatory lesions were significantly reduced at 12 weeks (P=0.015) and 16 weeks (P=0.04) compared with sham treatments. Optical microparticles enable selective photothermolysis of sebaceous glands. This appears to be a well-tolerated, effective treatment for acne vulgaris.
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Affiliation(s)
| | - Fernanda H Sakamoto
- Department of Dermatology, Wellman Center for Photomedicine, Massachusetts General Hospital; Harvard Medical School, Boston Massachusetts, USA
| | - William A Farinelli
- Department of Dermatology, Wellman Center for Photomedicine, Massachusetts General Hospital; Harvard Medical School, Boston Massachusetts, USA
| | - Garuna Kositratna
- Department of Dermatology, Wellman Center for Photomedicine, Massachusetts General Hospital; Harvard Medical School, Boston Massachusetts, USA
| | | | | | | | | | | | - Wang L Cheung
- Department of Pathology, University of Arkansas, Little Rock, Arkansas, USA
| | - Witold D Owczarek
- Department of Dermatology, Military Institute of Medicine, Warsaw, Poland
| | - Anna M Suwalska
- Department of Dermatology, Military Institute of Medicine, Warsaw, Poland
| | | | | | | | | | | | | | - R Rox Anderson
- Department of Dermatology, Wellman Center for Photomedicine, Massachusetts General Hospital; Harvard Medical School, Boston Massachusetts, USA
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Franco W, Jimenez-Lozano JN, Tam J, Purschke M, Wang Y, Sakamoto FH, Farinelli WA, Doukas AG, Rox Anderson R. Fractional Skin Harvesting: Device Operational Principles and Deployment Evaluation. J Med Device 2014. [DOI: 10.1115/1.4027427] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
As an alternative method to conventional split-thickness skin grafts (STSGs), we recently proposed fractional skin grafting (FSG), which consists in harvesting hundreds of microscopic skin tissue columns (MSTCs) to place them directly into the skin wound (Tam et al., 2013, “Fractional Skin Harvesting: Autologous Skin Graft Without Donor Site Morbidity,” Plast. Reconstructive Surgery–Global Open, 1(6)). This paper (i) introduces the concept and operational principles of a simple but robust fractional skin harvesting (FSH) device and (ii) presents the quantitative evaluation of the deployment of the FSH device with respect to different harvesting-needle sizes. The device utilizes a hypodermic needle with a specific cutting-geometry to core skin tissue mechanically. The tissue core is removed from the donor site into a collecting basket by air and fluid flows. The air flow transports the tissue core, while the fluid flow serves the purpose of lubrication for tissue transport and wetting for tissue preservation. The design and functionality of the device were validated in an animal study conducted to establish preclinical feasibility, safety and efficacy of the proposed FSH device and FSG method. The FSH device, operating at 55.16 kPa (8 psi) gauge pressure and 208 ml/min saline flow rate, cored 800 μm diameter × 2.5 mm length skin columns using a 1.05/0.81 mm outer/inner diameter needle. The MSTC harvesting rate was established by the user at 1 column/sec. For this columns size, about 50 MSTCs are required to cover a 1.5 cm × 1.5 cm wound. In comparison to STSGs, the proposed FSG method results in superior healing outcomes on the donor and wound sites. Most important, the donor site heals without morbidity by remodeling tissue, as opposed to scarring. The FSH device has the capability of extracting full-thickness skin columns while preserving its viability and eliminating the donor site morbidity associated with skin grafting.
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Affiliation(s)
- Walfre Franco
- Wellman Center for Photomedicine, Massachusetts General Hospital, Department of Dermatology, Harvard Medical School, Boston, MA 02114 e-mail:
| | - Joel N. Jimenez-Lozano
- Wellman Center for Photomedicine, Massachusetts General Hospital, Department of Dermatology, Harvard Medical School, Boston, MA 02114
| | - Joshua Tam
- Wellman Center for Photomedicine, Massachusetts General Hospital, Department of Dermatology, Harvard Medical School, Boston, MA 02114
| | - Martin Purschke
- Wellman Center for Photomedicine, Massachusetts General Hospital, Department of Dermatology, Harvard Medical School, Boston, MA 02114
| | - Ying Wang
- Wellman Center for Photomedicine, Massachusetts General Hospital, Department of Dermatology, Harvard Medical School, Boston, MA 02114
| | - Fernanda H. Sakamoto
- Wellman Center for Photomedicine, Massachusetts General Hospital, Department of Dermatology, Harvard Medical School, Boston, MA 02114
| | - William A. Farinelli
- Wellman Center for Photomedicine, Massachusetts General Hospital, Department of Dermatology, Harvard Medical School, Boston, MA 02114
| | - Apostolos G. Doukas
- Wellman Center for Photomedicine, Massachusetts General Hospital, Department of Dermatology, Harvard Medical School, Boston, MA 02114
| | - R. Rox Anderson
- Wellman Center for Photomedicine, Massachusetts General Hospital, Department of Dermatology, Harvard Medical School, Boston, MA 02114
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Haedersdal M, Sakamoto FH, Farinelli WA, Doukas AG, Tam J, Anderson RR. Pretreatment with ablative fractional laser changes kinetics and biodistribution of topical 5-aminolevulinic acid (ALA) and methyl aminolevulinate (MAL). Lasers Surg Med 2014; 46:462-9. [PMID: 24842112 DOI: 10.1002/lsm.22259] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES 5-Aminolevulinic acid (ALA) and methyl aminolevulinate (MAL) are porphyrin precursors used topically for photodynamic therapy (PDT). Previous studies have established that ablative fractional laser (AFXL) increases topical drug uptake. We evaluated kinetics and biodistribution of ALA- and MAL-induced porphyrins on intact and disrupted skin due to AFXL. MATERIALS AND METHODS Two Yorkshire swine were exposed to CO2 AFXL (10.6 µm, 1,850 µm ablation depth) and subsequent topical application of ALA and MAL cream formulations (20%, weight/weight). Porphyrin fluorescence was quantified by digital fluorescence photography (30, 90, and 180 minutes) and fluorescence microscopy at specific skin depths (180 minutes). RESULTS Porphyrins gradually formed over time, differently on intact and AFXL-disrupted skin. On intact skin (no AFXL), fluorescence photography showed that MAL initially induced higher fluorescence than ALA (t = 30 minutes MAL 21.1 vs. ALA 7.7 au, t = 90 minutes MAL 39.0 vs. ALA 26.6 (P < 0.009)) but reached similar intensities for long-term applications (t = 180 minutes MAL 56.6 vs. ALA 52 au, P = ns). AFXL considerably enhanced porphyrin fluorescence from both photosensitizers (P < 0.05). On AFXL-exposed skin, MAL expressed higher fluorescence than ALA for short-term application (t = 30 minutes, AFXL-MAL 26.4 vs. AFXL-ALA 14.1 au, P < 0.001), whereas ALA over time overcame MAL and induced the highest fluorescence intensities obtained (t = 180 minutes, AFXL-MAL 98.6 vs. AFXL-ALA 112.0 au, P < 0.001). In deep skin layers, fluorescence microscopy showed higher fluorescence in hair follicle epithelium for ALA than MAL (t = 180 minutes, 1.8 mm, AFXL-MAL 35.3 vs. AFXL-ALA 46.7 au, P < 0.05). CONCLUSIONS AFXL changes kinetics and biodistribution of ALA and MAL. It appears that AFXL-ALA favors targeting deep structures.
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Affiliation(s)
- Merete Haedersdal
- Department of Dermatology, Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114; Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, 2400, Denmark
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Garibyan L, Sipprell WH, Jalian HR, Sakamoto FH, Avram M, Anderson RR. Three-dimensional volumetric quantification of fat loss following cryolipolysis. Lasers Surg Med 2013; 46:75-80. [PMID: 24535759 DOI: 10.1002/lsm.22207] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Cryolipolysis is a noninvasive and well-tolerated treatment for reduction of localized subcutaneous fat. Although several studies demonstrate the safety and efficacy of this procedure, volumetric fat reduction from this treatment has not been quantified. This prospective study investigated the change in volume of fat after cryolipolysis treatment using three-dimensional (3D) photography. MATERIALS AND METHODS A prospective study of subjects treated with cryolipolysis on the flank (love handle) was performed at Massachusetts General Hospital. Volume measurements were performed with a Canfield Scientific Vectra three-dimensional camera and software to evaluate the amount of post procedure volume change. Clinical outcomes were assessed with caliper measurements, subject surveys, and blinded physician assessment of photographs. RESULTS Eleven subjects were enrolled in this study. Each subject underwent a single cycle of cryolipolysis to one flank. The untreated flank served as an internal control. The follow-up time after treatment was 2 months. The mean amount of calculated absolute fat volume loss using 3D photography from baseline to 2 months follow-up visit was 56.2 ± 25.6 from the treatment site and 16.6 ± 17.6 cc from the control (P < 0.0001). A mean absolute difference of 39.6 cc between the treated and untreated sides was calculated at 2 months post-treatment. Comparison of caliper measurements from baseline to 2 months post-treatment demonstrated significant reduction of the treated flank from 45.6 ± 5.8 mm at baseline to 38.6 ± 4.6 mm at 2 months post-treatment (P < 0.001). The untreated flank did not show significant reduction with caliper measurements demonstrating 45.3 ± 5.0 mm at baseline and 44.6 ± 5.1 mm at 2 months post-treatment (P = 0.360). No unexpected side effects or adverse events were reported. Post-treatment satisfaction surveys demonstrated 82% of subjects were satisfied with the results. CONCLUSIONS Cryolipolysis is a safe, well-tolerated, and effective noninvasive fat removal methodology that on average leads to 39.6 cc of fat loss of the treated flank at 2 months after a single treatment cycle.
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Affiliation(s)
- Lilit Garibyan
- Wellman Center for Photomedicine and Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Maryland, 02114
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Sakamoto FH, Doukas AG, Farinelli WA, Tannous Z, Su Y, Smith NA, Zurakowski D, Anderson RR. Intracutaneous ALA photodynamic therapy: dose-dependent targeting of skin structures. Lasers Surg Med 2012; 43:621-31. [PMID: 22057490 DOI: 10.1002/lsm.21073] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) using topical aminolevulinic acid (ALA) depends on local drug uptake, metabolism to porphyrins, and depth of light penetration using different wavelengths. Topical ALA-PDT has limited depth of drug penetration. We studied induced porphyrin distribution and PDT after intradermal ALA administration using different drug concentrations followed by high-fluence red light irradiation. MATERIALS AND METHODS Intradermal injections (∼2 mm deep) of ALA concentrations from 0.0005% to 1% were studied in swine to evaluated porphyrin fluorescence before PDT and clinical and histological damage 24 hours after PDT. Porphyrin accumulation was measured by fluorescence microscopy of frozen section. PDT was performed 3 hours after intradermal injections using a 635 nm LED array at a fluence of 200 J/cm2 . Skin responses to PDT were observed grossly and by histology (blind evaluation). RESULTS Intradermal ALA caused porphyrin accumulation in epidermis, hair follicles (HF), sebaceous glands (SG), sweat glands (eccrine glands, EG and apocrine glands, AG), and subcutaneous fat. Significant differences of fluorescence intensity were observed between different skin structures (P < 0.05), but there was no significant difference comparing HF to SG; epidermis with either HF or SG; and dermis with fat (P > 0.05). Intradermal ALA is potent. ALA concentrations ≥0.25% followed by red light exposures caused a very intense vascular PDT reaction. Moderate doses of injected ALA concentration (∼0.06%), selectively targeted EG. Low doses (≤0.016%) targeted fat; producing fat necrosis with minimal inflammation, manifested both clinically and histologically. In contrast to topical ALA-PDT, intradermal ALA-PDT can effectively photosensitize deep skin structures. CONCLUSION Potentially, intradermal ALA-PDT using various ALA concentrations may be useful for treating vascular lesions (malformations, hemangiomas, tumors), EG/AG disorders, fat or deep targets in skin.
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Affiliation(s)
- Fernanda H Sakamoto
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Sakamoto FH. Special issue in dermatology and plastic surgery. Introduction. Lasers Surg Med 2012; 44:143. [PMID: 22334297 DOI: 10.1002/lsm.22009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Fernanda H Sakamoto
- Wellman Center for Photomedicine, Massachusetts General Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA
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Sakamoto FH, Doukas AG, Farinelli WA, Tannous Z, Shinn M, Benson S, Williams GP, Gubeli JF, Dylla HF, Anderson RR. Selective photothermolysis to target sebaceous glands: Theoretical estimation of parameters and preliminary results using a free electron laser. Lasers Surg Med 2011; 44:175-83. [DOI: 10.1002/lsm.21132] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2011] [Indexed: 11/06/2022]
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Ibrahimi OA, Sakamoto FH, Tannous Z, Anderson RR. 755 nm alexandrite laser for the reduction of tumor burden in basal cell Nevus syndrome. Lasers Surg Med 2011; 43:68-71. [PMID: 21384386 DOI: 10.1002/lsm.20953] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE Basal Cell Nevus syndrome (BCNS) is characterized by numerous basal cell carcinomas (BCCs). Multiple treatments with the pulsed dye laser (PDL) have been shown, in small studies, to be effective for the treatment of superficial and nodular BCCs. Like PDL, the alexandrite laser can be vessel-selective, but has the added advantage of deeper tissue penetration. We evaluated the utility of the alexandrite laser in reducing the tumor burden in BCNS with a single treatment. STUDY DESIGN/MATERIALS AND METHODS A case report and review of the literature are presented. A 45-year-old man with BCNS and a history of radiation therapy presented with an extraordinarily high tumor burden (>250 BCCs). As a compassionate measure to reduce the tumor burden, we investigated the utility of a single treatment of the long-pulsed 755 nm alexandrite laser to several BCC lesions. The treated lesions were evaluated at 2-month and 7-month clinical follow-up. Histopathologic analysis of a treated lesion was performed at 7-month clinical follow-up. RESULTS At 2-month, and 7-month clinical follow-up, 15 of 18 treated lesions or about 83% of the alexandrite laser treated lesions showed a complete clinical response and appeared as hypopigmented areas with scarring. Histopathologic analysis of a treated lesion at 7-month clinical follow-up showed no evidence of residual tumor. CONCLUSIONS The long-pulsed alexandrite laser may be helpful in significantly reducing tumor burden in difficult to manage BCNS patients with a single treatment. This provides a facile and practical treatment alternative for the management of challenging cases of BCNS. The limitation of this study is that it is a single case observation. Larger, prospective studies are needed to confirm these observations.
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Affiliation(s)
- Omar A Ibrahimi
- Department of Dermatology & Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Abstract
BACKGROUND AND OBJECTIVES Ablative fractional resurfacing (AFR) creates vertical channels that might assist the delivery of topically applied drugs into skin. The purpose of this study was to evaluate drug delivery by CO(2) laser AFR using methyl 5-aminolevulinate (MAL), a porphyrin precursor, as a test drug. MATERIALS AND METHODS Two Yorkshire swine were treated with single-hole CO(2) laser AFR and subsequent topical application of MAL (Metvix(R), Photocure ASA, Oslo, Norway), placebo cream and no drug. MAL-induced porphyrin fluorescence was measured by fluorescence microscopy at skin depths down to 1,800 microm. AFR was performed with a 10.6 microm wavelength prototype CO(2) laser, using stacked single pulses of 3 millisecond and 91.6 mJ per pulse. RESULTS AFR created cone-shaped channels of approximately 300 microm diameter and 1,850 microm depth that were surrounded by a 70 microm thin layer of thermally coagulated dermis. There was no porphyrin fluorescence in placebo cream or untreated skin sites. AFR followed by MAL application enhanced drug delivery with significantly higher porphyrin fluorescence of hair follicles (P<0.0011) and dermis (P<0.0433) versus MAL alone at skin depths of 120, 500, 1,000, 1,500, and 1,800 microm. AFR before MAL application also enhanced skin surface (epidermal) porphyrin fluorescence. Radial diffusion of MAL from the laser-created channels into surrounding dermis was evidenced by uniform porphyrin fluorescence up to 1,500 microm from the holes (1,000, 1,800 microm depths). Skin massage after MAL application did not affect MAL-induced porphyrin fluorescence after AFR. CONCLUSIONS Ablative fractional laser treatment facilitates delivery of topical MAL deeply into the skin. For the conditions of this study, laser channels approximately 3 mm apart followed by MAL application could produce porphyrins throughout essentially the entire skin. AFR appears to be a clinically practical means for enhancing uptake of MAL, a photodynamic therapy drug, and presumably many other topical skin medications.
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Affiliation(s)
- Merete Haedersdal
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Abstract
BACKGROUND AND OBJECTIVES Ablative fractional resurfacing (AFR) creates vertical channels that might assist the delivery of topically applied drugs into skin. The purpose of this study was to evaluate drug delivery by CO(2) laser AFR using methyl 5-aminolevulinate (MAL), a porphyrin precursor, as a test drug. MATERIALS AND METHODS Two Yorkshire swine were treated with single-hole CO(2) laser AFR and subsequent topical application of MAL (Metvix(R), Photocure ASA, Oslo, Norway), placebo cream and no drug. MAL-induced porphyrin fluorescence was measured by fluorescence microscopy at skin depths down to 1,800 microm. AFR was performed with a 10.6 microm wavelength prototype CO(2) laser, using stacked single pulses of 3 millisecond and 91.6 mJ per pulse. RESULTS AFR created cone-shaped channels of approximately 300 microm diameter and 1,850 microm depth that were surrounded by a 70 microm thin layer of thermally coagulated dermis. There was no porphyrin fluorescence in placebo cream or untreated skin sites. AFR followed by MAL application enhanced drug delivery with significantly higher porphyrin fluorescence of hair follicles (P<0.0011) and dermis (P<0.0433) versus MAL alone at skin depths of 120, 500, 1,000, 1,500, and 1,800 microm. AFR before MAL application also enhanced skin surface (epidermal) porphyrin fluorescence. Radial diffusion of MAL from the laser-created channels into surrounding dermis was evidenced by uniform porphyrin fluorescence up to 1,500 microm from the holes (1,000, 1,800 microm depths). Skin massage after MAL application did not affect MAL-induced porphyrin fluorescence after AFR. CONCLUSIONS Ablative fractional laser treatment facilitates delivery of topical MAL deeply into the skin. For the conditions of this study, laser channels approximately 3 mm apart followed by MAL application could produce porphyrins throughout essentially the entire skin. AFR appears to be a clinically practical means for enhancing uptake of MAL, a photodynamic therapy drug, and presumably many other topical skin medications.
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Affiliation(s)
- Merete Haedersdal
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Sakamoto FH, Tannous Z, Doukas AG, Farinelli WA, Smith NA, Zurakowski D, Anderson RR. Porphyrin distribution after topical aminolevulinic acid in a novel porcine model of sebaceous skin. Lasers Surg Med 2009; 41:154-60. [DOI: 10.1002/lsm.20734] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sakamoto FH, Colleoni GWB, Teixeira SP, Yamamoto M, Michalany NS, Almeida FA, Chiba AK, Petri V, Fernandes MA, Pombo-de-Oliveira MS. Cutaneous T-cell lymphoma with HTLV-I infection: clinical overlap with adult T-cell leukemia/lymphoma. Int J Dermatol 2006; 45:447-9. [PMID: 16650175 DOI: 10.1111/j.1365-4632.2006.02687.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Adult T-cell leukemia/lymphoma (ATLL) is a malignant proliferation of mature helper T lymphocytes,(1) and is caused by human T-lymphotropic virus type I (HTLV-I);(2) an HTLV-I infection endemic in the Caribbean, south-western Japan, South America and Africa.(3,4) Seroepidemiological studies suggest that it is also endemic in Brazil.(5) Although carriers of HTLV-I show polyclonal integration of virus in T lymphocytes, only patients with ATLL of various subtypes show monoclonal integration of HTLV-I in tumor cells.(6,7) Cutaneous T-cell lymphomas (CTCL) are a group of primary cutaneous lymphoproliferative diseases(8) with unknown etiology.(9) The two most common presentations of CTCL are mycosis fungoides (MF) and Sézary syndrome (SS).(10-13) However, both CTCL categories can easily resemble ATLL. Therefore, in HTLV-I endemic areas, differentiation between ATLL and CTCL must be performed, as they have different prognoses and treatment approaches.(14).
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Affiliation(s)
- F H Sakamoto
- Department of Dermatology, Discipline of Hematology and Hemotherapy, Universidade Federal de São Paulo -, Brazil
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